hen you first hear about it, the trafficking of human organs sounds like a gruesome black-market practice, carried out by the shadowy characters of the global criminal underworld. And you wouldn’t be entirely wrong. Just Google “organ trafficking” and you’ll see hundreds of pictures of people holding up their shirts to reveal long scars from where their kidneys have been removed. None of the people photographed look like your college roommate or the captain of the tennis team. None of them are reclined in a plush Manhattan parlor or smiling as they climb into the back of a town car. They’re usually sitting on the dirty city streets of developing countries or lying on hospital cots looking undernourished and desperate. Add to this image the unconfirmed reports of people being kidnapped for the express purpose of organ removal and the whole business just seems disgusting and hellish. But what if your son was the captain of the tennis team? And what if you were told that without a kidney transplant he only had a few months left to live? And by the way he’ll join thousands of people on a waiting list (Good luck!). OR … for $100,000 someone offers to get you a kidney and perform the surgery and the whole thing can be taken care of in two weeks. Not only that: the donor is an Egyptian man who has come upon hard times and is eager to make $5,000 so he can provide for his family.
The fact is that the selling of human organs is banned in almost every country around the world, despite the fact that the demand for transplant organs vastly exceeds supply. It is also true that the only country that doesn’t suffer from organ shortage is also the only country that doesn’t ban organ sales: Iran. Sure the whole thing seems mighty unsavory. And in its current black-market form there is a lot of space for the exploitation of the desperate and impoverished. However, isn’t there a strong “greater good” argument to be made for allowing organ sales to occur in some sort of regulated way? It seems to work in Iran, after all, and regulating it could ensure that the donors are given a fair price, proper medical attention, and is made aware of the medical risks that she or he is taking. While I don’t endorse the immediate legalization of the organ trade, I do believe it’s time to have a serious discussion about the issue. If illicit markets exist to meet demand, then we don’t have many choices when it comes to curtailing organ-trafficking.
The black market organ trade will continue to flourish as long as waiting lists are 100,000 strong and the cost of waiting could be the lost-life of a loved one. It would be a different story if we were talking about black market iPods where the cost of not having one is… simply not having an iPod, but too many good people would willingly break this law to save the life of their son or daughter. Organ trade is the trade involving human organs for transplantation. There is a worldwide shortage of organs available for transplantation, possibly a result of regulations forbidding their trafficking. In the 1970s pharmaceuticals that prevent organ rejection were introduced. This along with a lack of medical regulation helped foster the organ market. Living donor procedures include kidney, liver, cornea and lung transplants. Most organ trade involves kidney or liver transplants.
Before legislation passed in 1994, India had a successful legal market in organ trading. Low cost and availability brought in business from around the globe and transformed India into one of the largest kidney transplant centers in the world. Several problems began surfacing during the period of legal organ trade in India. In some cases patients were unaware a kidney transplant procedure even took place. Other problems included patients being promised an amount much higher than what was actually paid out. Ethical issues surrounding contribution donating pushed the Indian government to pass legislation banning the sale of organs.
The sale of organs was legal in the Philippines until a ban took effect in March 2008.In China, organs are often procured from executed prisoners. Nicholas Bequelin, a researcher for Human Rights Watch, estimated that 90 percent of organs from China are from deceased prisoners. China still suffers a shortage of organs for transplant even with more lax regulation. The Chinese government, after receiving severe scrutiny from the rest of the world, has passed legislation ending the legal sale of organs. However, no legislation currently prohibits the collection of organs from deceased inmates who sign agreements before execution. In Iran the practice of selling one’s kidney for profit is legal. Iran currently has no wait lists for Kidney transplantation.
Kidney sales are legal and regulated. 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. The organizations match donors to recipients, setting up tests to ensure compatibility. The amounts paid to the donor vary in Iran but the average figures are $3000–$5000 for kidney donation. Employment opportunities are also offered in some cases. This legal trade has not been complication free but it has eliminated the waiting list for kidneys in Iran. Poverty and loopholes in legislation contribute to the illegal trade of organs. Poverty is seen in all countries with a large black market for organs. This, however, is not the only factor affecting the flourishing illegal markets. Some of the poorest countries in the world do not have organ trade. Legislation is another contributing factor in the organ black market. In Jordan, organ trade is illegal but in many cases organ donors are brought into Iran from Jordan to perform procedures.
India’s Transplantation of Human Organs Act (THOA) requires that an organ donor must be a relative, spouse, or donating for reasons of “affection”. No monetary transactions for organs are legal in India currently but there are no laws concerning funds given to a spouse. The spousal inclusion provides a loophole for illegal trade; in some cases contribution donors simply marry the recipient to avoid legal penalty. Illegal goods are often high priced and unstable in the black market. The amount a donor would receive for a kidney ranges from $800 to $10,000 or more. Liver donors see similar returns. In February 2007, an Observer newspaper investigation into India’s cash-for-organs trade revealed that transplants were making fortunes for middle men and brokers preying on desperate victims of the tsunami who were selling their kidneys on the black market. In 2007 a man in the United Kingdom became the first person convicted under the Human Tissue Act 2004 by trying to sell his kidney online for £24,000 in order to pay off his gambling debts. On June 27, 2008, Indonesian, Sulaiman Damanik, 26, pleaded guilty in Singapore court for sale of his kidney to CK Tang’s executive chair, Mr Tang Wee Sung, 55, for 150 million rupiah (S$ 22,200).
The Transplant Ethics Committee must approve living donor kidney transplants. Organ trading is banned in Singapore and in many other countries to prevent the exploitation of “poor and socially disadvantaged donors who are unable to make informed choices and suffer potential medical risks.” Toni, 27, the other accused, donated a kidney to an Indonesian patient in March, alleging he was the patient’s adopted son, and was paid 186 million rupiah (20,200 US). Upon sentence, both would suffer either 12 months in jail or a fine of 10,000 Singapore dollars (7,300 US). In April 2010, six Israelis were charged with suspicion of running an international organ trafficking ring and breaking promises to donors to pay for their removed kidneys. According to police, one of the arrested suspects is a retired Israeli army general. The traffickers offered up to $100,000 per kidney but in at least two cases didn’t pay the donors after the organs were surgically removed, police said.
The illegal status of organ trade creates a price ceiling for organs at zero dollars. This price ceiling affects supply and demand creating a shortage. In the economic theory advanced by the Cato Institute, the elimination of the price ceiling would eliminate the shortage. It is estimated that in America, if 0.06% of individuals aged 18–65 donated a kidney the waiting list for organs would be fulfilled. Currently with little incentives to donate an organ approximately 6,000 people die yearly waiting for a transplant organ. It has been argued by David Holcberg that the regulation of organ trade could solve the organ shortage and create safer and fair practices for donors. However, the idea of organ “scarcity” had been opposed by Ivan Illich and other authors who argued that “scarcity” is an “artificially created need”. There is not a real shortage of organs, but “excess and wasted” organs. Scarcity only exists for some groups of people—those who were denied the organs, and those who could not afford them. So what needs to be regulated, according to these authors, is organs procurement and distribution practices. For more information on this argument we invite you to watch H.O.T. ( Human Organ Traffic ) documentary movie made by Italian Roberto Orazi.
