Organ trade

Organ trade is the trade of human organs, tissues or other body parts for the purpose of transplantation. There is a global need or demand for healthy body parts for transplantation, far exceeding the numbers available.

As of 2011, about 90,000 people were reported to be waiting for a new organ.^[1] On average, an individual will wait three and a half years for an organ to become available for transplant.^[1] There is a worldwide shortage of organs available for transplantation,^[2] yet commercial trade in human organs was at one point illegal in all countries except Iran. The legal status of organ trade, however, is changing around the world. For example, in 2013, both Australia and Singapore legalized financial compensation for living organ donors.^[3][4]

Trade in human organs is illegal in many jurisdictions in a number of ways and for various reasons, though organ trafficking is widespread, as is transplant tourism. The data on the extent of the black market is difficult to obtain. The question of whether to legalize and regulate the organ trade to combat illegal trafficking and organ shortage is hotly debated.

Legalization of organ trade

Iran is the only nation that allows organs to be bought and sold legally. However, it 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.^[5] The system is largely charity- and volunteer-based, and those tasked with matching donors and patients are not paid for their work.^[6]

Proponents of legalized organ trade have hailed the Iranian system as an example of an effective and safe organ trading model. An article in the Clinical Journal of the American Society of Nephrology notes that the Iranian model has avoided many problems associated with organ trade. The article points out that every other solution attempted in other developing countries has failed even to slow down the continual growth of organ transplant wait lists.^[7]

As noted above, Australia and Singapore recently legalized monetary compensation for living organ donors. Kidney disease advocacy organizations in both countries have expressed their support for this new initiative.^[3][4]

All other nations have some form of legislation meant to prevent the illegal trading of organs, whether by an outright ban or through legislation that limits how and by whom donations can be made. Many countries, including Belgium and France, use a system of presumed consent to increase the amount of legal organs available for transplant.^[8]. In the United States, federal law prohibits the sale of organs; however, the government has created initiatives to encourage organ gifting and to compensate those who freely donate their organs. In 2004, the state of Wisconsin began providing tax deductions to living donors.^[9]

Worldwide, the current trend is toward increased regulation of organ trading.

Organ prices

In Iran's legal markets, the price of a kidney ranges from $2,000 to $4,000.^[10][11] On the black market, however, the price may be above $160,000, most of which is taken by middlemen.^[12] Additionally, when done through black market-affiliated medical providers, the transplant operation is dangerous to both the donor and recipient, and the recipient often contracts hepatitis or HIV.^[10] 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.^[13]

In Pakistan, travel and hospital expenses of about $500 are usually deducted from the agreed-upon price after black-market kidney transplants.^[14]

Arguments for legalization

Safety

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.

In 2014, Robert D. Truog, Center for Bioethics of Harvard Medical School's Department of Global Health and Social Medicine, wrote an open letter to President Barack Obama and other U.S. leaders supporting the creation of pilot projects to study forms of compensating live kidney donors.^[15] A number of health professionals, transplant professionals, ethicists, lawyers, religious leaders, academics, and other supporters co-signed the letter. In the letter, and in an earlier paper published in the New England Journal of Medicine, Truog addresses the urgent need for additional kidney donors; the transplant procedure's low safety risks; the significant decrease in financial costs, morbidity, and mortality rates associated with kidney transplants; and the ability to implement a system of compensated kidney donation with stringent government regulations and ethical safeguards.^[16]

Other safety-related arguments include the following:

• The risk due to kidney donation is very small - the same as some cosmetic surgeries, like liposuction^[10]
• On average, screened live kidney donors live longer than individuals with two kidneys^[10]
• Using legalized organ markets, both the donor and recipient would have more protections than they would on the black market^[10]
• The donor's remaining kidney will expand to fill the gap left by the donated kidney. A second kidney has almost no benefits, as the kidneys usually fail simultaneously.^[17]
• A kidney received from a living donor usually lasts years longer than a kidney received from a dead donor^[17]
• On the black market, donors may not get sufficient post-operative care^[18]

Organ safety

The legal trade on blood donation in the U.S. already produces much more blood donation than the uncompensated donation system in Britain. Decades ago, concerns about the quality of traded blood or organs were a main cause of opposition. However, proponents of organ trade argue that screening technology is now sufficiently efficient to guarantee the safety of traded organs.^[19]

Due to organ shortage, many transplanted organs are taken from the cadavers of elderly or ill people, which has at times led to the organs failing or containing cancers. However, waiting for a "better" organ can be dangerous, since those remaining on wait lists have a high risk of death.^[18]

Impulsive unthinking donations

Professors Becker and Elias note that impulsive or unthinking donations could be prevented via a written consent with a compulsory waiting period.^[20] They also argue that non-compensated organ donors may equally make impulsive donation decisions.

