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Organ trade (also known as Red market) is the trading of human organs, tissues, or other body products, usually for transplantation.(Carney, Scott. 2011. "The Red Market." Wired 19, no. 2: 112–1. Internet and Personal Computing Abstracts.) According to the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
(WHO), organ trade is a commercial transplantation where there is a profit, or transplantations that occur outside of national medical systems. There is a global need or demand for healthy body parts for transplantation, which exceeds the numbers available. , there are more than 100,000 candidates waiting for organ transplant in the United States. The median wait time for heart and liver transplants in the U.S. between 2003 and 2014, was approximately 148 days. Average time waiting for donor organs varies significantly depending on the patients UNOS status. Patients listed as Heart Status A1 wait an average of 73 days. There is a worldwide shortage of organs available for transplantation, yet the commercial trade of human organs is illegal in all countries except
Iran Iran, officially the Islamic Republic of Iran, and also called Persia, is a country located in Western Asia. It is bordered by Iraq and Turkey to the west, by Azerbaijan and Armenia to the northwest, by the Caspian Sea and Turkmeni ...
. Despite these prohibitions, organ trafficking and transplant tourism remain widespread (however, the data on the extent of the
black market A black market, underground economy, or shadow economy is a clandestine market or series of transactions that has some aspect of illegality or is characterized by noncompliance with an institutional set of rules. If the rule defines the ...
trade in organs is difficult to obtain). The question of whether to legalize and regulate the organ trade to combat illegal trafficking and organ shortage is greatly debated. This discussion typically centers on the sale of
kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...
s by living donors, since human beings are born with two kidneys but need only one to survive.


Legal organ trade


Iran

Iran Iran, officially the Islamic Republic of Iran, and also called Persia, is a country located in Western Asia. It is bordered by Iraq and Turkey to the west, by Azerbaijan and Armenia to the northwest, by the Caspian Sea and Turkmeni ...
is the only nation that allows organs to be bought and sold for money. Due to lack of infrastructure to maintain an efficient organ transplant system in the early 1980s, Iran legalized living non-related donation (LNRD) of kidneys in 1988. The Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD) control the trade of organs, with the support of the government. These
nonprofit A nonprofit organization (NPO) or non-profit organisation, also known as a non-business entity, not-for-profit organization, or nonprofit institution, is a legal entity organized and operated for a collective, public or social benefit, in co ...
organizations match donors to recipients, setting up tests to ensure compatibility. Donors receive tax credit compensation from the government, free health care insurance, and often direct payment from the recipient with the average donor being paid $1,200. Some donors are also offered employment opportunities. Charity organizations support recipients that cannot afford the cost of the organ.The Meat Market
, The Wall Street Journal, Jan. 8, 2010.
Iran does place restrictions on the commercial organ trade in an attempt to limit transplant tourism. The market is contained within the country; that is, foreigners are not allowed to buy the organs of Iranian citizens. Additionally, organs can only be transplanted between people of the same nationality – so, for example, an Iranian cannot purchase a kidney from a refugee from another country. Proponents of legalized organ trade have hailed the Iranian system as an example of an effective and safe organ trading model. In addition, the LNRD model is compatible with the social climate in the country. Religious practices in Iran stymies donation culture in the country as organ donations is often viewed as taboo. In 2017, from a possible 8,000 cases of brain death, 4,000 organs were viable, but only 808 were transplanted due to lack of consent. Some critics argue that the Iranian system is in some ways coercive, as over 70% of donors are poor. There is no short-term or long-term follow-up on the health of organ donors. In fact, there is evidence that Iranian donors experience highly negative outcomes, both in terms of health and emotional well-being.


Organ prices

In Iran's legal markets, the price of a
kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...
ranges from $2,000 to $4,000. On the
black market A black market, underground economy, or shadow economy is a clandestine market or series of transactions that has some aspect of illegality or is characterized by noncompliance with an institutional set of rules. If the rule defines the ...
, the same kidney can be worth over $160,000, with most of proceeds taken up by middlemen. The typical price paid to donors on the black market is thought to be about US$5,000, but some donors receive as little as $1,000. In addition, these black market transplants are often dangerous to both the donor and recipient, with some contracting
hepatitis Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes ( jaundice), poor appetite, vomiting, tiredness, abdominal ...
or HIV.


Government compensation for donors

Australia Australia, officially the Commonwealth of Australia, is a sovereign country comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands. With an area of , Australia is the largest country by ...
and
Singapore Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, bor ...
recently legalized monetary compensation for living organ donors. Proponents of such initiatives say that these measures do not pay people for their organs; rather, these measures merely compensate donors for the costs associated with donating an organ. For example, Australian donors receive 9 weeks' paid leave at a rate corresponding to the national minimum wage.
Kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can ...
advocacy organizations in both countries have expressed their support for this new initiative.Live donors to get financial support
, Rashida Yosufzai, AAP, APRIL 07, 2013
Although
American American(s) may refer to: * American, something of, from, or related to the United States of America, commonly known as the "United States" or "America" ** Americans, citizens and nationals of the United States of America ** American ancestry, pe ...
federal law prohibits the sale of organs, it does permit state governments to compensate donors for travel, medical, and other incidental expenses associated with their donation. In 2004, the state of
Wisconsin Wisconsin () is a state in the upper Midwestern United States. Wisconsin is the 25th-largest state by total area and the 20th-most populous. It is bordered by Minnesota to the west, Iowa to the southwest, Illinois to the south, Lake M ...
took advantage of this law to provide
tax deduction Tax deduction is a reduction of income that is able to be taxed and is commonly a result of expenses, particularly those incurred to produce additional income. Tax deductions are a form of tax incentives, along with exemptions and tax credits ...
s to living donors to defray the costs of donation.


