By Peter Andrews
Like many Latin American migrants traveling to the United States, 23-year-old Antonio Medina and his wife had to navigate the harsh terrain of the Mexican desert. Unfortunately, during their journey north, the couple was abducted by a Mexican gang. In a 2011 interview with Al Jazeera, Medina described how the gang forcefully took his wife and him to a facility and separated them into different rooms.  Sometime later, Medina heard the ear-splitting screams of his wife. When he was eventually allowed to enter the room, Medina encountered the sight of his lifeless wife, laying on a surgical table with her chest wide open. Her heart and her kidney had been removed to be sold on the black market. Luckily, Antonio Medina was rescued by Mexican soldiers before suffering the same fate as his deceased wife.
While stories like Medina’s are uncommon in the organ trafficking market, they provide a humbling insight into the wicked actions of some black-market operatives. Organ trafficking refers to “any sale or purchase of human organs for transplantation.”  Due to the unparalleled value of human organs, in addition to the potential for exploitation of impoverished individuals, institutes like the World Health Organization (WHO) insist that organ donations should remain altruistic. Despite this mandate, a massive 10% of all organ transplants are performed illegally.  With the increasing disparity of wealth, the rising number of global criminal organizations, and the growing demand for organ transplants, the organ trafficking black market will continue to grow through the use of coercion and exploitation of impoverished individuals.
The Department of Homeland Security (DHS) classifies human trafficking as “the use of force, fraud, or coercion to obtain some type of labor or commercial sex act.” The DHS, like many government entities, overlooks the predominance and severity of human organ trafficking. The illicit organ trade is a monstrous industry that generates between $840 million and $1.7 billion dollars annually.  The WHO estimated that about 10,000 kidneys are illegally sold every year.  In addition to the magnitude of the industry, the discrepancies between the organ trafficking black market and other black markets make it far more dangerous. For example, while other illicit industries profit off human maladies of lust, greed, and desire, the organ trafficking black market exploits an individual’s survival instinct, a very strong motivator. This market also caters exclusively to affluent demographics. These individual’s fiscal power makes them more capable of going to extreme lengths to get what they want. This differs greatly from most illicit industries that often operate in poorer communities. However, the biggest distinction is the exclusivity of this commodity. Unlike guns and drugs, human organs cannot be synthesized; they must be given or taken from a human body. This need for a donor creates the likelihood of exploitation and theft of these priceless commodities.
While it is a common misconception that organ trafficking is limited to kidney sales, trafficking of all organs takes place. The misconception leads many people to believe the only organs sold on the black market are those that individuals can live without. But many vital organs such as the heart, lungs, liver, and pancreas are sold at high price tags.  The only common organ sold for less than the kidney is the cornea. While actuaries and ethicists struggle to place a value on a human life, organ traffickers do it all the time. Based on the geography of the transplant, all of the aforementioned organs can be purchased between $620,000 and $702,000 USD. While this seems like a substantial amount of money, one should consider that the donor supplying the organs only receives a small fraction of the revenue.
In addition to insufficient payment for their organs, many donors also suffer from complications of their surgery due to unregulated operating conditions.  These substandard conditions also lead to the transmission of diseases like HIV and the Hepatitis virus. Ironically, many organ donors find themselves spending money on medical expenses from the botched surgeries, only dragging them deeper in poverty. Reports by the WHO show decreased health and economic well-being for those who donate organs through the black market. 
As previously stated, much of the fear that feeds this market stems from the limited supply of organs. In the United States, legal organ donation is overseen by the United Network for Organ Sharing (UNOS). This comprehensive organization determines the recipients of organs from deceased donors on the basis of age, the ability of a patient to recover functionality of the organ, proximity, time on the waiting list, etc. While this organization saves the lives of many thousands of Americans annually, about half of the patients on their waitlist die waiting for a transplant. It is estimated that about 22 Americans die each day waiting for an organ transplant. As of 2016, there were “121,678 people waiting for lifesaving organ transplants in the U.S. Of these, 100,791 [waiting for] kidney transplants.” 
It is important to note that while UNOS cannot match the high demand for organs, it still provides an unbiased and effective way to save American lives. Many developing countries around the world do not have organizations like UNOS to facilitate the non-profit transport of an organ from a donor to a recipient.  The absence of government organizations provides the ideal foothold for black market operatives to intervene and capitalize on this business opportunity. This idea was best characterized by Michelle Lillie, from Human Trafficking Search, who argues, “the majority of countries do not have ethically monitored transplant practices in place, leaving the organ search to fall into the hands of illicit criminal networks who procure an organ at a high price for the donee and an even higher one for the donor.” In addition to the financial incentives for impoverished organ donors, the lack of government infrastructure creates a vast market for illegal organ transplants in developing countries.