Bioethicist Gregory Pence has expressed concerns about the intense social pressure that family, friends, or employees often feel to donate to a patient.^[21] Some transplant centers reportedly solve this problem by "inventing" a medical excuse for reluctant donors.^[22] Monetary compensation has been suggested as a solution, as the availability of more organs would lessen the pressure on friends and family to donate.^[22]

Previous attempts to legalize organ trade

China

China has no organized system of organ donations.^[23] Since the late 1980s, there have been multiple indications that executed prisoners are the main (and essentially the only) source of organs and tissues for Chinese transplant programs.^[24] Although using executed prisoners' organs is legal in China, there is evidence that the government attempted to downplay the scope of organ harvesting through confidentiality agreements^[25] and laws, such as the Temporary Rules Concerning the Utilization of Corpses or Organs from the Corpses of Executed Prisoners.^[26] Nevertheless, China still suffered a shortage of organs for transplant.

The Kilgour–Matas report^[23] found that "there has been and continues today to be large scale organ seizures from unwilling Falun Gong practitioners",^[23] confirming an earlier report.^[27]

Shortly after reports of organ harvesting emerged, government leaders announced new legislation banning use of organs without consent.^[28] However, over a year later, this law did not appear to have been implemented.^[28] The Chinese government also passed legislation ending the legal sale of organs. However, no legislation currently prohibits the collection of organs from deceased inmates who sign agreements before being executed.

China also introduced new legislation aimed at standardizing its organ collection process. This legislation includes regulations specifying which hospitals can perform operations and standardizing the legal definition of brain death. Additionally, the legislation banned foreign transplant patients.^[29]

In a 2009 interview, Manfred Nowak, the United Nations Special Rapporteur on Torture, said: "The Chinese government has yet to come clean and be transparent ... It remains to be seen how it could be possible that organ transplant surgeries in Chinese hospitals have risen massively since 1999, while there are never that many voluntary donors available."^[30] Nowak submitted two reports to the United Nations Human Rights Council, formally requesting that the Chinese government respond to the allegations.^[30]

India

Before the passage of the Transplantation of Human Organs Act (THOA) in 1994, India had a successful legal organ trading market. 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.^[31] However, several problems began to surface. In some cases, patients were unaware that a kidney transplant even took place.^[32] In other cases, patients were promised payments that were much higher than what they actually received.^[33] These and other ethical issues pushed the Indian government to pass legislation banning the sale of organs.^[34] Nevertheless, current laws still contain loopholes. For example, the THOA states that an organ donor must be a relative, spouse, or an individual donating for reasons of "affection" for the recipient. Often, claims of "affection" are unfounded and the organ donor has no connection to the recipient.^[35] In many cases, the donor may not be Indian or even speak the same language as the recipient.^[26]

Iran

In Iran, it remains legal to sell a kidney for profit. Iran currently has no waitlists for kidney transplantation.^[7] 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. These not-for-profit organizations match donors to recipients, setting up tests to ensure compatibility. The compensation paid to the donor varies, but an average kidney donor is paid $1200.^[5] Some donors are also offered employment opportunities. Charity organizations support recipients that cannot afford the cost of the organ.^[18]

Some critics argue that the Iranian system is in some ways coercive, as over 70% of donors are considered poor by Iranian standards.^[6] There is no short-term or long-term follow-up on the health of organ donors.^[36] In fact, there is evidence that Iranian donors experience highly negative outcomes, both in terms of health and emotional well-being.^[37]

The Philippines

Before 2008, the sale of organs was legal in the Philippines, and the country was a popular destination for transplant tourism. The Philippine Information Agency, a branch of the government, even promoted "all-inclusive" kidney transplant packages that retailed for roughly $25,000.^[38]

The government banned the sale of organs, effective March 2008.^[39] Since the ban took effect, the number of transplants has decreased from 1,046 in 2007 to 511 in 2010.^[40] Professor Roger Lee Mendoza has suggested that declining numbers of transplant tourists and documented organ sales may serve to strengthen organ black markets. Often, he says, banning organ sales fosters compensation-based contractual systems between underground donors, brokers, and buyers.^[41]