Kidney paired donations

Although all nations apart from Iran prohibit financial transactions for organs, most permit "paired donations" or kidney swaps across multiple parties. Paired donations address the problem of tissue compatibility in organ transplants. For example, you may wish to donate a kidney to your spouse but cannot to due to antibody incompatibilities. However, your kidney is a good match for a stranger who happens to be married to someone whose kidney would be compatible with your spouse. In a paired donation, you would agree to donate your kidney to the stranger, in exchange for the stranger's spouse promising to donate a kidney to your spouse. Such paired donations are arguably a form of organ sale – instead of purchasing a kidney for a loved one with cash, a person pays for it with her own kidney. In fact, in the United States, the spread of kidney paired donations was initially stymied due to language in the National Organ Transplantation Act barring the transfer of human organs for "valuable consideration". It was only after the law was amended to specifically allow for kidney paired donations that the practice became popular.


Illegal organ trade

According to the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
(WHO), illegal organ trade occurs when organs are removed from the body for the purpose of commercial transactions. Despite ordinances against organ sales, this practice persists, with studies estimating that anywhere from 5% to 42% of transplanted organs are illicitly purchased. Research indicates that illegal organ trade is on the rise, with a recent report by
Global Financial Integrity Raymond W. Baker (born October 30, 1935) is an American businessman, scholar, author, and "authority on financial crime." He is the founder and president of Global Financial Integrity, a research and advocacy organization in Washington, DC workin ...
estimating that the illegal organ trade generates profits between $600 million and $1.2 billion per year, with a span over many countries. These countries include, but are not limited to: *
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Haiti Haiti (; ht, Ayiti ; French: ), officially the Republic of Haiti (); ) and formerly known as Hayti, is a country located on the island of Hispaniola in the Greater Antilles archipelago of the Caribbean Sea, east of Cuba and Jamaica, and s ...
*
Israel Israel (; he, יִשְׂרָאֵל, ; ar, إِسْرَائِيل, ), officially the State of Israel ( he, מְדִינַת יִשְׂרָאֵל, label=none, translit=Medīnat Yīsrāʾēl; ), is a country in Western Asia. It is situated ...
*
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*
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Pakistan Pakistan ( ur, ), officially the Islamic Republic of Pakistan ( ur, , label=none), is a country in South Asia. It is the world's List of countries and dependencies by population, fifth-most populous country, with a population of almost 24 ...
*
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Philippines The Philippines (; fil, Pilipinas, links=no), officially the Republic of the Philippines ( fil, Republika ng Pilipinas, links=no), * bik, Republika kan Filipinas * ceb, Republika sa Pilipinas * cbk, República de Filipinas * hil, Republ ...
*
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United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
Criminal networks increasingly engage in kidnappings, especially of children and teenagers, who are then taken to locations with medical equipment. There they are murdered and their organs harvested for the illegal organ trade.
Poverty Poverty is the state of having few material possessions or little income. Poverty can have diverse
and loopholes in legislation also contribute to the illegal trade of organs. Though claims of organ trafficking are difficult to substantiate due to lack of evidence and reliable data, cases of illegal organ trade have been tried and prosecuted. The persons and entities prosecuted have included criminal gangs, hospitals, third-party organ brokers, nephrologists, and individuals attempting to sell their own organs.


Transplant tourism

The
United Network for Organ Sharing The United Network for Organ Sharing (UNOS) is a non-profit, scientific and educational organization that administers the only Organ Procurement and Transplantation Network (OPTN) in the United States, established () by the U.S. Congress in 1984 ...
defines transplant tourism as "the purchase of a transplant organs abroad that includes access to an organ while bypassing laws, rules, or processes of any or all countries involved". The term "transplant tourism" describes the
commercialism Commercialism is the application of both manufacturing and consumption towards personal usage, or the practices, methods, aims, and distribution of products in a free market geared toward generating a profit. Commercialism can also refer, positive ...
that drives illegal organ trade, but not all medical tourism for organs is illegal. For example, in some cases, both the donor and the recipient of the organ travel to a country with adequate facilities to perform a legal surgery. In other cases, a recipient travels to receive the organ of a relative living abroad. Transplant tourism raises concerns because it involves the transfer of healthy organs in one direction, depleting the regions where organs are bought. This transfer typically occurs in trends: from
South South is one of the cardinal directions or compass points. The direction is the opposite of north and is perpendicular to both east and west. Etymology The word ''south'' comes from Old English ''sūþ'', from earlier Proto-Germanic ''*sunþa ...
to
North North is one of the four compass points or cardinal directions. It is the opposite of south and is perpendicular to east and west. ''North'' is a noun, adjective, or adverb indicating direction or geography. Etymology The word ''north ...
, from developing to developed nations, from
female Female ( symbol: ♀) is the sex of an organism that produces the large non-motile ova (egg cells), the type of gamete (sex cell) that fuses with the male gamete during sexual reproduction. A female has larger gametes than a male. Fema ...
s to
male Male (symbol: ♂) is the sex of an organism that produces the gamete (sex cell) known as sperm, which fuses with the larger female gamete, or ovum, in the process of fertilization. A male organism cannot reproduce sexually without access to ...
s, and from
people of color The term "person of color" ( : people of color or persons of color; abbreviated POC) is primarily used to describe any person who is not considered "white". In its current meaning, the term originated in, and is primarily associated with, the U ...
to
whites White is a racialized classification of people and a skin color specifier, generally used for people of European origin, although the definition can vary depending on context, nationality, and point of view. Description of populations as ...
. In 2007, for example, 2,500 kidneys were purchased in Pakistan, with foreign recipients making up two-thirds of the buyers. In the same year, in Canada and the United Kingdom, experts estimated that about 30 to 50 of their citizens illegally purchased organs abroad. The kidney is the most commonly sought-after organ in transplant tourism, with prices for the organ ranging from as little as $1,300 to as much as $150,000. Reports estimate that 75% of all illegal organ trading involves kidneys. The liver trade is also prominent in transplant tourism, with prices ranging from $4,000 to $157,000. Though livers are regenerative, making liver donations non-fatal, they are much less common due to an excruciating post-operative recovery period that deters donors. Other high-priced body parts commonly sold include corneas ($24,400) and unfertilized eggs ($12,400), while lower-priced bodily commodities include blood ($25–337), skin ($10 per square inch), and bones/
ligament A ligament is the fibrous connective tissue that connects bones to other bones. It is also known as ''articular ligament'', ''articular larua'', ''fibrous ligament'', or ''true ligament''. Other ligaments in the body include the: * Peritoneal l ...
s ($5,465). While there is a high demand, and correspondingly a very high price, for vital organs such as hearts and
lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...
s, transplant tourism and organ trafficking of these parts is very rare due to the sophisticated nature of the transplant surgery and the state-of-the-art facilities required for such transplants.


