2 Organized Crime

By Aisha Green

Disclaimer:

Even though these stories appear to be real, they are fictional. The vignettes address different aspects of the organ black market through the fictionalized retelling of well-researched, actual histories, events, and articles.

Prologue:

In the U.S., over 114,000 people are waiting for a life-saving organ transplant. Of these 114,000 people, 20 die each day stuck on the wait list. For the people at the top of the list, the United Network for Organ Sharing (UNOS) retrieves an organ within 90 days, but those at the bottom wait years. The many people on the donor list, who may never receive a life-saving organ often seek different alternatives–the global demand for organ transplants exceeds the organ supply. Even though a worldwide demand for organs would justify a commercial market, selling organs is illegal in all countries except Iran. Despite these prohibitions, organ trafficking and transplant tourism remain widespread. This series of vignettes describes how people become organ donors, and the variety of legal and illegal means of obtaining organs.

Chapter 1: Organ Donation

When Amanda Richardson recalled her life as a child, she realized that growing up in Compton, California was rough. Amanda’s kind, loving father worked two full-time jobs, volunteered in the community, and still made it home to tuck his children into bed. Whenever he got home from work early, they walked to the gas station, a normal trip for the two of them, but one trip was different. The gas station was eerie – a red “open” sign flickered in the front window, the smell of chicken grease wafted from the kitchen, and a thick layer of dirt covered the floor. As Amanda and her father arrived at the gas station’s front door, two gang bangers started shooting at each other. Amanda’s father shielded her from the bullets, and in doing so, he was shot in the leg. The gas station employee called 911, and fourteen minutes later, EMTs rushed Peter and his daughter to the hospital.

Once they arrived at the hospital, Amanda sat in the waiting room with a nurse while the doctor operated on her dad. Amanda’s mother burst through the doors at around seven o’clock, after her full-time job as a waitperson at Olive Garden. She frantically ran over to Amanda, hugging her so tightly that she could barely breathe. When the doctor arrived, she finally released her grip. The doctor told Amanda and her mother that they tried everything, but Amanda’s father passed away. The doctor explained that Peter died from a blood clot in his leg that traveled all the way to his brain. Amanda’s mother started crying hysterically. This was the first time Amanda had seen her cry. Then, the doctor took Amanda and her mother back to a hospital room to see her father’s body. When they entered the room, he was hooked up to a monitor that was still beeping, and Amanda’s mother began to question the doctor. She angrily shouted “What kind of sick game are you guys playing? My husband’s heart is still beating!” The doctor immediately began to explain the situation, “his heart is still beating and pumping blood to his other organs, but he has no brain activity. He is brain dead.” Then the doctor asked Amanda’s mother if she wanted to donate Peter’s organs. Amanda’s mother replied with a stern “No.” The type of “no” where the doctor knew not to ask again.

After a few minutes, the doctor left to give Amanda and her mother some time with her father’s body. Amanda told her mother that “Dad would have wanted to donate his organs to help other people.” Amanda’s mother looked at her with the same terrifying expression she had given the doctor. Her face softened when she realized that donating her husband’s organs is what he would have wanted.

A single organ donor can save up to 8 lives by donating various organs such as their heart, lungs, kidneys, liver, pancreas and intestines.¹ The organs donated by Amanda’s father saved people who would have died without them. In the US alone, only about 30,000 transplants have been performed in 2019, even though there are 114,000 people on the waiting list for a lifesaving organ.² The demand for organs far exceeds the supply, which means that people will look for alternative options to get vital organs.

Chapter 2: Illegal Organs

The billionaire tech mogul, Michael Ellison, gave his wife everything she wanted in life. The one time this didn’t hold true was when his wife, Karen Ellison, needed a new kidney. After two long battles with breast cancer, the mass amounts of chemotherapy and radiation caused her kidneys to go into renal failure. She was then placed on the United Network for Organ Sharing (UNOS) transplant list. Since Karen had cancer and was at risk for recurrence, she was placed towards the bottom of the list, meaning that she would have to wait around three and a half years for a kidney. After realizing that Karen may not get a life-saving kidney in time, Michael began to search for alternative options. Through mutual friends Michael located an organ broker who worked across international lines to arrange for an illegal donation. The broker found a hospital in the US to perform the operation.³ The broker also searched for surgeons to perform the operation and someone willing to donate their organs for money. After about two months, the broker reached out to Michael with good news: he located an organ for Michael’s wife. The one stipulation was that the seller from India wanted a free ticket to America along with the payment for the organ. Michael eagerly agreed to the provided terms.

