Trafficking Persons for Organ Removal

Just like sex and labor trafficking, organ trafficking is the illicit trafficking of humans in a trade fueled by high demand and low supply. It’s referred to as the trafficking of human beings for the purpose of organ removal, abbreviated as THBOR.

As with sex and labor trafficking, people often ask whether the crime affects individuals here in the United States. The answer is yes. In 2011, a resident of Brooklyn, Levy Izhak Rosenbaum, served just 2.5 years in prison for the first federal conviction of profiting from the illegal sale of human organs. In return for brokering three illegal organ transplants for three New Jersey-based customers, Rosenbaum received illegal payments upwards of $120,000 each. The organs were bought by Rosenbaum from desperate, vulnerable, and poor citizens of Israel for just $10,000. Transplants took place at respected American hospitals, including Albert Einstein Medical Center in Philadelphia. Although this case is currently the only federal conviction for this crime, the practice is more commonplace; in fact, LifeWay has served women in the past who were trafficked for the purpose of removing their organs.

There are many reasons why organ trafficking is particularly under-detected and under-discussed in the United States, largely because of US law. Organ trafficking is recognized as a form of human trafficking in the United Nations’ Palermo Protocol (which established a definition of human trafficking now accepted globally and by the US), but the United States’ federal human trafficking law, the Trafficking Victims Protection Act (TVPA), does not address it. Transferring organs for profit is addressed in a separate federal law, the National Organ Transplant Act (42 U.S. Code § 274e – Prohibition of organ purchases). Organ trafficking’s exclusion from the Palermo Protocol has implications for prevention, protection and prosecution efforts. Elizabeth Pugliese’s article, for instance, argues for an alignment of the federal law and the Palermo Protocol so that federal human trafficking resources can be used to address organ trafficking, and survivors can have access to protection and services. According to the International Criminal Police Organization (INTERPOL), the lack of awareness around organ trafficking by law enforcement agencies and the deficiency of communication between medical and police fields leads to an absence of organ trafficking reporting. The annual revenue of organ trafficking is estimated at anywhere from $840 million to upwards of $1.7 billion.

The United Nations also points out that there is a distinction between “trafficking organs” and “trafficking persons for the purpose of organ removal,” which makes tackling the crime also difficult. Establishing an illegal organ transfer is one thing, but proving that a person was exploited for their organs by means of fraud or coercion is extremely difficult to prove. In the case of Rosenbaum, for instance, his lawyer argued that all parties consented. True consent, however, is difficult to determine in these circumstances.

Worldwide, hubs of this practice include Iran, China, India and the Philippines. In Iran, organ selling is legal — a practice that further places vulnerable folks at risk. The issue with legalizing an industry for organ transfer is similar to the issue of legalizing commercial sex; it raises the question of what happens when enough people are not willingly consenting to provide their organs. We argue that were it made legal, traffickers would utilize tactics such as manipulation, lies, violence and fraud to obtain what they need to make a profit because they fear no legal ramifications or consequences. Below are quotes from an organ trafficker as well as survivors:

“I feel bad for them, I always give them their money, but there are other brokers who would agree with you on a price, then disappear after the surgery without paying you,” he said. “This happens at least 40% of the time.”

“They took my passport and clothes,” she said. “Then they drugged me. When I was awake, I found myself alone. I was in pain and there was blood on my side coming from a bandage. I had no idea what was happening.”

“‘The foreman told me that the meat will grow back,” Pariyar said. “Then I thought, If the meat will regrow again, and I get about $30,000, why not?” “What if I die?” Pariyar remembers asking the foreman. The foreman assured Pariyar that nothing would happen. He was given good food and clothes and was even taken to see a movie. Then he was escorted to a hospital in Chennai, a southern state of India.”

In China, human rights groups have advocated against the government for extracting organs of executed prisoners to source its supply of transplantable organs. The country’s organ-procurement laws and frequent use of the death penalty are consistent with the economic profit potential of organ trafficking. In India, before 1994, organ transplants were legal, and some states in India have poor and loose medical ethics and regulations, making the use of illegally procured organs in medical operations easy and unregulated.

Before 2008, in the Philippines organ trafficking and illegal organ acquisition were endorsed by the Filipino government. The federal government’s Philippine Information Agency government condoned kidney transplant options, costing about $25,000, that exploited vulnerable donors who received less than $2,000 for their organs.

The lack of international condemnation of this practice, coupled with lucrative financial incentives, has unfortunately added to why organ trafficking is often not acknowledged. There have been efforts from legislators to continue to build on existing legislation in the United States. Introduced in 2005, the Stop Organ Trafficking Act aimed to prohibit the export of United States devices “intended for use in organ transplant surgery” to countries and entities pinpointed as potential trafficking of persons for the purpose of organ harvesting. The bill also stops the authorization of visas and passports of individuals known to be involved in organ trafficking. The State Department would also be required to create a report on organ trafficking, which could create a larger awareness of its practice. It is our job to take action and prevent this illicit practice.

Organ Harvesting Facts

The definition of trafficking outlined in Article 3(a) of the Trafficking Protocol (UNODC 2000b) advances a formulaic understanding of exploitation composed of three elements: an action (e.g., recruitment), a means (e.g., the threat or use of force), and a purpose (e.g., the removal of organs).

Organ trafficking, or as it’s also known, Trafficking in Persons for Organ Removal, happens around the world, as evidenced by a ring recently discovered by the Pakistani police. Worldwide this is a USD $1.7 billion industry. Learn the facts about organ trafficking.

The commercial trade in human organs, including trafficking in persons for organ removal has developed into a global problem. This report describes the current situation regarding international organ trafficking, committed often by transnational criminal networks. It zooms in on the role of traffickers, international brokers, health professionals, and the recipients and suppliers. To combat and prevent organ commercialism and trafficking, a legal framework for the criminalisation of trafficking offences, and tailor-made law enforcement instruments have been developed by a number of international organisations. A number of recent trafficking cases in which European citizens were involved, have been analysed in detail to highlight the different forms of organ trafficking and to demonstrate how investigation and prosecution can result in an effective justice response to these crimes. The efforts of the EU and other European organisations, such as the Council of Europe or the OSCE, to develop binding legal instruments and formulate policy actions to step up law enforcement and legal cooperation in the combat against trafficking in organs, are described. The report concludes with observations and recommendations for the EU to prepare next steps in successfully fighting and preventing trafficking in organs and organ commercialism.

What is organ trafficking?

When a patient suffers from organ failure and all medical interventions have been explored, an organ transplant can be the only way to stay alive. This initiates a search for a compatible organ donor. Living donors are often family members or close friends. Organ donation can also come from a deceased person who has left documented consent to be an organ donor. In the process of such ethical organ donation, no one profits financially from the organ donation.

But the current global need for organs is far greater than the supply, according to Global Observatory on Donation and Transplantation, 2020. More than 150,000 transplants are performed annually worldwide, however, this is less than 10% of the global need. Some sick patients are willing to break the law and pay for an organ transplant, even if it involves exploiting vulnerable and impoverished people.

The terms “Organ Trafficking” and “Trafficking in Persons for Organ Removal” actually represent two very different crimes with distinct legal implications. “Organ Trafficking” refers to the illegal handling of organs. For example, selling an organ for profit or advertising the willingness to buy or sell an organ is organ trafficking.

“Trafficking in Persons for Organ Removal” is when a person of vulnerability is exploited, deceived, coerced, or abused for the illicit use of their organ. The organ doesn’t even have to be removed for this crime to take place, since it is the trafficking of the person that is the crime.

Modus operandi of organ traffickers

A description of the modus operandi of an organ trafficking network is already implied in the definition of ‘organ trafficking’ as proposed by the Declaration of Istanbul (and derived/adapted from the UN Palermo Protocol):

‘The recruitment, transport, transfer, harbouring or receipt of living or deceased persons or their organs by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability, or of the giving to, or receiving by, a third party of payments or benefits to achieve the transfer or control over the potential donor, for the purpose of exploitation by the removal of organs for transplantation’.

As can be seen this definition covers both THBOR and transplant tourism, as well as trafficking in organs from deceased persons.

The transnational character of trafficking in organs is represented in the figure below that schematically depicts the different modes of movement of both recipients and organ suppliers between countries. Mode 1 shows a recipient travelling from country A to country B, where the organ supplier and the transplant centre are located. Mode 2 shows an organ supplier travelling from country A to country B, where the recipient and the transplant centre are located. Mode 3 shows a situation where both recipient and organ supplier from country A travel to country B, where the transplant centre is located. Mode 4 shows a situation where the recipient from country A and the organ supplier from country B, both travel to country C where the transplant centre is located.

Modes of transnational trafficking in organs

As can be deduced from the above scheme, the operation of a trafficking network is essentially dependent on the travel of both recipients and suppliers, which calls for careful logistics, including: travel documents (flight tickets, visas, passports); ground/air transportation and accommodation; forged/fraudulent consent declarations and identity documents; financial transactions (mainly in cash); timely blood and tissue typing; obtaining recipients medical record.

An important issue is the observation that for both the recipient and the organ supplier the preparation of both the removal and the transplant must be done well in advance, so that the recipient and the supplier stay as short as possible in the country where the transplant is to be performed. This is done to diminish the risk of detection of the operation: in many cases both the recipient and the supplier are discharged and sent back home within a week, with grave risks to their health.

A short history of global trafficking in organs

The first reports on commercial trade in human organs date from the 1980s and concern the selling of kidneys by poverty stricken Indian citizens to foreign patients, especially from the Middle East. It was reported that around 80 % of all kidneys that were procured for transplantation in Indian hospitals were transplanted into patients coming from the Gulf States, as well as Malaysia and Singapore. A first scientific report appeared in the Lancet, and revealed that 131 kidney patients from the UAE and Oman had travelled to Bombay, together with their doctors, and were transplanted there with kidneys from local paid ‘donors’. The authors were not so much concerned about the commercialism, but more about the fact that many of the recipients had post-operative complications. This took place before the passage of the Indian Transplantation of Human Organs Act in 1994, which outlawed the selling and buying of human organs. But also after 1994 there are consistent reports of foreign patients travelling to India in search of a paid kidney donor: Goyal reported on over 300 citizens of Chennai who illicitly sold a kidney in the period 1994-2000. Even from developed countries where, it is claimed, no overt payment for organs is made, there is data that financial incentives may have influenced organ allocation: American and European transplant surgeons during the 1980s have solicited wealthy foreign patients to come to their transplant centres for a priority transplant. It was reported that in the United States in 1984 around 300 kidneys were transplanted into non-residents. Similar allegations were made by the Bellagio Task Force who reported that Belgian and Austrian transplant centres did not always exchange available organs with collaborating foreign centres, but required foreign patients to come to their centres, in order to raise their incomes.

Early evidence of EU citizens travelling abroad to obtain organs was provided by an article in the British Medical Journal in 1996, in which it was described that two German patients had died of post-transplant complications, after having been transplanted in India. It was stated that at least 25 German patients were known to have obtained kidneys abroad. The article requested ‘suitable legislation to prevent such incidents’. A high profile case of organ trafficking was reported in 1988 in the UK, when it was discovered that a kidney had been removed from a Turkish peasant in a London private clinic run by a well-known nephrologist. The Turkish ‘donor’ had been recruited through advertisements in Istanbul newspapers, promising a fee of GBP 2 000-3 000. When travelling to London, these donors carried a letter of introduction saying that they were going to support and care for a relative who was to undergo transplantation. There were no criminal charges against the perpetrators, but the nephrologist and three other doctors involved in this case (as well as similar other cases) were struck off the register by the General Medical Council. This case speeded up the passing of the UK Human Organ Transplant Act (1989), which made organ trafficking a criminal offence. Another case involving the UK concerned a Turkish company (Trans Transplantsyon) that offered UK citizens and other foreign patients to have a kidney transplant in India or Russia for a fee of GDP 22 000. The company was said to have been already in operation on the Continent for six years, facilitating 400 successful transplants, and planning to set up an office in London.

An important aspect of most of the above mentioned cases of organ trafficking and commercialism is that the reports rely to a great extent on media reports and investigative journalism, which makes it difficult to analyse the events in more detail. On these early cases no police investigation reports exist nor has there been any prosecution.

