The global organ market

Since the first successful organ transplant in the 1950s, organ transplantation has saved the lives of millions. But the number of people waiting for an organ transplant now far outweighs the number of organs available for legal and ethical transplantations, and some people seek transplants outside the system fuelling organ trafficking around the world.

The high demand for organs has become an opportunity for sellers on the black market to forcefully or deceptively procure organs from vulnerable people. According to a World Health Organisation report, the illegal trade in kidneys has resulted in more than 10,000 unethical and illegal kidney transplants a year, or more than one every hour.

Apart from it being a commercial enterprise on the black market, some people turn to organ trafficking out of desperation for their own health, or to alleviate poverty by selling their own organs.

What do we know about organ trafficking?

According to Dr Dominique Martin, Senior Lecturer in Health Ethics and Professionalism at Deakin University, ‘precise and comprehensive data relating to organ trafficking activities are lacking. However, we estimate that up to 10% of solid organ transplants performed worldwide each year involve organ trafficking.’

Dr Martin says that different forms of organ trafficking exist.  ‘For example, organs can be ‘donated’ by a living person in exchange for payment. Or, organs might be removed from a living or deceased person without valid consent. Human trafficking for the purpose of organ removal, for example, may  occur in conflict zones and amongst migrant populations. Payments might also be used to undermine equitable organ allocation systems, for example by giving an organ to a person who can pay extra money for a transplant, rather to the person who is the most suitable recipient, medically speaking.’

Dr Martin further explains that organ trafficking often coincides with travel for transplantation, or “transplant tourism”, which is a widespread issue. ‘This is when a person travels to a foreign jurisdiction specifically for the purpose of obtain a transplant involving an organ procured through illicit means. Common destinations for transplant tourism include Egypt and Pakistan.’

Transplant tourism comes in two common forms. Foreigners will fly in to countries to obtain organs from local people who have either willingly agreed to sell an organ, or who may be the victims of human trafficking. As Dr Martin explains, ‘these transplants may be performed outside of the hospital setting, and clinical outcomes for transplant tourists in this setting are extremely poor.’ A that followed transplant tourists who travelled to Pakistan shows the dramatic health impacts of this practice. A further complication is that transplant tourists don’t register with domestic or international authorities who monitor transplant activities, so it’s hard to know the full extent of the practice.

Another recent practice was transplant tourism to China, where foreign patients would travel to purchase a transplant organ obtained from an executed prisoner. However, since 2015 this has been increasingly difficult due to changes in policy governing organ procurement in China and restrictions on access to transplants there by foreign patients.

It’s estimated that very few Australians travel abroad to obtain transplants using trafficked organs, less than 10 per year. Organ donation and transplantation activities in Australia are carefully regulated to help detect and prevent organ trafficking domestically.

What’s being done?

Addressing the issue of organ trafficking is no easy feat. Building on work begun by the World Health Organisation in an attempt to deal with these issues, in 2008 the Declaration of Istanbul on Organ Trafficking and Transplant Tourism was established by two major international professional organisations, the Transplantation Society and the International Society of Nephrology. The Declaration provides guidance on combating unethical practices in organ transplantation. The Declaration of Istanbul Custodian Group, of which Dr Martin is current co-chair, works to engage health professionals in efforts to address trafficking and tourism around the world.

‘The Declaration comprises a set of principles and proposals which aimed to guide policy makers and health professionals in addressing organ trafficking, transplant tourism and commercialism, and promoting ethical practice in donation and transplantation,’ Dr Martin says.

Along with this, much more is being done around the world to combat organ trafficking and transplant tourism. In 2015, the Council of Europe developed a Convention against Trafficking in Human Organs which is the first legal document to provide an internationally agreed upon definition of trafficking in human organs.

‘Many nations are addressing domestic vulnerabilities to trafficking and transplant tourism by undertaking activities such as strengthening ethical review processes for organ transplants, educating transplant professionals, and by deterring outgoing transplant tourism by providing advice about the risks of transplant tourism to those at a greater risk of the practice,’ Dr Martin says.

The United Nations General Assembly last month approved a resolution urging Member States to prevent and combat organ trafficking. There’s still much to be done, and Australians themselves have their part to play. A recent parliamentary inquiry into organ trafficking sought feedback on two questions: whether Australia should sign the Council of Europe Convention, and whether extraterritorial jurisdiction should be applied to Australian laws governing organ trafficking, making it possible to hold Australians legally responsible on their return to Australia after obtaining a black market organ overseas. These questions are among others tabled for discussion at a public forum and symposium on transplant and donation ethics Dr Martin is convening at Deakin this month.

Why don’t you join the conversation about organ trafficking? Visit Controversial Conversations and learn how Australians can help to combat this global problem.