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Organ TraffickingCAN THE SMUGGLING OF HUMAN ORGANS BE STOPPED?

Headline-grabbing arrests of kidney brokers and renegade doctors provide glimpses into a global

black market in human organs that is thriving from South America to Asia. The World Health Or-

ganization estimates that 5-10 percent of the 100,000 organs transplanted each year have been pur-

chased illegally, typically from poor people desperate for cash. In China, thousands of organs re-

portedly have been forcibly removed from prisoners to feed a lucrative “transplant tourism” business. The full scope

of the global organ black market remains unknown because transplant doctors and hospitals either don’t know the

organs were trafficked or are complicit in the deals. Critics say hospitals should disclose the source of all transplant

organs so illegal sales can be tracked. Some doctors say legalizing government payments to organ donors — as Iran

has done — is the only way to eliminate

trafficking, but the mainstream medical

community says such payments would only

exploit the poor. Artificial organs eventually

could help satisfy the growing demand for

organs, eliminating the black market.

Since 2000, four members of a Pakistani family have solda kidney for about $1,200 apiece to pay off debts to theiremployer, who gives them each $12 a week to work in his

Rawalpindi brick factory. Recent reports indicate aresurgent organ black market in Pakistan, despite a banthat became law in 2007. Shown displaying their surgeryscars in 2009, are (from right) brothers Mohamed Riiz, 22,and Mohamed Ijaz, 25, and father, Karm Ali, 65. Ijaz’s wife

Farzana, 20, (seated) also sold a kidney.

JULY 19, 2011 VOLUME 5, NUMBER 14 PAGES 341-366 WWW.GLOBALRESEARCHER.COM

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H

342 CQ Global Researcher

ORGAN TRAFFICKING

THE ISSUES

343 • Is the global black mar-ket for organs growing?• Would legally payingdonors discourage trafficking?• Should governments andhospitals do more to crackdown on organ profiteers?

BACKGROUND

352 The First TransplantsA kidney was successfullytransplanted in 1954.

356 Foreign VariationsSome countries make every-one an organ donor atdeath unless they “opt out.”

357 Coercion and BansWorkers often sell a kidneyto pay off debts.

CURRENT SITUATION

358 Major Criminal CasesSeveral trafficking casesare pending.

360 Legalizing PaymentsThe transplant communityis debating whether tosanction reimbursements.

OUTLOOK

361 Making Trafficking ObsoleteEventually, artificial organscould eliminate illicit sales.

SIDEBARS AND GRAPHICS

344 Rich and Poor Collaboratein Global Kidney TradeKidneys usually travel frompoor to rich countries.

346 China Harvests Prisoners’OrgansActivists say China executes“on demand” to provide or-gans to foreigners.

348 U.S. Kidney Sellers Receive the MostPayments can run from $750to $30,000.

350 Transplant Gaps SpurOrgan TraffickingDisparity between organ sup-ply and demand fuels sales.

353 ChronologyKey events since 1901.

354 Singapore Allows Reim-bursements to OrganDonorsBut is additional cash paidunder the table?

358 Austria Leads in Per Capita TransplantsNorway has second-highestrate.

359 At IssueWould regulated reimburse-ments discourage organ traf-ficking?

366 Voices from AbroadHeadlines and editorials fromaround the world.

FOR FURTHER RESEARCH

363 For More InformationOrganizations to contact.

364 BibliographySelected sources used.

365 The Next StepAdditional articles.

365 Citing CQ Global ResearcherSample bibliography formats.

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July 19, 2011Volume 5, Number 14

July 19, 2011 343www.globalresearcher.com

Organ Trafficking

THE ISSUESF or 23-year-old con-

struction worker LuisPicado, it seemed like

a way to realize the Ameri-can dream. Returning to hishome in a slum in Managua,Nicaragua, one day in 2009,he told his mother he hadmet an American man whopromised him a job and apart-ment in New York if he’ddonate one of his kidneys.

Three weeks later, Picadocame out of surgery at a Man-agua hospital bleeding inter-nally from an artery doctorshad severed in removing hiskidney, according to medicalrecords. Picado bled to death.

Matthew Ryan, the Amer-ican man who received thekidney, did not fare muchbetter. Two months afterreceiving Picado’s kidneyat the same hospital, the68-year-old retired bus su-pervisor from New York died.Prosecutors in Managua areinvestigating whether Nicaragua’s lawprohibiting paying for an organ wasbroken. 1

Nicaragua is just one of the im-poverished countries — along withPakistan, India, Egypt and China —where people from the United States,Japan, South Korea, Persian Gulf na-tions and other wealthy countries goto buy organ transplants. In many casesthe patients, most of whom suffer fromkidney disease, face the prospect ofdying while waiting the typical five to10 years for a donated organ in theirhome country.

The global black market in humanorgans continues to thrive in manycountries, even though virtually everynation except Iran has banned buy-ing or selling organs or paying a bro-

ker for arranging such a sale. In Iran,such transactions are legal and fund-ed by the government. 2

The illicit organ trade continues be-cause knowing which transplants vi-olate the law can be tricky. If a pa-tient shows up at hospital with a cousinwho says he’s willing to donate a kid-ney, for example, the transplant is pre-sumed to be legal in most countries.But the hospital has no way of know-ing if the patient has written a bigcheck to his cousin to express his“thanks.” Or, the donor could be astranger, solicited by a broker andmasquerading as a devoted relativefor an agreed-upon sum.

The possibility of illegal paymentsbecomes more likely, but just as hardto trace, in cases of so-called “trans-

plant tourism,” in which pa-tients from, say, the UnitedStates or Saudi Arabia trav-el abroad for a kidney orpart of a liver. As far as thepatients are concerned, op-erations in a reputable hos-pital in India or Turkey mayappear perfectly legal, andthe hospital may assure thepatient that the procedure isabove-board. But the organmay have come from an im-poverished laborer who, un-beknownst to the patient, hasbeen promised from severalhundred to several thousanddollars by a broker or un-scrupulous doctor.

It’s difficult for interna-tional health organizationsand law enforcement agen-cies to know which trans-plants originated from an il-legal sale because medicalconfidentiality rules typical-ly hide a donor’s identityand bar access to medicalrecords. And transplanttourism can be perfectly legalif, for example, a Pakistani-

American goes to Pakistan to receivea kidney as a gift from a cousin there.

The Geneva, Switzerland-basedWorld Health Organization (WHO), whichoversees global organ transplant activi-ty, estimated in 2007 that 5 to 10 per-cent of the 100,000 organ transplantsperformed worldwide each year — 5,000-10,000 such operations — are illegal. 3

Most patients seeking transplants inrecent years have traveled from SaudiArabia, other wealthy Arabian Gulfcountries, Taiwan, Malaysia and SouthKorea, often because their home coun-try lacks modern transplant facilities. 4

(See map, p. 344.)No one knows how many Ameri-

cans travel abroad for transplants (orhow many of the operations are ille-gal). That’s because no one, including

BY SARAH GLAZER

AFP/Getty Images/Prakash Mathema

In a high-profile case of coercive organ donation, transplant doctorAmit Kumar has been charged with illegally removing the kidneysof some 500 impoverished laborers and farmers in Gurgaon, India.Some of them allegedly were lured there by false promises of jobsand then forced at gunpoint onto the operating table. Severalpolice officers also were charged with extortion and accepting

bribes in connection with the case, which is still pending.


U.S. hospitals that treat such patientson their return, is required to report thesecases, according to Francis Delmonico,a Harvard Medical School surgeon andpresident-elect of the Montreal-basedTransplantation Society, an organizationof transplant specialists.

Yet news reports and occasionalarrests of large-scale traffickers revealthat ostensibly legal transplants inhospitals abroad depend on a thriv-ing organ trade that preys on the

poor. In Egypt, South Africa, Braziland the Philippines, “international ca-bals of doctors and corruptible ethicsboards have slowly transformed slums. . . into veritable organ farms,” in-vestigative journalist Scott Carneywrites in The Red Market: On theTrail of the World’s Organ Brokers,Bone Thieves, Blood Farmers andChild Traffickers, a new book aboutthe worldwide illegal trade in organsand other body parts. 5

Meanwhile, some governments indeveloping countries have a strong in-centive to look the other way: Medicaltourism for all procedures, ranging fromface lifts to transplants, brought in about$100 billion in 2010. 6

Popular images of the illegal organmarket abound, but they’re often un-realistic. An example is the scenarioportrayed in the 2002 movie “DirtyPretty Things,” in which a criminalbroker persuades desperate immi-

ORGAN TRAFFICKING

Rich and Poor Collaborate in Global Kidney TradeThe illegal trade in kidneys from live donors generally ßows from donors in poor, developing countries — such as Bolivia, India, Romania and China — to patients in rich, developed nations, such as Canada, the United States, Japan and Saudi Arabia. Afßuent patients often travel to poorer countries overseas to buy kidneys because they can face up to 10 years waiting for a donated kidney in their home countries — if they live that long. On the Internet, medical tourism sites and hospitals offer cut-rate kidney transplants in India, Turkey and Latin America. In 2010, medical tourism was estimated to be a $100 billion industry, but no one knows how much of that business is based on illegal transplants.

Countries of Origin for Kidney Buyers and Sellers

Source: Organs Watch; news reports. Map by Lewis Agrell

Selling kidneysBuying kidneys

Countries of origin for those:

CANADA

BRAZILPERU

BOLIVIA

EGYPT

ISRAEL

ITALY

OMAN

TURKEY

ROMANIAMOLDOVA

IRANCHINA

AUSTRALIA

JAPAN

PHILIPPINES

INDIASAUDIARABIA

UNITED STATESOF AMERICA

PAKISTAN


grants to have one of their kidneysremoved in a hotel room and thenpasses the organs in a Styrofoamcooler to another kidney broker.“People don’t take out kidneys onkitchen tables,” says Gabriel Danovitch,medical director of the kidney trans-plant program at the David GeffenSchool of Medicine at the Universityof California Los Angeles. “For trans-plants to happen you need a decenthospital and well-trained surgeons.”Because organs last outside the bodyfor only a few hours, recipients typ-ically need to be in the same hos-pital with the donor.

While rumors abound in develop-ing countries of people being kidnappedfor their organs, such cases are rare.However, there have been plenty ofinstances of bonded workers, particu-larly in Pakistan, being coerced intoselling a kidney to pay off a debt. InGurgaon, India, an alleged outlaw doc-tor charged with removing the kidneysof 500 impoverished laborers and farm-ers in 2008, some of whom had beenlured there by false promises of jobsand then forced at gunpoint onto theoperating table. Others were persuad-ed to sell. 7

In China, human rights activists saytens of thousands of imprisoned prac-titioners of the Buddhist spiritual dis-cipline Falun Gong have been killedfor their organs — largely at militaryhospitals, which offer foreigners a trans-plant in as little as a week. “It meansnext Tuesday somebody has to be ex-ecuted so that an American can getan organ transplant,” says Delmonico.(See sidebar, p. 346.)

But in most of the world, expertssay, force is unnecessary. “It’s so easyto put an amount of money on thetable that will bring in people thatyou don’t need to kidnap,” says LucNoël, coordinator in essential healthtechnologies at WHO.

“The rumors and the urban mythof a person who wakes up in thehotel bathtub with a big scar and a

kidney missing have never beenproven,” he says.

Often, studies find, a kidney brokerpays much less than he promised, andthe donor, typically poor and desper-ate, suffers both physically and psy-chologically from lack of follow-up care.“The seller is always a victim,” says Noël.

In India’s Tamil Nadu province, Rani,the wife of an unemployed fisherman,agreed to sell her kidney to a brokerto pay hospital costs for her daughter,who had tried to commit suicide bydrinking pesticide. Rani was paid $900up front to cover her daughter’s ex-penses and promised $2,600 more whenthe operation was over. But when sheawoke, the broker had vanished. Monthslater, she said the pain in her side pre-vented her from getting the only workavailable to an unskilled woman: daylabor on construction sites. “The bro-kers should be stopped,” she said. “Myreal problem is poverty — I shouldn’thave to sell my kidney to save mydaughter’s life.” 8

“Transplant tourists” also face risks.Being poor and malnourished makesorgan sellers more likely to be un-healthy, with no incentive to disclosetheir true health conditions. Delmoni-

co warns that people who get trans-plants overseas can contract an eso-teric, new antibiotic-resistant bacteria —the superbug NDM-1 — or other in-fection, such as HIV. 9

Recently, some transplant surgeonshave been urging Western govern-ments to consider paying donors inorder to eliminate the black market,reduce long waiting lists for donatedorgans and ratchet down health risks.Organ trafficking could be drasticallyreduced, says Benjamin Hippen, a trans-plant nephrologist in Charlotte, N.C., if“the incentives that allow it to be prof-itable” were eliminated. If American andWestern governments paid domesticdonors, he maintains, it would satisfydemand in the countries sending trans-plant tourists to poor countries for or-gans. The United States has more than100,000 patients waiting for organs,and Europe has more than 56,000. 10

But proponents of payments remaina minority within the transplant com-munity. Almost every international bodyopposes paying for organs, arguing thatit would violate the existing altruistic sys-tem and turn human body parts intocommodities. Poor donors would prob-ably lie about serious medical condi-

Poor Sellers vs. Rich BuyersThe typical kidney seller in a developing country such as the Philippines is a male under age 30 with a family income of less than $500 a year. By contrast, buyers in developed countries such as Israel are much older and typically have family incomes above $50,000.