Global reaction

The international community has issued many ordinances and declarations against the organ trade. Examples include the World Medical Authority's 1985 denouncement of organs for commercial use; the
Council of Europe The Council of Europe (CoE; french: Conseil de l'Europe, ) is an international organisation founded in the wake of World War II to uphold human rights, democracy and the rule of law in Europe. Founded in 1949, it has 46 member states, with a p ...
's Convention on Human Rights and Biomedicine of 1997 and its 2002 Optional Protocol Concerning Transplantation of Organs and Tissues of Human Origin; and the
Declaration of Istanbul The Declaration of Istanbul was created at the Istanbul Summit on Organ Trafficking and Transplant Tourism held from 30 April to 1 May 2008 in Istanbul, Turkey. The Declaration clarifies the issues of transplant tourism, trafficking and commercia ...
on organ trafficking and transplant tourism.Glaser, Sheri R. 2005. "Formula to Stop the Illegal Organ Trade: Presumed Consent Laws and Mandatory Reporting Requirements for Doctors". Human Rights Brief. Volume 12: Issue 20 The Declaration of Istanbul defines transplant commercialism, organ trafficking, and transplant tourism. It condemns these practices based on violations to equity, justice, and human dignity. The declaration aims to promote ethical practices in organ transplantation and donation on an international level. It is nonbinding, but over 100 transplant organizations support its principles, including countries such as China, Israel, the Philippines, and Pakistan, which strengthened their laws against illegal organ trading after the declaration's release. The World Health Organization (WHO) has also played a prominent role in condemning the illegal organ trade. The WHO first declared organ trade illegal in 1987, stating that such a trade violates the
Universal Declaration of Human Rights The Universal Declaration of Human Rights (UDHR) is an international document adopted by the United Nations General Assembly that enshrines the rights and freedoms of all human beings. Drafted by a UN committee chaired by Eleanor Roosevelt ...
. It also condemns the practice on the grounds that it "is likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation and leads to profiteering and
human trafficking Human trafficking is the trade of humans for the purpose of forced labour, sexual slavery, or commercial sexual exploitation for the trafficker or others. This may encompass providing a spouse in the context of forced marriage, or the extr ...
." In 1991, at the 44th World Health Assembly, it approved nine guiding principles for human organ transplant. The principles clearly stated that organs cannot be the subject of financial transactions. On May 22, 2004, these guidelines were slightly amended at the 57th World Health Assembly. They are intended for the use of governments worldwide. These global initiatives have served as a helpful resource for establishing medical professional codes and a legal framework for the issue, but have not provided the sanctions required for enforcement.


Illicit organ trade in specific countries


China

Since the late 1980s, China relied on executed prisoners to provide the bulk of its transplanted organs. This ready source of organs made it second only to the United States for numbers of transplantations performed. There is evidence that the government attempted to downplay the scope of organ harvesting through confidentiality agreements and laws, such as the Temporary Rules Concerning the Utilization of Corpses or Organs from the Corpses of Executed Prisoners. Critics further allege that organs were not distributed on the basis of need, but rather allocated through a corrupt system or simply sold to wealthy Chinese and foreign individuals. One source estimates that China executed at least 4,000 prisoners in 2006 to supply approximately 8,000 kidneys and 3,000 livers for foreign buyers. China was also accused of fueling its transplant industry with organs harvested from living Falun Gong practitioners. The Kilgour–Matas report concluded that China was guilty of this practice; however, the report has come under criticism for its methodology, by both Chinese and Western sources. In the 2000s, the country came under increasing international and domestic pressure to end the practice of using organs from prisoners. Since then, it has implemented a number of reforms addressing these allegations. It has developed a registry of voluntary, non-incarcerated donors; it is believed that these living and deceased donors supply most of the organs transplanted in the country today. China also standardized its organ collection process, specifying which hospitals can perform operations and establishing the legal definition of
brain death Brain death is the permanent, irreversible, and complete loss of brain function which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is alive and some aut ...
. In 2007, China banned foreign transplant patients and formally outlawed the sale of organs and collecting a person's organs without their consent. Many non-profit organizations and international jurists are skeptical that China has truly reformed its organ transplant industry. In particular, although the number of organs taken from prisoners has dropped dramatically, there is no prohibition on collecting organs from deceased inmates who sign agreements purporting to donate their organs. There continue to be reports of prison officials offering death row inmates the opportunity to "voluntarily" donate their organs upon death, with the implication that those who decline may get worse treatment from their jailers.