Things started to change in the period after 2000. The Israeli nephrologist Michael Friedlaender reported in 2002 that over 80 Arab Israeli patients had travelled to Iraq to obtain a kidney transplant from a paid donor. However, Jewish Israeli patients were not able to go to Iraq (or other Arab countries), and transplant surgeons from the centre in Tel Aviv as a solution (circumventing Israeli law) made arrangements to go together with their patients to Estonia, Bulgaria, Turkey, Georgia, Romania and Russia to perform kidney transplants from paid unrelated donors. They charged their patients USD 200 000 for such service. It is reported that at least 26 patients were transplanted in this way. This arrangement was made semi-official through the Veterans Health Organisation, run by the Ministry of Defence, and was facilitated by the health insurance companies. This has been the beginning of the extensive involvement of Israeli recipients as well as transplant physicians in organ tourism and trafficking in the Eastern European region. Further evidence of trafficking in organs, especially in the Eastern European region came out of a fact-finding mission of the special rapporteur Mrs. RG Vermot-Mangold to the Parliamentary Assembly of the Council of Europe in 2003. She exchanged views with a representative of Europol and visited Moldova in October 2002. The report stated that trafficking in human beings (especially women and children) was already deemed a serious problem in Moldova, targeting the impoverished rural population. Trafficking in human beings for organ removal, though still small scale, appeared to be on the increase. Several dozen young men, aged between 18 and 28 years, had been taken to Turkey, where- in rented hospital facilities- a kidney was removed and transplanted, sometimes using coercion or force. These victims were paid around USD 2 500-3 000, but sometimes did not get the full amount promised. From the interviews and research it came out that this was not an operation confined to Moldova, but that ‘donors’ had also been recruited in the same way from neighbouring Ukraine, Bulgaria, Romania, Russia and Georgia. The operation was run by a well organized network, consisting of brokers, local recruiters, doctors and specialised nursing staff. There appeared also to be strong links with the police and customs, which were open to corruption. Following this report, the Parliamentary Assembly called on the Council of Europe to develop a European strategy for combating trafficking in organs, by drafting an additional protocol to the European Convention on Action against Trafficking in Human Beings.

At the beginning of 2000, two other European countries were found to be involved in the trafficking of human tissues. The State Forensic Medical Centre in Riga (Latvia) from 1994 to 2003, delivered human tissue material to the German company Tutogen, that paid ‘compensation’ to the Forensic Centre. Over the 10 year period tissues were taken from at least 400 deceased persons. When relatives of the deceased found out that the tissues were retrieved and sold without any valid consent, they informed the police who started a criminal investigation. In 2005 the Security Police concluded that no one was guilty, as the Latvian law was unclear about human rights protection, and the determination of a deceased person’s last will. In 2006 the case was reopened, and recently in 2015, the European Court of Human Rights ruled that taking and selling the tissues without consent, constituted a violation of articles 3 and 8 of the European Convention of Human Rights (degrading treatment, lack of respect to private life), and that Latvia was to pay financial compensation to the relative of a deceased person. A second case involving the abuse of human tissues, took place in the Czech Republic, where, in the period 2003-04 in the hospital in Brno employees of the local tissue bank sold skin grafts to a foreign (Dutch) company for a total of USD 340 000. Six employees were charged with organ/tissue trafficking; the prosecution took 3.5 years and the defendants faced prison sentences.

After the year 2000, around 2 000 pieces of information on trafficking in organs, which had been scant before, became more prominent. An important role in this was played by the organisation Organs Watch, founded by anthropologist/investigator Nancy Scheper-Hughes. The discovery and criminal prosecution of a number of high profile recent trafficking cases has increased the insight and knowledge of how trafficking in organs operates. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism established in 2008 and the work of its Custodian Group, brought pressure on a number of countries and governments to effectively change their legislation and ban trafficking in organs. As a consequence, trafficking in organs has decreased in a number of countries. However, trafficking operations have now shifted to other countries and new routes have been opened. According to recent information from the UN Office on Drugs and Crime (2014) around 0.3% of all reported persons trafficked are trafficked for organ removal, and some 50 countries around the globe are in some way involved in trafficking in organs. In Europe, the Council of Europe and the European Union, through the European Parliament, are actively developing new strategies to combat and prevent what is now considered a criminal offence on a global scale.

Recently there have been media reports that trafficking in human beings, including for the purpose of organ removal, may be increasing in Europe because of the economic and financial crisis. Also it is documented that there is an increase of organ offers over the internet and in newspaper advertisements (solicitation), in particular in Southern Europe and Russia. Serious, but as yet unconfirmed reports have been circulating recently on the alleged trafficking of organs from refugees in the Syrian conflict, and their being offered on the Lebanese and Turkish ‘black market’ in organs. Other alarming reports point to a shift of organ trafficking operations to countries in Latin America (Costa Rica, Panama, Peru), which led to a meeting of judicial officials from Central America and the Dominican Republic in June 2012. Finally there is recent evidence of THBOR networks in Vietnam-China, and Cambodia-Thailand.

Criteria for defining human trafficking

How prevalent is organ trafficking?

The organ trade, which includes illegal organ transplants, generates significant income, with conservative annual estimates between USD $840 million to USD $1.7 billion and 12,000 illegal transplants. About 10% of all transplants are believed to be illegal transplants.

Organ trafficking is far less common than labor or sex trafficking, partly because of the high level of medical knowledge and coordination necessary for the crime to take place. However, experts state that the magnitude of the problem is difficult to track since the crimes often happen within a network of legitimate medical settings with legally certified medical professionals.

“While trafficking in human beings for organ removal is not a new phenomenon, it is under reported due to the clandestine nature of the crime, combined with a lack of awareness by law enforcement agencies and the deficiency of information sharing channels between the medical and police sectors,” said Cyril Gout, INTERPOL’s Direct of Operational Support and Analysis.

We are just beginning to understand the scope of this crime as illustrated by the fact that the United States Department of Justice does not even include organ removal in its definition of human trafficking.

Stakeholders in trafficking operations

Trafficking (THBOR) networks show a wide variation in size, division of labour between the actors, and geographical scope. However, in practice in all networks there are essential roles and tasks that should be fulfilled and conditions that are required, for the operation to be successful. Figure 3 gives a schematic picture of a trafficking network. Emphasising the transnational character of THBOR, each box may represent a function located in a different country.

Diagram of THBOR network with transnational scope

Brokers

A criminal network that specialises in trafficking in organs (THBOR) is usually led by an international coordinator, who is generally also the person who established the network. The often used term ‘broker’ has no uniform definition, but the description used by Yea is an apt one: ‘an intermediary between a kidney buyer and seller who connects the two using his/her knowledge of medical personnel and facilities that engage in illegal transplantations. The broker’s key asset in this market is his/her greater knowledge of other stakeholders to whom the seller does not have direct access.’ The broker is the one who makes the strategic decisions for operating the network, and is generally also the person with whom potential recipients come first in contact with (through internet or word of mouth) in their search for an organ. In most networks the main role of the broker is to establish and regulate the supply of recipients, to channel all payments, and to oversee the matching logistics with the potential organ suppliers. In larger transnational networks there may be more than one broker. Brokers often see themselves as business executives who negotiate and set the price of the transplant package offered to the recipient, and set the fee for the organ supplier (in the most profitable way for the network). In some cases brokers are doctors/surgeons themselves, or directors of hospitals or tissue-matching laboratories. Actual prosecution cases against criminal trafficking networks and their brokers have shown that the more the broker acts as an international ‘business executive’ the greater the chance of engaging in trafficking in persons (THBOR), targeting vulnerable people as potential sellers, and exploiting these victims.

Local recruiters and other facilitators

Brokers should be distinguished from local recruiters: persons who are employed to find or identify the actual organ sellers/suppliers. Recruiters (or scouts) are usually operating within one country or a specific geographical area (such as a Philippines slum or a refugee camp). Recruiters are sometimes involved in other forms of human trafficking (sexual exploitation, forced labour). In some cases they are (corrupt) local police officers, but more often they have been former organ sellers themselves. Recruiters are usually paid per successful recruit, resulting in a transplant. Trafficking also depends on other facilitators who collaborate within the network: ‘minders’ accompany the recipients during their travel and while they are lodged in hotels/safe houses waiting for the transplant; ‘enforcers’ make sure that the organ sellers/suppliers go through with the contract; drivers take care of ‘safe’ transport of the recipients in the foreign country. Also important are interpreters who facilitate the communication with recipients/suppliers with local doctors and hospital staff.

Medical professionals and local hospitals

Crucial to the trafficking network is the collaboration with medical professionals and local transplant hospitals and matching laboratories. To perform the organ removal and transplant operations one needs surgeons, nephrologists/hepatologists and anaesthesiologists. Additionally, nurses and lab technicians are involved.

In some cases, the illicit transplants have been performed by doctors who were employed by, or even were themselves the co-ordinators of the trafficking network (e.g. the Medicus case). In other cases, the broker/co-ordinator of the network has to contract local hospitals and medical staff, who are open to a lucrative– but illegal– deal (e.g. in Turkey, the Philippines). In more rare cases, the transplants are performed in hospitals in developed countries, where hospital staff and executives have no idea that these are in fact illicit transplants, making use of paid non-related donors (e.g. the Rosenbaum network in the USA presented the donors as genetically related or emotionally related family volunteers).

A difficult question is to what extent medical personnel, nurses, lab technicians and others in a transplant hospital that is contracted by a trafficking network to perform illicit transplants are actually aware that they are engaging in criminal acts and are seen as accessories (e.g. in the Netcare case). It is even more complicated to establish to what extent doctors in European or American hospitals can be held criminally liable for facilitating organ trafficking or transplant tourism, when they counsel or prepare their patients for trying to have a transplant abroad.

The role of corruption

Corruption is an essential ingredient and prerequisite for trafficking in organs. The trafficking in persons (THBOR) for the purpose of organ removal on a larger scale would not be possible without the assistance of corrupt police officials, customs officers, officials giving out visa and travel documents, and sometimes officials in the health administration who issue false licenses to hospitals and doctors (see the Medicus case). In some cases networks have close links with existing organised crime groups who are engaged in ‘traditional’ human trafficking (prostitution, sexual exploitation, forced labor).

The background of organ buyers/recipients

In contrast to the suppliers of organs (victims of THBOR), there has been surprisingly little academic study or media attention for the recipients who travel abroad in search of an illegal transplant. They are not systematically reported to the health care system in their home country, although their treating nephrologist/hospital will know the circumstances. The confidentiality rules in medicine, as well as the fact that most recipients of bought organs are aware of the fact that they have committed an illegal act (although they avoid the term ‘crime’), makes it difficult to trace and interview these recipients.

The anthropologist Nancy Scheper-Hughes has given a very general indication of the background of recipients: ‘From North to South, from poor to rich, from young to old’. From existing trafficking cases there is more detailed information on the background and motives of recipients:

Although it has been reported that not all patients who travel to obtain a purchased kidney are necessarily rich, or necessarily come from a rich background, their economic situation is generally markedly better than that of the organ suppliers. Another undeniable fact is, that it is the recipients who provide the funds that make trafficking in organs possible and ‘drive the business’.

Characteristics of organ suppliers/victims

There is a vast literature on the background and characteristics of organ suppliers (sellers) that explains their motives for giving up an organ. The general characteristics are:

In general the organ supplier is not considered to be a participant in the trafficking network, but is seen as a victim of exploitation, who needs care and protection.

What organs are most frequently trafficked?

Kidneys are the most common on the “organ market,” followed by livers and corneas. Emerging markets exist for human eggs, skin, human embryos, and blood plasma.

Where does organ trafficking occur?

Trafficking in Persons for Organ Removal happens all around the world, but the highest numbers are in Northern Africa and in the Middle East. It is also more common in South and South-East Asia, Central America and Europe. When someone is willing to travel abroad for the purpose of obtaining an organ it is called Transplant Tourism.

Transplant tourism often happens in countries where there are fewer regulations. This is how traffickers can build criminal networks with the coordination of corrupt medical professionals, hospital administrators, laboratory staff, drivers, translators, and law enforcement.

Who are the most common victims of Trafficking in Persons for Organ Removal?

Refugees, migrants, and asylum seekers are targets of traffickers as they may be desperate to provide for themselves and their families in their host country and willing to use an organ to pay a smuggler’s fee. According to the United Nations Office on Drugs and Crime (UNODC), the average victim is a young adult male, around 30 years old.

How are victims of organ trafficking recruited?

Donors are recruited online and in person. They are usually people who are vulnerable due to a lack of financial stability. They may be uneducated and told lies by traffickers that kidneys grow back, that they have three kidneys, or that they will be given medical care after the surgery. They are promised anywhere from $500 to $10,000 but may never be paid at all. They are sometimes forced to sign papers indicating valid consent or to declare that they are related to the patient.

In the case in Pakistan in January 2023, the victims were lured with promises of jobs and large payouts. Their kidneys were sold for up to the equivalent of USD $4,000.

Unfortunately, victims of Trafficking in Persons for Organ Removal can sometimes be mistaken as criminals because they are being paid. However, we need to consider what exactly makes someone a victim of human trafficking and what makes them a criminal. A victim of human trafficking is someone who is recruited, deceived, harbored, transported, coerced, and exploited.