Source: Nancy Scheper-Hughes, “Organs Without Borders,” Foreign Policy, January-February 2005

Typical Kidney Buyers and Sellers in the Philippines and Israel

Typical seller(Philippines)

Age: 29

Sex: Male

Annual family income: $480

Education: 7 years

Typical buyer(Israel)

Age: 48

Sex: Male

Annual family income: $53,000

Education: University degree


tions, putting recipients at risk, oppo-nents add. And paying donors likelywould reduce the overall organ supply,they say, because family members wouldfeel less obligated to donate an organfor a loved one. Nor would it increasethe supply of organs other than kidneys,most of which come from cadavers.

“If you used every market incentiveout there, we’d still have a shortage,”says Arthur Caplan, a professor ofbioethics at the University of Pennsyl-vania and co-director of a United Na-tions study on organ trafficking. 11

Yet proponents of a regulated organmarket point out that simply banning

the practice has only sent it into theshadows. In India, Pakistan, Iraq andIndonesia, transplants have “been dri-ven underground, like abortion, to anunderground basement,” says JohnFung, director of the Cleveland Clin-ic’s Transplantation Center and a sup-porter of a legalized incentive payment

ORGAN TRAFFICKING

Chinese government officials have acknowledged sinceJuly 2005 that up to 95 percent of the organs trans-planted in China were harvested from convicted, exe-

cuted prisoners — allegedly with their consent. 1

Yet in 2006, Canadian human rights activists reported that thereweren’t enough executed prisoners or other donors to accountfor 41,500 transplants performed in China between 2000 and 2005.The report’s authors, human rights lawyer David Matas and for-mer Canadian Parliament member David Kilgour, concluded that,rather than coming from executed criminals, most of the organscame from imprisoned practitioners of the Buddhist spiritual dis-cipline known as Falun Gong, who were either shot first or diedduring the organ harvesting operation. 2

Since the government banned the practice of Falun Gongand declared it subversive in 1999, hundreds of thousands ofpractitioners have been arrested, and those who refused to re-cant disappeared into slave labor camps, according to Matas andKilgour. The Laogai Research Foundation, a Washington-basedadvocacy group that exposes human rights violations in China,estimated that in 2008 between 500,000 and 2 million FalunGong were being detained. 3 At least 62,000 were victims oforgan harvesting operations from 2000-2008, according to Matasand Kilgour and Ethan Gutmann, an investigative journalist. 4

Matas and Kilgour, who were nominated for a Nobel Prizefor their investigation, say the organs were then “sold” to for-eign transplant tourists. Conducted mainly at military hospitalswith access to prisoners, the transplants funneled $1 billion ayear to the hospitals, which had lost most of their subsidiesfrom the Communist government, according to Matas.

The activists’ undercover reports include taped conversationswith transplant doctors at Chinese hospitals promising foreigncallers that they could receive a transplant in as little as a week— a process that usually takes months to years in most coun-tries. “They’re clearly blood-typing and tissue-typing prisoners”— to match them to prospective recipients — “and then shoot-ing them,” says Arthur Caplan, a professor of bioethics at theUniversity of Pennsylvania.

In 2008, advocacy groups and media reports charged thatsome of bodies and organs on display in the popular “Bod-ies” exhibit that traveled to several major American cities were

those of executed Chinese prisoners. After Andrew M. Cuomo,then-attorney general of New York, investigated the allegations,the exhibitor admitted that it had received the bodies from theChinese Bureau of Police and that, despite its prior denials, itcould not verify that the human remains used in its exhibitshad not come from executed Chinese prisoners. On May 29,2008, Cuomo announced a settlement with Premier Exhibitions.The company agreed henceforth to obtain documentation demon-strating the cause of death of its bodies and disclose on its web-site that it could not confirm whether currently displayed bodieshad come from executed prisoners. It also said it would refundticket prices to prior visitors who requested it. 5

Perhaps in response to allegations of “execution on demand”policies and to allay negative publicity during the 2008 OlympicGames, the Chinese government in 2007 banned the harvest-ing of organs from living donors without their consent andoutlawed the sale of organs. 6 Many websites advertising cheaptransplants at Chinese hospitals suddenly disappeared. The gov-ernment also ordered that Chinese patients waiting for organsbe given priority over transplant tourists, and it limited donorsto close relatives.

John Fung, a Chinese-American transplant surgeon at theCleveland Clinic who frequently visits Chinese hospitals as avisiting professor, says since China’s 2007 clampdown he nolonger sees Saudi and Israeli patients in transplant wards. “Ihaven’t seen a Caucasian in five years,” he says.

The number of organ transplants did dip in 2007, and someobservers wondered if harvesting of prisoners’ organs was be-coming a thing of the past. But since 2008, Matas maintains, over-all transplants have returned to historic highs. Amnesty Interna-tional estimates that changes in Chinese law have cut in half thenumber of criminal prisoners executed. But that just means evenmore of the approximately 10,000 annual transplants in Chinaare coming from Falun Gong who have refused to recant theirbeliefs, Matas says. He estimates that the number of transplantsharvested from Falun Gong members has risen from about 7,500a year before 2007 to about 8,500 today.

Matas acknowledges that “there’s a real downturn in trans-plant tourism in China. There used to be charters going fromTaiwan to China organized by brokers, but the Chinese [gov-

China Harvests Prisoners’ OrgansActivists say China executes “on demand” to provide foreigners with organs.


to organ donors. “Once you ban some-thing and the demand is there, youno longer have accountability.”

Yet others find the idea of sellinga body part — whether legally or ille-gally — morally repellant, even canni-

balistic. “It’s not unlike slavery whenyou think you can own a part of an-other person,” says journalist Carney.

As the debate over organ trans-plants continues, here are some of thekey questions being discussed:

Is the global black market fororgans growing?

Because organ trafficking — the buy-ing and selling of organs — is illegal,there are no reliable statistics on the ex-tent of the practice. From the buyers to

ernment] stopped them. There were whole wings of hospitalsin northern China that had nothing but Koreans in them.”

But the government crackdown and the scarcity of organsalso have spawned an undercover black market, according torecent news reports. Each year, China has more than a millionpeople waiting for replacement organs, but only 1 percent re-ceive a transplant. 7 A voluntary donation program started bythe government in 2009 has led to only 67 transplants in acountry with cultural traditions that oppose organ donation. 8

Some Chinese-language websites still advertise illegal pack-ages aimed at Chinese patients, including accommodations,meals and a kidney transplant. 9 In a highly publicized casereported this year, a 26-year-old welder, who changed his mindafter agreeing to sell his kidney for $6,000, had his kidneyforcibly removed at a grungy local hospital in Shanxi province.The brokers’ henchmen forced Hu Jie into the hospital wherethe recipient was waiting, and Hu Jie later woke up to findhis kidney gone and $2,000 less in his bank account than thebroker had promised, he said. 10

Despite recent public declarations from the health ministerthat the government intends to stop harvesting organs fromprisoners over the next five years, it’s not clear that anythinghas changed yet, experts say. “It’s an attempt to answer criti-cism through a charm offensive, removing websites [advertis-ing kidney transplants] as evidence for what they’re doing [with-out] actually improving the situation,” says Matas.

Gutmann, an American investigative journalist whose esti-mates of the number of Falun Gong harvesting victims echoesthose of Matas, says it’s hard to say what is happening now.He doesn’t trust Chinese government statistics. “Frankly, I don’tknow if harvesting of Falun Gong stopped, stopped and thenstarted again, or never stopped at all,” says Gutmann, an ad-junct fellow at the Foundation for Defense of Democracies, athink tank in Washington. “My interviews with recent refugeesyield only fragmented clues, and the Chinese health authori-ties are certainly acting as if they want to put the issue to bed.”

It’s also unclear whether transplant tourism is still thrivingin China. “For the past six months to a year it looks like it’spicking up again,” says Damon Noto, spokesman for DoctorsAgainst Forced Organ Harvesting, an international group cam-paigning against forced organ harvesting in China. For militaryhospitals, where the bulk of transplants are done, Noto says,“their biggest source of income is organ transplant.”

Caplan concurs that transplant tourism is a big money-makerfor China and other countries. “You’ve spent a lot of money to beprestigious by doing transplants, and you need kidneys and liversto transplant, but the only way you’re going to get them is throughliving donor purchase,” he says, or from prisoners in China’s case.“So the government condemns it but looks the other way.”

— Sarah Glazer

1 David Matas, “Anti-rejection Drug Trials and Sales in China,” speech given atDoctors Against Forced Organ Harvesting Forum, May 1, 2011, Philadelphia,Penn., www.dafoh.org/Matas_speech.php.2 David Matas and David Kilgour, Bloody Harvest (2009).3 Matas, op. cit.4 Scott Carney, The Red Market (2011), p. 82. Also see Matas and Kilgour,op. cit., and Ethan Gutmann, “ ‘How Many Harvested?’ Revisited,” East ofEthan blog, http://eastofethan.com/2011/03/10/how-many-harvested-revisited/.5 “Cuomo Settlement with ‘Bodies: the Exhibition’ Ends the Practice of UsingHuman Remains of Suspect Origins,” press release, Office of the New YorkAttorney General, May 29, 2008, www.ag.ny.gov/media_center/2008/may29a_08.html.6 “Ending Abuse of Organ Transplantation in China,” China Uncensored,Aug. 20, 2010, www.chinauncensored.com/index.php?option=com_content&view=article&id=249:ending-abuse-of-organ-transplantation-in-china&catid=36:organ-harvesting-in-china&Itemid=79.7 Bo Gu, “Chinese man wakes up — minus his kidney,” NBC News, March 31,2011, http://behindthewall.msnbc.msn.com/_news/2011/03/31/6382271-chinese-man-wakes-up-minus-his-kidney.8 Ted Alcorn, “China’s Organ Transplant System in Transition,” The Lancet,June 4, 2011, pp. 1905-1906.9 “New Law Targets Organ Traders,” China Daily, Feb. 28, 2011, http://usa.chinadaily.com.cn/epaper/2011-02/28/content_12087280_2.htm.10 Gu, op. cit.

Activists in Australia protest the reported practice in China ofkilling members of the banned Falun Gong spiritual movement,detained in labor camps, and harvesting their organs to sell toforeign transplant tourists. Websites advertising “transplantpackages”disappeared after a government crackdown, but

advocacy groups say prisoners still are being killed for their organs.

AFP/Getty Images/Greg Wood


the surgeons, participants have every in-centive to hide the transaction underthe cloak of a legal operation in a main-stream hospital. Thus, what starts as anillegal sale of a kidney in one countryoften ends up in a transplant operationthat is ostensibly legal in another.

WHO — which does not regularlycollect statistics on this activity —has not revised its 2007 estimate that5-10 percent of transplants involve il-legally removed organs. “We don’t knowhow many illegal transplants thereare,” says the Transplantation Society’sDelmonico.

“I receive anecdotal information,” hesays, such as when “a colleague tellsus an American has been here [at aforeign hospital] or someone from theMideast comes to a U.S. center for anorgan transplant” — which would beillegal if, say, the patient brought alonga “friend” who had actually been paidor promised money. Although some ex-

perts think the trade is decreasing, hesays, “My colleagues from the MiddleEast tell me, ‘It’s business as usual.’ ”

Transplant tourism has become“much less visible” since the WorldHealth Organization’s 2007 report, and“because it’s gone underground” it’smore difficult to estimate the scope ofthe problem, says WHO’s Noël. “Wespeculate it has decreased to some ex-tent,” despite some high-profile cases,such as the alleged 2008 coercion in-cident in Gurgaon, India.

Recent bans on organ-selling in suchcountries as Pakistan, China and Egyptmay account for more activity occur-ring under the radar. For example,India’s 1994 ban on the organ tradecaused a drop in the number of for-eign recipients but apparently spurredmore foreigners seeking transplants tohead to Pakistan or the Philippines.And after the ban was in effect for afew years, the underground market in

India appeared to bounce back, withabout 2,000 Indians selling a kidneyevery year, according to the VoluntaryHealth Association of India. 12

Recent reports in the press andfrom medical experts indicate a resur-gent organ black market in Pakistan,despite a government ban that tookeffect there in 2007. Pakistan oncevied with India as the world’s illegalorgan bazaar, performing kidney trans-plants for more than 1,500 foreignersa year. The new law appeared to haltthe illegal donor trade, but only tem-porarily, according to the Sindh Insti-tute of Urology and Transplantationin Karachi, which provides medicalcare to low-income patients. The banis weakly enforced because authori-ties look the other way, according tothe institute.