India

Before 1994,
India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area, the List of countries and dependencies by population, second-most populous ...
had no legislation banning the sale of organs. Low costs and high availability brought in business from around the globe, and transformed India into one of the largest kidney transplant centers in the world. However, several problems began to surface. Patients were often promised payments that were much higher than what they actually received. Other patients reported that their kidneys were removed without their consent after they underwent procedures for other reasons. In 1994, the country passed the Transplantation of Human Organs Act (THOA), banning commerce in organs and promoting posthumous donation of organs. The law's primary mechanism for preventing the sale of organs was to restrict who could donate a kidney to another person. In particular, the THOA bars strangers from donating to one another; a person can only donate to a relative, spouse, or someone bound by "affection". In practice, though, people evade the law's restrictions to continue the trade in organs. Often, claims of "affection" are unfounded and the organ donor has no connection to the recipient. In many cases, the donor may not be Indian or even speak the same language as the recipient. There have also been reports of the donor marrying the recipient to circumvent THOA's prohibition.


Philippines

Although the sale of organs was not legal in the
Philippines The Philippines (; fil, Pilipinas, links=no), officially the Republic of the Philippines ( fil, Republika ng Pilipinas, links=no), * bik, Republika kan Filipinas * ceb, Republika sa Pilipinas * cbk, República de Filipinas * hil, Republ ...
, prior to 2008 the practice was tolerated and even endorsed by the government. The Philippine Information Agency, a branch of the
government A government is the system or group of people governing an organized community, generally a state. In the case of its broad associative definition, government normally consists of legislature, executive, and judiciary. Government i ...
, even promoted "all-inclusive" kidney transplant packages that retailed for roughly $25,000. The donors themselves often received as little as $2,000 for their kidneys. The country was a popular destination for transplant tourism. One high-ranking government official estimated that 800 kidneys were sold annually in the country prior to 2008, and the WHO listed it as one of the top five sites for transplant tourists in 2005. In March 2008, the government passed new legislation enforcing the ban on organ sales. After the crackdown on the practice, the number of transplants has decreased from 1,046 in 2007 to 511 in 2010. Since then, the government has taken a much more active stance against transplant tourism.


United States

On September 21, 2021, 92 Republican members of the U.S. Senate and House asked the heads of multiple federal agencies to investigate organ harvesting for research purposes. The letter stated, "We are alarmed by public records obtained from the National Institutes of Heath (NIH) which show that the University of Pittsburgh (Pitt) may have violated federal law by altering abortion procedures to harvest organs from babies who were old enough to live outside the womb." However, PolitiFact reported several months earlier that "There is no indication that the fetal tissues used in the niversity of Pittsburghexperiments were 'purchased'," suggesting that the congress members' later description of this research as involving organ harvesting was inaccurate.


Impact on the poor

Data from the World Health Organization indicates that donors in the illegal organ trade are predominantly impoverished people in developing nations. In one study of organ donors in India, for example, 71% of all donors fell below the poverty line. Poor people ( including poor migrants) are more likely to fall victim of organ theft. Accounts of this practice usually characterize the victims as unemployed individuals (often but not always men) between the ages of 20 and 40 who were seeking work and were taken out of the country for operations. Poor people are also more likely to volunteer to sell their organs. One of the primary reasons donors articulate for why they sell their organs is to pay off debt. Migrants for instance may use the money to pay off human traffickers. The most impoverished are frequently viewed as more reliable targets for transplant tourists because they are the most in need of money. While some supporters of the organ trade argue that it helps lift some people out of poverty by providing compensation to donors, evidence of this claim is hotly debated. In many cases, people who sell their organs in order to pay off debt do not manage to escape this debt and remain trapped in debt cycles.Scheper-Hughes, N 2000, ‘The global traffic in human organs’, Current Anthropology, vol. 41, no. 2, pp. 191–224Moazam, F., R. M. Zaman, et al. (2009). Conversations with Kidney Vendors in Pakistan: An ethnographic study, Hastings Centre Report. Often, people feel like they have no choice but to donate their kidneys due to extreme poverty. In some cases, organs are sold to family members, either from parents to offspring, or from adult children to parents. This is more frequent in nations where waitlists are less formal, and among families which cannot afford to leave the country for transplants. Reports by the World Health Organization show decreased health and economic well-being for those who donate organs through transplant tourism. In Iran (where organ sales are legal), 58% of donors reported negative health consequences. In Egypt, as many as 78% of donors experienced negative health outcomes, and 96% of donors stated that they regretted donating. These findings are relatively consistent across all countries: those who sell their organs on the market tend to have poorer overall health. Substandard conditions during transplant surgeries can also lead to transmission of diseases like
hepatitis B Hepatitis B is an infectious disease caused by the '' Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection. Many people have no symptoms during an initial infection. ...
,
hepatitis C Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine, ...
, and HIV. Donors' poor health is further exacerbated by depression and other mental illnesses brought on by the stress of donating and insufficient care after surgery. Impoverished donors' economic outcomes are no better than their health outcomes. A study of Indian donors found that while 96% of donors sold a kidney to pay off debts, 75% still required operative care that is not provided by the buyer. Donors in all countries often report weakness after surgery that leads to decreased employment opportunities, especially for those who make a living through physical labor.


Issues with enforcement

Though many statutes regarding organ trade exist, law officials have failed to enforce these mandates successfully. One barrier to enforcement is a lack of communication between medical authorities and law enforcement agencies. Often, enforcement officials' access to information regarding individuals involved in illegal organ transplants is hindered by medical confidentiality regulations. Without the ability to review medical records and histories to build an effective case against perpetrators, officials cannot fully enforce organ trade laws. Many critics state that in order to prohibit illegal organ trading effectively, criminal justice agencies must collaborate with medical authorities to strengthen knowledge and enforcement of organ trade laws. Critics also support other criminal justice actions to meet this goal, such as prioritizing organ trafficking issues among local legislative bodies; multidisciplinary collaboration in cross-border offenses; and further police training in dealing with organ trafficking crimes.