Another interesting factor that greatly decreases the supply of organs in countries like Israel are their socio-cultural and religious beliefs. Kevin Sack, of the New York Times argues that the decrease in organ supply is due to “nearly 2,000 years of Talmudic debate… that life ends at the moment when breathing stops.” This religious definition of mortality conflicts with the modern understanding of brain death, the ideal scenario for organ donation. As a result, many Jews choose not to donate the organs of their loved ones, thinking that they may come back to life. This religious interpretation is the primary reason Israel has among the lowest rates of deceased organ donation of any developed country.
From a contrasting economic perspective, the demand for organs differs from the supply in that it is very dynamic. As the rates of diabetes, high blood pressure, and cardiac problems rise in the United States, so does the demand for organ donation.  Over the past two decades, there has been about a 500% increase in the number of patients put on the UNOS waiting list. Figure 1 shows the relative changes in the number of waiting lists patients, transplants occurred, and donors since 1991. This increase in the number of patients on the waiting list reflects the increased demand for organ donation in the United States. Desperate individuals turn to the black market when the legal process doesn’t accommodate them.
This worldwide shortage of organs for transplantation leads to the rise of transplant tourism, the manifestation of the organ trafficking black market. The Journal of Transplantation referrers to transplant tourism as the “phenomenon where patients travel abroad to purchase organs for transplants.” In these scenarios, the rich patients travel to developing countries where they buy the organ and have it transplanted by local surgeons. This power dynamic was illustrated in Misha Glenny’s book McMafia where he writes, “Western Europeans spend an ever-burgeoning amount of their spare time and money sleeping with prostitutes; smoking untaxed cigarettes; …; and purchasing the liver and kidney of the desperately poor in the developing world.”  This further demonstrates how many affluent communities treat their poverty-stricken counterparts.
In these developing countries, organ brokers lure poor and uneducated individuals into selling kidneys for the promise of financial gain and a better life. Economic deprivation motivates organ donors to rationalize these decisions. The organ donor is typically cheated in these interactions as they usually make less than the organ broker or the surgeon performing the transplant. While this is not as criminal as stealing organs as happened with Antonio Medina’s wife, this practice clearly exploits desperate impoverished individuals.
Coercion is another tactic used to obtain many organ donors’ consent. In a 2016 Washington Post article, Asif Efrat depicts a scenario in Pakistan where police raided an apartment in the city of Islamabad. In the apartment, police found 24 terrified individuals locked inside, waiting to be taken to a clinic to have their kidneys removed. These individuals were brought there through threats and deception.
Surprisingly, it is relatively simple for government agencies to follow the activity of the illegal organ market.  Because the operations require venues like hospitals, their limited number of locations make them easily identifiable. In addition, it takes a special skill set to perform an organ transplant, making the doctors performing the operations easily distinguishable. This begs the question of why governments don’t do more to prevent this type of black-market activity?
Government entities don’t take an active role to prevent this organ trafficking activity mainly because of a lack of motivation to do so.  Organ trafficking does not look harmful from a transactional perspective. An organ transaction seems deceivingly advantageous for both parties, with little to no violence exhibited. It also does not call into question ethical values, like the prostitution industry, as the motive is to save someone’s life. Lastly, it is difficult for governments to crack down on people who are struggling to save their lives. They also don’t want to reprimand doctors who normally are associated with respectability and are commonly viewed as high standing members of society.
The complacency of governments introduces the ethical debate on whether organ trafficking should be legal. Many people also see a moral justification for this industry, as it deals with saving lives. Some from this group argue that people should have the right to bodily autonomy for personal fiscal gain.  The closest equivalent to this would be the debate regarding legal prostitution. Currently, there are 32 countries that allow legal prostitution, none of which however, allow for legal organ trade. Another valid argument is the idea that the regulation of organ trading would remove the potential of coercion, exploitation, and theft/murder from corrupt organ brokers. The last and most compelling argument for the legalization of organ trading is the notion that the supply of organs will increase if people are not worried about legal ramifications and if it’s properly regulated. The increase in the supply of organs would, in turn, lead to more lives being saved.