At least 450 people in several vil-lages have sold their kidneys sincethe ban took effect, according to aneyewitness account presented at anApril press conference by KishwerZehra, a member of Pakistan’s par-liament. Typically, these kidney sell-ers are bonded agricultural laborerswhose indebtedness to their land-lords makes them near-slaves. Theysell their organs in a vain attempt toescape from lifelong debts but oftenend up worse off, a 2011 report onPakistan’s organ black market said,because there is no postoperative care,medicines or follow-up. 13

“Entire villages in southern Punjabare selling their kidneys out of des-peration of debt, poverty and landlordcoercion,” with doctors “at the centerof this trade,” said Adibul Hasan Rizvi,a physician and president of the Trans-plantation Society of Pakistan at anApril press conference at the Sindh In-stitute of Urology and Transplantationin Karachi. “Pakistan is being draggedback to the era of illegal organ traf-ficking, spurred on by the unrelent-ing greed of the medical professionin collusion with the law-enforcingauthorities.” 14

ORGAN TRAFFICKING

U.S. Kidney Sellers Receive the MostPeople who illegally sell one of their kidneys can receive from as little as $750 to $30,000, depending on where they live, according to the most recent available survey of organ trafÞcking in selected countries. The asking price for an American kidney, for instance, is $30,000 — more than in any other country — because the buyers are wealthier. Kidneys sold in a developing country — such as India, the Philippines and Iraq — garner less than $2,000.

* Asking price

Source: Nancy Scheper-Hughes, “Organs Without Borders,” Foreign Policy, January-February 2005

Compensation for a TrafÞcked Kidney(in selected countries)

(in current $US)0$ 5,000 10,000 15,000 20,000 25,000 30,000

Iraq (pre-war)

Philippines

India

Moldova and Romania

Brazil

Turkey

Peru

Israel

United States $30,000*

$10,000-$20,000$10,000

$7,500

$6,000$2,700

$1,500$1,500$750-$1,000


Earlier this month, three doctors wereapprehended as they were about to per-form an illegal kidney transplant for aSomali man in a private house in thePakistani provincial capital of Lahore.According to law enforcement authori-ties, 40 kidney operations had been car-ried out mostly on Arab and Middle Eastclients, while most of the kidney sellerswere from poor Pakistani families. 15

Demand for kidneys is growing inboth wealthy and developing countriesfor several reasons. Developing coun-tries are building transplant facilities andoffering transplants for less than theycost in wealthy countries. New im-munosuppressive drugs have improvedtransplant survival rates, and doctors areadding older, sicker patients, who nowhave a better chance of survival, totransplant lists. 16 In countries such asJapan, South Korea and Taiwan, de-mand for transplants has increased asthe population has grown wealthier. IfChina follows the same pattern, its wait-ing lists for kidney transplants coulddouble in 15 years. 17

That global growth — in both de-mand and transplants — is likely push-ing up demand for trafficked organs,some observers say. “Why wouldn’tthe criminal market be growing?” asksjournalist Carney. Declining costs fortransplants have been driving up glob-al demand for them, he writes in TheRed Market.

“We’re seeing people more com-fortable with medical tourism. And med-ical tourism is definitely growing,” hepoints out, adding that countries suchas India are aiming to reap billionsfrom the industry. India’s Council onMedical Research predicts that medicaltourism could generate $2.3 billion inannual revenue by 2012. 18 India’s med-ical tourism industry predicts growthof around 17 percent annually. 19

Would legalizing payments todonors discourage trafficking?

Offer: $175,000 for your kidney. Howmany people would jump at that pay-

ment? Answer: Enough to eliminatethe U.S. waiting lists for organs, NobelPrize-winning economist Gary S. Beck-er estimated in 2002. Becker proposedpaying both living and deceased donors(or their heirs) for any organ.

If governments or health insurancecompanies could legally make suchpayments, it “would essentially knockout the black market,” he argued. Withan increased supply of organs stimu-lated by financial incentives, patientswould no longer have to travel over-seas for a transplant, Becker conclud-ed. Legalization also would reduce theadvantage wealthy patients enjoy overpoorer patients, who can’t afford tojump the queue by paying cash for aquick, illegal transplant. 20

In recent years, some kidney trans-plant physicians have embraced theidea of a government-regulated organmarket. Financial incentives to livedonors would bring in enough kid-neys to satisfy demand, they say, andsave the lives of those who otherwisemight die while on a waiting list. Italso would put unscrupulous brokerswho exploit the poor out of business.

“To me it’s horrifying that the areaof medicine I’ve devoted my life tomay be responsible for atrocities aroundthe world,” says transplant nephrolo-gist Hippen, who has been a promi-nent advocate of government payments

for organs. “I don’t see another wayto fix that.”

Arthur J. Matas, a professor of surgeryat the University of Minnesota, calcu-lated in 2004 that U.S. society couldbreak even by paying $90,000 to a livekidney donor, because it would savethe cost of months or years on dialy-sis (funded by Medicare, Medicaid orhealth insurance) while the recipientwaited for a donated kidney. 21 Today,he estimates that break-even point couldbe as high as $500,000, if one includesthe benefits from the patient’s improvedquality of life. He adds, “If everyonecould have a transplant in an above-board market, who would go abroadto get an illegal transplant?”

Matas does not think donors shouldnecessarily be paid in cash, however.“It could be a tax deduction, a smallamount that the donor gets each yearto come back for a check-up, college

Cash-strapped Indonesians reportedly are selling their organs online, exploiting a loophole inlocal laws and fueling a dangerous and illegal trade in human body parts. “I want to sell my

kidney to buy a house for my mother, thanks call me,” reads the online ad. Such ads onIndonesian personal websites offer kidneys for as little as 50 million rupiah ($5,860).

AFP/Getty Images/Adek Berry


tuition or assistance with getting a job,”he says.

Proponents often cite Iran’s experi-ence in paying donors for organs. Afterlegalizing government payments todonors in 1988, Iran claims to have elim-inated its organ waiting lists and avoid-ed transplant tourism by prohibiting trans-plantation to foreigners. It also boastsgood postoperative health for organ re-cipients, although some studies showsellers often experience deterioratinghealth. 22 (See Background, p. 357.)

But critics say middlemen continueto exploit the poor in Iran, and UCLA’sDanovitch doubts that Iran’s waitinglist counts every kidney patient whoneeds a transplant. Nancy Scheper-Hughes, an anthropologist at the Uni-versity of California, Berkeley, whostudies the organ trade, has reported,“When the government took over re-sponsibility for managing the blackmarket kidney trade, the so-called bro-kers and kidney hunters were re-branded as ‘transplant coordinators.’But they’re still just thugs who trollthe streets and homeless shelters forpeople to donate on the cheap.” 23

Besides a fixed government fee of$1,200, each Iranian kidney donoralso may receive a “rewarding gift,”negotiated between donor and recip-ient under the auspices of a patient-run kidney foundation, which match-es donors with compatible recipients.The gifts can run as high as $5,000,according to Nasrollah Ghahramani,a transplant nephrologist at PennState College of Medicine in Hershey,Pa., who practiced medicine in Iranfor a decade.

However, Ghahramani, who visitedIran recently, says Scheper-Hughes’ pic-ture of brokers trolling the streets isnot accurate. “Most people in largermetropolitan areas with access to themedia are aware that . . . they can godirectly to the patient advocacy group”to find a match, he says. But he wor-ries that under the so-called gift ex-change, the donor and recipient cancontact each other. “Nothing says theycan’t meet and potentially coerce oneanother into higher or lower bargain-ing” under the table, he says.

That’s exactly what’s happening, saysScheper-Hughes. “More affluent trans-

plant patients demand healthier, stronger,better-off kidney donors, and are will-ing to pay for a ‘higher quality’ and ‘moreeducated’ organ. Rather than replace theblack market, the government of Iranhas legalized it,” she has argued. 24

“A government-regulated programwill not end the black market,” arguesDebra Budiani-Saberi, executive directorof the Cairo, Egypt- and Washington-based Coalition for Organ-Failure So-lutions, which works with organ sell-ers victimized by the black markettrade. “People will go where the priceis cheaper, and it will always be cheap-er somewhere.”

“Under the circumstances, wheredeveloping countries have almost nomechanism of regulation, to thinkthat the government could run a reg-ulated [market] program is idiotic,”says Farhat Moazam, chairperson ofthe Sindh Institute’s Centre of Bio-medical Ethics and Culture. Shepoints out that even in the UnitedStates a Brooklyn kidney broker wasarrested in a 2009 FBI sting in NewJersey after allegedly arranging forpurchased kidneys to be transplant-ed at reputable U.S. hospitals foryears without being discovered.

Market supporters Matas and Hip-pen, however, say they are proposinga regulated market only for the Unit-ed States — and perhaps Western Eu-rope — where law enforcement ismore trustworthy. And by satisfyingdemand in wealthy countries, the traf-ficking in poorer countries almost couldbe eliminated, they argue.

However, Danovitch doubts such amarket could be contained within U.S.borders. In the age of Twitter, he pre-dicts, “Within three seconds flat therewill be twice the U.S. price offered inSingapore or somewhere else.”

International bodies such as the WHOand U.N. and pillars of the medicalworld, such as the U.S.-based Instituteof Medicine, all oppose the paymentidea, largely on moral grounds. 25 “Mostpeople wouldn’t want to live in a

ORGAN TRAFFICKING

Transplant Gaps Spur Organ TrafÞckingMore than 105,000 people were on organ transplant waiting lists in the United States in 2009, but there were fewer than 15,000 donors. Such gaps between supply and demand in wealthier countries such as the United States help to explain why afßuent patients often travel to poorer countries for transplants, fueling the black market in organs.

Source: “The Gap Continues to Widen,” U.S. Department of Health and Human Services, www.organdonor.gov/DLINK-gapgraph.asp

No. of Organ Donors and People on U.S. Transplant Waiting Lists,

1989-2009

0

20,000

40,000

60,000

80,000

100,000

120,000

20092007200520032001199919971995199319911989

Donors

Waiting list

(No. of people)


society where the government paid thepoor to be organ supplies,” Budiani-Saberi says.

International groups contend thatpaying donors would reduce the over-all organ supply because fewer rela-tives would donate an organ. But pro-ponents point out that while donationsdropped sharply after payment was le-galized in Iran, paid organs more thanmade up for the difference. 26

Many opponents of outright paymentsay they would support reimbursementsfor things such as transportation to thehospital, accommodations and medicalexpenses, which are not always cov-ered by health insurance in the UnitedStates. In Britain and Europe donor ex-penses for surgery and follow-up careare generally covered.

Should governments and hospitalsdo more to crack down on organprofiteers?

Who profits most when organs aretrafficked? “They’re called ‘doctors’ —and that’s why they’re untouchable,” saysjournalist Carney. “You don’t go to aMafia don in Bangalore to get a kid-ney,” he says, “You go to a hospital.”

“It’s mainstream elite hospitals anddoctors,” adds bioethicist Caplan, whoco-chaired a U.N. investigation of traf-ficking in 2009. “It’s not gangs ofthugs; they’re around, but they’re notthe driver.” 27

Indeed, white-coated doctors are thereal brokers at the end of an illegalchain, says Carney, either by directlypurchasing organs or just turning “ablind eye to something they know about.”

When the FBI sting operation in2009 uncovered a criminal ring thatpaid Israelis to donate organs toAmerican patients, the surgeries werebeing performed at reputable NewYork City hospitals, according toScheper-Hughes, who had investigat-ed the kidney broker who was ar-rested. (See Current Situation, p. 360.)

A combination of medical prestige,corruption and cronyism helped pro-

tect doctors behind India’s largest re-cent organ-selling scandal. In Tamil Naduprovince, a refugee camp for survivorsof the 2004 tsunami had so many peo-ple selling their kidneys that it becameknown as Kidneyvakkam or “Kid-neyville.” After local newspapers begancovering the scandal in 2007, the De-partment of Medical Services discov-ered that 52 Indian hospitals were in-volved in transplanting sold organs fromthousands of impoverished refugees.

Those who sold a kidney were typ-ically offered the equivalent of about$3,000 by brokers, but most receivedonly a fraction of that after their pro-

cedure. Although brokers took a cutof what recipients paid for a kidneytransplant — typically $14,000 — doc-tors and hospitals profited the most,according to Carney. Even thoughpaper trails linked dozens of surgeonsto more than 2,000 illegal transplants,authorities let the doctors off with alecture, forcing only two small nurs-ing homes to close. 28

In Pakistan, rural villagers and bond-ed laborers view doctors as the like-ly purveyors of their kidneys, FarhatMoazam, chairperson of the Sindh In-stitute’s Centre of Biomedical Ethicsand Culture, discovered in 2007 while

Levy Izhak Rosenbaum, of Brooklyn, N.Y, was arrested in 2009 as part of an FBI sting andcharged with conspiring to broker the sale of an Israeli citizen’s kidney — for $160,000 —

for an American transplant patient. Rosenbaum allegedly had been brokering kidney sales for 10 years. Critics of the organ transplant process

say look-the-other-way hospital policies foster the illegal trade.