Once the donor arrived in America, he was taken to a hospital under an assumed name, Mohammed Kumar, so as not to raise any suspicions with the administration. Karen arrived at the hospital around the same time as Mohammed, because the surgeries took place simultaneously. While, one of the doctors removed the kidney from Mohammed the other prepped Karen to receive the kidney transplant. There were no complications in either surgeries and Karen gained a lifesaving kidney. As for the payments, Michael gave the broker and the surgeons $200,000 a piece for their troubles, while the donor only received $5,000.³ Desperate organ donors will take any amount of money to pay off their debts. Through the illicit market, Michael obtained a kidney for his wife that was inaccessible through legal means.

In most countries, the buying and selling of organs is illegal. However, few laws restrict an individual from leaving or entering a country to obtain an organ abroad. Mohammed was able to travel to America easily because due to the lack of these restrictions. The free entry into countries allows donors to arrive without suspicion, leading to an extensive black market without regulation from the government. According to Global Financial Integrity, “It is difficult to know exactly how much transplant tourism generates annually worldwide but it is estimated that the illegal organ trade conservatively generates approximately $840 million to $1.7 billion annually.”⁴ Even with the estimated flow of funds crossing $1 billion annually, law enforcement and the anti-money laundering (AML) professionals struggle to detect illegal activity.⁵ Many factors, make preventing illegal organ transplant difficult, such as a lack of domestic laws deterring people from traveling abroad, the transnational nature of the crime, and creativeness of people to circumvent the laws through shell companies. Michael used a shell company, a corporation that exists only on paper but holds a person’s assets, to pay the surgeons and donor. The government has difficulty tracing and tracking shell companies to their owners allowing the black market to grow due to lack of enforcement.

Chapter 3: Legal Organs

Three years ago, Diego Cortez was fighting to stay alive. Diego battled kidney disease for years, and things were getting worse. As the disease progressed, fluid filled his legs, his skin itched from dryness, and nausea reduced his appetite. Before the disease, Diego participated in a basketball league, hiked once a week, and swam laps at the local pool. As a previously athletic 39 year old, Diego was in sound physical shape, but now he struggled to walk up the stairs. Diego’s doctor said he had reached the point where a transplant or ongoing dialysis was necessary. Later, Diego asked friends and family if they would offer him a kidney as a living donor. In all, 22 people said yes. As Diego recounts his story, he discovered, “My mum was meant to be donating for me and she was the most compatible one, but suddenly on the donor list there was someone who was more compatible.” Diego had been on the waiting list for just 20 days. All he knows about the person who saved his life was that the person lived in Madrid, was eight years older than him, and died from a stroke.

Highly compatible deceased and living donors are rare, but in Spain, the leading country in organ donation, this situation occurs frequently. A total of 5,259 organ transplants were carried out in Spain during 2017, which means that there were 46.9 individual donors per million people, which is much higher the EU and US average at 19.6 and 26.6, respectively. Spain operates an “opt-out” system in which all citizens are automatically registered organ donors unless they choose to state otherwise.⁶ When a donor dies, any healthy organs donated have to be surgically removed. This is done quickly because, after the heart stops beating, organs stop receiving oxygen and other nutrients from the blood. Through the “opt-out” system, Diego received a lifesaving organ in less than a month reducing his need to look for alternative options.

The US adopted the opt-in system, opposite of Spain, where citizens register to be organ donors. If a non-donor dies in the US, the doctors must go to the family and ask consent to have the organs for transplantation. The doctors lose valuable time, since an organ becomes unusable 24 hours after death. By using the “opt-out” system, doctors routinely consider organ donation when a patient dies regardless of the circumstances of death.⁶ The “opt-out” system reduces the need to get organs illegally. Incorporating this system in other countries could decrease black market activity.

Chapter 4: Organ Theft

Shin Lee, a normally upstanding Chinese citizen, was imprisoned for practicing the spiritual religion of Falun Gong.⁸ Falun Gong is a spiritual group based around meditation that China banned 20 years ago after 10,000 members appeared at the central leadership compound in Beijing in silent protest. Thousands of members have since been jailed. After being held in captivity for less than two months, Shin Lee died. A month and a half later, his family was notified and visited the prison. When his family saw his body, Shin’s daughter, Meilin Lee, noticed that his body was sliced open. Meilin described what she had seen to her uncle, “there were stitches at the throat area, using very thick black threads. The incision extended down until covered by the clothes. When I pressed the abdomen it was hard, like it had been stuffed with ice.” Her father’s organs, she said, had been harvested.