Illegal organ trade

According to the World Health Organization (WHO), illegal organ trade occurs when organs are removed from the body for the purpose of commercial transactions.^[42] The WHO has stated that “Payment for...organs is likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation and leads to profiteering and human trafficking.”^[43] Despite ordinances against organ sales, it was estimated that in 2005, 5% of all organ recipients had engaged in commercial organ transplants.^[44] Research indicates that illegal organ trade is on the rise, with a recent report by Global Financial Integrity 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:

• Angola
• Balkan Region
• Brazil^[45][46][47]
• Canada^[43]
• China^[48][49][50]
• Colombia^[51]
• Costa Rica^[52]
• Eastern Europe
• Ecuador^[45]
• Georgia^[53]
• Haiti^[54][55]
• India ^[56]
• Macedonia
• Mexico^[57][58]
• Pakistan
• Peru^[45]
• Philippines^[41][59]
• Russia
• South Africa ^[45][47]
• The United Kingdom
• The United States of America^[47][60]

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.^[58][61]

Poverty and loopholes in legislation also contribute to the illegal trade of organs.^[62] Poverty is common in all countries with a large black market for organs. As discussed above, legislation containing loopholes, like India's Transplantation of Human Organs Act, allows organ sales to continue.^[35] Likewise, India's laws forbid monetary transactions for organs, but do not regulate funds given to a spouse. This provides another loophole for illegal trade; in some cases, an organ donor will marry the recipient to avoid a legal penalty.^[63]

History

The international community and national governments have long attempted to find stable, ethical systems to deal with the high demand for organ transplants. In 1968, the United States implemented the Uniform Anatomical Gift Act of 1968, which gave individuals the right to donate their organs after their death. Later, the U.S. enacted the National Organ Transplant Act of 1984, which established a national online registry for organ donors and prohibited organs from being bought or sold in the U.S. The most recent efforts of the United States to combat high organ demand include the revision of the Uniform Anatomical Gift Act in 2006 and the 2007 Charlie W. Norwood Living Organ Donation Act.^[42]

Many other countries have passed laws aimed at ending illegal organ trade. For example, South Africa adopted the Human Tissue Act of 1983, which outlaws the transfer of tissue (including flesh), bone, organ, or bodily fluid in exchange for payment.^[35] In May 2007, China adopted the Human Transplantation Act, banning organ commercialism.^[64]

Prosecuted cases

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 in the past. It is estimated that 42% of transplanted organs come from illegal trafficking in organs.^[65]

In 1993, Bombay police exposed a kidney sale and transplantation operation run by a man known as Santosh Raut. Eleven people, including Raut and two nephrologists, were arrested, but Raut managed to escape. Authorities believe that Raut went on to establish similar illegal kidney centers across many Indian cities. In February 2008, another kidney transplant center, run by a man called Amit Kumar, was discovered by police in Delhi and nearby Gurgaon. Due to technological advances in fingerprinting, Kumar and Raut are now believed to be the same perpetrator, having gone by many aliases throughout years of illegal activity. Kumar is facing charges for his decades of involvement in illegal organ trade, which includes over 600 illegal kidney transplants and the involvement of at least two hospitals.^[37]

In 2007, a man in the United Kingdom became the first person convicted under the Human Tissue Act 2004 after he attempted to sell his kidney online for £24,000 in order to pay off his gambling debts.^[66]

In July 2009, Levy Izhak Rosenbaum of Brooklyn was arrested for conspiring to arrange the sale of an Israeli citizen's kidney to an undercover FBI officer for $160,000 during Operation Bid Rig.^[67] According to the charges against him, Rosenbaum said he had been involved in the illegal sale of kidneys for 10 years. Acting US Attorney Ralph Marra said: "His business was to entice vulnerable people to give up a kidney for $10,000 which he would turn around and sell for $160,000." Anthropologist and organ trade expert Nancy Scheper-Hughes stated that she had informed the FBI that Rosenbaum was "a major figure" in international organ smuggling 7 years prior, and that many of Rosenbaum's donors had come from Eastern Europe. She also heard reports that Rosenbaum held donors at gunpoint to ensure they donated their organs.^[68] Rosenbaum pleaded guilty to organ trafficking in 2011.