AP Photo/Mel Evans


conducting interviews in the country-side. She was shocked when poor vil-lagers approached her colleagues wear-ing physicians’ garb and asked if theycould help with selling a kidney. 29

To the extent there are criminal ringsin Pakistan, Moazam says, “You cancall it a kind of Mafia . . . connectedto certain doctors and certain hospi-tals.” Although the middlemen take acut, black market brokers can be quitepoor themselves, while “the surgeonsand hospitals make a whole lot ofbucks out of it,” she contends.

Several Pakistani transplant surgeonsinvolved in this illegal activity are well-known, according to Moazam, but nophysicians have been jailed eventhough the law calls for up to 10 yearsin prison for selling or buying organs.“There’s quite a strong lobby amongtransplant surgeons in Punjab,” she says.

In Pakistan, police arrested doctorsearlier this month, charging them withrunning an illegal kidney transplantring in Lahore using kidneys boughtfrom poor Pakistanis and sold to for-eign patients, yielding an estimated$1 million. 30

Carney says hospitals should be re-quired to provide the identity of everyorgan recipient and donor. “It isn’tlegal to sell stolen cars, nor is it legalto sell ones that are sure to breakdown,” he writes. The same standardsshould apply to body parts, he says.

Some countries, such as Switzerland,allow authorities — including foreignauthorities and international organiza-tions — to examine medical records inorder to expose illegal organ traffick-ing. “Every country’s transplantation lawsshould allow this form of disclosureand traceability,” Canadian human rightslawyer David Matas has urged. 31

Yet many members of the medicalcommunity resist revealing donors’names. Caplan would like to “hold thetransplant centers accountable forwhere they get organs” but says thiscan be done without violating patientconfidentiality.

Delmonico notes that in Israel,where religious objections traditionallykeep donation rates low, insurancecompanies used to pay for overseastransplants. But Israel recently bannedinsurance payments if the overseas op-erations were illegal. “I would hope theU.S. government would take the sameapproach,” says Delmonico.

Carney, in his book, cites health in-surance companies that have toutedtransplant operations abroad as cheap-er than at home. “Their websites saythey will only cover things that are legalin the [United] States,” he says. But wouldthey actually cover an illegal transplant?That’s an open question, he says: “It’snot difficult in India to make an illegaltransplant look legal.”

In Chennai, India, the committeeresponsible for authorizing transplantsadmitted to Carney on tape that it wastaking bribes. Even reputable hospi-tals “won’t look harder than they’relegally forced to,” he says, partly be-cause they benefit financially from per-forming operations with “donated” or-gans, which may actually have beenpurchased under the table.

In the United States, doctors saythat when a patient shows up at thehospital with a purported friend or rel-ative wanting to donate a kidney, it isdifficult to determine whether an ille-gal organ sale has occurred. The hos-pital’s social workers and psychiatristsprobe the donors about their real mo-tives, but a question often remains: “Isthe motivation really ‘I want to helpsomeone’ . . . or get $1,000?” asks NewYork University transplant surgeonThomas Diflo. 32

“The transplant community can doa lot to control black markets and ex-ploitation, but they just haven’t cho-sen to do it,” says Caplan. He urgesdoctors to boycott conferences if theyinvolve transplant research in Chinabased on organs from executed pris-oners. And Danovitch urges journalsnot to publish similar articles. “If youmake pariahs of people who engage

in the behavior, you could get be-havior to change,” Caplan says.

But Carney sees these as only half-measures. “It seems like doctors don’twant to reevaluate their own role,” hesays. That will only happen, he says,if the profession agrees to make thesupply chain transparent.

BACKGROUNDThe First Transplants

An unfettered market in humantissue and blood was both com-

mon and legal in the United Statesand other countries for nearly three-quarters of the 20th century.

The discovery in 1901 of four sep-arate blood types ushered in an eraof blood transfusion, permitting moreextensive surgeries. Selling blood waslegal and increasingly in demand inthe United States. After World War II,blood collection clinics sprang up inskid row neighborhoods of every majorcity, endangering the blood supply withblood sold by alcoholics, drug usersand others suffering from hepatitis andother blood-borne diseases. 33

This market approach changed rad-ically with the publication in 1970 ofa highly influential book by RobertTitmuss, a British social researcherand professor of social administrationat the London School of Economics.In The Gift Relationship: From HumanBlood to Social Policy, he argued thatselling blood and human tissue is ex-ploitative and that an “altruistic” ap-proach, in which people donate theirblood, would yield a safer and moreample supply.

When people can sell their blood,he argued, the desperately poor lieabout drug use or prostitution and the

ORGAN TRAFFICKING

Continued on p. 354


Chronology1900s-1950sSale of blood and organs islegal in many countries.

1901Discovery of four blood groups al-lows transfusion-aided surgery.

Dec. 23, 1954Doctors in Boston perform firstsuccessful kidney transplant.

•

1960s-1970sFirst lung, heart transplanted;states adopt organ donation laws,which make it easier for individu-als to donate their organs afterdeath, specifying it is a “gift.”

1963First lung transplant performed inJackson, Miss.

1967First heart transplanted, in SouthAfrica.

1970British social researcher Robert Titmusspublishes The Gift Relationship, urg-ing altruism as the basis of organdonation in U.S. and U.K.

1971All 50 states have adopted theUniform Anatomical Gift Act, giv-ing individuals the right to donatetheir organs after death with asimple document or donor card;some interpret law as barring in-centives for living donors.

•

1980s New immuno-suppressive drug makes organ

transplants safer, sparks rise indemand, raising concern aboutdistribution and safety of organs.United States, other countriesban organ sales.

1983Anti-rejection drug cyclosporineapproved in the United States. . . .Reston, Va., doctor announces kid-ney exchange to buy/sell kidneys,arousing concern in Congress.

1984Congress passes National OrganTransplant Act banning organ sales.

•

1990s India, theworld’s organ bazaar, bansorgan sales; Iran legalizes pay-ments. European Union (EU) isempowered to harmonize mem-ber states’ laws governingblood, organ distribution.

1994India bans organ sales; illegal salescontinue.

1998Iranian government begins payingliving donors for their organs.

1999Iran claims to have eliminated itskidney waiting list. . . . EU getsnew powers to harmonize members’laws governing organs.

•

2000s Medical groupscondemn organ trafficking, Chi-nese organ harvesting fromprisoners; debate over legalizingpayment for organs heats up.Organ traffickers are arrested

in India, New Jersey and Istan-bul, but trafficking continuesin Pakistan, Egypt, China.

2006Two Canadian human rights lawyersreport China is harvesting organsfrom Falun Gong prisoners and sell-ing them to “transplant tourists.”

2007WHO estimates 5-10 percent oforgan transplants are illegal. . . .Pakistan bans organ sales. . . .China bans organ sales, gives Chi-nese citizens priority for transplantsover foreigners.

2008Declaration of Istanbul condemnsorgan selling. . . . EU formulatesOrgans Directive for members,emphasizing organ donations mustbe unpaid, requiring traceability oforgans.

2008Amit Kumar, a doctor in Gurgaon,India, arrested for 500 illegal trans-plants.

2009Brooklyn man charged with bro-kering organ from Israel for U.S.patient.

2010Pakistan’s ban becomes law. . . .Egypt bans trafficking. . . . EUfinds Kosovar politicians ran organsmuggling ring.

2011Turkish doctor arrested for allegedinvolvement in Kosovo organsmuggling ring. . . . Pakistan’s ille-gal trade returns.

Aug. 27, 2012Deadline for EU states to adopt theOrgans Directive.


supply is at risk for blood-borne dis-eases. Based on a comparative studyof blood supplies in England and theUnited States, he concluded that Eng-land, where most blood donations camefrom unpaid volunteers, had a safersupply than did the United States. 34

Titmuss’ altruism concept eventual-ly became the dominant ethical prin-ciple, not just for blood but also fororgan distribution in the United Statesand most other Western countries. Thefirst successful kidney transplant wasconducted on Dec. 23, 1954, in Boston,and the first lung transplant in 1963 atthe University of Mississippi in Jack-son. On Dec. 3, 1967, newspapers acrossthe world splashed front-page head-

lines about the first successful hearttransplant, in Cape Town, South Africa,by surgeon Christiaan Barnard. 35

A few months later the NationalConference of Commissioners on Uni-form State Laws produced a frame-work for standardizing organ and tis-sue donation laws in the UnitedStates, and by 1971 the model Uni-form Anatomical Gift Act of 1968 wasadopted in nearly identical form byall 50 states. 36 It made it easier forpeople to donate their organs formedical purposes after death.

In 1983, the Food and Drug Ad-ministration’s approval of cyclosporine,a revolutionary anti-rejection drug,promised improved transplant survivalrates and sparked a huge increase in

transplants. It also spurred concernsabout how to distribute available or-gans, which fell short of demand.

In 1984 lawmakers passed the land-mark National Organ Transplant Act(NOTA), which makes it “unlawful forany person to knowingly acquire, re-ceive, or otherwise transfer any humanorgan for valuable consideration” — avaguely-defined term that has been thesubject of legal debate. A violation ofthe ban is punishable by a $50,000fine, five years in prison or both. 37

But it exempts “reasonable payments”to donors to cover travel, housing andlost wages incurred by the donation. 38

Similar bans were adopted in othercountries. The sale of blood and tis-sue is now illegal in most countries.

ORGAN TRAFFICKING

Continued from p. 352

Singapore retail tycoon Tang Wee Sung had a net worthestimated at more than $170 million. He also had end-stage kidney disease. 1

But even Tang couldn’t count on getting a legal kidney inSingapore, where the wait for a donated kidney is up to nineyears. In 2008 he was convicted of offering to pay an organbroker the equivalent of $244,558 for a kidney from an In-donesian man. 2 Tang served a day in prison and was finedabout $14,000. 3

The highly publicized case spurred a debate in Singaporeover how best to control the illegal organ trade. During a par-liamentary hearing on proposed legislation, health ministerKhaw Boon Wan said the Southeast Asian city-state should con-sider legalizing payments to kidney donors. “We may be ableto find an acceptable way to allow a meaningful compensa-tion for some living, unrelated kidney donors without breach-ing ethical principles or hurting the sensitivities of others.”

However, Singapore didn’t go quite that far. It did allowdonors to be reimbursed for donation-related costs, such asmedical care, loss of income, travel and lodging. It also ex-tended the prison sentences of anyone convicted of buying orselling organs, to up to 10 years. 4

The law, which took effect in 2009, came in for harshcriticism from some legislators, who charged it would leadto an organ trading market. The law not only permits for-eigners who donate an organ in Singapore to be reimbursedbut also allows foreigners to receive a transplant there afteragreeing to pay a donor’s costs.

Lawmaker Halimah Yacob expressed fears that foreign la-borers might “become a ready, vulnerable pool of organ donorsto be exploited and abused.” 5

Unlike transplant procedures elsewhere, in Singapore theprospective donor and recipient apply as a pair for the trans-plant and usually know one another. The law also permits therecipient to pay whatever reimbursement costs he chooses,which must be approved by a three-person ethics committee,composed of two doctors and a layperson.

Jacqueline Chin, who teaches medical ethics at the NationalUniversity of Singapore’s Centre for Biomedical Ethics and hasreviewed eight such cases as a member of a transplant com-mittee, says the system has flaws. Under the law, the commit-tee must reject the transplant if it suspects money has changedhands. If an employee is donating his kidney to his employer,she says, “Those things get our antennae up.”

But, she observes, “We have no expertise or powers to inves-tigate” whether there’s been a cash exchange under the table. Bythe time a foreign donor-recipient pair shows up on Singapore’sshores, the recipient has presumably already paid for the donor’sairfare and possibly promised other compensation.

Ideally, to prevent an under-the-table sale of an organ, thereshould be a third party who collects the money from the recip-ient and passes it on to the donor, Chin says. Currently, Singa-pore’s National Kidney Foundation offers up to 5,000 Singaporedollars ($4,100) in lost income to organ donors.

The ethics committee also has no way to enforce the re-cipient’s promise to pay for the donor’s operation or follow-up

Singapore Allows Reimbursements to Organ DonorsBut is additional cash paid under the table?


(It remains legal in the United Statesfor donors to sell blood plasma, a prod-uct extracted from blood, and women’seggs as well as sperm.)