In Chinese prison camps, 1.5 million detainees are killed for organs serving a transplant trade that is worth one billion dollars per year.⁷ Instead of relying on the national organ donation system, the Chinese government takes advantage of the prisoners by executing them and harvesting their organs.

The large supply of illegally harvested organs in China makes shorter waiting times for patients who need donors. In most countries, the limited supply of organ donation means that patients wait months or even years for a transplant. In China, patients can get an organ in weeks or even days. People travel from overseas to take advantage of this market, unaware of the where the organs originated.⁹ China has one of the world’s largest transplant programs in the world; however, the country has an extremely low rate of voluntary organ donation. China’s deputy health prime minister, Huang Jiefu states, “over 90% of organ transplants from deceased donors are sourced from prisoners.”¹⁰ The World Medical Association demanded that China cease harvesting organs from prisoners who are not deemed able to properly give consent. In 2015, Jiefu said that the reliance on organ harvesting was declining, while simultaneously defending the practice of using prisoners’ organs in the transplantation system.¹³ No evidence suggests that Chinese officials have stopped the harvesting of inmates’ organs. Human rights advocate, David Kilgour testified that, “This crime is not only continuing, we document that it’s in fact getting worse. The machinery that’s taking organs from Falun Gong is getting greater, not smaller.”¹⁰ The Chinese government has created their own black market by using prisoners’ organs to generate a profit.

Chapter 5: Legal Market in Iran

Ali Rezaei posted signs every few days to spread the word about his available kidney. The wide framed reading glasses and button up dress shirt gave Ali the appearance of a white-collar worker, who once made enough to support a middle-class life for his wife and two children. But that changed after he was recruited to install air conditioners as a part of the public housing project for low income families. When many of the apartments began to fail, the developers fled, leaving all contractors unpaid. Ali owed the bank $7,000 and had no means to pay them back.

One day, he was talking to an old friend, Reza Kurd who had sold a part of his liver to put his daughter through college. Reza explained that, “you can cut deals to earn up to thousands more from well-off Iranians that are eager to bypass the roughly year long wait for a transplant under the government system.”¹² After discovering the unforeseen organ market, Ali began to post large signs on walls next to medical supply companies and hospitals. To repay his debts, Ali wanted at least $9,000, but he had no real plan. He was hoping a broker would call with an offer to smuggle him across the border to Turkmenistan, where the doctors perform transplants in private clinics. Or, he would contact an Iranian buyer and pose as a friend in hopes of speeding up the surgery. Ali returned the next morning to ensure that his ads were still there. When he returned, he found that another seller had added his number to the page in red marker and a third had attached his using small blue stickers.¹² Ali did not receive any calls from someone waiting for an organ and proceeded to go bankrupt.

The only country that allows the selling of one’s kidney for profit is Iran. A government foundation regulates the system that registers buyers and sellers, and matches them selling organs at a fixed price of $4,600 per organ.¹¹ Along the streets in Iran, dozens of messages are affixed to windows, telephone utility boxes, sidewalks, and road signs that read “Kidney for sale,”¹² accompanied by phone numbers and blood types. The legal organ market in Iran is still accompanied by an illegal market. Many rich organ recipients will pay large sums to get the organ quicker, undercutting the government’s legal system.

On average, 20 people die every day from the lack of available organs for transplant and that number is steadily rising.¹³ Nasar Simforoosh, the chairman of the urology and kidney transplantation department at the Shahid Labbafinejad Medical Center, believes the sale of human organs should be legalized. Simforoosh states “people donate because they need money, but this is a reality all over the world, but instead of doing something illegal to cover their debts, like stealing or smuggling, they are saving a life first. This is not exploitation. The end result is good for the recipient.”¹² The Iranian sellers need money and are saving a life without causing harm to others. Even though Iran has legalized the sale of human organs, it still has a black market for organs. People who need organs undercut the government and make sales with people who need money, satisfying both consumers.