In November 2010, the South African National Direct of Public Prosecution found St. Augustine's Hospital, owned and operated by the private company Netcare Kwa-Zulu (Pty) Limited, guilty of 102 counts of activity relating to illegal kidney transplant operations. Convicted along with the private company were four transplant doctors, a nephrologist, two transplant administrative coordinators, and a translator. The charges against the parent company, Netcare, and its CEO, Richard Friedland, were dropped in order to obtain an admission of guilt from the hospital. The private company pleaded guilty to 109 illegal kidney operations performed on Israeli, Romanian, and Brazilian citizens between June 2001 and November 2003, including five minors. These citizens received cash following their surgeries, while the private company was paid up-front for its involvement in the operations.^[69]

In December 2010, Turkish nationals were reported to be involved in organ trafficking in Kosovo.^[70][71] In 2013, "an international panel of judges from the European Union Rule of Law Mission in Kosovo"^[72] convicted five people for illegal organ trade.

In 2014, an alleged member of the Mexican Knights Templar Cartel was arrested for kidnapping and murdering minors. Children were found wrapped in blankets and stuffed in a refrigerated container inside a van. Various accounts have stated the arrested man is part of a network that kidnaps and kills minors, after which their organs are removed. The Cartel's other sources of income include drug trafficking, extortion, illegal mining, and, illegal logging.^[57][73]

Media portrayal

There have been various portrayals of illegal organ trade and organ trafficking in the mass media over the past few decades. The 1977 fictional novel Coma by Robin Cook, made into a movie by Michael Crichton, tells of unsuspecting medical patients who are put into a coma in order for their organs to be removed. Similarly, the 1993 book The Baby Train by Jan Brunvand reveals the mythical story of a man who wakes up in his hotel room with a missing kidney the night after flirting with a woman at a bar.^[65] In addition to books and films, stories of organ trafficking are often depicted through television, tabloid magazines, emails, and the Internet.^[74]

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, Honduras, Argentina, and Russia. One episode discussed a man named Pedro Reggi, reporting that his corneas 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.^[74]

Critics, such as Silke Meyer, argue that this sensationalized view of organ trafficking, often depicted as an urban myth, 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 [organ trafficking] be taken seriously by all governments affected and will the results constitute a solid ground for the field of policy-making."^[65]

The Red Market

In 2011, Scott Carney coined the term "Red Market" to describe a broad category of economic transactions related to the human body.^[75] He argues that advances in science have served to increase the demand for human body parts. He writes that this increased demand has enabled a vast "Red Market," encompassing a wide variety of transactions, from organ sale to organ thievery, 'bone thievery,' 'blood farming,' and even rented space in women's wombs.^[75]

Drawing on the concepts of black markets, white markets, and gray markets, Carney suggests that commerce in body parts is distinct because bodies are not commodities in a strict sense. That is, a body part and its worth cannot be assigned a monetary value. Furthermore, Carney argues, trade in body parts creates a lifelong debt between the provider and the recipient. Straight commerce in human bodies reduces a human life to its 'meat value.' Carney calls for "radical transparency" in the red market supply chain in order to protect its humanness.^[75]

Current state

According to the most recent Bulletin of the World Health Organization on the state of the international organ trade, 66,000 kidney transplants, 21,000 liver transplants, and 6,000 heart transplants were performed globally in 2005.^[44] A 2008 article reported that the median waiting time for the United States transplant list was greater than 3 years (with projections to increase in the next few years); at the same time, the United Kingdom reported lacking organs for 8,000 patients, with the rate increasing at 8%.^[42]

The high demand for organs and long waitlists have been met with a corresponding expansion of the illegal organ trade. Currently, it is estimated that about 10% of all transplants occur illegally, with the Internet acting as a facilitator.^[76] One source estimates that at least 4000 prisoners were executed in 2006 to supply approximately 8000 kidneys and 3000 livers for foreign buyers.^[76] In 2007, 2500 kidney transplants were purchased in Pakistan, with foreign recipients making up two-thirds of the purchasers.^[42] As of 2007, the Voluntary Health Association of India estimated that approximately 2000 Indians sell a kidney every year. In the same year, in Canada and the United Kingdom, experts estimated that about 30 to 50 patients illegally purchased organs abroad.^[44]

Transplant tourism

The United Network for Organ Sharing defines transplant tourism as "the purchase of a transplant organ abroad that includes access to an organ while bypassing laws, rules, or processes of any or all countries involved."^[64] The term "transplant tourism" describes the commercialism 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.^[64] 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 to North, from developing to developed nations, from females to males, and from people of color to whites - trends that experts say "[have] exacerbated old...divisions."^[37]