But the law did not eliminate prof-its from the organ business, Red Mar-ket author Carney points out. In fact,the donation requirement allowed U.S.hospitals to acquire organs virtually forfree while charging up to $500,000 fortheir transplantation. That system, plusmedical privacy rules that forbid pub-lic scrutiny of donors, masks the truenature of the supply — including il-legal transactions — “behind a curtainof ethics,” he writes. 39

NOTA has been challenged onlyonce in the United States, when Penn-sylvania in 1994 enacted its Burial Ben-efit Act, providing funeral expenses from

a state-administered fund for those whoagreed to donate organs after death.Questions about whether the law vio-lated NOTA led the state to specify thatthe funds should be used to pay onlyfor food, travel, lodging and lost wages— already authorized by NOTA. InEuropean countries, deceased donors’families commonly are reimbursed forfuneral expenses. 40

In 2003 the first tax incentive to en-courage organ donation was adoptedin Wisconsin, allowing donors to claima $10,000 state deduction to cover lostwages and expenses for travel, lodg-ing and medical care. 41 Since then, 15states have adopted similar laws. 42 By2008, many states had passed otherlaws aimed at offering inducements orremoving disincentives for donating an

organ. At least 30 have provided paidor unpaid leave for bone marrow ororgan donors who are state employ-ees. At least eight states have requiredcompanies to provide a leave of ab-sence for employees who donate. 43

In 2007, questions arose aboutwhether NOTA’s ban on “valuable con-sideration” was being violated by so-called paired donations, in whichdonor-recipient pairs who were not agood transplant match swapped kid-neys with another incompatible pairso that each patient received a suit-able organ. In 2007 the U.S. AttorneyGeneral’s office said the approach didnot violate NOTA. On Dec. 21, 2007,the Living Organ Donation Act wassigned, clarifying that NOTA did notoutlaw paired donations. 44

medical care. “If we have any doubts that the recipient is notsincere about reimbursing, we’ll not authorize the transplant,”she says. But what if the recipient just walks away withoutpaying? “Lately, I’m concerned about this. I ask the hospitaland physicians if they are intending to pursue the donor forpayment.”

Singapore’s system, for all its flaws, is intended to followinternational guidelines specifying that donations should be an“altruistic” gift, not an exchange for money or valuables. Butsometimes those lines become blurred, especially if the donoris a poor relation or an employee in a wealthier cousin’s family-owned business. If the family patriarch dies, the poor employeemight be out of a job, Chin points out. Might not a poor per-son want to donate an organ to a rich employer “to put somefood on the table, give my children a better education, getsome health insurance?” she asks.

Critics of the new law question why the government didn’tprohibit foreigners from receiving transplants and reimbursementsin order to crack down on the international organ trade.

Singapore, like Thailand and Malaysia, is heavily com-mitted to medical tourism — which attracts all types of pa-tients, not just those seeking transplants. In 2003, Singapore’sgovernment set up an agency just to attract foreigners to itsup-to-date hospitals, which are some of the finest in Asia.At some of Singapore’s best private hospitals, foreigners ac-count for a third of the patients — and up to 40 percent ofrevenue. 6

“I think Singapore wants to establish a reputation for trans-plantation expertise,” Chin says. “To do that, you have to do alot of operations.”

As for the tycoon Tang, he finally got a kidney. In January2009 he received one from organized-crime boss Tan Chor Jin,known as the “One-Eyed Dragon” because he had lost an eye.Tan, who was hanged for murdering a nightclub owner, re-portedly donated his kidney voluntarily. 7

— Sarah Glazer

1 “Tang Wee Kit,” Forbes, Aug. 24, 2006, www.forbes.com/lists/2006/79/06singapore_Tang-Wee-Kit_JU3W.html.2 Peter Ritter, “Legalizing the Organ Trade?” Time, Aug. 19, 2008, www.time.com/time/world/article/0,8599,1833858,00.html#ixzz1QyTcaZIK.3 “Tang Wee Sung Gets 1-day Jail,” Channelnewsasia.com, Sept. 3, 2008,www.channelnewsasia.com/stories/singaporelocalnews/view/373494/1/.html.4 See “Human Organ Transplant Act (HOTA), FAQs,” Singapore Ministry of Health,www.pqms.moh.gov.sg/apps/fcd_faqmain.aspx?qst=2fN7e274RAp%2bbUzLdEL%2fmJu3ZDKARR3p5Nl92FNtJie8pByIMium%2b96IFsmAcEka%2bpIKxFLl%2bbsTxHVE3%2fpFsXIkii%2bakrP9JvTq0g9m%2fgz6kkbcvQptk23HEACXM9FNn0UQqJ%2fPlcO17qN9e7L%2b43g4GT9QiZGWWvdvoB4Vi%2bNy6oZpxAfJtcAR%2fEIKqmp2YAozrd9VgIg%3d..5 David Gutierrez, “Singapore to Legalize Financial Compensation for OrganDonors,” Natural News, July 14, 2009, www.naturalnews.com/026619_Singapore_organ_donor_WHO.html.6 Ritter, op. cit.7 Gutierrez, op. cit. Also see Jessica Jaganathan and Teh Joo Lin, “Tang getskidney, believed to be from ‘One-Eyed Dragon,’ ” The Straits Times (Singapore),Jan. 10, 2009.


Foreign Variations

Organ shortages vary dramaticallyacross the European Union, a dif-

ference that many experts attribute todifferences in national laws and poli-cies governing how organs are donat-ed. For example, deceased-donation ratesrange from a low of 14.7 per millionpeople in Britain to a high of 34.4 mil-lion in Spain. 45

Spain is one of several EU coun-tries with a policy of “presumed con-sent,” in which organs are taken afterdeath unless a person “opts out” be-fore death or the family objects. Bycontrast, Britain — like the UnitedStates — has an “opt in” system, inwhich a donor must specify on a dri-ver’s license or other directive a de-sire to donate an organ after death.

Many experts suggest countries with-out presumed consent could eliminatetheir organ shortfalls by following Spain’sexample. While Spain’s high donationrate might be attributed to its presumed

consent law, organ donation rates start-ed to rise only after Spain created a co-ordinated hospital-based policy of en-couraging consensual donation, knownas the “Spanish model.” 46

Under the policy, every hospital ap-points as donation coordinator a seniorphysician with special training in talk-ing with families of dying patients. Bycontrast, in Britain, a very junior staffmember, typically untrained in how tosensitively approach this difficult sub-

ject, raises the issue with the family,says Margaret Brazier, a law professorat the University of Manchester.

“Perhaps we could avoid radicalchanges” such as legalizing paymentsto donors, “by just having a thoroughlygood system for encouraging consen-sual donation,” she says, citing Spainas “the shining example.”

In 1999, the EU gained new pow-ers to adopt measures aimed at “har-monizing” member states’ measuresgoverning blood, human tissue andorgan donations. Members have untilAug. 27, 2012, to adopt the EU’s Or-

gans Directive, formulated in 2008, thefirst legally binding international regimeimposing legislative requirements onorgan donation. Among other mea-sures, it draws on the Spanish ap-proach of appointing specially trainedcoordinators at hospitals to speak withfamilies about donating. 47

However, the directive says littleabout organ trafficking except that theEU will monitor the situation — avagueness due in part to the lack ofdata on how extensive trafficking isin Europe. 48 That information may beuncovered by the directive’s require-ment that members begin verifyingdonor identities and the origins of or-gans — not just within donors’ owncountries but also in organ exchangeswith other countries. 49

Under the directive, EU nations mustensure that donations are voluntary andunpaid, although this does not preventliving donors from being reimbursed forexpenses or loss of income. However,in an analysis published this year,Anne-Maree Farrell, a senior lecturer inlaw at the University of Manchester’sCentre for Social Ethics and Policy,criticized the directive for failing to ac-knowledge the “longstanding academ-ic and policy debate” over legalizedpayments and other alternative incen-tives for donations. She blames the EU’savoidance of this crucial issue on “alargely technocratic mindset.” 50

Live donor rates in the EU also varywidely — low in Spain but much high-er in Scandinavia. Only 17 percent oforgan donations across Europe comefrom living donors. 51 In Britain, livedonations have been controversial, part-ly because of concerns about possi-ble abuses, according to David Price,professor of medical law at Britain’sDe Montfort University in Leicester.But legislation in Britain in 2004 and2006 explicitly endorsed such dona-tions and regulated them. 52

Britain and many other Europeannations are “actively promoting livingorgan donation to help boost trans-

ORGAN TRAFFICKING

Activists from India’s main opposition Bharathiya Janata Party demand an investigation of akidney black market uncovered in New Delhi in February 2008. Although India banned organsales in 1994, police have seen a resurgence in the underground organ market, with about

2,000 Indians selling a kidney every year, according to the Voluntary Health Association of India.

AFP/Getty Images/Raveendran


plant rates,” according to Price. InBritain, the National Health Servicenow funds transplants of liver sectionsfrom living donors, in addition to kid-neys. The legal framework also allowsswaps of kidneys between pairs orwithin groups of pairs. 53 Under theHuman Tissue Act of 2004, which tookeffect in England in 2006, an inde-pendent agency must approve proce-dures where there could be abuses,such as paired swaps or donations bychildren or vulnerable adults. 54

Consensus documents from med-ical professional groups around theworld increasingly establish guide-lines to ensure voluntary and in-formed consent of donors. They fre-quently recommend psychological andpsychosocial evaluation of donors toensure there has been no pressure todonate. However, Price points out, thereis no legal requirement in Britain tofollow this guideline. 55

Since the 1980s, many countrieshave banned compensation for organs.Iran’s compensation system evolved ina war-torn country without the facili-ties to perform organ transplants forits citizens with kidney disease. Be-tween 1967 and 1988, the number ofIranians on dialysis steadily increased,but only 100 transplants occurred.

In 1980, the health minister allowedIranians to get transplants abroad, paidfor by the government. The lack of adeceased-donor program meant thecountry had no other source of organdonations. Between 1980 and 1985, morethan 400 traveled abroad for transplants,and by 1988 there were long waitinglists for overseas transplants.

Faced with the rising cost of oper-ations abroad, the government in 1988introduced a plan to subsidize organtransplants at home. Currently the gov-ernment pays donors $1,200, whichcan be supplemented by paymentsfrom recipients for associated expens-es. After the program began, the num-ber of transplant teams in Iran jumpedfrom two to 25.

By 1999, Iran said its kidney wait-ing list had been eliminated. More than78 percent of kidneys transplanted inIran come from living donors unre-lated to recipients. 56

Coercion and Bans

Even though it banned organ salesin 1994, India became a major des-

tination for Western organ tourism in

the 1990s, and by 2002 sales throughcorrupt brokers were commonplace, ac-cording to a widely cited study. The lawpermitted nonfamily members to donatean organ if they signed a form sayingthey had not been paid, so brokers per-suaded impoverished people to lie.

Frequently, local moneylenders de-manded that debtors sell a kidney to payoff debts and refused additional credit tothose who still had both kidneys. Al-though 91 percent of organ sellers stud-

ied by a research team at The Johns Hop-kins School of Public Health had sold akidney in hopes of paying off debts,three-quarters were still in debt six yearsafter the organ was removed. 57

In Egypt, poor kidney sellers whohave been cheated on the price quot-ed by a broker or who suffer phys-ical ailments after the surgery arefrequently afraid to report their ex-ploitation for fear of arrest, accord-ing to the Coalition for Organ-Failure

Solutions. The group says men fromwestern Sudan’s troubled Darfur re-gion have been recruited for jobs inCairo, where they were forced to workwithout pay, accumulated rent debtsand then were lured into selling akidney to pay the debts. 58

Black market sellers are frequentlyfinancially and physically worse off.Of 32 Pakistani laborers who sold akidney to pay off debts to their land-lords, none received the amount they

Marsha Payne and her husband James — “transplant tourists” from South Florida —traveled to New Delhi’s premiere Apollo hospital, where she donated half her liver for James’liver transplant in 2008. The operation, plus the couple’s 10-week hospital stay, cost the

uninsured former investment banker $58,000 — a fraction of the $450,000 he was quotedin Florida for the same procedure. The $100 billion global medical tourism industry is helping

to reduce the cost of transplants and increasing the demand for organs, but it is oftendifficult for hospitals to determine whether “donated” organs have been purchased.

Chica

go Trib

une/McClatchy Tribune via Getty Images/Laurie Goering


ORGAN TRAFFICKING

were promised, and most remainedin debt after the sale, according to astudy by Moazam, of the Sindh In-stitute’s Centre of Biomedical Ethicsand Culture. Three years later, allcomplained of symptoms related totheir operations, and all said they couldnot work as hard as before. 59 Simi-lar after-effects, including high rates ofdepression and worsened financial sit-uations, have been found among organsellers in India and the Philippines.

Strikingly, most sellers in Iran haveexperienced deteriorating health, andmany have expressed regrets similarto those of illegal sellers in other coun-tries, according to several recent stud-ies. Many said they’d been stigmatizedby their families and communities forselling a kidney. 60

In 2008, the international Transplan-tation Society and the International So-ciety of Nephrology, meeting in Istan-bul, adopted the Declaration of Istanbulon Organ Trafficking and TransplantTourism, a document condemning poli-cies “in which an organ is treated asa commodity, including by being boughtor sold or used for material gain.” 61

Since then, Pakistan and Egypt havebanned organ-selling, but the bans haveonly “curbed” the organ trade, accord-ing to the Coalition for Organ-FailureSolutions’ Budiani-Saberi. They have “byno means ended it.”