Media portrayal

There have been various portrayals of illegal organ trade and organ trafficking in the mass media over the past few decades. Many, such as the 1993 book ''The Baby Train'' by
Jan Brunvand Jan Harold Brunvand (born March 23, 1933) is a retired American folklorist, researcher, writer, public speaker, and professor emeritus of English at the University of Utah. Brunvand is best known for popularizing the concept of the urban legend, ...
, are variations of the
urban legend An urban legend (sometimes contemporary legend, modern legend, urban myth, or urban tale) is a genre of folklore comprising stories or fallacious claims circulated as true, especially as having happened to a "friend of a friend" or a family m ...
of an individual who wakes up in a hotel bathtub to discover that one of his or her kidneys has been removed. The 1977 novel ''
Coma A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhi ...
'' by Robin Cook, made into a movie by
Michael Crichton John Michael Crichton (; October 23, 1942 – November 4, 2008) was an American author and filmmaker. His books have sold over 200 million copies worldwide, and over a dozen have been adapted into films. His literary works heavily feature tech ...
, tells of unsuspecting medical patients who are put into a
coma A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhi ...
in order for their organs to be removed. In addition to books and films, stories of organ trafficking are often depicted through television, tabloid magazines, emails, and the Internet.Leventhal, Todd. 1994. "The Child Organ Trafficking Rumor: A Modern Urban Legend." United States Information Agency Report. Many of the organ trafficking tales depicted in the media contain unsubstantiated claims. For example, the 1993 British/Canadian TV program ''The Body Parts Business'' made a number of claims about organ trafficking that later proved to be false. The program investigated alleged organ and tissue trafficking in
Guatemala Guatemala ( ; ), officially the Republic of Guatemala ( es, República de Guatemala, links=no), is a country in Central America. It is bordered to the north and west by Mexico; to the northeast by Belize and the Caribbean; to the east by Hon ...
,
Honduras Honduras, officially the Republic of Honduras, is a country in Central America. The republic of Honduras is bordered to the west by Guatemala, to the southwest by El Salvador, to the southeast by Nicaragua, to the south by the Pacific Oce ...
,
Argentina Argentina (), officially the Argentine Republic ( es, link=no, República Argentina), is a country in the southern half of South America. Argentina covers an area of , making it the List of South American countries by area, second-largest ...
, and Russia. One episode discussed a man named Pedro Reggi, reporting that his
cornea The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Along with the anterior chamber and lens, the cornea refracts light, accounting for approximately two-thirds of the eye's total optical ...
s had been removed without his consent while he was hospitalized in a mental facility. Reggi later disputed this claim, saying that his corneas were still intact, and he had just been suffering from an acute eye infection. Critics, such as Silke Meyer, argue that this sensationalized view of organ trafficking, often based in
urban myth An urban legend (sometimes contemporary legend, modern legend, urban myth, or urban tale) is a genre of folklore comprising stories or fallacious claims circulated as true, especially as having happened to a "friend of a friend" or a family m ...
, distracts attention from the illegal organ trade. They call for increased scientific research on illegal organ trade, so that organ trafficking legends can be replaced by scientific fact. Meyer argues: "Only then will rgan traffickingbe taken seriously by all governments affected and will the results constitute a solid ground for the field of policy-making."


Proposed solutions

Various solutions have been proposed to staunch the flow of illegal organs around the globe. The primary strategy is to increase the supply of legally donated organs, thereby decreasing the demand that drives the illicit organ trade. One way to accomplish this goal is for states to implement policies of presumed consent. With presumed consent laws (also known as "opt out" laws), consent for organ donation is assumed upon death unless the individual previously "opted out" by submitting documentation. This is in contrast to "opt-in" organ donation policies, which assume that a deceased person would not have wished to donate unless they had previously notified the government of their intention to donate. Presumed consent policies have already been adopted in various countries, including Brazil, certain jurisdictions of the United States, and several European nations. Research shows a 25–30% increase in the amount of available organs in "opt-out" countries. Another proposed method is to enact laws that would hold doctors accountable for not reporting suspected organ trafficking. Scheper-Hughes has written extensively on the issue of doctors knowingly performing illegal operations with illicit organs. She argues that though doctors might be violating doctor-patient privilege by reporting suspected organ trafficking, their legal obligation to the patient is superseded by public interest in ending medical violations of human rights. If accountability measures were imposed, doctors would be liable as accomplices if they knowingly performed operations with black market organs.
Personal health record A personal health record (PHR) is a health record where health data and other information related to the care of a patient is maintained by the patient. This stands in contrast to the more widely used electronic medical record, which is operate ...
s for migrants can help to document information on detected missing organs, and even previously done surgeries. Some projects have been started to keep personal health records of immigrants. Detection of missing organs and associated surgeries is an important first step to detect illicit organ harvesting. Many people in the United States believe that adopting a system for regulating organ trading similar to Iran's will help to decrease the national shortage of kidneys. They argue that the U.S. could adopt similar policies to promote accountability, ensure safety in surgical practices, employ vendor registries, and provide donors with lifetime care. They further argue that private insurance companies and the federal government would be invested in providing such care for donors, and that laws could be enacted to make long-term care an inviolable condition of any donation agreement.


