ORGAN TRAFFICKING AND RESPONSIBILITY OF

MEDICAL INSTITUTIONS

INTRODUCTION

Organ trafficking is an organized crime, involving the trade and sales of human organs, tissues
or other body parts. It falls under the category of human trafficking. This form of trafficking
has become a major global problem and criminal offense. Many countries are unaware of the
amount of organ trafficking going on and society is uneducated on the issue because organ
trafficking is such a private problem in which takes place within a small organization called
the black market. The black market is an illegal traffic or trade system unofficially controlled
within a shadow economy, usually focused upon recruiting, transporting, transferring or
receiving illegal product.1 This market is worth up to $1.2 billion USD, which results in money
being the main driving force behind the trafficking.2

Organ trafficking is considered to be “one of the most serious crimes against humanity”.
Victims of organ trading are targeted with threat, force and coercion for the purpose of
exploitation for organ removal.3 Organ trafficking starts with demand for supply. Due to such
a high desire for organs in health/medical systems around the world, approximately 115 000
legal transplants are completed every year, which is a small percentage of only 15% of all
patients of the wait list.4 These statistics demonstrate that there is a storage of illegally obtained
organs. The organ trafficking process and money network is very complex. Commonly, the
recruiter is employed to find an organ seller in a specific region and is paid per recruit. Donors
often donate organs for financial gain or are victims of forced transplant resulting in death. The
donor or donor’s organs are then generally transported safely to the specific region, where

1
Brock, 2016
2
Scutti, 2013
3
DFLA3, 2016
4
Organ Procurement and Transplantation Network, 2017.
organ removal and transplant occurs inside of a clinic, hospital or medical facility.
Furthermore, hospital administrative staff help facilitate medical operations and medical
professionals such as doctors and surgeons proceed in the operation. Most of the time staff are
unaware they are partaking in criminal activity. The organ banks and laboratories help facilitate
organ transplants.5 Recipients and buyers are either domestic or foreign customers in need of
the specific organ. The root of the organ trafficking is the broker, whom is rarely ever exposed.
The broker is usually an international coordinator who establishes and operates the network
and within that contacts the sellers and the buyers. They often contact funeral home directors,
forging consent forms and a death certificate to harvest human tissue before the body is
cremated or buried. Organ trafficking is not dealt with properly and needs to be a higher priority
issue. It is a worldwide problem that many do not realize the magnitude of its global nature. In
order to bring an end to organ trafficking, many issues need to be tackled. With the help of an
expert on organ trafficking, it will be easier to understand the issue better and develop a
solution. In order to understand what the root of the problem is, the organization or group of
people who have the control behind organ trafficking needs to be addressed. If the purpose
behind people encouraging organ trafficking is addressed; it is easier to find a solution. With
that it is important to understand those people’s thinking. Organ trafficking flows down a long
line of people and to understand how to solve it, it is important to understand the logic behind
the actions. If the logic is understood, there may be alternative ways to fulfill the needs and
desires behind these actions.

Organ trafficking, a lucrative global illicit trade, is often a lesser discussed form of human
trafficking among anti-human trafficking stakeholder’s due to its intricate and often stealth
nature. Trafficking sex and/or labor are the more commonly thought of forms of human
trafficking among public policy leaders and general awareness campaigns. However, organ
trafficking holds a critical place with transnational organized crime groups due to high demand
and relatively low rates of law enforcement.