The kidney is the most sought-after organ in transplant tourism, with prices for the organ ranging from as little as $1300^[37] to as much as $150,000.^[64] In fact, reports estimate that 75% of all illegal organ trading involves kidneys.^[77] The liver trade is also prominent in transplant tourism, with prices ranging from $4000^[78] to $157,000.^[79] 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 bodily organs commonly sold in the organ trade 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/ligaments ($5,465).^[79] While there is a high demand, and correspondingly a very high price, for vital organs such as hearts and lungs, 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.^[79]

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'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 on organ trafficking and transplant tourism.^[35] The World Health Organization (WHO) has 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.^[43] 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.^[42] 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.^[64]

Declaration of Istanbul

The Declaration of Istanbul on organ trafficking and transplant tourism, drafted by the international transplant community, defines transplant commercialism, organ trafficking, and transplant tourism.^[43] It denounces these practices based on violations to equity, justice, and human dignity.^[76] The Declaration aims to promote ethical practices in organ transplantation and donation on an international level.^[43] 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.^[43]

Impact on the poor

Demographics

Data from the World Health Organization indicates that impoverished people in developing nations are the primary group targeted by the illegal organ trade. In one study of organ donors in India, 71% of all donors fell below the poverty line.^[44] Tales of organ theft usually characterize the victims as unemployed males between the ages of 20 and 40 who were seeking work and were taken out of the country for operations.^[42] One such case involved Makbuba Aripova, whose husband left Uzbekistan for a job in Canada. His corpse, and those of family members traveling with him, were found several days later with missing organs and bags of money believed to be the proceeds from an organ sale.^[26] While men feature prominently in anecdotes on the organ trade, impoverished women are also frequent victims.^[44] However, most data show that women are rarely the recipients of purchased organs.^[37]

Reasons for donating

One of the primary reasons donors articulate for why they sell their organs is to pay off debt.^[42] 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.^[6] 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.^[80][81] Often, people do not make an informed choice to donate their kidneys to strangers, but are forced into doing so due to extreme poverty.^[81][82] It is therefore problematic to establish informed consent when the decision to donate is economically motivated, particularly in unregulated organ markets. The donor's socioeconomic situation is crucial in understanding the motives and outcomes of organ donation, particularly in relation to economically disadvantaged organ donors.

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 waiting lists are less formal, and among families which cannot afford to leave the country for transplants. The trend of younger people donating to their more aged relatives is relatively new, and has been criticized for placing greater value on kidneys from live donors.^[83]

Outcomes

Reports by the World Health Organization show decreased health and economic well-being for those who donate organs through transplant tourism. In Iran, 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.^[44] 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 C, 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.^[42][64]

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 had those operative care that is not provided by the buyer.^[38] 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.^[38]

Scholarly debate

The issue of organ trade, both illegal and legal, continues to be the subject of much debate from a wide range of scholars. These debates have resulted in many proposed solutions addressing the high demand for organs and the rise in illicit trading. These proposals have included a free market for organs; increased legislative regulations and sanctions against illegal organ trading; and implementation of "presumed consent" laws for organ donations.^[84] The wide range of academic perspectives on organ trade is discussed in the following sections.

Academic perspectives

According to a literature review, of the 72 economic researchers who have studied organ trade, 68% supported legalization of the organ trade, while 21% opposed it.^[85]

Criminal justice perspective

The criminal justice perspective considers organ trade from a legal, judicial viewpoint. 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.^[65] 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.^[43]

Economic perspective

The consensus of American Economic Association members is that organ trade should be legalized, with 70% in favor and 16% opposed.^[86]

In the Journal of Economic Perspectives, Nobel laureate Gary Becker and Julio Elias estimated that a $15,000 compensation would alleviate the shortage of kidney donors. The government could pay the compensation to guarantee equality. This would save public money, as dialysis for kidney failure patients is far more expensive.^[18]