While these are all valid points, the legalization of organ trafficking would still have negative repercussions. One thing to consider is that the poor would feel a greater pressure to sell their organs.  This pressure would only widen the power differential between those of high and low socioeconomic status. Another consideration is that a financial incentive for human organs would only further incentivize people to commit acts of murder. Many would now be encouraged to murder out of desperation for the financial incentive. In addition, this could potentially further grow the human trafficking black market by creating new opportunities for financial gain. These possibilities directly oppose the intent of legalizing organ trafficking. The biggest counterclaim to the legalization argument, though, is that it wouldn’t significantly increase the supply of organs. If there were a price tag on organs, people would stop donating for altruistic reasons which would only decrease the supply of organs. In addition, people would be more hesitant to donate the organs of their deceased loved ones if there were a transactional aspect to it. It would completely diminish the altruistic reasons that people currently donate their organs. The last minor point is that it would cheapen the value of human life. This would lead to the ideology that the human body is nothing more than a commodity.
While the future of the organ trafficking market looks bleak, there have been some important efforts to address its negative elements. Proclamations like the Declaration of Istanbul on Organ Trafficking, “proclaim that the poor who sell their organs are being exploited, whether by richer people within their own countries or by transplant tourists from abroad.” Attempts like these to educate the impoverished, who are targeted by organ brokers, may lead to a reduction in organ trafficking. Another theory is to find a way to increase the number of donated organs. One possible solution would be for countries to move toward presumed consent laws. This legislation assumed that people will donate their organs in the event of death unless they choose to opt-out of it. It is theorized that efforts like this could increase the licit transplants of organs, in which case people would not have to rely as heavily on assistance from the black market.
The ability to save a dying patient through the transplant of an organ from one individual to another is one of the greatest successes of the medical field. Unfortunately, this modern miracle has been tarnished through greed and general apathy towards our fellow human. Through these fundamental human weaknesses, one of the cruelest black market industries was born. Direct actions like the Declaration of Istanbul are the first of many steps in ridding the world of horrific experience like that of Antonio Medina.
Arsenault, C. (2011, May 17). Organ trafficking: ‘Her heart was missing’. Retrieved from https://www.aljazeera.com/indepth/features/2011/05/2011515153229450357.html.
Bain, C., Mari, J., & Delmonico, F. L. (2018, June 26). ACAMS Today. Retrieved from https://www.acamstoday.org/organ-trafficking-the-unseen-form-of-human-trafficking/.
Dougherty, C. J. (1987, June). Body futures: the case against marketing human organs. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10282295.
Efrat, A. (2019, April 18). Organ traffickers lock up people to harvest their kidneys. Here are the politics behind the organ trade. Retrieved from https://www.washingtonpost.com/news/monkey-cage/wp/2016/12/07/organ-traffickers-lock-up-people-to-harvest-their-kidneys-here-are-the-politics-behind-the-organ-trade/.
Evans, C., & Scagliarini, M. (2019, October 20). What’s Organ Donation Got to Do With Human Rights Anyway? Retrieved from https://rightsinfo.org/whats-organ-donation-got-human-rights-anyway/.
Frederike, Zaitch, Damián, Swaaningen, van, Wilma, & Willem. (2012, May 10). Cross-Border Quest: The Reality and Legality of Transplant Tourism. Retrieved from https://www.hindawi.com/journals/jtrans/2012/391936/.
Glenny, Misha. McMafia: a Journey through the Global Criminal Underworld. Anansi, 2018.
Lillie, M. (2018, December 12). Organ Trafficking Around the World. Retrieved from https://humantraffickingsearch.org/organ-trafficking-around-the-world/.
Organ Donation and Transplantation Statistics. (2016, January 11). Retrieved from https://www.kidney.org/news/newsroom/factsheets/Organ-Donation-and-Transplantation-Stats.
Organ Donation Statistics. (2019, September 30). Retrieved from https://www.organdonor.gov/statistics-stories/statistics.html.
Perry, P. (2018, October 5). What you need to know about human organ trafficking. Retrieved from https://bigthink.com/philip-perry/what-you-need-to-know-about-human-organ-trafficking.
Sack, K. (2014, August 17). A Clash of Religion and Bioethics Complicates Organ Donation in Israel. Retrieved from https://www.nytimes.com/2014/08/17/world/middleeast/a-clash-of-religion-and-bioethics-complicates-organ-donation-in-israel.html.
Shimazono, Y. (2011, March 4). The state of the international organ trade: a provisional picture based on integration of available information. Retrieved from https://www.who.int/bulletin/volumes/85/12/06-039370/en/.
What Is Human Trafficking? (2019, June 28). Retrieved from https://www.dhs.gov/blue-campaign/what-human-trafficking.