One might think that if someone is paid for their organ, then they are profiting and therefore a part of the crime and not a victim of human trafficking, but if a donor was coerced and their vulnerability exploited, it would not be considered valid consent. The World Health Organization, among other authorities, actually requires a psychological evaluation to confirm that the donor is not financially profiting from or otherwise coerced into organ donation.

What can be done about organ trafficking?

Awareness-raising campaigns can make a difference to educate the general public and increase accountability among medical professionals. However, tracking the scale of the problem remains complicated. While other forms of human trafficking for sex or forced labor generally happen repeatedly over a period of time, human trafficking for organ removal only happens once, making it more difficult to track.

Those who have been trafficked for organ removal may remain silent because selling an organ has a stigma and is illegal. Therefore, the very person who has been exploited might fear being charged as a criminal. Confidentiality and patient privacy, while an essential component of professional medical care, can actually hinder legal investigations.

In October 2022, the (UNODC) released a toolkit to support the investigation and prosecution of this crime. This toolkit is a big step forward in the international community to build the capacity of law enforcement to address this crime.

‘For me, there was no other choice’: inside the global illegal organ trade

They travelled at night, for what seemed like hours, but it was difficult to tell. Yonas was blindfolded and drowsy from the Xanax he had been given. He wasn’t sure where he was, but he could smell salt in the air when the car stopped. Yonas heard Ali, the other passenger, wind down his window and light a cigarette. The driver sat motionless, breathing heavily. Several minutes passed in silence. Then Yonas heard a pinging noise. Someone’s phone had received a message.

The door next to Yonas was opened, and two men escorted him into a building. After they took off his blindfold, the men walked down a long corridor and took the stairs to the basement. There, Yonas entered a room where a man dressed in blue scrubs was talking to Ali, the broker who had brought him here. He assumed the other man was the doctor who would perform the surgery. Before Yonas could ask any questions, he was taken to another room where he was told to change into a surgical gown and wait for a medical attendant to prepare the anaesthetic.

As he waited, Yonas thought of his parents at home in Eritrea, his younger brother conscripted into military service, his sister destined to a life of servitude. He hoped his sacrifice would help them. The attendant came in. The needle scratched his arm; fluorescent lights gave way to darkness.

Yonas had made three attempts to reach Europe, twice from Libya and once from Egypt. But each time he was detained and forced to pay large sums of money – between $3,000 and $7,000 – for his release. Destitute and already heavily in debt, Yonas borrowed money from lenders in Cairo. He was under pressure from his creditors, who were threatening to call in their debts, with force if necessary. But above all else he was desperate to send money back to his family in Eritrea. Trapped in a spiral of debt, he traded the only thing of value that he had: one of his kidneys.

It is illegal to buy or sell an organ anywhere in the world, with the exception of Iran. Nevertheless, estimates suggest that around 10% of organs for transplantation come from illegal sources. Most cases, however, go unreported, so the true number is likely to be much higher.

Several countries, including Pakistan, Egypt, Bangladesh, India, Turkey, the Philippines and China, have been identified as centres of organ trafficking, but the trade in organs is a transnational operation. In its 2018 Global Report for Trafficking in Persons, the United Nations Office on Drugs and Crime identified more than 700 cases of organ trafficking, the majority in the Middle East and north Africa. A 2021 Interpol report claimed that organ trafficking was of particular concern in north and west Africa, “where impoverished communities and displaced populations are at greater risk of exploitation”.

According to the Global Observatory on Donation and Transplantation (GODT), only 10% of the global demand for transplants is met each year. Increased demand for kidney transplants, in particular, has been exacerbated by a shortage of altruistic donations and limited access to transplant services. This has led to an increased dependence on criminal networks that obtain organs from vulnerable individuals.

There is a black market for organs including kidneys, corneas and liver lobes. Rising demand for kidneys is partly a result of the spread of so-called diseases of affluence – diabetes, hypertension, obesity – and the subsequent rise in kidney failure. According to the charity Kidney Care, in the UK, the waiting list for a kidney transplant has increased dramatically since the pandemic. Consequently, more people are travelling overseas for transplant surgery. In many countries that attract transplant tourists, kidneys are sourced from the bodies of the poor and disenfranchised.

As a legal academic, I have been investigating the global trade in organs since 2014. Over the past 10 years, I have spoken to 43 people from Sudan, South Sudan and Eritrea who sold a kidney out of economic necessity. In most cases, people were targeted by criminal groups because of their precarious status as asylum seekers, refugees or undocumented migrants. Most were not paid what they were promised. Some were paid nothing. Doubly criminalised, as illegal migrants and organ sellers, they were in no position to negotiate a price, or to ensure they got paid the agreed amount. Because of their precarious legal status they were also less likely to report abuse to the authorities.

In the absence of legal pathways to migration, many had sold their kidneys after they had been arrested, detained and in some cases deported back to countries where their lives were under threat. Most had opted to avoid refugee camps, describing them as “prisons” and “death camps” where people go to die. They were disillusioned with the United Nations Refugee Agency (UNHCR). It was better to risk crossing the Sahara, Yonas told me, than to live under permanent surveillance, captive and dependent on a broken asylum system. Many, like Yonas, had expended all their resources trying to reach Europe and claim asylum. Categorized as illegal and pushed to the margins of society, they were exposed to exploitation of different kinds.

The illicit networks that supply organ markets depend on the close cooperation of medical doctors. Criminal intermediaries are involved in the negotiation of fees, and the preparation of official-looking paperwork presented as evidence of informed consent to an altruistic donation. These brokers, who connect sick patients with impoverished and vulnerable “donors”, also form long-term partnerships with medical professionals. Without the involvement of surgeons who perform illegal transplants for profit, the trade in organs would cease to exist.

In March 2023, the UK tried its first organ-trafficking case. A Nigerian politician, his wife and their broker were found guilty of conspiring to bring a man to the UK from Lagos to obtain his kidney for transplant. The judge said in sentencing: “The trafficking of people across international borders to harvest their organs is a form of slavery. It treats human beings, and their body parts, as commodities to be bought and sold. It is a trade that preys on human poverty, misery and desperation.” Unfortunately, as war and climate crisis displaces more people, there is no shortage of desperate people to prey on.

Yonas was conscripted into national service in Eritrea at the age of 14. He was sent for educational training at the Sawa Defence Training Centre, a sprawling military complex in western Eritrea notorious for its military-style discipline, physical punishments and forced labour. “My brother was with me,” Yonas recalled. “They tried to brainwash us. They don’t want people to have political ideas, thoughts. I had to escape that place.”

One night in September 2012, Yonas made a break for freedom. His family had paid a smuggler to take him across the border into Sudan, and there was a truck waiting for him on the far side of the compound. To reach it, Yonas had to crawl on his hands and knees, under wire fencing and across jagged rocks, avoiding the searchlights sweeping from above. He knew that if he was caught, he would be shot.

Outside an old garrison town close to the border, Yonas climbed on to another truck heading to the Sudanese capital, Khartoum. In Omdurman, the twin city of Khartoum on the opposite side of the Nile, he was introduced to a smuggler who, he was told, could organise transport across the Mediterranean.

The journey was expensive and dangerous, but Yonas felt he had nothing to lose. His family had given everything they had to help him escape Sawa; he was determined to make it to Europe and pay them back. Yonas had heard stories of kidnapping on migrant routes, but this smuggler had a good reputation, and Yonas was hopeful that he could make it.

After a long and difficult journey across the Sahara, between Sudan and Libya, Yonas was delivered to the Mediterranean coast, outside Tripoli, as agreed. In April 2018, he was shoved on to a small boat along with about 100 other migrants. They were from different parts of Africa – Eritrea, Somalia, Sudan, South Sudan, Chad and Nigeria. One of the passengers, with no experience of sailing, was handed the responsibility of manning the boat. After about an hour, the engine cut out.

Men, women and children sat helpless, dehydrated and fatigued, as the boat floated idly. Six hours passed before the Libyan Coast Guard intercepted the vessel and took them back to the African mainland for processing. They were told they would be detained for attempting to enter Europe illegally. After the engine had cut out, Yonas recalled, the passengers thought they might die. “And when the coastguard came,” he said, “some of us wished we had, because we knew where we were going.”

Libya’s immigration detention centres, which are partly funded by the EU, are notorious. Detainees have been subjected to torture, harassment, physical violence, sexual exploitation and forced labour, with no formal registration, no legal process and no access to lawyers or any judicial authorities. Yonas never spoke to anyone from the UNHCR or the International Organization for Migration (IOM) when he was detained. “I think someone like this came to visit,” he said, “but they just look around.”

In the absence of legal process, the only way to escape the punishing conditions of detention centers is to pay the officers a bribe. “When the guards receive the money, they leave you in the desert. Then you just try not to get picked up [arrested] again,” Yonas said.

Yonas had left some money with friends in Egypt in case of an emergency. He also had relatives living in Sweden, the Netherlands and the UK, who raised funds to help him pay his way out of detention in Libya. “The money was sent to a Libyan bank account via Western Union,” he said. He said he paid the prison guards around $7,000. After he was released, Yonas travelled to Cairo.

By the time he had bought his way out of detention in Libya, Yonas had exhausted the funds he received from friends and family. Once in Cairo, he borrowed 30,000 Egyptian pounds (around £470) from lenders – a temporary measure, he thought, to cover the cost of food and accommodation while he searched for work.

Two months went by. Yonas could not find reliable employment, and he was unable to make any repayments. He knew that if he missed his next payment, there would be serious consequences. “This guy [a debt collector] told me that he would take a tooth for every payment I missed.”

Yonas had all but given up hope of reaching European shores when he was approached by a Sudanese man, who gave his name as Ali, at a street market in Cairo. Yonas told him his story. Ali said that he knew a way that Yonas could pay back all his debts and secure a place on a more reliable fishing vessel crossing from Egypt to Italy. He told Yonas he could sell his kidney, make a lot of money and save a life in the process.

Yonas had his doubts. But he had amassed significant debts trying to cross the Mediterranean and he was coming under pressure to pay back friends, family and moneylenders. “This is the last thing you want to do,” he explained. “But for me there was no other way.” Ali, the broker, was personable and seemed genuine. Yonas agreed to the deal. He was promised $10,000 for his kidney. The money, he hoped, would be enough to cover his debts and pay for his onward journey across the Mediterranean.

The surgery took place at a medical facility near Alexandria in November 2018. “I remember waking up and feeling confused,” said Yonas. The first thing Yonas he was aware of was a buzzing noise coming from a loose lightbulb, like the sound of a trapped insect. Next came pain, then fear, panic, anger. “I was shouting as loud as I could. I just wanted to get out of there.” Yonas rolled over and vomited on to the floor.

Hours passed. Finally the door opened and a man holding a clipboard came in. The man told that Ali would be coming soon, at which point he could leave. He handed Yonas two painkillers and a glass of water, and slid out the door before Yonas could ask any questions.

When Ali finally appeared, he told Yonas to get dressed. His voice was hard, all his old charm now gone. A nurse removed the drip attached to Yonas’s hand and two heavy-set men escorted him back to the car. Yonas spent the next two weeks in an apartment in Cairo convalescing. He was closely monitored, in case he should decide to leave the apartment. They did not want him to attract attention. If someone were to see him, they might report his presence to the police. Best to keep him hidden while he healed.

Yonas had been promised $10,000, but he was given just $6,000 in notes. This would just about pay off his existing debts, but it was not enough to cover the cost of smugglers’ fees ($3,500) for the next stage of his journey, across the Mediterranean. Yonas went to the police and reported Ali for trafficking. He was trying to explain that he had been deceived into selling a kidney when another officer entered the room. The second officer informed Yonas that it was a criminal offence to sell a kidney. He took out a notebook and asked Yonas for his identification papers. Yonas fumbled in his pockets, searching for documents he knew he didn’t have.

The officers joked that Yonas didn’t look like an Egyptian, remarking on his dark skin and curly hair. If he was a refugee, they suggested, he should go and complain to the UNHCR. But maybe he wasn’t a refugee. Maybe he was an illegal migrant. The second officer reminded Yonas he could be arrested or deported for failing to produce his identification papers.

Yonas was regretting going to the police. He looked around, nervously waiting for someone to speak. The second officer smiled scornfully and told him to leave.

In my research, I wanted to learn more about how the trade in organs was organised, and how brokers rationalised what they were doing. As it turned out, certain brokers were aware of my work. Some of them wanted to meet me, to ask me about it, and to explain their perspective.