5
Small-Jordan, 2016
ROLE OF CONTROL

“Trafficking in organs is a crime that occurs in three broad categories. Firstly, there are cases
where traffickers force or deceive the victims into giving up an organ. Secondly, there are cases
where victims formally or informally agree to sell an organ and are cheated because they are
not paid for the organ or are paid less than the promised price. Thirdly, vulnerable persons are
treated for an ailment, which may or may not exist and thereupon organs are removed without
the victim’s knowledge.”6
In every horrific story of organ trafficking, there is a long chain of people with whom it affects
throughout the process. At the beginning of this chain is the broker. Commonly, the broker is
a desperate man or women who is well aware and educated on the demand for organs and that
desperately ill people are willing to pay for an organ on the black market. With this knowledge,
they manipulate and deceive others to take part in organ trafficking and harvesting. The broker
seeks out and lures in the impoverished and desperate who are willing to do anything for a
certain amount of money (usually small amount). Money is not only the ultimate driving force
for the broker, but the broker’s first of many targets, the recruiter. This is the recruiting process.
Once the broker has full control and has completely manipulated the recruiter, the recruiter is
then employed and sent out to find organs. They are promised to be paid a specific amount per
recruit but are often paid to a lower price. Once a victim is targeted, the donor either donates
their organ for a profit gain (which is usually below the matched price promised or not received
at all) or are victims of forced transplants and held against their will. The recruiter here now
holds the control of the organ trafficking process. The broker continues the process and
establishes the transporting, transferring and receiving steps through international coordinating
with other networks. From there, transport industries, hospital administrators and organ banks
are manipulated and often are unaware they are taking part in an illegal act. Unfortunately,
when organ trafficking takes place most donor victims are put to their death for their organ so
therefore there is no correct system to resolve the problem. The awareness is so important for
organ trafficking because the only way to prevent the issue, is to stop the brokers from taking
action. Without the donors taking action and beginning that recruiting process, the threat, force
and coercion would not be placed on victims of organ trafficking. In organ trafficking, the
government has little to no control on whether or not the illegal act takes place. Although a
country can set regulations and laws against it, the black market is very hard to govern. Even

6
Organ Procurement and Transplantation Network, 2017).
if a government prohibits it, that does not mean the people will stop illegally trafficking organs
in the black market. The black market is described as a “dark, secretive world where the
traffickers operate after arranging the sale online”7 which makes it very hard to uncover and
set laws against that will be properly followed. Some governments do not strictly set laws
against the act because of the struggle they face with the demand for organs in their economy.

7 Patience, 2015
CASE STUDY – INDIA

India is a country located in South Asia. It is the world’s seventh largest country with the
second highest population with over 1.2 billion people. It shares land borders with Pakistan to
the west; China, Nepal, and Bhutan to the northeast; and Myanmar and Bangladesh to the east.
“India can be rightly proud of its status as one of the world’s fastest growing economies but
there’s an infamous label that refuses to go away. Despite the country’s best efforts to destroy
the black market for illegal organ trade, India retains its reputation as an easy place to buy
organs such as kidneys and livers”8. In 1994, before the passage of the Transplantation of
Human Organs Act (THOA), India had an effective organ trading market. The Transplantation
of Human Organs Act states that the “removal, storage and transplantation of human organs
for therapeutic purposes and for the prevention of commercial dealings in human organs and
for matters connected therewith or incidental thereto” (Ministry of Law, Justice and Company
Affairs, 2017) must be regulated by the government. The main aims of the act are is regulate
the removal, storage and transplantation of human organs for therapeutic purposes, only accept
brain death and make it possible to use these patients as potential organ donors and prevent
commercial dealings of organs (Human Organs Transplant Laws in India, 2017). Dr. Sunil
Shroff, who manages trustees of the Mohan Foundation (a Chennai-based non-government
organization working on organ donation) proclaimed that approximately 200,000 people need
a kidney every year, but only around 3% of the demand is met.9 Unfortunately, out of this large
number only around only 7,000 of these patients on the waiting list can afford transplant (same
above). Even when patients are able to pay for medical expenses and the transplant, it is
extremely difficult to find a matching donor. Often when foreign tourists visit in India in states
such as Goa, after the expiry of their visa due to overstay, they are targeted by loan sharks and
deceived into selling their organs for profit. The country also greatly struggles with poverty
and in 2013, India was pronounced to be the country with the largest number of people living
below poverty line (PTI, 2016). Therefore, more than 30% of its population is under the $1.90
a day poverty measure (PTI, 2016). Poverty has a huge influence on the organ trafficking in a
country because most victims turn to selling their organs because they have no other option to
get money for needed necessities such as food or shelter. More recently “in 2016, reports also
surfaced from Pandoli, a small community in rural Gujarat where villagers were allegedly