Ethical debate for organ trade

The ethical debate of organ trade rests on whether or not people have an inherent right to sell their own organs and, if so, whether or not the potential harms of organ sales override that right. While in most democratic countries, there is an implied ethical right to what happens to your body, in the US this right was dictated by the Scheloendorff decision through the court's opinion by Justice Benjamin Cardozo,
"Every human being of adult years and sound mind has a right to determine what shall be done with her own body"
However, this autonomy is limited in organ trade as governments and some ethicist argue the potential harm of organ trade outweighs the rights of an individual. The closest legalized comparison of a right to bodily autonomy for financial gain would be
prostitution Prostitution is the business or practice of engaging in Sex work, sexual activity in exchange for payment. The definition of "sexual activity" varies, and is often defined as an activity requiring physical contact (e.g., sexual intercourse, n ...
. Currently 32 countries allow prostitution; none of them allow for the sale of an organ. Views on legalization of prostitution have often viewed it as a "necessary evil" and of prostitution can be legalized as long as the sex worker's human rights such as freedom of speech, travel, work, immigration, health insurance, and housing, are not deprived. Similarly, many argue that as long as the donors rights are respected and the trade is regulated, it would be ethically responsible for organ trade to exist. Organ trade also raises ethical and legal concerns for healthcare providers towards the treatment of patient. Specifically, currently there is little to no guidance on how does the doctor–patient relationship change if the patient received an organ through illegal means. Further more, if organ trade is legalized, an obligation for a physician to respect the patients wish to sell an organ. In the US, there is controversy on whether organ donation wishes are legally enforceable. The primary law governing organ donation is the
Uniform Anatomical Gift Act The Uniform Anatomical Gift Act (UAGA), and its periodic revisions, is one of the Uniform Acts drafted by the National Conference of Commissioners on Uniform State Laws (NCCUSL), also known as the Uniform Law Commission (ULC), in the United States ...
(UAGA). However, it is widely considered inadequate as it is up to each state to regulate and uphold this law, with enforcement varying between states for cadaver body donation. Further more, donor shortages still persists in the United States. To avoid lawsuits, providers would violate UAGA and side with the next of kin and ignore any preexisting organ donation requests. As such, if organ trade is legalized, there will need to be ethical consideration on if a physician has a duty to perform financially motivated organ transplants.


Arguments for legalization


Increased organ supply

The main argument made in favor of legalized organ sales is that it would increase the number of organs available for transplantation. Although governments have implemented other initiatives to increase organ donation – such as public awareness campaigns, presumed consent laws, and the legal definition of
brain death Brain death is the permanent, irreversible, and complete loss of brain function which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is alive and some aut ...
– the waitlist for vital organs continues to grow. Further more,
cadaver A cadaver or corpse is a dead human body that is used by medical students, physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue to repair a defect in a living human being. Stud ...
organ transplantations have poorer clinical outcomes as compared with live organ donations. Legalizing payments for organs would encourage more people to donate their organs. Each organ sold on a market could potentially save the life (and improve the quality of life) of its recipient. For example, patients with
kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can ...
who receive a kidney transplant from a living donor typically live 7 to 15 years longer than those who depend on dialysis. Economists generally lean in favor of legalizing organ markets. The consensus of
American Economic Association The American Economic Association (AEA) is a learned society in the field of economics. It publishes several peer-reviewed journals acknowledged in business and academia. There are some 23,000 members. History and Constitution The AEA was esta ...
members is that organ trade should be allowed, with 70% in favor and 16% opposed.The Policy Views of American Economic Association Members: The Results of a New Survey
, Robert Whaples, Econ Journal Watch, Volume 6, Number 3, September 2009, pp. 337–48.
Another
literature review A literature review is an overview of the previously published works on a topic. The term can refer to a full scholarly paper or a section of a scholarly work such as a book, or an article. Either way, a literature review is supposed to provid ...
, looking at the publications of 72 economic researchers who have studied organ trade, reached a similar conclusion: 68% supported legalization of the organ trade, while only 21% opposed it.


Minimal negative consequences for donors

Proponents also assert that organ sales ought to be legal because the procedure is relatively safe for donors. The short-term risk of donation is low – patients have a mortality rate of 0.03%, similar to that of certain elective cosmetic procedures such as
liposuction Liposuction, or simply lipo, is a type of fat-removal procedure used in plastic surgery. Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems. In the United States, lipo ...
. Moreover, they argue, the long-term risks are also relatively minimal. A 2018 systematic review found that kidney donors did not die earlier than non-donors. Donors did have a slightly increased risk of
chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years. Initially generally no symptoms are seen, but later symptoms may include leg swelling, feeling tired, vo ...
and
pre-eclampsia Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease ...
(a condition sometimes seen in pregnancy). The review found no difference in the rates of
diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...
,
heart disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...
,
high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
, or mental illness. Multiple studies of American and
Japan Japan ( ja, 日本, or , and formally , ''Nihonkoku'') is an island country in East Asia. It is situated in the northwest Pacific Ocean, and is bordered on the west by the Sea of Japan, while extending from the Sea of Okhotsk in the n ...
ese donors found that they reported a higher quality of life than the average non-donor. Proponents of organ markets argue that, given the comparative safety of donating a kidney, individuals should be permitted to undergo this operation in exchange for payment. Critics challenge this view of transplantation as being overly optimistic. Specifically, they cite research suggesting that individuals who ''sell'' their organs fare worse after the procedure than those who freely ''donate'' their organs. Kidney sellers are more likely to have renal problems after the operation (such as
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high b ...
and chronic kidney disease), to report reduced overall health, and to suffer from psychological side effects such as depression. Opponents of markets usually ascribe these worse outcomes to the fact that kidney sellers are drawn from the ranks of the poor; if organ sales are permitted, most sellers will be poor and can expect the same dangerous consequences. Proponents of organ markets respond by blaming these bad outcomes on the fact that kidney sellers have been forced into the black market, with minimal oversight, follow-up care, or legal protections from abuse; thus in a regulated market in the developed world, kidney sellers could expect to see outcomes more akin to those of kidney donors


Respect for autonomy

Many proponents argue for legalized organ sales on the grounds of autonomy. Individuals are generally free to buy or sell their possessions and their labor. Advocates of organ markets say that, likewise, people ought to be free to buy or sell organs as well. According to this perspective, prohibitions against selling organs are a
paternalistic Paternalism is action that limits a person's or group's liberty or autonomy and is intended to promote their own good. Paternalism can also imply that the behavior is against or regardless of the will of a person, or also that the behavior expres ...
or moralistic intrusion upon individuals' freedom. Proponents acknowledge that, unlike selling a material possession such as a car, selling a kidney does carry some risk of harm. However, they note that people are able to undertake dangerous occupations (such as logging, soldiering, or
surrogacy Surrogacy is an arrangement, often supported by a legal agreement, whereby a woman agrees to delivery/labour for another person or people, who will become the child's parent(s) after birth. People may seek a surrogacy arrangement when pregna ...
) which carry significant chance of bodily harm. If individuals are allowed to take on that risk in exchange for money, then they ought to be able to take on the risks of selling a kidney as well.