The brokers I interviewed did not necessarily see what they were doing as wrong. If anyone was to blame, they said, it was the doctors who knowingly performed illegal transplants. For the most part, they saw themselves as service providers, part of a supply chain for an already corrupt medical system. To them, it was just business.

I met Hakim in Egypt in February 2020. He had been introduced to the brokerage business after getting into financial difficulties. “My uncle took me under his wing,” Hakim told me. His family was from Khartoum, and his uncle was an established organ broker, with connections to doctors and transplant units in Egypt and overseas, mainly in Saudi Arabia, Oman and the UAE. Hakim said that his uncle introduced him “to all the top guys, the doctors and other mediators [brokers] who work with the clients”. The clients were transplant patients, some from Egypt, and others from across Europe, the Middle East and North America.

When I met him, Hakim was based in Cairo and was responsible for recruiting donors and referring them to his uncle. At the time, March 2004, the central government in Khartoum, supported by the Janjaweed militia, had launched a brutal counter-insurgency campaign against rebels in Darfur, killing hundreds of civilians and displacing thousands more. Amid the chaos, Hakim saw an opportunity for recruitment. He contacted smugglers in Khartoum, many of whom had connections with border officials on the Sudan-Egypt border, who had the power to let migrants through in exchange for payment. The brokers started to solicit people fleeing the fighting who might be desperate enough to sell a kidney. “I thought: they are in a very difficult position,” Hakim said. “Maybe they will sell a kidney for $5,000. Someone in Cairo will ask for more.”

Around the world, the cost of a transplant on the black market ranges from $20,000 to $200,000 – the higher price generally reflecting better treatment and care. The “donor” typically receives a fraction of this cost. The amount that they receive varies from country to country. In the Philippines and Colombia impoverished farmhands and bonded labourers have been documented as receiving less than $2,000 for a kidney. In contrast, kidneys have been sold for between $10,000 and $20,000 in Israel and Turkey.

In Egypt a kidney can sell for anywhere between $5,000 and $20,000. Patients, or “transplant tourists”, pay between $50,000 and $100,000 for a kidney transplant, including travel and accommodation. The price generally depends on market demand. For a kidney, the price paid to the seller can be anywhere between $5,000 and $20,000. Part of the broker’s job is to find out just how wealthy the buyer is, and to establish the absolute minimum the seller is prepared to accept. An impoverished, unemployed seller with no legal status is in no position to negotiate. For this reason, illegal migrants make valuable targets.

A series of drawn-out conflicts in the region have supplied a steady flow of people whose desperation can be commodified in different ways: bodies to be smuggled, sold or harvested. Hakim said that he referred between 20 and 30 sellers a week, who are themselves referred to him by his contacts in Khartoum. “They agree the deal [organ sale] in advance, and I call my uncle to receive them. After the operation, they continue to the coast to try and make the crossing,” he said. Most, he said, don’t make it across the Mediterranean.

I asked whether he felt any remorse for the people he was exploiting. “Yes, I feel bad for them. But I always give them their money. There are other brokers who would agree with you on a price, then disappear after the surgery without paying you,” Hakim said. “This happens at least 40% of the time.”

Most people are not paid what they are promised, but because it is illegal to sell a kidney there is little they can do. Brokers and the medical professionals they work with are aware of this, using the threat of criminal prosecution to silence their victims.

I met Hiba, a young single mother from Sudan, in Cairo in March 2020. She sold her kidney to help support her young daughter. She had been promised $10,000, but was paid $4,000. After she recovered from the surgery, she went back to the hospital to get her money. But prior to the surgery, she had signed documents that stated she was donating her kidney for free. This was enough to give those involved with the surgery legal cover. And now, if Hiba chose to report them to the police, she could be arrested for the criminal offence of selling a kidney. She was powerless to get the full fee she’d been promised.

One reason that worldwide convictions for illicit organ removal are so rare is that victims are reluctant to come forward. Another is systemic corruption. Hakim suggested that doctors pay bribes to protect themselves from police investigations. But he added, a little vaguely: “The doctors are not controlling the business. The people who control this business take a commission from the doctors. You don’t know them or what they do. You just know that those people take a commission from doctors, they control the business [the organ trade] – otherwise, no doctor would be able to work [performing transplants].”

When I asked Hakim if he meant government officials, he simply replied, “They are people higher up.” The threat of arrest, Hakim claimed, acts as a form of official extortion. Corrupt medical professionals, performing illegal transplants, who pay for protection will not be investigated, while those who refuse to pay could be arrested.

Three years later, in March 2023, I met Hakim again in Khartoum. I was following up on reports from contacts in Egypt who claimed that people, mostly from Darfur, were being trafficked from Khartoum to Cairo for organ removal. They were being promised safe passage across the Mediterranean, part of a “go now, pay later” scheme. But when they arrived in Cairo, they were forced to give up a kidney as the price for continuing their journey.

I wrote to Hakim on WhatsApp to see if he knew anything about this. He replied, “If you want to talk, I am in Khartoum now. I don’t speak about this on the phone.”

I don’t know if it was for dramatic effect, but he arranged to meet me at a graveyard close to Tuti Island, where the Nile divides. We discussed the mounting tension between the Sudanese army and the paramilitary Rapid Support Forces (RSF). The following month, violent street battles would break out between these two factions, a conflict that quickly exploded into a devastating civil war, which continues to this day. According to figures released by the IOM, more than 10 million people have been displaced in Sudan. All are in desperate need of humanitarian assistance.

“How has business been?” I asked Hakim.

“More people are coming now, with the fighting,” he said. “Some of these people will try to go to Libya. Others will try and make it [across the Mediterranean Sea] from Egypt, but this is more difficult. So, they can sell their kidneys,” he said. Hakim denied any knowledge of human trafficking for organ removal, saying that in times of conflict people are forced to do things they would normally never do.

The ongoing war in Sudan and the ensuing humanitarian crisis has pushed people to the brink. At the borders of conflict zones, selling a kidney is becoming a currency of last resort for people seeking refuge. In June 2023, I managed to contact two young Sudanese women who had fled the fighting in Khartoum. In April 2023, Rania was with her friend Fatima, both students at the University of Khartoum, when the RSF raided the main campus, on the banks of the Nile. “We were trying to hide from the fighting,” Rania told me on the phone. “There were a lot of [female] students there who were afraid to leave. We thought we would be safe, but they found us and forced us to have sex with them.”

Soon after that they packed up their belongings and took a bus heading towards the border with South Sudan. They had heard the route south was cheaper than trying to go north to Egypt, and Rania had a brother living in Kampala, Uganda, whom they hoped to join. It was a seven-day journey from Khartoum to Renk, a small town in South Sudan close to the border where thousands of people had set up temporary camps in bleak conditions. A lack of food, water, healthcare and sanitation had left people at increased risk of disease, malnutrition and violence. There were hundreds of new arrivals each day. “People are crammed together under tarpaulins,” Rania said. “There are mosquitoes everywhere. There’s not enough food, water, soap. Everyone is desperate for assistance. It’s chaos.”

When Rania and Fatima arrived at a makeshift camp on the outskirts of the town, they were approached by soldiers in plain clothes selling tickets for flights from a small airstrip outside Renk to South Sudan’s capital, Juba, and the city of Nimule. The flights, which should form part of the humanitarian corridor, are being controlled by armed militias charging exorbitant fees to board them. “They wanted a lot of money,” Rania said. “The price would go up every day. They said if we didn’t have any money we could have sex with them.”

When they refused, they were told there was something else they could sell: a kidney. “They said that this was the only way we were going to get a flight out of here,” Fatima said. “There were two men who had agreed to this [selling a kidney], but I don’t know what happened to them. I was worried that they would kill me and take my kidney.”

Two weeks after Rania and Fatima first arrived in Renk, they messaged me from Kampala. “We received some money from family members in Uganda. They paid a smuggler $500 to take us to Kampala.” Rania said. “There were no humanitarian agencies or government officials transporting people. The drivers, the militias, they are exploiting people every step of the journey.”

In Renk, they had watched as large trucks carried hundreds of people further south to transit camps that were rumoured to be less crowded and better resourced. Others boarded cramped and overcrowded boats down the Nile to the city of Malakal, from which they would attempt to reach Juba, 970km to the south. Each stage of the journey would come at a cost.

“We are telling you this for a reason,” Fatima said. “We desperately need more support for people trapped in Sudan. In Darfur, there is genocide. But no one is talking about it. Women are being raped every day. Children have been killed and abducted. People are desperate. This is when you sell your kidney.”

All names have been changed

Understanding Human Trafficking for Organ Removal

Human trafficking for organ removal is surrounded by myths and misconceptions. In movies, it’s often portrayed as a person waking up in a bathtub filled with ice, missing a kidney. However, the reality of this crime is far more complex, and these myths hinder our comprehension of how traffickers operate.

In this article, we shed light on what is known and unknown about this hidden crime.

1. What is human trafficking for organ removal?

It is a form of trafficking in which individuals are exploited for organs. Although victims often appear to have consented to the removal of their organs, their consent is invalid when deception, fraud or abuse of a position of vulnerability is involved. In such cases, they are considered victims of human trafficking.

The traffickers, who are usually part of sophisticated criminal networks, profit by selling these organs to recipients who are unable or unwilling to wait for legal transplants.

2. How prevalent is this crime globally?

In 2007, the World Health Organization (WHO) estimated that 5-10 per cent of all transplants worldwide used organs from the black market. However, with a growing and aging global population, the globalization of unhealthy lifestyles, and increased mobility, the actual number could be significantly higher.

The exact scale of this criminal activity remains unknown. Few studies have been conducted, as the crime’s clandestine nature makes data collection and verification difficult. Victims may also be hesitant to step forward, as organ selling constitutes a crime in most countries.

3. Why is there a demand for unethical organ transplants?

The demand for human trafficking for organ removal largely arises from the global shortage of organs available for ethical transplant procedures. While more than 150,000 transplants are performed annually worldwide, this meets less than 10 per cent of the global demand.

Desperation drives patients with organ failure to resort to obtaining organs through illegal means. The organ trade, which includes human trafficking for organ removal, is a lucrative criminal business, amounting to between 840 million to USD 1.7 billion USD annually.

4. Which organs are harvested in this form of human trafficking?

The most harvested organs from victims of trafficking in persons are kidneys, followed by parts of livers.

5. How do these traffickers operate?

Traffickers typically operate within complex and elusive global networks, requiring a sophisticated infrastructure involving medical specialists, logistical coordination and access to healthcare facilities. They connect with their victims using local advertisements, social media or via direct approaches by recruiters, who may be former victims themselves or trusted individuals within the victim’s community.

These criminal networks are highly organized and flexible, often functioning as mobile units or specialized groups. Key players include brokers who coordinate logistics, recruit medical professionals, and prepare fraudulent documents. To ensure smooth operations, they rely on a wide range of facilitators such as healthcare officials, hospital administrators, customs officers and local recruiters.

Detecting this crime can be challenging, as traffickers often train victims to pretend that they are related to the recipient to evade suspicion during evaluations at hospitals or clinics.

6. Who are the victims?

Victims of this form of trafficking are typically from poor, uneducated and vulnerable backgrounds. Organized criminal groups specifically target unemployed individuals, migrants, asylum seekers and refugees. Many are coerced, deceived or see organ selling as a last resort to improve their dire situations.

Although some victims receive limited financial compensation, many receive no money at all and sometimes no post-operative care. Most of the victims are men, with two-thirds of reported cases involving male donors.

7. How do illicit organ transplants affect victims?

The long-term health consequences for victims can be devastating, with many experiencing a sharp decline in their physical condition post-surgery, along with stigmatization and depression. The psychological impacts often lead to a further deterioration in their standard of living, trapping them in a cycle of poverty and poor health.

8. What is UNODC doing to address this issue?

The UN Office on Drugs and Crime (UNODC) provides technical and legislative assistance to bolster criminal justice responses to human trafficking for organ removal. To support criminal justice practitioners, UNODC has published the Toolkit on the Investigation and Prosecution of Trafficking in Persons for Organ Removal.

UNODC is developing research and capacity-building programmes, along with guidance, to enhance national capabilities in addressing human trafficking for organ removal and organ trafficking and is ready to provide capacity-strengthening to interested States.

Organ Trafficking: The Unseen Form of Human Trafficking

Organ trafficking, a lucrative global illicit trade, is often a lesser discussed form of human trafficking among anti-human trafficking stakeholders 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.

Organ traffickers profit in the shadows, while their destructive medical footprint is the only thing that is felt. It leaves vulnerable populations, aka “donors,” and first world beneficiaries, aka “recipients,” open to severe exploitation and a lifetime of health consequences.

