WHO Briefing

Organ trade policy briefing

Introduction
Organ transplantation is an effective treatment for ‘end-stage organ failure’[1] and is practised around the world. According to the WHO transplant observatory, in 2015 there were 126,670 organ transplants, including 84,347 Kidney transplants and 7,023 Heart transplants[2]. There are two types of organ transplantation: deceased donation, which is more common and is where a deceased patients’ functioning organs are transplanted to someone in need, and live donation which is where a living person donates a kidney or liver to someone, who in most circumstances, they have an emotional, legal or genetic connection to.

However, the demand for organs greatly outstrips the supply. In the US, for example, as of the 22/10/17 there were 127,357 people on the waiting list for organ donation[3] and the average waiting time for a Kidney transplant in the UK is 2 to 3 years[4]. In some countries deceased organ donation is hampered by sociocultural, legal and other factors; but even in countries with developed organ donation programmes, there is still a greater demand than supply.

 

Illegal organ trade

The mismatch between organ supply and demand has generated significant financial opportunity for those involved in organ donation. As most Member States prohibit the buying and selling organs for commercial purposes an illegal organ trade has developed without regulation. The WHO estimates that between 5 to 10% of all organ transplants are done so illegally, with the internet acting as a facilitator, and that the organ trade generates between $600 million and $1.2 billion in profits per year. When people travel aboard in order to receive an illegal organ transplant this is known as ‘transplant tourism’ and is the main way to trade organs across national borders. Certain countries, such as Pakistan, India, Iraq, Egypt, Kosovo, Mozambique, Israel, Moldova, China and Bangladesh, are know to be ‘donor exporting’ countries. Whereas countries such as the United States, Australia, Canada, Japan, Oman, Saudi Arabia act as the major ‘organ-importing’ countries.

The organs used in the illegal organ trade are most frequently obtained through organ trafficking, which the UN classifies into 3 main categories[5]. The first category is where traffickers force or deceive victims into giving up an organ. The second is where the victim formally or informally agrees to giving up an organ but is cheated because they are not paid for the organ or are paid less than the agreed price. The third category is where vulnerable people, including migrant workers, the homeless, or the illiterate, are treated for an ailment which may not even exist and their organs removed without their knowledge.

The illegal organ trade is closely associated with the exploitation of those in poverty. First, people would rather sell their kidney than starve or be unable to afford the basic good and services needed for their survival. Second, there is no regulatory regime that covers both the donors and the traffickers, making it all too easy for the traffickers to exploit, under-pay, not pay or simply lure donors under false pretences to give up an organ. Frequently donors who come from a state of poverty will be ill-informed of the consequences of their actions and have little understanding of what their rights are.

There are also serious health risks associated with the illegal organ trade. It is not uncommon for donors and recipients to contract HIV, hepatitis B or hepatitis C as a result of the substandard conditions during transplant surgeries. Moreover, it is uncommon for donors and recipients to receive post-operative care in illegal transplants which can lead to further complications after the transplant is complete.

Possible solutions

We have listed these as a starting point for your research, this list is not exhaustive and may not contain the most appropriate approach for your country.

Legalising organ trade.

In Iran it is legal to sell human kidneys for profit. The market is regulated by charities and the government and the average price paid for a kidney is $1,200. However, it is estimated that 70% of Iran’s donors are considered poor among the Iranian society which leaves doubt as to how successful the policy has been at ending the exploitation of the vulnerable. Although legalising organ trade has reduced the illegal organ trade in Iran, the poor are still exploited and coerced into giving up their organs. (More research on Iran’s policy can be found here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2322914/ )

The sale of organs has also previously been legalised in both the Philippines and India.

Methods to increase the supply of organs

By encouraging organ donation there would hopefully be an increase in the supply of organs which could potentially remove the need for a black market. This can be done at a national level through media campaigns or by introducing ‘presumed consent’ or ‘opt-out’ organ donor systems (more information on the French system here: https://www.theguardian.com/society/2017/jan/02/france-organ-donation-law?CMP=Share_iOSApp_Other ). Other countries such as Australia and Singapore have recently introduced legislation to allow organ donors to be compensated, in the hope this encourages more people to become living donors.

Methods to combat trafficking

Currently, one problem with combatting the illegal organ trade and enforcing current regulations is the obstacle posed by confidential medical records. Often enforcement officials’ access to information regarding individuals involved in illegal organ transplants is hindered by medical confidentiality laws.

Finding ways of reducing demand

To prevent the demand for organs increasing, countries should consider promoting healthier lifestyles to prevent organ failure. Moreover, research new technology such as bio printing could make it possible to print human organs in future which would reduce the demand for organs from humans and perhaps remove the need for an illegal organ trade (see more information here: https://www.theguardian.com/technology/2017/jul/30/will-3d-printing-solve-the-organ-transplant-shortage?CMP=Share_iOSApp_Other)

Key terms

  • Organ trade – trade of human organs, tissues or other body parts for the purpose of transplantation.
  • Illegal organ trade – when organs are removed for the body for commercial purposes.
  • Organ trafficking – is the recruitment, transport, transfer, harbouring 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.
  • Transplant tourism – the purchase of a transplant organ aboard that includes access to and organ while bypassing laws, rules, or processes of any or all the countries involved.
  • Opt-out system (I.e. Spain, Belgium and Austria) – a national  system of organ donation where everyone is presumed to have given consent for their organs to be donated upon their death, unless they have otherwise stated.
  • Opt-in systems (I.e. United States, Germany) – a national system of organ donation that relies on explicit consent for a deceased persons organs to be donates.

Things to consider when researching

  • What is your country’s policy on organ donation (I.e. legal or illegal)?
  • What is your country’s policy on organ trade and financial compensation for donors?
  • Are there legal, social, ethical, cultural, religious or other reasons why your country has legalised or banned organ donation?
  • Should organ trade for commercial purposes be legalised

Useful links
http://www.who.int/bulletin/volumes/85/12/06-039370/en/

https://en.wikipedia.org/wiki/Organ_trade

http://bigthink.com/philip-perry/what-you-need-to-know-about-human-organ-trafficking 

http://www.medicaldaily.com/organ-trafficking-international-crime-infrequently-punished-247493

http://www.un.org/apps/news/story.asp?NewsID=32521#.We76MmhSwdU

https://www.unodc.org/documents/human-trafficking/2015/UNODC_Assessment_Toolkit_TIP_for_the_Purpose_of_Organ_Removal.pdf 

https://www.unodc.org/documents/human-trafficking/2008/BP011HumanTraffickingfortheRemovalofOrgans.pdf

http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R22-en.pdf?ua=1

http://www.wsws.org/en/articles/2012/07/orga-j14.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813140/

Trafficking for Organ Trade: The Often-Overlooked Form of Human Trafficking

[1] http://www.who.int/bulletin/volumes/85/12/06-039370/en/
[2] http://www.transplant-observatory.org/data-charts-and-tables/chart/
[3] https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/
[4] https://www.nhs.uk/Conditions/Kidney-transplant/Pages/When-it-should-be-done.aspx
[5] http://www.medicaldaily.com/organ-trafficking-international-crime-infrequently-punished-247493