8 Bedi, 2016
9 Masoodi, 2015
pressured into selling their kidneys to solve their financial problems”. Victims of organ
trafficking in India also face problems such as they were unaware that an organ had been
removed during a surgical procedure or patients are promised payments but do not receive the
promised price. Continuous problems found such as these for people in India pushed the Indian
government to pass legislation banning the sale of organs. This is when the The Human Organs
Transplant Act was brought into act to lay down rules and boundaries (Human Organs
Transplant Laws in India, 2017). “According to Organ Transplant Laws, no money exchange
between the donor and the recipient was allowed. According to the 1994 Act, the unrelated
donor had to file an affidavit in the court of a magistrate stating that the organ is being donated
out of affection. Later, the donor had to undergo a few tests before the transplant. The
Authorization Committee checked all the supplied documents” (Human Organs Transplant
Laws in India, 2017). Overall, the government tried to stop illegal organ transplants and selling
with the 1994 law but allows for "unrelated kidney sales," a loophole that has led to corruption.
Nonprofit organizations in the area claim the trade is rising now that it has gone underground.
MEDICAL PROFESSIONALS

Specialist doctors such as transplant surgeons, nephrologists (kidney specialists) and

anaesthesiologists play a key role in organ transplantation. Of all actors, however, probably
least is known about the involvement of transplant professionals and other medical personnel
in trafficking in persons for the purpose of organ removal. Also nurses and other assistants of
the surgical team may be involved. One of the first charges against transplant professionals
(and facilities, see below) were filed in 2004 by a South African court, in a case that concerned
over one hundred illegal kidney transplants involving purchased organs – the Netcare Case.
This case is included in UNODC’s Human Trafficking Case Law Database46 [“State v.
Netcare Kwa-Zulu Limited”] and one of the key investigators of this case participated in
UNODC’s expert group meetings.
A nephrologist involved in the Netcare Case pleaded guilty to ninety counts of contravening
Section 34 (a) of the (South African) Human Tissue Act, in acting in common purpose with
other persons by unlawfully acquiring, using or supplying kidneys of living persons, in that the
suppliers were paid for their kidneys in contraventions of Section 28(1) of the said Act. The
nephrologists got fined 150,000 South African Rand. Charges were then also laid against two
transplant administrative coordinators and four transplant surgeons. At the end of 2012, the
Durban High Court ordered a permanent “stay of proceedings”, permanently halting further
legal process in the trial. The experts in UNODC’s expert group meetings also reminded of a
case in 2007, where an arrest of a foreign transplant surgeon took place in Turkey, for
performing illegal transplant operations in Turkey. It remained unclear, however, what charges
he was arrested for and whether he was convicted or not. Other charges and convictions of
transplant professionals mentioned by the experts, took place in India against a transplant
surgeon and against doctors in Brazil. In June 2013, a Costa Rican surgeon was arrested,
suspected of running an international transplant ring with links to Israel and Eastern Europe.47
However, as mentioned above, experts suggested that surgeons, who perform illegal organ
transplantations that involve financial gain over organ purchases, are generally not known to
get indicted, or extradited following requests by prosecution authorities. The 2014 UNODC
Global Report on Trafficking in Persons states that despite legislative progress made
concerning the crime of trafficking in persons, globally, there are still very few convictions for
trafficking in persons. The low number of convictions may reflect the difficulties of the
criminal justice systems to effectively respond to trafficking in persons. Experts agreed that
impunity also prevails especially in the field of trafficking in persons for organ removal and
especially among those medical professionals that would be involved in the crime. It was
mentioned that it still seems to present an obstacle for law enforcement and criminal justice to
initiate investigations against members of a highly regarded medical profession.