In Egypt, organs traditionally weredistributed through sales, althoughmost recipients were not foreigners.As recently as 2009, some 80-90 per-cent of living kidney donors in Egypthad no family link to the recipients.In February 2010, Egypt banned organtrafficking, and, for the first time, per-mitted transplants from deceaseddonors. 62

But the law has not been aggres-sively enforced, according to Budiani-Saberi, whose organization works withEgyptian victims of organ trafficking.And with the current vacuum in thegovernment following this spring’souster of President Hosni Mubarak,

enforcing the transplant law is not ahigh priority, she observes. “Traffick-ing could flourish again, because it’sa vulnerable moment,” she warns. 63

In Pakistan, reports of organ salesby impoverished people surfaced inApril, and again just this month in thearrest of several Lahore doctors chargedwith transplanting purchased kidneys,despite the ordinance criminalizingorgan-selling. 64

The Chinese government’s 2007 reg-ulations prohibiting organ trafficking andremoval of organs from the living with-out their consent were aimed at dis-couraging transplant tourism. The gov-ernment also began giving Chinese citizenspriority for organs and in 2009 limiteddonors to close relatives. 65

CURRENTSITUATION

Major Criminal Cases

Several high-profile cases againstorgan-traffickers are pending around

the world, including those against:• Alleged renegade doctor Amit

Kumar, in Gurgaon, India, who isin jail awaiting the resolution of histrial. 66 He is charged with illegal-ly removing the kidneys of some500 day-laborers, farmers and rick-shaw drivers. 67 Several police of-ficers also have been charged withextortion and accepting bribes. 68

• Brooklyn, N.Y., resident Levy IzhakRosenbaum, arrested in 2009 oncharges of conspiring to brokerthe sale of a human kidney fortransplant at a cost of $160,000 toan American buyer. According tothe complaint, filed in the U.S.District Court of New Jersey, Rosen-baum had been brokering kidneysales for 10 years. He allegedlyinstructed an undercover buyer topretend to be a relative or friend

Continued on p. 360

Austria Leads in Per Capita TransplantsAustria has the world’s highest per capita organ transplant rate, with 95 transplants each year for every million residents. Kidney transplants are the most common. Most trans-plants are performed in the United States, followed by China, say experts who caution that Chinese statistics are unreliable.

Source: Global Observatory on Donation and Transplantation, World Health Organiza-tion, www.transplant-observatory.org

Top 20 Organ Transplanting Countries, 2011

(based on number of transplants per million population)

Austria 95.24Norway 91.88United States 90.38Portugal 87.55Spain 86.16Belgium 83.80France 71.94Sweden 71.61Netherlands 64.85Canada 64.45Switzerland 62.11United Kingdom 61.47Croatia 60.23Denmark 59.45Ireland 58.00Czech Republic 57.62Germany 57.45Italy 56.81Malta 55.00Australia 53.62

no


At Issue:Would regulated reimbursements discourage organ trafficking?yes

yesBENJAMIN HIPPEN, MDTRANSPLANT NEPHROLOGISTCHARLOTTE, N.C.

WRITTEN FOR CQ GLOBAL RESEARCHER, JULY 2011

r egulation probably would discourage trafficking. But issu-ing broad generalizations about illegal, undergroundorgan trafficking in developing countries is a hazardous

proposition. Published information about the workings and out-comes of organ trafficking around the world is piecemeal andoften second- or third-hand. The information we do have indi-cates that it typically involves the transfer of organs from thevery poorest to the comparatively very rich, and that those pur-chasing organs on the black market do so because the opportu-nities for transplantation in their native country are limited.

For the last decade, the core strategy of most transplanta-tion opinion leaders has been to aggressively condemn organtrafficking; identify and apply public pressure on high-levelgovernment functionaries in the worst-offending countries andencourage the development of robust deceased-donor pro-grams in the developing world.

It’s impossible to know whether this strategy has had anymeaningful impact on the prevalence of organ trafficking,though there is ample room for doubt. Pakistan, for instance,passed the Human Organ Tissue Transplant Act (HOTTA) togreat acclaim and trumpeted its success in the media and inat least one bioethics journal last year. Although the lawbanned the sale of organs, reports now are surfacing of aresurgence of illegal underground trafficking.

More specifically, this anti-trafficking strategy fails to addressthe fundamental social and economic allure of organ trafficking:desperation. When a person’s very life depends on a neworgan, he suddenly finds himself willing to pay exorbitantsums to individuals he knows nearly nothing about; risk hislife (and the lives of others); violate established laws in acountry where he is a visitor, and undertake a major surgicalprocedure in sometimes substandard conditions.

The flourishing of organ trafficking in developing countriesis caused by the manifest failure of organ procurement poli-cies in developed countries to meet the growing demand fororgans. It is the current system that is, and has been, morallycomplicit in the existence of organ trafficking. It is time to ac-cept that this strategy has been insufficient to the challenge.

A regulated market may or may not cure much of whatails global organ transplantation. But, correctly structured, sucha market would assuredly remove the incentives for recipientsof means to provide key economic support for organ traffick-ing. And, it is a reasonable hypothesis that, absent this crucialeconomic support, organ trafficking will wither and die.no

GABRIEL DANOVITCH, MDMEDICAL DIRECTOR, KIDNEY TRANSPLANTPROGRAM, DAVID GEFFEN SCHOOL OFMEDICINE, UNIVERSITY OF CALIFORNIALOS ANGELES

WRITTEN FOR CQ GLOBAL RESEARCHER, JULY 2011

t he 2008 Declaration of Istanbul on Organ Trafficking andTransplant Tourism (www.declarationofistanbul.org) and theGuiding Principles endorsed by the World Health Organi-

zation (WHO) have helped to reduce the venal exploitation ofvulnerable organ donors intrinsic to organ trafficking. The wide-spread endorsement of these pronouncements represents an un-precedented consensus against all forms of organ commercialism.

Though organ trafficking still occurs, distinct and measuredprogress has been made in countries previously designated as“hotspots” by the WHO. Plus, several countries that traditionallyhave “exported” transplant tourists have taken measures to re-duce the trade. For example, Japan passed brain-death lawsthat enable it to start addressing its citizens’ transplant needs,and Israel prohibited insurance reimbursements for citizenswho travel abroad for transplants.

Commercialization of organ (typically kidney) donation hasbeen shown to undermine the very fabric of the organ trans-plant endeavor, which is based on mutual benefit and trust —both in the diagnosis of death and in the welfare of livingdonors and their recipients. The outcome for kidney sellers isworse than for altruistic donors — from both a medical view-point and a psychosocial one. Recipients are also put at greaterrisk as the mutual caring that underlies successful living donortransplantation is displaced by financial considerations.

Furthermore, a “regulated organ market” is an oxymoron. InIran, where such a system has been in place since 1970,“under the table” payments to “supplement” the regulated gov-ernment payment are near universal. The transplant communi-ty has documented the inferior outcomes for vulnerabledonors and is struggling to unburden itself from a system thathas hampered the development of related living donation andvoluntary deceased donation.

Moreover, it is facile to think that commercial organ dona-tion would somehow “solve” the organ donor shortage. Expe-rience has shown that paid donation comes at the expense ofand not in addition to voluntary donation.

Countries and regions must strive to become self-sufficientin answering their citizens’ transplant needs. We must redoubleour efforts to prevent end-stage organ failure and do our utmostto remove the economic, educational, legal and cultural disin-centives to organ donation, so both the living and deceasedcan manifest the humanity that is the core of a safe, successfuland effective organ transplant endeavor.


of an Israeli donor-seller he wouldbring to New York City for thetransplant operation. Rosenbaumwas arrested as part of an FBIsting that charged 44 people —including New Jersey politiciansand rabbis — with a variety ofcrimes including internationalmoney laundering. 69 A trial datehas not yet been set.

• Yusuf Ercin Sonmez, a Turkishdoctor arrested in January for al-leged involvement in an organsmuggling ring based in Kosovo,described in a recent Council ofEurope * investigation.

According to the 2011 report, Koso-var politicians stole organs when theKosovo Liberation Army was fightingSerbian forces in the late 1990s. Theircriminal faction detained Serb pris-oners in Albania and killed them inorder to extract organs for shipmentabroad, the report alleges.

It further claimed that KosovoPrime Minister Hashim Thaci, a for-mer Kosovo Liberation Army leader,headed the faction that controlled il-licit criminal enterprises, including theorgan trafficking. Thaci has denied thecharges. The report suggested the organtrafficking continued after the war, andthat there was a link between the ringand the Kosovo clinic where Sonmezwas working in 2008. 70

Legalizing Payments

Proposals to allow payments for or-gans are being vigorously debated

in Europe and the United States.“There has been in general a willing-ness to look at the issue again,” saysBrazier, the British law professor.

The Nuffield Council on Bioethics,an influential British think tank, isscheduled to release a report this fallconsidering various incentives to en-courage organ donations, includingcash payments, priority on the trans-plant waiting list for previous donorsand payment of funeral expenses ofdeceased donors. 71

Nadey Hakim, surgical director of thetransplant unit at London’s HammersmithHospital, said he became interested ina regulated market after presenting anews program on organ trafficking fora British television station. Since then,he says, more colleagues have begunto support the idea.

“Instead of abusing patients inThird World countries and offeringthem peanuts for their kidneys, weought to legalize organ payments inthe United Kingdom so at least it’swell-organized,” he says. But he wouldpay only British donors.

Despite the renewed interest, thedebate so far has been more theoret-ical than legislative. In the United States,in 2008 former Sen. Arlen Specter, thena Republican from Pennsylvania, draft-ed a bill that would have allowed fed-eral, state or local governments to pro-vide donors with in-kind rewards. 72

However, the bill — expected to facefierce opposition from medical groups— was never introduced.

Nevertheless, the once-taboo idea ofproviding donors with financial incen-tives, or at least reimbursement, appearsto now have the support of a sizableproportion of American transplant doc-tors, according to a 2009 survey by theSociety of Transplant Surgeons. It foundthat most members support providingliving donors with coverage for lost wages,guaranteed health insurance and an in-come tax credit. For deceased donorsthe poll showed support for payingfuneral expenses. But most oppose pro-viding lump-sum cash payments. 73

UCLA’s Danovitch notes that U.S.organ donation rates have been de-clining slightly in recent years, whichhe blames on the recession. Peopleworried about holding onto their jobsare reluctant to take time off fromwork, another reason to consider re-imbursing them for lost wages andother expenses, he says.

In China, with its low donation rate,the health minister has said the gov-ernment should consider providing

ORGAN TRAFFICKING

Continued from p. 358

Police escort Turkish doctor Yusuf Ercin Sonmez to a court in Istanbul, Turkey, on Jan. 12, 2011.He was arrested in January and charged with organ trafficking at a Kosovo clinic in 2008

and has been implicated in an organ smuggling ring based in Kosovo in 1999.

AP Photo/Ibrahim Usta

* The council is an organization of 47 coun-tries in Europe that seeks to ensure humanrights and democratic principles.


funeral costs, tax rebates, medical in-surance, hospital costs or tuition waiversfor donors’ family members. 74

OUTLOOKMaking Trafficking Obsolete

Some experts think medical advances— such as the use of regenerative

medicine to produce artificial organs —could kill the black market in organsby reducing the need for transplants.

Although the use of artificial organson a mass basis may not happen forat least another decade, many expertssay, surgeons in Sweden have just givena cancer patient a new windpipe,made with stem cells from the pa-tient’s bone marrow, the BBC report-ed on July 7. It was the first trans-plant of a synthetic organ that did notrequire a donor. 75

“Thanks to nanotechnology, this newbranch of regenerative medicine, weare now able to produce a custom-made windpipe within two days or oneweek,” said Paolo Macchiarini, chairmanof the Hospital Clínic at the Universityof Barcelona in Spain, who led thetransplant team. “This is a synthetic wind-pipe. The beauty of this is you canhave it immediately. There is no delay.”In addition, “This technique does notrely on a human donation.” 76

He said many other organs couldbe repaired or replaced in the sameway. Other research aims to use stemcells to repair defective organs or cre-ate hearts and livers from a patient’sown cells by growing cells on plasticor natural scaffolds. 77

“If we pushed, we could see cell re-placement in 10 years,” says bioethicistCaplan, which he says will be far moreeffective in ending organ trafficking

than politically charged market pro-posals. “You’re not going to get a so-lution to the needs of people in organfailure by arguing about markets,” hesays, noting that millions of patientsaren’t even on a transplant list “becausethere’s no transplant center where theylive in Bolivia or Mozambique.”

Other experts see an even simplerway to reduce black market demand:better disease prevention so patientsdon’t need a replacement organ. Agrowing epidemic of obesity and theresultant growth in diabetes is a majordriver of the increasing demand forkidney transplants.

In addition, “there are about to beseveral dramatic improvements in treat-ing hepatitis C — a major cause ofend-stage liver disease,” which could“dramatically reduce the need for livertransplants,” says UCLA’s Danovitch.

Waiting times for heart transplantshave already declined, he points out,because treatment of heart failure hasimproved over the past five to 10years. “Prevention,” Danovitch main-tains, “is the best way and the onlysolution” to stem the shortage-drivenblack market and the inevitable flowof organs from poor to rich countries.

Otherwise, he says, the poor halfof the world will continue selling or-gans to the wealthier half.

