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The red market: High costs of the illegal organ trade

The buying and selling of human organs is booming business today. Human livers, kidneys and corneas are market commodities, traded at various prices in the shadow economy. The illegal organ trade market, also known as the ‘red market’, is estimated to have existed for about 30 years and, according to Washington-based think tank, Global Financial Integrity (GFI), generates roughly between US $600 million and US $1.2 billion annually.

Illegal organ trade is driven by a global shortage in the supply of organs through legal channels. An individual in need of a new organ may depend on a donation from a friend or family member or is placed on a waiting list that will allocate an altruistic and unpaid organ donation by a stranger. Placement on waiting lists to find a matching donor often requires long waiting times, spanning up to several years in some cases. Potential recipients, fearing that the long waiting time may exceed their lifetimes, are driven to bypass the waiting list and seek organs through illegal means.

With the exception of Iran, the practice of buying and selling organs, known as transplant commercialism, is criminalised around the world. Iran is the only country in the world where one can sell a kidney. The waiting list system was eradicated and today kidney donors receive money from the buyer and the state.

Transplant commercialism is a growing global economy

According to GFI, organ transplant commercialism, which is banned by the World Health Organisation, is estimated to make up about 10% of the global transplants which includes organs such as the liver, heart and lungs. The most traded organ is the kidney as individuals are born with two kidneys, but can live long and healthy lives with a single kidney. An estimated 10 000 kidneys are sold globally annually—more than one kidney sold each hour. In Pakistan, kidneys are estimated to be worth about US$50,000 to US$60,000.

Social media has made it easier for the organ trade to expand as they are now offered for sale online. Today, more individuals travel to countries where there is poor enforcement of laws prohibiting organ sales. This is known as transplant tourism. The individuals travel abroad to countries such as Bangladesh, Egypt and the Philippines to quickly obtain an organ and undergo a transplant. According to data from NHS Blood and Transplant in the United Kingdom, Pakistan is the top destination for patients seeking kidneys overseas.

Ethical concerns of buying and selling organs

The commodification of organs has raised serious questions about the ethics of exchanging body parts for cash. As transplant commercialism is an unregulated activity, the health and safety of donors may be compromised. Individuals supplying organs in exchange for money are predominantly from countries with high poverty levels and low education. Parents sell their organs to feed their children and send them to school. In some communities and family settings, individuals also convince their friends and family to sell their organs in an effort to raise money. There are major concerns about possible coercion or exploitation used in obtaining organs, but organ recipients are blinded to how the organ may have been obtained. There is no guarantee that no human rights abuses were involved.

Exploitation of the poor and vulnerable

Without proper regulation and access to licensed professionals, the consequences of trading one’s organs for money through illegal means can carry dire consequences for the donors. The transplants may take place in unsterile environments which increases the risk of infections. After the organ removal, many donors do not receive the promised or much-needed post-surgical care to ensure recsafe recovery. A nephrectomy (the surgical removal of a kidney), for example, carries the risk of a post-operative wound infection or complication. In some cases, this may require another re-operation for a complication. Those involved in illegal organ trade may not have access to the necessary aftercare if they experience complications.

Roughly two-thirds of donors on the black market have reported that they experienced lasting physical damage and this harms their ability to work and earn an income. Many are unable to return to their labour-intensive jobs,trapping them in the poverty cycle that forced them to sell their organs in the first place. In addition to that, up to 80% of donors do not receive the full amount of cash they were promised for their organs. While their organs are sold for tens of thousands of dollars, they only receive a small fraction of the money as compensation.

Cases of organ trafficking

In some cases, organ dealings include kidnapping individuals and forcibly removing their organs. In 2017, BBC News reported the rescue of 24 individuals who were held hostage and awaiting the forced removal of their kidneys in Rawalpindi, Pakistan. The individuals were lured by false job prospects and then locked in a building where they were beaten and threatened. There have also been cases where doctors remove a kidney without the patient’s consent during an operation for other unrelated health problems.

