Holden Rierson

With a constant international organ shortage and even the most efficient transplant waitlists reporting an average delay of several years, the global organ trafficking market is thriving. 10% of all transplants are performed using trafficked organs, and around 5% come through overseas “transplant tourism” surgeries. Traffickers wear a variety of masks: they pose as reputable organizations, forcibly remove organs from vulnerable populations, and pay those willing to donate their body parts.. Transplant tourism has been proven to undermine an individual country’s ability to provide reliable and safe transplant services for their own citizens, yet few laws prohibit this type of travel.

In Iran, the only country to legalize and regulate for-profit donations, there have been no waiting lists or shortages since 1999. Though its officials connect this feat to incentivizing donation, outside analysis cites consistently late or misdiagnosed renal failure as its main driving force. Public health officials argue that this for-profit system preys on poorer Iranians and forces them into unnecessary and unsafe surgeries that provide only temporary economic relief. Lead politicians, however, counter that government intervention in the national organ infrastructure diminishes the local black market’s prowess and makes operations safer for people who would end up selling their organs regardless.

A February 2017 Summit on the matter, hosted by the Pontifical Academy of Sciences, called on all countries to see transactional organ payment “as crimes that should be condemned worldwide and legally prosecuted at the national and international level.” Illegal trade generates approximately 840 million to 1.7 billion dollars annually and victims of organ trafficking are frequently victims of labor and sex trafficking as well. Despite this, several countries, including the U.S. and Canada, do not include organ-specific language in their legislation that bars human trafficking.

In some countries like China, meager donation rates have spurred civic desperation and unrest. For years the Chinese government harvested organs out of executed prisoners to help manage their vast shortages, and though this practice was recently repealed, even public officials admit compliance will be difficult to enforce. Prisoner transplants so often went to wealthy foreigners who could afford elevated pricing (over half of the nation’s liver and kidney transplants in 2004 ended up in non-Chinese citizens), that some members of the World Health Organization have now labelled the People’s Republic of China a part of the international trade. In other nations that face similar deficits, cadaver donations become a significant portion of all transplants, with 13% of Iranian donations coming from the deceased.

In nations where overseas or international surgery dominates, donors and recipients are often in their most desperate state. Unauthorized intermediary organizations often coordinate matches and recruit donors, advertising a large, one-time payment in exchange for a relatively safe procedure. Instead, participants are met consistently with skyrocketed infection rates (mainly HIV and Hepatitis B and C) and decreased chances of survival once they stray from official operations. Sometimes, when these surgeries are performed without research into the patients’ prior medical history, the organizations end up giving donors and recipients lifelong complications or illnesses. The expected economic or health benefit becomes counteracted in a declining health post-operation that, especially for donors who engage solely for monetary benefit, limits one’s future ability to earn money and work.

Without follow-up care, surgeries are often linked to regret and depressive symptoms, yet international transplants remain the primary and most popular option in several regions. The proliferation of this industry stems from inefficient healthcare systems across the world that leave hundreds of thousands with no other choice but subpar, illegal, and dangerous medical treatment. And ultimately, the impossibility of ethically fulfilling shortages indicates the long-lasting and complicated moral nature of this issue.