Epilogue:

The shortage of organs has led to the development of an international organ trade. In some cases potential recipients travel abroad to obtain organs through illegal transactions. In China, to meet the demand of the billion-dollar organ transplant market, officials harvest prisoners’ organs and shows no evidence of stopping. In most countries, law enforcement and government agencies prove ineffective at reducing the organ black market due to loose domestic laws and the transnational nature of the crimes. Even in Iran’s legal market, recipients pay cash to receive an organ from individuals in desperate financial need, thus undermining the government system. However, a reduction in activity on the organ black market has occurred in countries like Spain where the “opt-out” system has increased the supply of available organs. The demand for organs severely outweighs the supply, leading to extensive growth of the illegal organ market to fast-track one’s needs.

In order to reduce the organ black market and increase the number of available organs, a system of contract sale should be used. If there were a free market for organs, companies would offer payments to the person’s family for their organs in the event of a fatal accident. This would immediately increase the supply of organs and save a countless number of lives. If a free market prevailed, there would be no shortage of much-needed organs, as supply and demand would set the price that clears the market. Open markets in organs are the best available way to enable people with defective organs to get transplants much more quickly than under the present system. The arguments against allowing the sale of organs are not compelling, especially when weighed against the number of lives that would be saved or significantly improved by the increased supply stimulated by financial incentives.

1. Reviewed by Transplant Services April 26, 2015. “How Many Lives Can One Organ Donor Affect?” UPMC HealthBeat, 25 Apr. 2019, share.upmc.com/2015/04/the-impact-of-one-organ-donor/.
2. “Transplant Trends.” UNOS, unos.org/data/transplant-trends/.
3. Perry, Philip. “What You Need to Know about Human Organ Trafficking.” Big Think, Big Think, 5 Oct. 2018, bigthink.com/philip-perry/what-you-need-to-know-about-human-organ-trafficking.
4. “Transnational Crime and the Developing World,” Global Financial Integrity, March 2017, http://www.gfintegrity.org/wp-content/uploads/2017/03/Transnational_Crime-final.pdf.
5. “Trafficking in human organs: Council of Europe convention enters into force,” Council of Europe, January 3, 2018, https://www.coe.int/en/web/cdpc/-/trafficking-in-human-organs-council-of-europe-convention-enters-into-force.
6. The Local. “Spain Is the Undisputed World Leader in Organ Transplants.” The Local, The Local, 11 Jan. 2018, www.thelocal.es/20180111/spain-is-the-undisputed-world-leader-in organ-transplants.
7. Smith, Saphora. “China Forcefully Harvests Organs from Detainees, Tribunal Concludes.” NBCNews.com, NBCUniversal News Group, 18 June 2019, www.nbcnews.com/news/world/china-forcefully-harvests-organs-detainees-tribunal-concludes-n1018646.
8. Lemish, Leeshai. “Why Is Falun Gong Banned?” Why Is Falun Gong Banned?, 19 Aug. 2008, www.newstatesman.com/blogs/the-faith-column/2008/08/falun-gong-party-chinese.
9. Bowcott, Owen. “China Is Harvesting Organs from Detainees, Tribunal Concludes.” The Guardian, Guardian News and Media, 17 June 2019, www.theguardian.com/world/2019/jun/17/china-is-harvesting-organs-from-detainees-uk tribunal-concludes.
10. Dockrill, Peter. “Worst Fears About China’s Organ Transplants and Prisoners Were Just Confirmed.” ScienceAlert, www.sciencealert.com/our-worst-fears-about-where-china-s-human-organs-come-from-were-just-confirmed.
11. Krishnan, Madhumitha, and Sophia. “Legalizing Trafficking: Iran’s Unjust Organ Market and Why Legal Selling of Organs Should Not Be The Resolve .” Berkeley Political  Review, 3 May 2018, bpr.berkeley.edu/2018/05/03/legalizing-trafficking-irans-unjust-organ-market-and-why-legal-selling-of-organs-should-not-be-the-resolve/.
12. Bengali, Shashank, and Ramin Mostaghim . “’Kidney for Sale’: Iran Has a Legal Market for the Organs, but the System Doesn’t Always Work.” Los Angeles Times, Los Angeles Times, 15 Oct. 2017, www.latimes.com/world/middleeast/la-fg-iran-kidney-20171015-story.html.
13. “Facts and Myths about Transplant.” American Transplant Foundation, www.americantransplantfoundation.org/about-transplant/facts-and-myths/.