Harm reduction

Other physicians and philosophers argue that legalization will remedy the abuses of the illicit trade in organs. The current ban on the sale of organs has driven both sellers and buyers into the black market, out of sight of the law. Criminal middlemen often take a large cut of the payment for the organ, leaving comparatively little money left for the donor. Because the mainstream medical establishment is barred from participating in the transplantation, the procedure typically occurs in substandard facilities and not according to best practices. Afterwards, the donors often do not receive important medical follow-up because they are afraid that their role in the crime will be discovered. There have also been reports of criminal gangs kidnapping people and illegally harvesting their organs for sale on the black market. Proponents of legalization argue that it will result in better medical care for donors and recipients alike, as well as larger payments to the donors. Some critics challenge the proponents' assumptions that legalization will eliminate the black market for organs or its problems. For example, one scholar argues that once the organ trade became legalized in Iran, it did not end the under-the-table sales in organs. Instead, people made deals outside the government-sanctioned system to acquire organs from more desirable (i.e., healthier) donors.


Arguments against legalization


Susceptibility to coercion

Critics often argue that organ sales should remain prohibited because any market solution will take advantage of the poor. Specifically, they fear that a large financial incentive for donating organs will prove irresistible to individuals in
extreme poverty Extreme poverty, deep poverty, abject poverty, absolute poverty, destitution, or penury, is the most severe type of poverty, defined by the United Nations (UN) as "a condition characterized by severe deprivation of basic human needs, includi ...
: such individuals may feel like they have no choice but to agree to sell a kidney. Under these circumstances, the decision to sell cannot be regarded as truly voluntary. Consequently, it is appropriate for the government to protect poor people by prohibiting the sale of organs. Critics of legalization argue that proponents exaggerate the impact that a market would have on the supply of organs. In particular, they note that legalized organ sales may “crowd out” altruistic donations. In other words, people who would otherwise give their organs to relatives may decline to do so, opting instead to purchase the organ (or rely on the government to buy one) for their relatives. Proponents of markets counter that while altruistic donations might decrease slightly if organ sales were legalized, this decrease would be more than offset by the influx of organs. Legalization of human organ trading has been opposed by a variety of human rights groups. One such group is Organs Watch, which was established by Nancy Scheper-Hughes – a medical anthropologist who was instrumental in exposing illegal international organ-selling rings. Scheper-Hughes is famous for her investigations, which have led to several arrests due to people from developing countries being forced or fooled into organ donations.Transplantation in the USA: The Shortage of Available Organs and Public Health Policy
, Jonathan A. Winston, M.D., Program Chair, April 19, 2010, Kidney & Urology Foundation of America.
Like the World Health Organization, Organs Watch seeks to protect and benefit the poverty-stricken individuals who participate in the illegal organ trade out of necessity.


Direct harms of organ selling

Some opponents of markets adopt a paternalistic stance that prohibits organ sales on the grounds that the government has a duty to prevent harm to its citizens. Unlike the "coercion by poverty" line of argumentation discussed above, these critics do not necessarily question the validity of the donors' consent. Rather, they say that the dangers posed by donating an organ are too great to allow a person to voluntarily undertake them in exchange for money. As noted previously, critics of organ sales cite research suggesting that kidney sellers suffer serious consequences of the operation, faring far worse than altruistic kidney donors. Even if one assumes that kidney sellers will have similar outcomes to donors in a regulated market, one cannot ignore the fact that a
nephrectomy A nephrectomy is the surgical removal of a kidney, performed to treat a number of kidney diseases including kidney cancer. It is also done to remove a normal healthy kidney from a living or deceased donor, which is part of a kidney transplant pr ...
is an invasive procedure that – by definition – inflicts some injury upon the patient. These critics argue that the government has a duty to prevent these harms, even if the would-be seller is willing to undertake them. A similar argument focuses on the fact that selling a kidney involves the loss of something unique and essentially irreplaceable on the part of the donor. Given the special value placed on
bodily integrity Bodily integrity is the inviolability of the physical body and emphasizes the importance of personal autonomy, self-ownership, and self-determination of human beings over their own bodies. In the field of human rights, violation of the bodily int ...
in society, it is appropriate to outlaw the sale of body parts to protect that value.


Objectification

Another criticism of legalized organ sales is that it objectifies human beings. This argument typically starts with the Kantian assumption that every human being is a creature of innate dignity, who must always be regarded as an end to itself and never just a means to an end. A market for organs would reduce body parts to commodities to be bought and sold. Critics argue that, by permitting such transactions, society would reduce the seller of the organ to an object of commerce – a mere means to an ends. Assigning a monetary value to a key organ is essentially assigning a value to its bearer, and putting a price on a human being violates his or her intrinsic dignity. Proponents of organ sales claim that this line of argument confuses the kidney with the whole person; so long as the transaction is conducted in a way that minimizes risks to the donor and fairly compensates him or her, that person is not reduced to a means to an end.