This form of illicit trade also leaves the private sector, in particular the financial industry, susceptible to being an unknowing conduit for its facilitation. Although, with the right training and raised awareness, financial institutions may play a pivotal role in unmasking organ traders by way of the financial trail they leave behind.

Low Supply, High Demand

When describing organ trafficking, there is often confusion as to how this crime can happen. Global Financial Integrity (GFI) estimates that 10 percent of all organ transplants including lungs, heart and liver, are done via trafficked organs. However, the most prominent organs that are traded illicitly are kidneys, with the World Health Organization (WHO) estimating that 10,000 kidneys are traded on the black market worldwide annually, or more than one every hour.

On their own, these numbers can be stark; however, when compared to average wait times for organs in developed countries, one can start to better understand the demand being diverted to black markets. In Canada, it is estimated that the average wait time for a kidney is 4 years with some waiting as long as 7 years. In the U.S., the average wait time for a kidney is 3.6 years according to the National Kidney Foundation. In the U.K., wait times average 2 to 3 years but could be longer.

Hiding in Plain Sight

Once obtained, trafficked organs can be transplanted to recipients in the most reputable of hospitals in major cities throughout the world but makeshift operating rooms in houses have often been the clandestine locations for such transplants.

Traffickers orchestrate the recruitment of the donor often from a place of vulnerability, and victims are not necessarily properly screened for their qualifications to be a healthy donor. Desperate patients in need of an organ may fall prey to a trafficker who could be posing as a “reputable” representative of an altruistic organ matching organization. Financial exploitation plays a key part in both sides of this scenario. In addition, organ traffickers could also be involved in other forms of human trafficking, such as sex and/or labor trafficking. Cases are emerging where an organ donor may have been a victim of sex trafficking and/or labor trafficking as well as a victim of organ trafficking, creating a multi-level equation of exploitation. The term “transplant tourism” is often utilized in describing this crime, as defined by the Declaration of Istanbul:

“…travel for transplantation that involves organ trafficking and/or transplant commercialism or if the resources (organs, professionals and transplant centers) devoted to providing transplants to patients from outside a country undermine the country’s ability to provide transplant services for its own population.”

Expanding the Human
Trafficking Lexicon

How does organ trafficking fit within the broader definition of human trafficking? As stated in the Palermo Protocol of 2000, the basis for most national laws on human trafficking, organ trafficking is defined within the broader definition as:

“Trafficking in persons’ shall mean the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs.”

In most countries, the buying and selling of organs is illegal (e.g., Iran is the only country in the world where buying and selling an organ is legal but this exception only applies to its citizens). Conversely, there are few laws that restrict an individual from leaving one’s country to obtain an organ from someone abroad. In fact, there are many companies that cater to “transplant tourism” but purport to only match up recipients with donors who are willing.

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, according to GFI.

Unfortunately, even with estimated flow of funds crossing $1 billion annually, it is difficult for both law enforcement agents and anti-money laundering (AML) professionals to detect related financial activity. This is due to a myriad of factors such as a lack of domestic laws deterring citizens from travelling abroad, the transnational nature of the crime, and the savviness of the purveyors who know the laws related to organ trafficking well enough to circumvent them by way of shell companies and sanitized (legal) offerings via public websites.

Money Laundering Indicators

While it may be difficult for banks to detect financial transactions related to organ trafficking, it is not impossible as there are some indicators available. These red flags could include the following indicators and may be innocuous on their own but when combined, could present potentially suspicious behavior:

One thing to keep in mind is that while traveling abroad to obtain an organ may be legal in certain countries, associated financial transactions would still be considered reportable in many jurisdictions as the act of purchasing an organ may be illegal within their country of citizenship. This stance gives AML professionals an interesting perspective above and beyond that of law enforcement as they are in a position to offer up intelligence that law enforcement agencies may have no insight on, nor a requirement to.

Intelligence gathered by financial intelligence units (FIUs) within financial institutions associated with organ trafficking or transplant tourism can be further disseminated to international partners by national FIUs.

Project Protect Expands: Project Organ

As previously stated, reporting on transactions related to organ trafficking is no easy feat. This way of raising awareness may prove to be an equally effective tool in deterring organ trafficking while increasing investigative knowledge toward reporting transactions.

One example of how awareness is being raised, within the context of AML and organ trafficking, is through the Project Protect initiative in Canada, launched by AML guru, Peter Warrack, in 2016. While initially designed to address sex trafficking, Project Protect was expanded to cover organ trafficking at the request of Dr. Francis L. Delmonico, M.D., professor of surgery at Harvard Medical School in 2018. The expansion is now known as “Project Organ” and its goals are similar to that of the original project, as it seeks to raise awareness and increase reporting to Canada’s national FIU, the Financial Transactions and Reports Analysis Centre of Canada.

Looking Forward

Countries like the U.S. and Canada did not include organ trafficking as a form of human trafficking when adopting their national laws on human trafficking. However, in the U.S. for example, some individual states like Massachusetts include organ trafficking within their state laws on human trafficking.

Since the Palermo Protocol, the public policy discourse of organ trafficking has been steadily gaining. In 2008, a group of key stakeholders in the global fight against organ trafficking convened to form the Declaration of Istanbul, which after Istanbul, created crucial new definitions around organ trafficking and transplant tourism, and developed promising practices to tackle the organ trade. Dr. Delmonico was one of co-founders of the Declaration of Istanbul and consequently, the Declaration of Istanbul Custodian Group (DICG), an international body tasked with implementing the principles of the Declaration. He said the following:

“The DICG has been an effective group of international colleagues monitoring illegal practices by their awareness of patients who return to their home country for sophisticated medical care following an organ transplant. Notifying the responsible authorities has led to the arrest of organ traffickers in Israel, China, Pakistan, India, Costa Rica, Egypt, and the United States.”

In addition, the Council of Europe has adopted a Convention Against Trafficking in Human Organs in 2014 which recently went into effect in January of 2018.⁹ This is a critical development as the first legal mechanism with a more universally agreed upon definition of organ trafficking.

More recent events, such as the February 2017 Summit on Organ Trafficking hosted by the Pontifical Academy of Sciences in Vatican City, have also shed light on the state of the organ trade.

As of today, the extent of organ trafficking is still unknown as to the number of such transplants performed annually. Furthermore, the full integration of the issue within the human trafficking field as a whole is still lacking.

In order to effectively combat organ trafficking and also raise its visibility among other forms of transnational organized crimes, it is vital to engage in effective public-private partnerships. The private sector, including the financial industry, can be essential in this global fight.

Trafficking in Human Beings for the Purpose of Organ Removal and the Ethical and Legal Obligations of Healthcare Providers

Abstract

Physicians and other health care professionals seem well placed to play a role in the monitoring and, perhaps, in the curtailment of the trafficking in human beings for the purpose of organ removal. They serve as important sources of information for patients and may have access to information that can be used to gain a greater understanding of organ trafficking networks. However, well-established legal and ethical obligations owed to their patients can create challenging policy tensions that can make it difficult to implement policy action at the level of the physician/patient. In this article, we explore the role—and legal and ethical obligations—of physicians at 3 key stages of patient interaction: the information phase, the pretransplant phase, and the posttransplant phase. Although policy challenges remain, physicians can still play a vital role by, for example, providing patients with a frank disclosure of the relevant risks and harms associated with the illegal organ trade and an honest account of the physician’s own moral objections. They can also report colleagues involved in the illegal trade to an appropriate regulatory authority. Existing legal and ethical obligations likely prohibit physicians from reporting patients who have received an illegal organ. However, given the potential benefits that may accrue from the collection of more information about the illegal transactions, this is an area where legal reform should be considered.

Trafficking in human beings for the purpose of organ removal (THBOR) and human organ trade are universally condemned. However, despite efforts to curb and to elucidate the illegal nature of the practice, the buying and selling of organs continues, involving patients traveling to countries throughout the world. It has been estimated that approximately 10% of all transplants may occur illegally.

Before travel, patients will often—of necessity—discuss their plans with their home jurisdiction health care provider, usually a physician who is a transplant professional, a nurse, or a social worker. This interaction may include questions about the transplant process and the destination country and/or a request for relevant medical records and supporting documentation. In addition, returning patients will often re-engage with their home country physician for their required follow-up care.

Given this interaction, physicians and other health care professionals seem well placed to play a role in the monitoring and, perhaps, the reduction of organ trafficking practices. They serve as important sources of information for patients and may have access to information that can be used to gain a greater understanding of organ trafficking networks. However, well-established legal and ethical obligations owed to their patients can create challenging policy tensions that can make it difficult to implement policy action at the level of the physician/patient.

In this article, we outline the potential role of physicians during 3 key phases of the physician patient interaction. The first is the phase when the patient is investigating all the clinical options, including the possible purchase of an organ. The second phase is when the patient has made up his mind and has chosen to pursue the purchase of an illegal transplant. And the third phase is posttransplantation. Below, we briefly explore the legal and ethical tensions at each phase and offer recommendations on how best to negotiate the relevant professional norms. Although there are health care professionals involved throughout the organ trafficking process, the focus in this article is on the role of physicians with patients considering the illegal procurement of an organ. It should also be noted that although the focus of our analysis has been on ways to eliminate THBOR, this article considers illegal organ transplantation on a broader scale. This is because physicians may not be aware if THBOR is involved in their particular patients’ situation. As such, from the perspective of the relevant physician, and for the purposes of this article, the most salient issue is the decision by a patient to purchase an organ. Of course, addressing this broader issue also helps to address the critical issues associated with THBOR.

INFORMATION PHASE

Numerous studies have suggested that patients discuss their medical tourism plans with their physicians. This may include questions about transplant options and the appropriateness and safety of an organ trafficking procedure. At this phase, physicians should also be alert to patients who may be interested or tempted to buy an organ—even if not explicitly noted by the patient. Physicians should provide information to the patient about the ethical issues associated with illegal buying an organ and an honest assessment of the health risks, such as possible complications and a lack of clinical continuity. The physician should also consider discussing the dangers for the organ donor, particularly if there are signs that the patient is going to a country where donors are being paid poorly, treated badly, or even being killed for their organs. There are questions around whether the informed consent obligation—buttressed in some jurisdictions by fiduciary duties—creates an obligation to disclose to desperate patients the availability of organs “for sale.” However, given the risks associated with the practice and the clinical uncertainty involved and the fact that it is illegal in all countries (except Iran)—to say nothing of the social harms—this would seem to fall outside the traditional bounds of the disclosure obligation.

Although physicians likely do not, technically, owe a legal duty to the individual providing the organ, disclosure of the relevant ethical issues and social harms would seem to be something a reasonable person in the patient’s position would want to know and, as such, would fit with existing consent law. Moreover, as members of the medical community, all physicians have responsibilities to society and the health of others, as recognized in professional codes of ethics.

In addition, in some jurisdictions, physicians may have a responsibility to disclose their personal views, particularly if they conflict with a patient’s treatment decision. Such a conflict may impact the physician/patient dynamic and, as such, seems something that should be disclosed as part of a physician’s fiduciary and consent obligations.

Given this disclosure responsibility, there is a growing need to ensure relevant health care providers have the knowledge necessary to provide patients with the relevant information. Resources should be made available that provide clinicians with a concise summary of the facts and ethical concerns about organ trafficking most relevant to this phase of the physician/patient interaction.

PRETRANSPLANT STAGE

Once a patient has decided to purchase an organ, additional legal and ethical challenges emerge. In such situations, doctors must continue to act in the best interest of their patients, including performing appropriate investigations and prescribing medications that are necessary for current clinical management. Also, of course, the patient maintains all his/her legal rights. These rights are not eroded as a result of the patient’s “wrong” decision.

For example, in most jurisdictions, patients retain the right to access and obtain a copy of their medical record. This right is often supported by both legislation and case law. As such, if a patient requests a copy of his/her medical record, it must be provided (most jurisdictions allow for the charging of a reasonable fee) even if the physician knows the information will be used for the purchase of an organ. However, physicians have no obligation to take any actions that would facilitate an illegal transplant, such as providing a patient with a summary of the medical file or a letter for the surgeon that is going to perform the transplant. Nor are physicians obliged to do additional tests to facilitate transplantation. On the contrary, it seems appropriate for physicians to remind patients at this phase of the interaction of the continuity issues—such as a lack of access to records and medical information located at destination clinics—that may create clinical challenges for the patient.

In some jurisdictions, physicians may also have a professional obligation to report colleagues who are facilitating illegal transplantations to the appropriate regulatory authority, as required by professional regulatory bodies. This practice will help to reinforce professional practice norms that will clarify physician duties and, perhaps, reduce patient interest in accessing illegal organs, but more work is likely needed on the impact of physician advice in this context.