Refugees are also highly vulnerable to organ trafficking as they battle hunger and poor living conditions. A 2020 CBS documentary, Selling Organs to Survive, has shown that vulnerable Syrian refugees living near the border of Turkey are trading organs such as livers and kidneys in a desperate effort to earn money for survival. In the documentary, CBS News foreign correspondent, Holly Williams, and producer Haitham Moussa uncover the exploitation of the refugees as they are often cheated out of promised money once their organs are taken.

Illegal organ trade is a lucrative business—except for the exploited

While the poor are exploited and their health seriously compromised in the process, illegal organ trade is a lucrative business for the criminal networks driving the underground business.

Recruiters or middlemen play a major role in finding individuals to sell their organs. According to the United Nations Office on Drugs and Crime (UNODC) Trafficking in Persons for the Purpose of Organ Removal, recruiters (also known as brokers or coordinators) carry the task of identifying vulnerable individuals and communities to persuade them to sell an organ which, in most cases, is a kidney. The profile of individuals facilitating the illegal organ trade varies. They are not always conspicuously dodgy characters and are sometimes trusted medical professionals such as surgeons and nursing staff.

The recruiters can often be from the same social background or ethnic group as the potential victims, making it easier to gain their trust of the potential victims and persuade them. They may rely on deception to lure their victims, downplaying the risks of removing organs. The potential victims are told the benefits of selling their organs that may lead to a better life but are not told about the risks or consequences of removing the organ from the body.

It is important to note that it is not always recruiters who initiate an organ trade. In many cases, the potential donor, compelled by financial constraints, is the one who actively seeks to sell an organ and approaches the middleman. The donor often sells an organ at a low price, the recipient buys at a much higher price and the middleman who facilitates the exchange between buyer and the seller, reaps the most benefits from the process. These middlemen profit in the shadows while the vulnerable donors are left to deal with major ramifications on their health.

International efforts to address organ trafficking

In 2008 the Istanbul Summit on Organ Trafficking and Transplant Tourism was held to address the challenges of transplant tourism, organ trafficking and organ commercialism. This resulted in the creation of the Istanbul Declaration Organ Trafficking and Transplant Tourism. The Declaration of Istanbul was the first document to define organ trafficking. According to the document, organ trafficking is:

"the recruitment, transport, transfer, harboring or receipt of living or deceased persons or their organs by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability, or of the giving to, or the receiving by, a third party of payments or benefits to achieve the transfer of control over the potential donor, for the purpose of exploitation by the removal of organs for transplantation."

The Istanbul Declaration states that the practice should be prohibited on the grounds that it violates the principles of equity, justice and respect for human dignity. Transplant commercialism often preys on those who are uneducated and living in poverty. The Declaration proposed that governments establish systems and structures of transparency and accountability in organ donations and that donors undergo psychosocial evaluation by mental health professionals during screening.

In September 2017, the United Nations General Assembly adopted a resolution titled Strengthening and promoting effective measures and international cooperation on organ donation and transplantation to prevent and combat trafficking in persons for the purpose of organ removal and trafficking in human organs to combat organ trafficking and uphold accountability to prevent the illegal trade. Countries were urged to adopt laws and frameworks to guarantee ethical and safe donation of organs.

It is clear that the illegal organ trade exploits the vulnerable. Criminals prey on the poor to generate profit. For many who sell an organ under unsafe conditions, their economic situation is improved in the short term at best. Unfortunately, the economic situation may be worsened in the long term if they face post-surgery complications and health problems. There may also be possible psychological consequences after organ removal. In some cases selling an organ may result in depression, health anxiety, and feelings of bodily violation.

In his 2011 book, The Red Market: On the Trail of the World's Organ Brokers, Bone Thieves, Blood Farmers, and Child Traffickers, investigative journalist Scott Carney, describes how the global class divide and high inequality allows exploitation of the poor and desperate in the red market.

Human organs and flesh are removed from the poor and vulnerable and sold at a low price. The organs then move upwards to higher social classes with a costlier price tag. Those who can afford to pay such costly prices reap the benefits of health and a better life quality. There are no fundamental life changes for the poor man who has sold his kidney. He is still trapped in the vicious cycle of poverty. And the middleman who facilitates the trade, after tallying his profits, seeks out to find more victims.


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