Notes

1 Michael Smith, “Kidneys at Hub of Deadly‘Transplant Tourism,’ ” Bloomberg News, in TheNews Tribune, May 15, 2011, www.thenewstribune.com/2011/05/15/1665819/kidneys-at-hub-of-deadly-transplant.html.2 For background, see Barbara Mantel,“Organ Donations,” CQ Researcher, April 15,2011, pp. 337-360.3 Yosuke Shimazono, “The State of the Inter-national Organ Trade: A Provisional PictureBased on Integration of Available Information,”Bulletin of the World Health Organization, De-cember 2007, pp. 901-980, www.who.int/bulletin/volumes/85/12/06-039370/en/#. Also see, Coun-cil of Europe/United Nations, “Trafficking in

Organs, Tissues and Cells and Trafficking inHuman Beings for the Purpose of the Removalof Organs,” 2009, www.un.org/apps/news/story.asp?NewsID=32521&Cr=&Cr1=.4 D. A. Budiani-Saberi and F. L. Delmonico,“Organ Trafficking and Transplant Tourism,”American Journal of Transplantation, 2008,p. 927, www.cofs.org/COFS-Publications/Budiani_and_Delmonico-AJT_April_2008.pdf.5 Scott Carney, The Red Market (2011), p. 65.

“Entire villages in southern Punjab are selling their

kidneys out of desperation, . . . debt, poverty and

landlord coercion. Pakistan is being dragged back to

the era of illegal organ trafficking, spurred on by the

unrelenting greed of the medical profession in

collusion with the law-enforcing authorities.”

— Adibul Hasan Rizvi,

President, Transplantation Society of Pakistan


6 Smith, op. cit.7 Amelia Gentleman, “Poor Donors Duped byOrgan-Transplant Racket in India,” The New YorkTimes, Jan. 9, 2008, www.nytimes.com/2008/01/29/world/asia/29iht-kidney.3.9573650.html.8 Carney, op. cit., pp. 69-70. Note: Nameshave been changed in Carney’s book to pro-tect the privacy of interviewees.9 See Robert C. Moellering Jr., “NDM-1: ACause for Worldwide Concern,” The New Eng-land Journal of Medicine, Dec. 16, 2010, www.nejm.org/doi/full/10.1056/NEJMp1011715.10 Anne-Maree Farrell, et al., Organ Short-age: Ethics, Law and Pragmatism (2011), pp.195, 229.11 Council of Europe/United Nations, op. cit.12 Shimazono, op. cit.13 “Resurgence of Pakistan’s Organ Bazaar.Can You Still Deny? Continued Violation ofTransplant Law in Pakistan,” Sindh Institute ofUrology and Transplantation, April 29, 2011,www.siut.org/news-events/news/resurgence-of-pakistan.14 Ibid.15 Asif Chaudhry, “Probe into illegal kidneytransplants Surgeons made $1m from 40 clients,”Dawn, July 7, 2011, www.dawn.com/2011/07/07/probe-into-illegal-kidney-transplants-surgeons-made-1m-from-40-clients.html.16 Ahad J. Ghods and Shekoufeh Savaj, “Iran-ian Model of Paid and Regulated Living-Un-related Kidney Donation,” Clinical Journal ofthe American Society of Nephrology, Novem-ber 2006, pp. 1136-1145, http://cjasn.asnjournals.org/content/1/6/1136.full. Also seeMantel, op. cit.17 Ted Alcorn, “China’s Organ Transplant Sys-tem in Transition,” Lancet, June 4, 2011, pp.1905-1906, www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60794-0/fulltext?version=printerFriendly.18 Carney, op. cit., p. 142.19 See “Asian Countries amongst Favorites forMedical Tourism,” press release, RNCOS,April 21, 2011, www.rncos.com/Press_Releases/

Asian-Countries-amongst-Favorites-for-Medical-Tourism.htm.20 Gary S. Becker and Julio Jorge Elías, “In-troducing Incentives in the Market for Live andCadaveric Organ Donations,” presented at theconference, “Organ Transplantation: Economic,Ethical and Policy Issues,” University of Chica-go, May 16, 2003. An earlier version was pre-sented in 2002, http://home.uchicago.edu/gbecker/MarketforLiveandCadavericOrganDonations_Becker_Elias.pdf.21 Arthur J. Matas and Mark Schnitzler, “Pay-ment for Living Donor (Vendor) Kidneys,” Amer-ican Journal of Transplantation, Feb. 25, 2004,www.medscape.com/viewarticle/468104_1.22 Council of Europe/United Nations, op. cit.Also see Ghods and Savaj, op. cit.23 Carney, op. cit., pp. 81-82.24 Nancy Scheper-Hughes, “A World Cut inTwo,” British Medical Journal, June 21, 2008,www.bmj.com/content/336/7657/1342.full/reply#bmj_el_197479.25 Council of Europe/United Nations, op. cit.Also see Institute of Medicine, “Organ Do-nation: Opportunities for Action,” May 2006,www.iom.edu/Reports/2006/Organ-Donation-Opportunities-for-Action.aspx.26 Ghods and Savaj, op. cit.27 Council of Europe/United Nations, op. cit.28 Carney, op. cit., p. 65.29 Farhat Moazam, et al., “Conversations withKidney Vendors in Pakistan: An EthnographicStudy,” Hastings Center Report, May-June 2009,pp. 29-44, www.thehastingscenter.org/Publications/HCR/Detail.aspx?id=3472.30 Chaudhry, op. cit.31 David Matas, “Anti-rejection Drug Trials andSales in China,” speech at the Doctors AgainstForced Organ Harvesting Forum, May 1, 2011,Philadelphia, Penn., www.dafoh.org/Matas_speech.php.32 Diflo quotes from a discussion session ata New York Academy of Sciences Anthro-pology Session, “Trafficking the Traffickers,”Oct. 6, 2008, www.thirteen.org/forum/topics/

science/trafficking-the-traffickers-undercover-ethnography-in-the-organs-trafficking-underworld/147/.33 Carney, op. cit., p. 9.34 Critics have pointed out that a few yearsafter Titmuss’ book came out, new tests wereintroduced for hepatitis C, hepatitis B andlater HIV, and transfusion-related diseasesplummeted. See Sally Satel, When AltruismIsn’t Enough (2008), p. 103.35 Ibid., p. 131.36 Ibid.37 Ibid., p. 114.38 Ibid., p. 135. Also see http://history.nih.gov/research/downloads/PL98-507.pdf.39 Carney, op. cit., pp. 13-14.40 Farrell, op. cit., p. 29.41 Ibid., p. 118.42 For recent state laws see, www.kidney.org/transplantation/livingdonors/pdf/LDTaxDed_Leave.pdf.43 Satel, op. cit., p. 140.44 Farrell, op. cit., p. 211.45 Ibid., p. 229.46 See Monica Navarro-Michel, “InstitutionalOrganisation and Transplanting the ‘SpanishModel,’ ” in ibid., pp. 151-170. Presumed con-sent legislation can be found in countrieswith some of the highest rates of deceased-organdonation (Spain, Portugal, Belgium, France) andsome of the lowest (Bulgaria, Greece, Lithuania).47 Farrell, op cit., pp. 238-239. The Directiveestablishes minimum guidelines but does notaffect EU countries’ existing national laws onthe donation or medical use of organs.48 Ibid., p. 236.49 Ibid., p. 238.50 Ibid., pp. 240-243.51 Ibid., p. 234.52 See David Price, “Promoting Organ Do-nation: Challenges for the Future,” in ibid.,p. 256.53 Ibid., pp. 256-7.54 Ibid., pp. 257-258.55 Ibid.56 Ghods and Savaj, op. cit.57 Ibid., p. 55. Also see Madhav Goyal, et al.,“Economic and Health Consequences of Sellinga Kidney in India,” Journal of the AmericanMedical Association, 2002, pp. 1589-1592.58 Debra Budiani-Saberi and Amr Mostafa,“Care for Commercial Living Donors: the ex-perience of an NGO’s outreach in Egypt,”Transplant International, 2010, pp. 1-7, http://onlinelibrary.wiley.com/doi/10.1111/j.1432-2277.2010.01189.x/pdf. For background, see KarenFoerstal, “Crisis in Darfur,” CQ Global Researcher,

ORGAN TRAFFICKING

About the Author

Sarah Glazer, a London-based freelancer, is a regular con-tributor to CQ Global Researcher. Her articles on health,education and social-policy issues also have appeared inThe New York Times and The Washington Post. Her recentCQ Global Researcher reports include “Radical Islam in Eu-rope” and “Social Welfare in Europe.” She graduated fromthe University of Chicago with a B.A. in American history.


Sept. 1, 2008, pp. 243-270.59 Moazam, et al., op. cit., pp. 33-34.60 Budiani-Saberi and Mostafa, op. cit., pp. 3, 4.61 Satel, op. cit., pp. 50-51. Also see www.declarationofistanbul.com and Budiani-Saberi andMostafa, op. cit.62 Budiani-Saberi and Mostafa, op. cit.63 For background, see Roland Flamini, “Tur-moil in the Arab World,” CQ Global Researcher,May 3, 2011, pp. 209-236.64 “Resurgence of Pakistan’s Organ Bazaar.Can You Still Deny? Continued Violation ofTransplant Law in Pakistan,” op. cit. Also seeChaudhry, op. cit.65 “Ending Abuse of Organ Transplantation inChina,” China Uncensored, Aug. 20, 2010, www.chinauncensored.com/index.php?option=com_content&view=article&id=249:ending-abuse-of-organ-transplantation-in-china&catid=36:organ-harvesting-in-china&Itemid=79.66 “Kidney Racket Case,” indianexpress.com,June 8, 2011, www.indianexpress.com/news/kidney-racket-case-cbi-wants-modification-in-hc-order/800842.67 Gentleman, op. cit.68 “Court Grants Bail to Accused Police In-spector,” Hindustan Times, Sept. 23, 2008, www.hindustantimes.com/special-news-report/News-Feed/Court-grants-bail-to-accused-police-inspector/Article1-339821.aspx.69 “Two-Track Investigation of Political Cor-ruption and International Money LaunderingRings Nets 44 Individuals,” Press Release, U.S.Attorney, District of New Jersey, July 23, 2009,www.fbi.gov/newark/press-releases/2009/nk072309.htm. Also see USA v. Levy Izhak Rosen-baum, Criminal Complaint Mag No. 09-3620,U.S. District Court, District of New Jersey.70 “Turkish doctor suspected of human organtrafficking arrested,” CNN, Jan. 12, 2011, http://premium.edition.cnn.com/2011/WORLD/europe/01/12/kosovo.organs/index.html?iref=topnews.Also see “Trafficking Investigations Put Surgeonin Spotlight,” The New York Times, Feb. 11, 2011,www.nytimes.com/2011/02/11/world/europe/11organ.html?pagewanted=1&_r=2&emc=eta1.71 “Organ Donors Could Be Rewarded UnderPlans to Boost Registration,” The Times, April 20,2010, www.timesonline.co.uk/tol/life_and_style/health/article7102299.ece. Also see www.nuffieldbioethics.org/human-bodies.72 Satel, op. cit., p. 153.73 J. R. Rodrigue, et al., “Stimulus for OrganDonation: A Survey of the American Society ofTransplant Surgeons Membership,” AmericanJournal of Transplantation, 2009, pp. 2172-2176,

http://deepblue.lib.umich.edu/bitstream/2027.42/74730/1/j.1600-6143.2009.02741.x.pdf.74 “China Considers Financial Incentives toPromote Organ Donation,” Reuters, April 25,2011, www.reuters.com/article/2011/04/25/us-china-organs-idUSTRE73O1HX20110425.

75 Michelle Roberts, “Surgeons Carry out FirstSynthetic Windpipe Transplant,” BBC News,July 7, 2011, www.bbc.co.uk/news/health-14047670.76 Ibid.77 Farrell, op. cit., p. 22.

FOR MORE INFORMATIONCentre for Biomedical Ethics, National University of Singapore, Clinical ResearchCentre, Block MD11, #02-0110 Medical Drive, Singapore 117597; (65) 6516 7201;http://cbme.nus.edu.sg. Academic center that tracks organ trafficking and legislationto curb it.

Coalition for Organ-Failure Solutions, 5 Sakr Kouraish, Apt. 1, Zone 7, Nasr City,Cairo, Egypt; U.S. phone: (330) 701-8399; www.cofs.org. Nonprofit internationalhealth and human rights organization dedicated to combating organ trafficking.

Declaration of Istanbul on Organ Trafficking and Transplant Tourism;www.declarationofistanbul.org. A website providing up-to-date news about organtrafficking hosted by signers of the 2008 Declaration of Istanbul, a proclamationissued by transplant specialists condemning organ selling.

Doctors Against Forced Organ Harvesting, P.O. Box 58123, Washington, DC,20037; (202) 510-3894; www.dafoh.org. International group of doctors campaign-ing to end China’s use of prisoners for organ harvesting.

Falun Dafa Information Center, P.O. Box 577, New York, NY 10956-9998;(845) 418-4870; www.faluninfo.net. Organization provides information about thepersecution of Falun Gong practitioners in China, including deaths from organharvesting.