POSTTRANSPLANT STAGE

There seems to be a broad consensus that when a patient returns, physicians continue to owe a duty of care to their patients. This is particularly so in the context of emergent care. For example, returning patients may require a range of tests and screens, such as for pathogens. In nonemergent situations, individual physicians may elect to defer care to another physician, so long as that referral does not prejudice the health of the patient. Having accepted professional responsibility for a patient, the physician must continue to provide services until they are no longer required or wanted, or until arrangements have been made for another suitable physician to assume care of the patient. Punishing returning patients seems an inappropriate policy lever as unequal treatment—including unequal compensation—creates justice issues, and it seems unlikely to be effective at deterring trafficking practices.

More controversial is whether a physician can disclose to a third party, such as some specified authority, that a patient has purchased and returned with an illegally purchased/procured organ. Collecting data about trafficking and reporting trafficking is a common recommendation because it is hoped that would both slow the practice of organ trafficking and provide valuable information that would inform policy. Such disclosure might support the police and judiciary in investigating, disrupting, and prosecuting organ trafficking networks. Information might include the names of hospitals, clinics, cities, and/or hospital staff that are involved in illegal transplant activities.

However, in many jurisdictions, reporting a patient involved in trafficking—or even the existence of a trafficking network—would require a change in the law (ie, new legislation, an amendment to an existing law, or significant case law). This can be a complicated process. In some jurisdictions, it would require the coordination of numerous pieces of legislation (eg, in Canada, it would require each province to take action). Nevertheless, given the potential benefits of a reporting system, it seems appropriate to urge policymakers to explore the possible benefits of a framework that would allow the reporting of basic information. Ideally, this could be done in a manner that does not disclose the identity of the patient. A system that allows for a clear accounting of the magnitude of the transplantation problem will both assist our understanding of the phenomenon and help to generate the political will necessary to generate policy change.

To justify the development of a legal exception to physician obligations, evidence will be required to support the contention that the exception is needed and can achieve the desired result. As noted in other domains—such as in the area of mandatory reporting of gunshot wounds³⁰—without solid evidence, it may be difficult to justify the required change in the law, particularly given the strength of the norm of confidentiality, the fact that existing law often errs on the side of protecting confidentiality,³¹ and the limited breadth of the existing exceptions (eg, in many jurisdictions, they are limited to situations where there is an identifiable individual who may be in imminent harm.

CONCLUSIONS

Physicians are well placed to play a role in the mitigation of the illegal organ trade, including trafficking in human beings for the purpose of organ removal. They have unique access to patient information and are in a position to provide patients with critical information about the nature of the illegal trade. The legal and ethical obligations physicians owe to their patients create challenges that complicate this role and their potential influence. Also, of course, physicians are subject to all the relevant laws in the jurisdictions where they practice. Still, we feel several definitive statements can be made about how physicians should proceed.

Although the focus of this article is on the responsibilities of physicians to patients seeking illegal organs, there are, of course, many related issues that warrant further consideration, including the nature of the duties and responsibilities of physicians who deal with the victims of the organ trade. In addition, we encourage jurisdictions throughout the world to continue to support research into the nature and scope of the organ trafficking phenomenon. Such work is essential, as it will help to inform the development of needed regulatory frameworks. Finally, health professional bodies—such as the relevant regulatory entities for physicians and nurses—should provide guidance to their members on how best to proceed when a patient is involved with organ trafficking.

How Social Media and Crypto Help Organ Traffickers

Heart valves, skin, corneas, a middle ear: These are just some of the human organs that are being advertised for sale in clandestine social media groups, with potential buyers offered body parts of their choice in exchange for thousands of dollars in cryptocurrency, a Newsweek investigation reveals.

Newsweek has infiltrated groups on the social media platform Telegram, purporting to sell a range of organs from so-called donors in what is a lesser-known human trafficking trend that flouts federal law.

The illicit sale of organs takes place either through trafficking human beings for the intent of organ removal, wherein people are coerced or exploited and trafficked before donating organs, or through organ trafficking—the illegal handling of organs, which includes selling them or advertising an intent to buy or sell them.

According to a U.S. Department of State 2024 Trafficking in Persons Report, kidneys are the most commonly trafficked organ and victims of trafficking, mostly refugee men aged 30, according to the United Nations Office on Drugs and Crime (UNODC), are often told that their kidneys will grow back or that there will be no side effects to organ donation.

Meanwhile, the UNODC estimates there were around 700 victims of trafficking in persons for the purpose of organ removal between 2008 and 2022 but that the scale of the problem is not known and is likely to be much larger. In 2018, the World Health Organization (WHO) estimated that 10,000 kidneys are traded annually on the black market.

Cryptocurrency Fueling Sales of Human Organs — A Newsweek investigation found a darker underbelly of online organ sales proliferated by social media applications. **Photo-illustration by Newsweek/Getty**

Underground Network of Organ Sellers

One group Newsweek found called “kidney organ for sale USA” is a forum of people who claim to want to sell or buy organs, using the group as an intermediary.

Mel Luten, who runs the group and claims to be a doctor based in California, told Newsweek that he started his business a year ago to “help those who have been suffering from issues like heart failures or kidney failures.”

He said he’s recruited a team of 20 worldwide surgeons who take donations and oversee transplants from people who pay in cryptocurrency.

“We have a team of professional surgeons who remove and do the transplant in our clinic or overseas,” he told Newsweek over Telegram.

He said that he sold organs with “100 percent discreet packaging and safe shipping worldwide.” He owns machines that can keep organs fresh for a year.

He’s aware that his group is illegal, adding that “we do safe life’s [sic] on a daily basis.”

Screenshots sent to Newsweek by Luten appear to show crypto bank balances of $11 million and $5 million (USD) across two accounts. He provided messages he claimed were from donors and organ recipients he did business with.

Another group appearing to capitalize on this market, uncovered by Newsweek and aptly named “organs trafficking humanparts bodyparts for sale,” instructs interested punters to make payments in Bitcoin to receive organs from a menu boasting an array of options from lungs, priced at $10,800, to bone marrow for $1,500. The group has 1,044 subscribers.

Organ trafficking — A screenshot of an organ ‘menu’ found on a Telegram group. Newsweek investigation has revealed a social media group advertising human organs available to purchase with cryptocurrency payments. **Telegram**

A third group with 781 subscribers called “sell, buy kidney” describes itself as “the largest shopping center for kidney, liver, bone marrow.”

It requests payments via TRC20, cryptocurrency issued by the firm Tether.

A Tether spokesperson told Newsweek: “Unlike fiat, with Tether every action is online, every action is traceable, every asset can be seized, and every criminal can be caught. We work with law enforcement to do exactly that.”

A Telegram spokesperson told Newsweek: “Since its creation, Telegram has actively moderated harmful content on its platform. Telegram moderators use a combination of proactive monitoring of public parts of the platform and user reports in order to remove millions of pieces of content each day that breach Telegram’s terms of service.”

Newsweek also contacted the Department of Justice through their respective website forms to comment on this story.

The groups mentioned in this story were also contacted for comment, as were five other groups that Newsweek found on Telegram and multiple people who are members of these groups. No attempt at organ purchase was made to verify the veracity of these groups though it is illegal to advertise organs online in the U.S.

Black Market Centers on the ‘Desperate’

In the U.S., a person who transfers a human organ for use in human transplants may see five years in prison, a $50,000 fine or both.

Those risking incarceration may be buoyed by the potential of financial reward. According to a 2019 article in the American Journal of Biomedical Science & Research, kidneys are sold for $50,000 to $120,000.

A 2017 report by think tank Global Financial Integrity (GFI) estimated that the global illegal organ trade generates $840 million to $1.7 billion annually.

“I don’t know that anything has been done internationally,” GFI President and CEO Tom Cardamone told Newsweek. “It’s primarily an activity of people preying on the desperate—migrants, refugees from war zones. They have no sort of financial wherewithal at all. The most valuable thing they may possess is their organs. Some people get so desperate, they’re willing to sell them.”

He said it also depends on law enforcement agencies, which routinely focus on more pressing priorities like terrorism, narcotics and financial crimes “that are far more prevalent and far more lucrative.”

“When you have limited resources, you try to go at the most severe problems,” he said. “That’s not to say law enforcement is not concerned about this, no doubt they are. But it would take a heck of a lot of effort to try to infiltrate networks that might be involved in this type of trade activity. It comes down to a numbers game.”

A spokesperson for the National Kidney Foundation (U.S.) told Newsweek that there were 21,764 donors in 2023—that includes 15,471 deceased donors and 6,293 living donors. The average wait time for a kidney transplant is three to five years but can be as long as 10 years in some states.

Currently, about 90,000 people are waiting for a kidney transplant though tens or hundreds of thousands more who could potentially benefit from a transplant but never made it to the waitlist. Twelve people die each day waiting for such a transplant, equating to roughly 5,600 annual deaths according to research from the University of Pennsylvania’s Leonard Davis Institute of Health Economics.

Social Media, Dark Web Aid Illicit Networks

“I think proving organ trafficking is really tough as most of the time the victims are not willing to cooperate, and to tackle this problem we need to make organ trafficking illegal—which is much easier to investigate,” Silvia Tabusca, a Romanian organized crime expert and coordinator of the Human Security Program at the European Center for Legal Education and Research, told Newsweek.

The demand to purchase organs is accompanied by the demand to sell them.

One member of “kidney organ for sale USA,” who spoke to Newsweek under the condition of anonymity, said he wanted to sell his kidney because he needs money. “When you are dying due to hunger and lenders are threatening then everything is legal,” he said. He said lots of scammers who ask donors for a fee then block them. Newsweek was unable to verify his identity.

Jarrod Sadulski, an associate professor in the School of Security and Global Studies at American Military University and an expert in human trafficking, explained social media’s role in facilitating organ trafficking.

“Social media is the primary way that criminals offer illicit services. Yes, the Dark Web is used to sell organs, but social media is used to both seek out illicit organs that are being sold and to find buyers,” he told Newsweek.

“The problem is that similar to sex trafficking, organ traffickers use a complex way of communicating. They use emojis and terminology that is not detected by law enforcement or social media platforms themselves as organ harvesting. Both the type of emoji and color of the emoji have implications to organ harvesting.”

He cited the example of a red heart being used to indicate someone in need of a heart, while a blue heart can indicate someone selling that organ.

Ramesh Srinivasan, professor of information studies at UCLA and founder of the UC-wide Digital Cultures Lab, said nefarious online sales aren’t new or unique—referencing Dark Web sites like Silk Road that gained traction in the early 2010s and facilitated legal and illegal sales totaling 9,519,664 Bitcoins, according to court documents.

The speed and “greater disorientation” presented by a fast-moving digital world becoming only more convoluted will allow bad actors to proliferate, he added.

“Our online lives will be ones where scams will continue to grow in their importance as a real problem that we have to deal with,” Srinivasan told Newsweek. “And that’s because of the emergence of AI systems; the ability to deploy cryptocurrencies to facilitate different transactions. And, increasingly, that sense that we can’t really trust what we engage with online.

“As it becomes a place where we do commerce activity, where we do almost everything, it’s likely that scams will continue to be more and more prevalent.”

The Dark Side of Transplant Tourism: Inside the Illegal Organ Black Market

An organ black market thrives in certain regions based on skirted laws, bad actors and an unethical approach to broader organ transplantation—and law enforcement collaboration at the international level is the only way to curb it, experts have told Newsweek.

A Newsweek investigation previously uncovered a global marketplace trafficking organs through social media channels like Telegram and the Dark Web. Some of the traffickers operate openly in the public domain, facilitated by organ harvesting conducted through coercion or exploitation.

The United Nations Office on Drugs and Crime (UNODC) estimates there were around 700 victims trafficked for organ removal between 2008 and 2022. But numbers are difficult to parse based on in-person and online sales combined with “transplant tourism,” with the World Health Organization (WHO) estimating in 2018 that 10,000 kidneys—the most trafficked organ—are traded annually on the black market.

Transplant tourism refers to individuals who travel abroad to more easily obtain readily accessible organs for transplantation, either from poorer or desperate individuals who will sell body parts like kidneys, a lobe of the liver or a cornea in nations with fewer laws and regulations; or from wealthier, more developed nations with long waiting lists.

The role of governments

Francis Delmonico has been on the forefront of organ transplantation for more than 50 years, becoming an international figure in combating an illicit black market that exists in certain parts of the world.

He carries many titles: former surgeon at Harvard Medical School at Massachusetts General Hospital; past president of nongovernmental organization The Transplantation Society, which has a presence in over 100 nations; adviser on organ donation and transplantation to the WHO since 2006; and medical director of the New England Organ Bank since 1995.

