Combatting Transnational Crime: Organ Trafficking and Transplant Tourism

https://reverehealth.com/live-better/how-well-do-you-know-your-kidneys/

Edited by Asmi Kansagra, Thomas Baxter, Owen Andrews, and Sarah Ahmad

For those living in the villages of rural Nepal, selling one’s kidney to pay off a debt is nothing out of the ordinary. In the Kavre District, known internationally as Nepal’s “Kidney Valley,” there is at least one person in every other household who has sold their kidney for financial gain. Known as kidney vendors, these people sell their organs out of necessity or the hope for a better life. These goals, however, are hardly (if ever) realized: vendors receive much less than what they have been promised and soon find themselves poorer than ever as their weakened state of health forces them out of their previous, often physically demanding, jobs. Yet the industry continues to thrive in countries such as Nepal, Indonesia, Myanmar, Vietnam, and Pakistan, fueled by endemic issues of unemployment and poverty and the unending global demand for organ transplants, as well as its lucrativeness. Globally, organ trafficking profits are estimated to be somewhere between $840 million and $1.7 billion annually.

The black market for organs involves two distinct but related crimes: organ trafficking (the illegal buying, selling, and handling of an organ) and human trafficking for organ removal. The latter usually begins with brokers who approach potential organ providers either with direct promises of payment or through cyber scams offering employment or threats. Victims are often transported across porous borders to circumvent laws and hide traces. Professional medical personnel are recruited to perform transplantation procedures. Payment for the organ goes mostly towards brokers and doctors, with victims receiving less than what they were promised and often left in chronic pain (they are either not given proper medical attention or are simply abandoned). Demands for justice remain unanswered: in most countries, legislation is either nonexistent or weakly enforced.

Notable recent cases of organ trafficking include the discovery of a kidnapped Pakistani boy whose kidney was removed without his knowledge. The kidney was then given to an Arab, likely a “transplant tourist,” a wealthy patient who failed to obtain organs legally or wished to bypass inefficient domestic donor systems. Preferring to skip the waiting lists, transplant tourists travel abroad to receive organs from underprivileged providers instead. 

Transplant tourism is not ethically neutral. It is the driving force behind many cases of organ trafficking. Though they are not directly involved in the coercion or deception of trafficking victims, their willingness to break the law is ultimately what keeps the market running. 

Aware of social stigma and possible legal ramifications, transplant tourists are unwilling to report or provide details about their procedures, which makes it difficult to quantify the scale of the practice. The World Health Organization estimates, however, that 5-10% of all global transplant procedures source organs from organ trafficking networks. Other studies indicate that transplant tourism is responsible for around 10% of all global kidney transplants. Typically, transplant tourists, often citizens of developed economies in North America, Australia, Japan, or Saudi Arabia, undergo procedures in countries such as India, Pakistan, China, the Philippines, or Egypt. These discoveries make it clear that organ trafficking, fed by transplant tourism, is a persistent global issue.

And yet, legislators are giving organ trafficking and transplant tourism far less attention and criticism than they deserve. The U.S. Department of Justice’s definition of human trafficking includes sex trafficking and forced labor but does not even mention human trafficking for the purpose of organ removal, despite the fact that it likewise involves the blatant exploitation of an individual for illegal services. In 2022, the UN Office on Drugs and Crime (UNODC) published a toolkit providing guidance for anti-human trafficking organizations, a resource remarkable for its inability to contribute to the anti-trafficking efforts. Composed of articles, diagrams, and virtual reality simulations, the Toolkit is a textbook idea that falls far short of operational needs in the real world.

More concrete legislation exists, but its effectiveness varies. In theory, the issue of transnational trafficking networks is addressed by the UN’s Palermo Protocol. The protocol criminalizes human trafficking and requires states to enact legislation that punishes traffickers and protects victims. So far, the Protocol has been adopted by almost all existing countries. Many, however, expressed a reservation against Article 15(2), signifying a refusal to grant jurisdiction to the World Court in the event of an extended dispute concerning the interpretation or application of the Protocol. While these countries have pledged themselves to criminalize human trafficking (including trafficking for organ removal), national sovereignty is given precedence in matters of arbitration, handicapping the enforcement of transnational anti-trafficking legislation. To remedy this, states should consider extending extraterritorial jurisdiction over processes such as tracking and indicting organ traffickers.

In the United States, organ trafficking is prohibited by the National Organ Transplant Act (NOTA), a foundational anti-trafficking act passed in 1984, as well as the recent Stop Forced Organ Harvesting Act. Judging from the effects of similar legislation in other countries, effective implementation is doubtful, particularly because trafficking activities are so hard to track. The one-time nature of transplantation procedures, the silence of transplant tourists, the fear and distrust harbored by human trafficking victims against judicial systems due to past failures to protect them, and the traces covered up by legitimate medical practitioners — all contribute to the notorious difficulty of tracking down organ traffickers and transplant tourists.

Legislators, policymakers, and healthcare professionals must work together to find more effective solutions. In countries where large quantities of organs are illegally sourced and transplanted, organ trafficking hinges on the vulnerability of those suffering from unemployment, poverty, educational inequity, and political instability. Residents of Nepal’s “Kidney Valley” might as well demand of their unstable and inefficient government why no alternatives for survival exist apart from selling a kidney, which frequently marks the beginning of a ruined life and disintegrating family. Nepal is one country amongst many for which reducing poverty, strengthening labor protections, and expanding access to healthcare are foundational to combating organ trafficking.

In more prosperous countries, a more efficient organ donation and distribution system is needed to give patients a viable alternative to transplant tourism. Safe, legal pathways should be given to both donors and recipients, including transparent waiting lists, funding for donor programs, and public education that encourages voluntary donation.

Improved legislation is another necessity. Most countries, the United States included, lack legislation surrounding transplant tourism. Some legislate against organ trafficking but fail when it comes to effective implementation. Domestic governments must begin instituting systems that track and prosecute organ brokers, human-trafficking rings, and medical personnel who violate not just laws but the very ethics of their profession.

On the international level, resolutions like the Palermo Protocol will fail to have real power unless there are transnational cooperation and accountability mechanisms that reach beyond mere paper agreements. The ultimate prevention of organ trafficking depends on the creation of a reliable investigative network that combats the international community’s tendency to exploit economic inequalities and encourage the commodification of the human body. What we need is a concrete global response, one that pairs domestic policy with coordinated international enforcement and humanitarian awareness.