Global Observatory on Donation and Harvesting, www.transplant-observatory.org/pages/home.aspx. Hosted by the World Health Organization and the SpanishNational Transplant Organization (www.ont.es); tracks news and data on organtrafficking and transplantation activities worldwide.

The Hastings Center, 21 Malcolm Gordon Road, Garrison, NY 10524-4125; (845)424-4040; www.thehastingscenter.org. Bioethics center that has published reportsand articles about the ethics of organ donation.

Laogai Research Foundation, 1734 20th St., N.W., Washington, DC 20009; (202)408-8300; Founded by Harry Wu, a survivor of the Chinese slave-labor campsknown as laogai; provides information about the camps and other Chinesehuman rights abuses including organ harvesting from executed prisoners.

Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi 74200,Pakistan; (92-21) 9215752 & 9215718; www.siut.org. Provides transplants and med-ical care for low-income patients; monitors Pakistan’s resurgent organ trade.

The Transplantation Society, International Headquarters, 1255 University St.,Suite 605, Montreal, QC, Canada H3B 3V9; (515) 874-1717; www.tts.org. Interna-tional group of transplant physicians and specialists.

World Health Organization, Clinical Procedures, CPR/EHT/HSS, Essential HealthTechnologies, Avenue Appia 20, 1211 Geneva 27, Switzerland; 41 22 791 21 11;www.who.int/transplantation/en/. Web site of the WHO unit responsible for pro-moting ethical donation and transplantation.

FOR MORE INFORMATION

Books

Carney, Scott, The Red Market: On the Trail of the World’sOrgan Brokers, Bone Thieves, Blood Farmers and ChildTraffickers, William Morrow, 2011.An investigative journalist spent five years tracing the routes

of illegal organs and other body parts from the original sellersthrough brokers to recipients.

Farrell, Anne-Maree, David Price and Muireann Quigley,Organ Shortage: Ethics, Law and Pragmatism, CambridgeUniversity Press, 2011.Academics from Britain and elsewhere discuss financial in-

centives for organ donation and the donation experience inthe United Kingdom, European Union and United States.

Matas, David and David Kilgour, Bloody Harvest, SeraphimEditions, 2010.Two Canadian lawyer/human rights activists were nomi-

nated for a Nobel Prize for this investigation concluding thatthousands of Falun Gong practitioners in China have beenkilled for their organs.

Satel, Sally, When Altruism Isn’t Enough: The Case forCompensating Kidney Donors, AEI Press, 2008.Experts argue for legalizing payments to organ donors to

increase supply. The book is based on a conference spon-sored by the conservative American Enterprise Institute.

Articles

Alcorn, Ted, “China’s Organ Transplant System in Transition,”Lancet, June 4, 2011, pp. 1905-1906.Alcorn describes China’s still-paltry efforts to adopt a voluntary

organ-donation system and crack down on transplant tourism.

Gu, Bo, “Chinese man wakes up — minus his kidney,”March 31, 2011,MSNBC, http://behindthewall.msnbc.msn.com/_news/2011/03/31/6382271-chinese-man-wakes-up-minus-his-kidney.Twenty-six-year-old Hu Jie, who changed his mind about

selling a kidney, describes how his kidney was forcibly re-moved by a broker’s henchmen, a widely publicized storysignaling a renewed black market in China.

Gutmann, Ethan, “China’s Gruesome Organ Harvest,” TheWeekly Standard, Nov. 24, 2008, www.weeklystandard.com/Content/Public/Articles/000/000/015/824qbcjr.asp.An investigative journalist and fellow at the Foundation for

Defense of Democracies, an advocacy group in Washington,describes large-scale organ harvesting from Falun Gong pris-oners while still alive, confirmed by his interviews with es-capees from Chinese labor camps.

Interlandi, Jeneen, “Not Just Urban Legend,” Newsweek,Jan. 10, 2009, www.newsweek.com/2009/01/09/not-just-urban-legend.html.A reporter describes the organ trafficking investigations of

anthropologist Nancy Scheper-Hughes.

Moazam, Farhat, et al., “Conversations with Kidney Vendorsin Pakistan: An Ethnographic Study,”Hastings Center Report,May-June 2009, www.thehastingscenter.org/Publications/HCR/Detail.aspx?id=3472.The chair of the Centre of Biomedical Ethics and Culture

in Karachi and her team interviewed 32 Pakistani laborerswho sold a kidney to pay off debts to their landlords.

Shimazono, Yosuke, “The State of the International OrganTrade: A Provisional Picture Based on Integration ofAvailable Information,” Bulletin of the World Health Or-ganization, December 2007, pp. 901-980, www.who.int/bulletin/volumes/85/12/06-039370/en/#.Based on an analysis of more than 300 articles and re-

ports, the article concludes that, conservatively, about 5 per-cent of all organ transplants worldwide in 2005 involvedblack market transactions. The World Health Organizationused the article as the basis of its estimate that 5-10 percentof transplants each year involve illegal sales.

Smith, Michael, “Kidneys at Hub of Deadly ‘TransplantTourism,’ ”The News Tribune, May 15, 2011, www.thenewstribune.com/2011/05/15/1665819/kidneys-at-hub-of-deadly-transplant.html.A Bloomberg News reporter describes the illicit market for

organ transplants in Nicaragua and around the world stimulatedby the growing “transplant tourism” business.

Reports and Studies

“Resurgence of Pakistan’s Organ Bazaar. Can You StillDeny? Continued Violation of Transplant Law in Pakistan,”Sindh Institute of Urology and Transplantation, April 29,2011, www.siut.org/media-siut/data-files/resurgence-of-pakistan-organ-trade.pdf.A Karachi medical center reports a resurgence of Pakistan’s

illegal organ trade since a law criminalizing organ selling tookeffect in 2007.

“Trafficking in Organs, Tissues and Cells and Trafficking inHuman Beings for the Purpose of the Removal of Organs,”Council of Europe/United Nations, 2009, www.coe.int/t/dghl/monitoring/trafficking/docs/news/OrganTrafficking_study.pdf.A WHO estimate that 5-10 percent of annual worldwide

kidney transplants involve trafficking is conservative, accordingto this comprehensive report.

Selected Sources


Bibliography

Black Market

Bryant, Lisa, “EU May Investigate Kosovo PM for OrganTrafficking,” Voice of America, Dec. 15, 2010, www.voanews.com/english/news/europe/EU-May-Investigate-Kosovo-PM-for-Organ-Trafficking-111952224.html.The European Union plans to investigate allegations that Koso-

vo’s prime minister has sold human organs on the black market.

Ogilvie, Jessica Pauline, “A Kidney Market At What Cost?”Los Angeles Times, March 28, 2011, p. E1, articles.latimes.com.The unregulated, underground market for human organs

in developing countries has had catastrophic effects for bothdonors and recipients.

Simon, Alina, “New Law to Plug Black Market for Organs,”New Straits Times (Malaysia), Oct. 5, 2010, www.nst.com.my/nst/articles/14tissue/Article/.The Malaysian Health Ministry is drafting a new law in-

tended to ensure that organ and tissue transplantation isconducted without turning to the black market.

China

“China to Launch Crackdown in Illegal Organ Transplants,”Xinhua (China), April 18, 2011, news.xinhuanet.com/english2010/china/2011-04/19/c_13834757.htm.The Chinese Ministry of Health is launching a nationwide

campaign to target illegal organ transplants performed byunqualified medical institutions.

Kamm, John, “Is Mercy Coming to China?” The Washing-ton Post, Aug. 16, 2010, p. A13, www.washingtonpost.com/wp-dyn/content/article/2010/08/15/AR2010081502150.html.The executive director of the Dui Hua Foundation, a San

Francisco-based human rights group, says capital punishmenthas reached astonishing levels in China largely to harvest or-gans from executed prisoners.

Varma, K.J.M., “China to Amend Organ Transplant Rules toEncourage Donations,” Press Trust of India, Jan. 10, 2011.China is set to amend its organ transplant regulations to

build a national donation system that relies less on obtainingorgans from executed prisoners.

Demand

Callahan, Maureen, “Invasion of the Body Snatchers,”The New York Post, June 12, 2011, p. 28, m.nypost.com.The growing demand for organs such as kidneys has led

to profitable trading rings in the United States, Brazil, Egypt,Israel, Japan and South Africa.

Smith, Lewis, “Sale of Human Organs Should Be Legalised,Say Surgeons,” The Independent (England), Jan. 5, 2011,www.independent.co.uk/life-style/health-and-families/health-news/sale-of-human-organs-should-be-legalised-say-surgeons-2176110.html.Many leading British surgeons are calling for the legaliza-

tion of organ sales in order to meet growing demand.

Widhiarto, Hasyim, “When Disease Creates Demand,”Jakarta (Indonesia) Post, Oct. 25, 2010, www.thejakartapost.com/news/2010/10/25/when-disease-creates-demand.html.An estimated 80,000 people in Indonesia are waiting for

kidney transplants, leading many to wonder whether illegalorgan trafficking is occurring in the country.

Laws and Regulations

“Relaxed Rules May Lead to More Organ Donations,”Yomiuri Shimbun (Japan), Aug. 11, 2010, www.yomiuri.co.jp/dy/national/T100810004970.htm.The relaxation of requirements for organ donations would

raise the number of annual donors in Japan for the foresee-able future, according to the Japan Society for Transplantation.

Rahn, Kim, “NK Defector in Legal Dispute Over OrganTransplantation,”Korea Times (South Korea), May 23, 2011,www.koreatimes.co.kr/www/news/nation/2011/05/113_87535.html.A South Korean law designed to prevent organ trafficking

is preventing a North Korean defector from receiving a trans-plant, even though he has found a donor.

Additional Articles from Current Periodicals

CITING CQ GLOBAL RESEARCHER

Sample formats for citing these reports in a bibliography

include the ones listed below. Preferred styles and formats

vary, so please check with your instructor or professor.

MLA STYLEFlamini, Roland. “Nuclear Proliferation.” CQ Global Re-

searcher 1 Apr. 2007: 1-24.

APA STYLE

Flamini, R. (2007, April 1). Nuclear proliferation. CQ Global

Researcher, 1, 1-24.

CHICAGO STYLE

Flamini, Roland. “Nuclear Proliferation.” CQ Global Researcher,

April 1, 2007, 1-24.

www.globalresearcher.com July 19, 2011 365

The Next Step:

Voices From Abroad:

KANCHHA BUDHATHOKIGarment factory worker

Nepal

Misled“He [a fellow worker] said

he would find me a goodjob in India. When we reachedNew Delhi, we went to ahospital and they tested myblood. Another day they gaveme alcohol then they gaveme an injection. I became un-conscious and when I wokeup I was in hospital and theyhad already taken one of mykidneys.”

Nepali Times, June 2011

JOHN KAMMExecutive Director, DuiHua Foundation, China

Not just a deterrent“While many have thought

the death penalty is invokedto deter crime, there is an-other reason capital punish-ment reached such astonish-ing levels in China. For yearsorgans were harvested fromexecuted prisoners.”

News Journal (Delaware) August 2010

LALITHA RAGHURAMDirector, Multi Organ

Harvesting Aid NetworkIndia

Only in times of need“Ninety-nine percent of us

will accept an organ transplantif we need one to live, butnot even one of every 10 ofus are signed up to donate.”

India Today, August 2010

JOSE OLIVEROSCatholic Bishop, Philippines

Preserving dignity“Human organ sale or

trade, by its very nature, ismorally unacceptable. It iscontrary to the dignity of thehuman person, his or herauthentic autonomy and theessential equality of all per-sons. The dignity of thehuman person as the imageof God includes not only hisor her soul but his or hercorporeal being. Hence, ourbody ought not to be treat-ed as a commodity or ob-ject of commerce, whichwould amount to the dis-possession or plundering ofthe human body.”

Philippines News agency July 2010

HUANG JIEFUVice Health Minister

China

Transplants and ethics“With the amendment,

China will be a step clos-er to building up a nationalorgan donation system,which is being run as apilot project in 11 provincesand regions now and thusensure the sustainable andhealthy development oforgan transplants and savemore lives. An ethicallyproper source of organs forChina’s transplants that issustainable and healthywould benefit more pa-tients.”

Press Trust of India, January2011

CagleCartoons.com/Ares

of money. Although it mightbe voluntary, they are not awareof the health risks. What’smore, the illegal organ trade isharmful to society as a whole.”

Chinadaily.com.cn, February2011

DENG LIQIANGLegal Affairs Director,

Chinese Medical DoctorAssociation, China

Illuminated circumstances

“The scarcity of availablehuman organs is a globalphenomenon. It is just moreobvious in China because ofthe number of illegal organtrades due to poverty.”

Anchorage (Alaska) DailyNews, February 2011

ISMAIL MERICANHealth Director-General

Malaysia

Related donors only“If living donation is to be

carried out, it should comefrom genetically, legally or emo-tionally related donors. . . . Un-related donation is not a pre-ferred solution to increase thedonor pool.”

New Straits Times (Malaysia)November 2010

LIU RENWENLaw Researcher, ChineseAcademy of Social Sciences

China

Harmful to society“Some poor people sell their

own organs for a small amount

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