Many scholars advocate the implementation of a free market system to combat the organ shortage that helps drive illegal organ trade.^[84] The organ trade's illegal status creates a price ceiling for organs at zero dollars. This price ceiling affects supply and demand, creating a shortage of organs in the face of a growing demand.^[87][88] According to a report published by the Cato Institute, a U.S.-based libertarian think tank, eliminating the price ceiling would eliminate the organ shortage.^[6] However, the idea of organ "scarcity" had been opposed by Ivan Illich and other authors, who argue that "scarcity" is an "artificially created need." These critics argue that there is not an actual shortage of organs, but rather a surplus of "excess and wasted" organs. Scarcity only exists for some groups of people: those who are denied the organs, and those who cannot afford them. Thus, what needs to be regulated, according to these authors, is organ procurement and distribution practices.^[89]

Currently, with little incentive to donate an organ, approximately 6,000 people die yearly waiting for a transplant organ. David Holberg has argued that regulating the organ trade could solve the organ shortage and create safer, fair practices for donors.^[90] Supporters of regulation argue that by implementing a regulated market system, prices for organs would actually be lower than current black market values, since an increased supply drives prices down. These lowered organ prices could result in a disincentive to engage in black market organ trading, since illegal brokers would have less to gain financially. Additionally, the increased supply would result in shorter waiting periods for transplant recipients, which would in turn reduce hospital costs.^[84]

However, other critics state that such a market would only increase already high prices for organs, creating an imbalance: only wealthy individuals would be able to purchase these organs. They also 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.^[84]

Medical ethics perspective

The debate on the ethics and morality of organ trade remains spirited in modern society. Relevant evidence changes frequently due to the dynamic nature of our technological advancements in medicine and our understanding of ethics itself.^[37] At the moment, although organ trade is illegal in almost all countries, it is still difficult to provide a solid conclusion in the field of business ethics without a bias based on one's basic beliefs, culture, or religion. Particularly, religion plays a major role in the topic of bodily autonomy as it relates to organ trade. Bodily autonomy is defined as the "ability to make choices about how [one's] body is to be treated by others."^[84] Many religious activists and theorists say this idea of bodily autonomy treats the body as property, which violates many religious views that the body and self are one entity. Therefore, from many religious stances, selling a part of your body is analogous to selling your inner self, or soul, which many religious communities regard as a violation of human dignity.^[91]

Advocates for bodily autonomy argue that the freedom to make decisions about one's body does not violate one's dignity, but actually increases a person's sense of control and empowerment. By exercising their right to choose what to do with their body, a person will be further empowered and effectively increase their bodily autonomy. Advocates argue that people regularly make choices about their body that carry risks analogous to the organ trade. For example, the right to endanger one's body by joining the military, acting as a surrogate mother, or engaging in medical experiments are all accepted in today's society - and are fueled by financial incentives. By these standards, advocates argue, the right to choose whether to sell an organ should be supported.^[84]

Some researchers have said that legalization would allow state supervision of the organ trade, and hence minimize medical dangers and exploitation.^[92] This could serve to protect donors, who in the black market often receive inadequate (and costly) post-operative care.^[18]

Human rights perspectives

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 that lead to several arrests due to third-world people being forced or fooled into organ donations.^[93]

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.^[94] However, by 2010, Scheper-Hughes and Organ Watch supported legal compensation for organ donations.

Proposed solutions

Various solutions have been proposed to increase the number of legally available organs and stanch the flow of illegal trafficking around the globe. Policies of presumed consent have been successful in various countries, including Brazil, the United States, and several European nations. These policies can be either opt-in or opt-out. In a nation with an opt-out policy, consent for organ donation is presumed upon death, although one can choose not to donate by submitting documentation. Research shows a 25-30% increase in the amount of available organs in opt-out countries.^[42] In nations with an opt-in policy, like the United States or France, a person may choose to donate their organs during their lifetime. In opt-in countries, families have on occasion succeeded in overturning the deceased's decision to donate.

Presumed consent programs cut down on organ trafficking in many ways. These laws help increase the amount of available organs, decreasing patients' reliance on the black market. At the same time, the increased supply of organs decreases the financial cost of a transplant, lessening the need for medical tourism.^[26]

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.^[37] She argues that though doctors would be violating doctor-patient privilege, their legal obligation to the patient is superseded by public interest in ending alleged 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.^[26]

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 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.^[6]

See also

• Black market
• China:
  • Organ transplantation in China
  • Organ harvesting from Falun Gong practitioners in China
  • Persecution of Falun Gong#Organ harvesting
• Fetus Farming Prohibition Act
• Gurgaon kidney scandal
• Organ donation
• Organ donation in Israel
• Organ harvesting
• Organ theft in Kosovo
• Persecution of people with albinism

References