Human Organs Investigation Part 2 — The international organ black market has dissipated in recent years but continues in certain parts of the world due to lack of regulations, complicit actors and desperate people. **Photo-illustration by Newsweek/Getty**

He has traveled to more than 70 countries, including China, Iran, Nepal, Sudan and Canada, to discourage trafficking while touting the proven surgical procedure of transplantation.

By 2005, Delmonico and colleagues discovered that trafficking accounted for approximately 10 percent of all annual kidney, liver and heart transplants. Black market transactions are still common today in the Indian subcontinent, Africa and the Middle East, Delmonico noted, aided by physicians from other countries who may travel to Egypt or elsewhere if deals are negotiated.

He and other international transplant experts called organ shortages “the root cause of organ trafficking and transplant tourism—practices that pose a severe risk to individual and public health and to the notion of national self-sufficiency.”

“Organs ought to be voluntarily given,” Delmonico told Newsweek. “A living donor should not be compensated financially as a motivation for organ donation. And similarly, a deceased donation should be a volunteer situation because otherwise it becomes a market.”

Delmonico has visited cities like the Philippine capital Manila, where he said family donations are rare and organs are routinely purchased.

He and other medical experts have successfully corresponded with Pope Francis and the Vatican “to address [the] crime against humanity that is organ trafficking.” They warned in 2023 that India “is poised to be a major force in global organ transplantation as the burden of kidney failure exponentially increases in this region.”

National embassies are involved too, Delmonico added, like those in Nepal and surrounding nations that will send organ donors to India where organ “payoffs” lead to “big business” for sellers and physicians. Other aspects at play aside from legal tender include provided visas as part of predetermined agreements.

A September 2022 research paper published by Nepalese medical practitioners noted that while “stringent laws” are in place to regulate national human body organ transplantation, it warns of “a racket of human traffickers who lure rural people from this low-income country into the illegal organ trade” that is benefited from a lack of general public awareness.

The South Asian country is home to what is described as “Kidney Valley,” a region where nationals will sell organs due to financial desperation.

The U.S. embassy in Nepal did not respond to request for comment.

“If you were to ultimately see the people that have been victimized, I think you would have a sense of just human nature to say, abusing someone for their kidneys is not something that I wish to be involved with or foster,” Delmonico said. “And that’s just a common human person. You don’t want to see somebody exploited for their kidneys that could expose them to hazard, where you could die.”

“Transplantation is a very noble act,” Delmonico added. “My having been in this for 50 years has been demanding but a rewarding career saving lives, fixing people by giving them a new organ. That nobility is something that has been energy for me to be in all the places I’ve been.”

In China, doctors and officials were making large profits by selling organs from executed prisoners—with some hospitals even advertising heart transplants for prices in the six figures. In 2005, Delmonico made inroads with China when he received a call from Jiefu Huang, China’s former vice-minister of health.

In 2007, Chinese officials passed law-based regulations on organ transplantation that led to “arduous reform,” according to Huang, resulting in “remarkable achievements.” Delmonico said the Chinese have made positive strides to drastically reduce illicit sales.

Newsweek reached out to Chinese officials for comment.

Human trafficking and open advertising

Christina Bain, a human trafficking expert who formerly initiatives at Babson College and Harvard University, began associating organ transplantation with human trafficking about a decade ago.

“It’s all one to me because you can’t have the organ without the human, the organ. The organ can travel. But you still have to have the human, and the human is still in that moment exploited, which is the definition of human trafficking,” Bain told Newsweek.

Dark Web organ listing — An example of a listing on a Dark Web site of an individual purportedly looking to get into human trafficking for the purpose of harvesting organs. **Michael Falls, ATII**

Unlawful or unethical transplantation is aided by an inconsistently regulated online world, said Michael Falls, a data collection and technology manager at the Anti-Human Trafficking Intelligence Initiative.

He provided Newsweek with multiple examples of organ sales being advertised on both the Dark and Clear Web, the latter being what is accessible to the general public.

Sites on the Clear Web are blatantly publicizing organ sales for tens of thousands of dollars seemingly without any repercussions from online platforms, with names that sound fabricated—such as organ-city.com and realhumanbodypartsforsale.com.

Newsweek reached out to both websites for comment.

Another website called activescienceparts.com, based out of Mary Esther, Florida, currently lists human lungs, hearts, kidneys and livers on sale for $40,000, $85,000, $70,000 and $50,000, respectively.

On the website, Active Science Parts International, Inc. says it is “committed to providing legally and ethically obtained” natural and replica specimens for professional, medical and educational communities.

The kidney presently available is for sale “from the most reliable medical experts in the world,” according to a website description.

The company did not respond to Newsweek‘s repeated attempts for comment.

“You can almost trace it back to the beginning of Bitcoin,” Falls said. “It’s just like AI now; they started using AI for a bad purpose. It’s kind of the same way with any new technology: [illicit actors] jump right on it because they know there’s bound to be less regulation.”

Cutting out the middleman

More international partnership took hold in 2008 with the Declaration of Istanbul (DOI), created to further influence government compliance. The main sponsors are The Transplantation Society and the International Society of Nephrology.

Thomas Müller, a nephrologist—or kidney specialist—in Zurich, Switzerland, is co-chair of the Mission of the Declaration of Istanbul Custodian Group (DICG), which promotes traditional transplantation methods and ethics while combating organ trafficking, transplant tourism and transplant commercialism. Nearly 80 countries are involved.

“Just working with one country will not really work,” Müller told Newsweek. “It has to work in collaboration, to see where the donors coming from, where the recipient is coming from. You have these hotspots that we had in previous times, but they are now enlarged.

“So, it’s not one country or two countries, it’s neighboring countries. Now, you can have places where there’s quite a big group of cases where the donor comes from a different region, the recipient comes from a different region, the organization is located in another region. And then the surgeon as well as the nephrologist comes again from another region, and they do it in another country.”

He said one focus was in Eldoret, Kenya, where DOI saw donors come from former Soviet Union republics like Tajikistan or Azerbaijan or from wealthier Western countries. Surgeons and nephrologists, meanwhile, traveled to Eldoret from India and operated at a private hospital.

“[Kenyan officials] were not aware about the extent of it,” Müller said. “But there was really a building up of trust. We were invited to speak more directly about it. And they were really embarrassed, the Kenyan colleagues, and they asked us to help them so we wrote a letter to the health ministry…and then slowly they acted on this hospital in Eldoret.

“But it’s a very long process, and it did not stop the whole thing. We heard that it’s kind of starting again. It’s profitable for the hospitals. It’s not just the physician but it really brings the revenue in for the hospital.”

India’s Ministry of External Affairs referred Newsweek to the country’s Transplantation of Human Organs and Tissues Rules enacted in 2014, which includes rules and laws individuals and entities should follow. India’s National Organ & Tissue Transplant Organization also posts updates about its activities “for proper regulation of organ transplantation in India, including prevention of any associated illegal activities.”

They did not reply to Newsweek‘s question on whether national laws have been broken in the black market.

Research published in 2023 in Kidney International Reports by U.S. transplantation surgeon Ronald Parsons and Indian doctor Priyadarshini John warned that a global uptick in chronic illness has made people look for wider options.

“Not surprisingly, patients continue to explore any means necessary, often outside their country or continent, to achieve access to kidney transplantation which has led to a growth in ‘transplant tourism,’” the report reads.

Müller and colleagues are traveling back to Kenya in October after identifying physicians performing unethical transplants.

“I’m very optimistic that we can interfere there quite effectively, but I’m realistic enough to know that it’s then moving to another hospital,” Müller said, adding that the middleman in these scenarios is often the hardest to track.

Organ trafficking: ‘Her heart was missing’

Trafficking accounts for up to ten per cent of transplants globally, but health advocates are fighting back.

The World Health Organisation (WHO) estimated in 2007 that organ trafficking accounts for between five and 10 per cent of kidney transplants performed annually across the globe.

Antonio Medina, 23, a paperless Central American migrant moving through Mexico to the US, says he knows a fellow traveller who witnessed organ trafficking, after he and his wife were captured by a criminal gang.

“He was travelling with his wife and they [gangsters] took both of them,” Medina told Al Jazeera during an interview in Mexico. “They [gangsters] put them in separate rooms. He heard his wife screaming. After he went in and saw her on a table with her chest wide open and without her heart or kidney.”

Medina’s friend said he was saved from the grisly house-turned-clinic by Mexican soldiers. The claims, like many aspects of the organ trafficking business, are impossible to independently verify.

The profit motive

“I have no doubt organs are being removed from bodies,” says David Shirk, a professor of political science and director of the Trans-Border Institute at the University of San Diego who has investigated trafficking. “But for the most part, organ trafficking occurs in hospitals, where there are corrupt medical practitioners.”

“Maybe people are cutting organs out as a form of torture – a great way to torture someone would be to tie them to a chair and pull their guts out in front of their eyes – but it is not credible to me that bodies are being used for transplants, as the procedure requires very sanitary conditions and careful donor matching,” he told Al Jazeera.

The World Health Organisation (WHO) defines organ trafficking as commercial transplantation, where there is profit, or transplantations occurring outside of national medical systems. Direct organ theft, including the case Medina described, represents only a small portion of global trafficking.

“There are criminal underground organisations providing kidney transplantations,” says Luc Noel, coordinator of essential health technologies at the WHO. “But most cases involve the poor, the destitute and the vulnerable that are willing to part with an organ for money.”

“The common denominator [with theft and “consensual” sales] is profiteering,” he told Al Jazeera.

Poor people can reportedly earn between $3,000 to $15,000 for selling their organs, specifically kidneys, to middlemen who re-sell them to wealthy buyers for as much as $200,000

In a 2009 report on organ trafficking, the Council of Europe and the United Nations concluded that there was possibly “a high number of unreported cases”, attributing this to the “huge profits and rather low risks for the perpetrators”.

Mexico is not considered one of the worst countries for organ trafficking; the grisly practice is thought to be most prevalent in Israel, India, China, Pakistan, Turkey, Brazil, Nepal, the Philippines, Kosovo, Iran, and former Soviet states in eastern Europe.

“Transplant tourisms flourishes in areas with weak authorities,” says Noel from the WHO. “We do not want to see a society where the destitute become a store of organs for the wealthy and powerful.”

Online buyers

Customers normally come from the US, Western Europe, the Arab Gulf states, Israel and wealthy enclaves in the developing world. “The patients are also vulnerable and often extremely sick,” Noel says. “The solution is that each community should address its needs in organs. Public authorities need to increase awareness on the benefits of [volunteering] for transplants.”

Most people are coerced into selling their organs through a combination of misinformation and poverty, says Debra Budiani, a visiting scholar at the University of Pennsylvania’s Centre for Bioethics.

So, how does one go about buying an illicit organ? It’s a bit more complicated than walking to a shady part of town and haggling with a guy carrying wads of kidneys in his trench coat.

“The procedure for American patients is to go online and look for these services,” Budiani told Al Jazeera. “This has been the framework for transplant tourism.”

China has been particularly sophisticated in using the internet to attract transplant tourists, she says. The nominally communist country has one of the world’s highest execution rates, and dead convicts provide a ready supply of healthy young organs.

Once patients arrive in China and the deal is set up, organisers will often force them to compete for the organs in intense bidding wars, Budiani says. “They will get into a situation in the hospital where they are waiting to see who will get the first organ from an executed prisoner,” and the highest bidder gets first pick, even though prices are normally negotiated before foreigners arrive in China.

“There is a lot of dirty business around these operations,” she says. “And it started with a lot of coordination on the internet.”

In a posting on a free announcements website in Tuxla Gutierrez, the capital of economically marginalised Chiapas state in southern Mexico, a user offers to pay $25,000 for an organ and promises to be “absolutely discrete and serious” with whoever responds to the add. The user leaves an e-mail address and says that the operation will be done in Houston, Texas. The proposed transaction is illegal, Budiani says.

New organising tools

In addition to her academic work at the University of Pennsylvania, Budiani directs the Coalition for Organ-Failure Solutions, a grassroots advocacy group.

The coalition is planning a trafficking hotline, to take calls from victims, so they can be linked to doctors and the appropriate authorities.”We are establishing a virtual social network, with mobile phones as the common denominator,” Budiani says. “Even if they are illiterate, they still have access to mobile phones.”

A prototype of the plan will be tested in Egypt and India in the coming months. The hotline could also act as a resource for understanding the sources of this kind of crime, she says, adding that Egypt’s recent revolution, and the political instability it has caused, creates a “vulnerable period where human trafficking could thrive”.

Back in Mexico, Antonio Medina says his friend whose wife had her organs stolen just wants to forget the whole experience. “We keep in touch by email, he is back in Honduras.”

As seems standard with trafficking victims, they fall back into the shadows, often irreparably physically and emotionally scarred, isolated and alone.