Unwanted pressure to sell an organ

Another argument against organ markets is that they will give rise to a pressure to sell organs which would harm all people (even those who did not participate directly in the market). Under the current ban on the organ trade, debtors and heads of families in the developed world face little pressure to sell their organs. If a person's creditors or dependents suggest that said person sell their kidney to raise money, they could refuse on the grounds that it is illegal. In contrast, if organ sales were legalized, a destitute individual could face pressure from family and creditors to sell a kidney – and possibly endure social consequences such as scorn or guilt if they declined. Legalizing organ sales would create this unwanted pressure (and attendant disapproval) for all poor individuals, regardless of whether or not they wished to sell their kidneys. Thus a legal prohibition on selling organs is warranted to protect poor people from this undesirable pressure.


Models for legalization


Erin Harris model

Ethicist An ethicist is one whose judgment on ethics and ethical codes has come to be trusted by a specific community, and (importantly) is expressed in some way that makes it possible for others to mimic or approximate that judgment. Following the advice of ...
s Charles A. Erin and John Harris have proposed a much more heavily regulated model for organ transactions. Under this scheme, would-be sellers of organs do not contract with would-be recipients. Instead, a government agency would be the sole buyer of organs, paying a standard price set by law and then distributing the organs to its citizens. This safeguard is designed to prevent unscrupulous buyers from taking advantage of potential donors and to ensure that the benefits of the increased organ supply are not limited to the rich. Moreover, participation in the market would be confined to citizens of the state where the market is located, to prevent the unilateral movement of organs from developing nations to the developed world. Erin and Harris's model has been endorsed by a number of prominent advocates of organ markets.


Free market model

Many scholars advocate the implementation of a
free market In economics, a free market is an economic system in which the prices of goods and services are determined by supply and demand expressed by sellers and buyers. Such markets, as modeled, operate without the intervention of government or any ot ...
system to combat the organ shortage that helps drive illegal organ trade. The organ trade's illegal status creates a
price ceiling A price ceiling is a government- or group-imposed price control, or limit, on how high a price is charged for a product, commodity, or service. Governments use price ceilings ostensibly to protect consumers from conditions that could make com ...
for organs at zero dollars. This price ceiling affects supply and demand, creating a shortage of organs in the face of a growing demand. According to a report published by the
Cato Institute The Cato Institute is an American libertarian think tank headquartered in Washington, D.C. It was founded in 1977 by Ed Crane, Murray Rothbard, and Charles Koch, chairman of the board and chief executive officer of Koch Industries.Koch Ind ...
, a US-based
libertarian Libertarianism (from french: libertaire, "libertarian"; from la, libertas, "freedom") is a political philosophy that upholds liberty as a core value. Libertarians seek to maximize autonomy and political freedom, and minimize the state's en ...
think tank, eliminating the price ceiling would eliminate the organ shortage. In the ''
Journal of Economic Perspectives The ''Journal of Economic Perspectives'' (JEP) is an economic An economy is an area of the production, distribution and trade, as well as consumption of goods and services. In general, it is defined as a social domain that emphasize the pra ...
,'' Nobel laureate
Gary Becker Gary Stanley Becker (; December 2, 1930 – May 3, 2014) was an American economist who received the 1992 Nobel Memorial Prize in Economic Sciences. He was a professor of economics and sociology at the University of Chicago, and was a leader of ...
and Julio Elias estimated that a $15,000 compensation would provide enough kidneys for everyone on the wait list. The government could pay the compensation to guarantee equality. This would save public money, as dialysis for kidney failure patients is far more expensive. However, other critics argue that such a free market system for organ trade would encourage organ theft through murder and neglect of sick individuals for financial gain. Advocates for the free market of organs counter these claims by saying that murder for financial gain already happens; sanctions against such acts exist to minimize their occurrence; and with proper regulation and law enforcement, such incidents in a legal organ trade could be minimized as well.


Other models

The incentivized Kidney Donation Model (IKDM) exists as an intermediate between complete Free Market Model and Erin Harris Model, with strong government regulation and rewards with free market approach to donations. Currently in place in Turkey, Iran, in which a free organ market exists which "donations" between donor and recipients are allowed. However, the government also supplements this donation with incentives such as free/discounted medical health insurance, exemptions from co payments/contribution shares, priority when receiving an organ in the future, priority when finding a job, income tax exemptions for salaried employees, and free or discounted public utilities.


In popular culture

*The American
death metal Death metal is an extreme subgenre of heavy metal music. It typically employs heavily distorted and low-tuned guitars, played with techniques such as palm muting and tremolo picking; deep growling vocals; aggressive, powerful drumming, fe ...
band
Cannibal Corpse Cannibal Corpse is an American death metal band formed in Buffalo, New York in 1988, now based out of Tampa, Florida. The band has released fifteen studio albums, two box sets, four video albums, and two live albums. The band has had little radi ...
released a song in 2021 titled "Inhumane Harvest", which has lyrical content about organ harvesting. The song was also released with a
music video A music video is a video of variable duration, that integrates a music song or a music album with imagery that is produced for promotional or musical artistic purposes. Modern music videos are primarily made and used as a music marketing devic ...
.


See also

*
Black market A black market, underground economy, or shadow economy is a clandestine market or series of transactions that has some aspect of illegality or is characterized by noncompliance with an institutional set of rules. If the rule defines the ...
* China: ** Organ transplantation in China ** Organ harvesting from Falun Gong practitioners in China * Fetus Farming Prohibition Act * Gurgaon kidney scandal *
Organ donation Organ donation is the process when a person allows an organ of their own to be removed and transplanted to another person, legally, either by consent while the donor is alive or dead with the assent of the next of kin. Donation may be for re ...
* Organ donation in Israel *
Organ harvesting Organ procurement (also called organ harvesting) is a surgical procedure that removes organs or tissues for reuse, typically for organ transplantation. Procedures If the organ donor is human, most countries require that the donor be legally de ...


References


External links


Doctors Against Forced Organ Harvesting
{{DEFAULTSORT:Organ Trade Trade by commodity Organized crime