“Migrants are highly vulnerable to various forms of exploitation,” says David Shirk. And that reality extends across the globe, from refugees of Sudan’s internal conflicts facing organ trafficking in Egypt to Moldovans and Kazakhs who have had their kidneys illicitly removed in Kosovo.

Debra Budiani hopes the proposed anti-trafficking hotline will help prevent abuses, while providing solace to those who are missing organs, facing shame and sickness.

“We want to allow people to mobilise and share resources on how they have been abused,” she says, “to put them in touch with other victims so they aren’t so isolated.”

A Criminological Perspective: Why Prohibition of Organ Trade Is Not Effective and How the Declaration of Istanbul Can Move Forward

The Declaration of Istanbul is the first document that has been established by the international transplant community that defines and prohibits transplant commercialism and organ trafficking. Its Custodian Group has successfully led various countries to implement legislation against trafficking and commercialism. The question arises, however, whether efforts to prohibit organ trade are realistic and effective. The Declaration differentiates trafficking from commercialism, yet it does not mention how both acts should be approached by policy. Policies that address transplant commercialism work differently from policies that tackle organ trafficking. There is considerable room for improvement in the current prohibitive approach to commercialism and organ trafficking. The Custodian Group and World Health Organization (WHO) should address commercialism by encouraging the expansion of living donation in the same manner as they encourage deceased donation. Furthermore, the Custodian Group and the WHO can improve their strategy to combat organ trafficking by raising awareness for enforcement. To achieve a consistent and effective prohibition of trafficking, legislation and law enforcement must go hand in hand. Ideally, this can best be achieved by close collaboration between the medical field and (international) criminal justice agencies.

Introduction

The Declaration of Istanbul on organ trafficking and transplant tourism (hereafter Declaration) is the first document, drawn up by the international transplant community that defines and condemns transplant commercialism, organ trafficking and transplant tourism. Its primary aim is to inform, inspire and promote ethical practices in organ donation and transplantation around the world. Building on the Universal Declaration of Human Rights and World Health Assembly Resolution 57.18, it aspires to achieve this aim by endorsing prohibition of transplant commercialism, tourism and trafficking of organs and penalization of those that aid or encourage it. The Declaration’s custodian group and four task forces have been established to implement and monitor its effects.

The Declaration, by nature nonbinding, has proven to have significant influence. Over 100 transplant organizations endorse its principles. Countries including China, Israel, the Philippines and Pakistan have passed new legislation or strengthened existing laws that ban organ trafficking and organ sales.

This acclaimed success is for a large part because of the World Health Organization (WHO) and its Guiding Principles on human cell, tissue and organ transplantation; hereafter Guiding Principles). Whereas the Declaration is intended to influence transplant professionals and societies, the WHO intends to influence governments. Both act in concert to address growing problems of transplant commercialism, transplant tourism and trafficking by strict prohibition and penalization.

The prohibitionist discourse in the Guiding Principles and Declaration, however, has a predominant focus on prohibition (through legislation) of commercialism and trafficking, but the importance of enforcement of the crime is neglected. Furthermore, there is a discomforting lack of criminological and legal expertise about what exactly we are trying to prevent by prohibition. Commercialism and trafficking are presented as being equally problematic crimes. However, coercion and exploitation of donors (trafficking) differs from the sale and purchase of organs (commercialism). Both acts warrant a different policy approach. The Declaration’s Custodian Group and the WHO, in their discourse on prohibition, do not take account of this distinction. They can improve their strategy to prevent and deter commercialism and trafficking in a number of ways. In the following paragraphs we explain why and how.

Why Organ Trade Is Prohibited

The WHO first declared the prohibition of organ trade in 1987, affirming that such trade is inconsistent with the most basic human values and contravenes the Universal Declaration of Human Rights. The WHO Guiding Principles state the reason why organ sales are prohibited. The commentary to principle five states: “Payment for […] organs is likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation and leads to profiteering and human trafficking. Such payment conveys the idea that some persons lack dignity, that they are mere objects to be used by others.”

The organ trade prohibition must be seen in context of when it was formed: at a time when there was no shortage of organs and organ trade and trafficking offences barely occurred. Back then, the prohibition was successful in its aim to prevent trade and trafficking, simply because the root cause of the crime (organ shortage) was not as rampant as it is now. The prohibition worked, not only as a preventative mechanism, but also as a universal norm that organs were not to be used commercially. Almost every single country endorses the noncommerciality principle in organ transplantation and has implemented it into their national laws.

Since the 1990s, however, transplantation has become a victim of its own success, with demand for organs far outpacing their supply. Organs have become more valuable and profitable to sell. This leads to black markets that involve various actors who increasingly make use of organs’ high profitability.

The Global, Illicit Flow in Organs

Together with drugs, humans, arms, diamonds, gold and oil, organs are becoming the subject of an illegal multibillion-dollar industry. A recent report by Global Financial Integrity estimates that the illicit organ trade generates illegal profits between $600 million and $1.2 billion per year. It ranks the trade in human organs on number 10 of the illegal activities studied in terms of illegal profits made. The report further states that profits from these illicit markets are making their way to transnational crime syndicates through vast international trade networks. These networks take advantage of globalization and new communication and transportation technologies. Key to the growth and success of global criminal networks is their flexibility and versatility, which have expanded their activities to a wide diversity of legal and illegal fields. Many of these networks are successfully integrated in legal structures and institutions.

Indeed, an increasing number of organ trafficking rings are globally active that involve actors who operate in different countries from where recipients and donors are recruited. Organ trafficking accounts come from all over the world, including Egypt, India, South Africa, the Philippines, Israel, Colombia, the Balkan Region, Turkey and Eastern Europe. A growing number of countries, including the United States, the United Kingdom, Macedonia and Canada report on patients leaving to well-known organ exporting countries who allegedly buy organs on the black market.

Only in very few cases have crime control efforts led to accusations by victims and prosecutions of the accused. Indeed, organ trafficking may be one of the most difficult crimes to detect. Moreover, its enforcement is not a priority of local, national and international law enforcement institutions. The universal response to the crime is characterized by punitive condemnation through legislation but awareness and expertise on how to detect and enforce the crime is practically nonexistent.

Prohibition of Demand-Driven Crimes May Herald Significant Risks

Prohibition of demand-driven crimes is not new to the field of criminology. For centuries, countries have been struggling to control criminalized, demand-driven activities often with limited effect. Disregarding evidence that crime does not readily respond to severe sentencing, legislatures have over the years repeatedly adopted a punitive “law and order” stance. David Garland describes this ambivalent response as a form of acting out, which is to say that legislatures engage in a form of impulsive and unreflective action, avoiding realistic recognition of underlying problems. The reasons behind these repressive policies are often political: they are motivated by politically urgent needs to “do something” decisive about crime, restore public confidence, illustrate good intention and demonstrate state control. These policies are seldom evidence-based, are not aimed at removing the root cause of crimes and do not acknowledge the risks that may arise.

A wealth of studies illustrates the resilience of demand-driven activities such as drug use, gambling, alcohol consumption and prostitution to prohibition. These studies also highlight how harms associated with these demand-driven crimes including violence, disorder and corruption are, in fact, caused by their prohibition. These studies show how prohibition generates black markets, drives up prices, provides illegal incomes, displaces crime to other regions and drives trade underground leading to higher crime rates and victimization. One illustration is the “war on drugs”. A recent report by the International Centre for Science in Drug Policy argues that enforced drug control in the United State led to unintended, harmful consequences. Efforts in the United State to suppress the sale and use of cannabis have substantially increased in the last years. The costs for stronger enforcement rose from $1.5 billion in 1981 to more than $18 billion in 2002. The report’s authors claim that despite increased repression rates of violence, organized crime, the availability of illegal cannabis and the number of users substantially increased. These conclusions on the failures of the system are in line with reviews of evidence from a global perspective. The authors advise alternatives to prohibition, such as decriminalization and regulation. Indeed, evaluation of more liberal drug and prostitutions policies involving a harm-reduction approach in countries such as the Netherlands have shown that the social harms within regulated markets are lower than in prohibited markets.

Despite substantial differences in nature between demand-driven crimes including the organ trade, drug trade and prostitution, the ways in which most states attempt to control them are similar. Unintended implications that may arise from prohibition of crimes such as the drug trade may be equally relevant and applicable to organ trade. First, prohibition of organ trade and drug trade has the similar effect of making them more worth and, thus, more profitable. Second, arguments often made in favor of regulating the drug and organ trade share the view that legalization is likely to reduce social harms inflicted upon vulnerable groups.

We believe that the risks known to arise despite or as a result of prohibition of demand-driven crimes should be taken seriously. The evidence that organ trade occurs despite its prohibition warrants a careful, critical and realistic approach by the WHO, the Custodian Group and others who prohibit or encourage its criminalization.

The WHO and Declaration in our view take little account of the possible implications that prohibition of organ trade may herald. Their response to organ trade and trafficking has little to no recognition for the limits of crime control and limited acceptance of exploring alternative polices that possibly herald less harmful effects. Rather, their belief seems to be that prohibition will take away the problem and decrease illegal activity. The passing of legislation against organ trade and trafficking is proudly announced and expected to be followed by successful tackling of the problem. Such announcements, in our opinion, are potentially misleading. One example of ineffective prohibition occurs in Pakistan that as a result of the Declaration lobby, passed an ordinance in 2008 prohibiting foreign patients from purchasing transplants there. Despite the initial hope that the ordinance would prevail, a recent Pakistani newspaper article admits how despite the new law, Pakistan is being “sucked back into the vortex of kidney trade and transplant tourism.”

The WHO and Custodian Group should, thus, take measures to prevent the current prohibitionist strategy of organ trade from becoming ineffective and symbolic. This does not mean that they should let go of prohibition altogether. It is almost impossible to evaluate whether or to what extent these risks are a direct consequence of prohibition. The question can be equally posed, “What the effect of decriminalization or regulation would be on the nature and number of demand-driven trade?”. We argue rather that between prohibition and decriminalization, a wide range of alternatives exists that can be addressed to control organ trade more effectively. The point is not to choose one over the other, but to think critically and be realistic with what we can achieve and with what means. Later, we present a number of ways in which the current prohibitionist strategy of organ trade can be improved.

What Works and the Way Forward for the Declaration of Istanbul

To assess what works, we need to get our definitions straight. Organ trade takes on a wide variety of forms: only after we agree on the definition of commercialism and trafficking and on what we find condemnable, can we agree on their prohibition. Putting a price on organs (commercialism) is different from coercing someone into selling one (trafficking).

The Declaration correctly defines and differentiates trafficking from commercialism, yet it does not mention how both acts should be approached by policy. Its principles in our opinion wrongly conflate organ trafficking and transplant commercialism to constitute one and the same problem that both warrant equally repressive and punitive responses. However, policies aimed to suppress or reshape an illegal trade or market work differently from policies addressing coercion and other harms associated with trafficking. Evaluative studies have shown that criminalization of commercialism is likely to reinforce trafficking. Indeed, it has been argued that “there is much more scope for exploitation and abuse when a supply of desperately wanted goods is made illegal.” We, therefore, claim that the Declaration should clearly differentiate between policies needed to address commercialism and those needed to address trafficking.

First of all, to tackle and prevent organ trade, the root cause of the problem (organ scarcity) should be addressed. This ultimately means boosting organ supply. One such strategy that the Declaration already strongly supports is to help governments implement deceased donation programs to increase deceased donation rates and achieve self-sufficiency. Such initiatives are being conducted in the Balkans and Black Sea region with the support of the Custodian Group, the WHO and European Union. Yet promotion of deceased donation alone is not enough to fill the gap between demand and supply of organs.

The WHO and Custodian Group should therefore, secondly, also encourage expansion of living donation in the same manner as they encourage deceased donation. They should do so by explicitly stating the need to promote living donation in the text of the Declaration and Guiding Principles. The Custodian Group and WHO should, furthermore, encourage governments to remove restrictions regarding living unrelated or anonymous donation to make alternative living donation programs possible. Such programs should be implemented in consistence with international standards to ensure quality and safety of donors and recipients. Current restrictions to unrelated donation are based on the belief that living unrelated donation induces trade. However, there is no evidence of illegal trade in countries with well-organized systems allowing for high numbers of living unrelated donation such as in the United States, the Netherlands, Norway and the United Kingdom.

A final example is to support regulated trials of incentives for donation. This asks for a more liberal approach by both the WHO and the Declaration towards commercialism. In our opinion, there is no validation for the Declaration’s and WHO’s premise that commercialism should be banned because it leads to profiteering and trafficking. Trafficking will occur as long as scarcity exists, with or without prohibition. A more realistic approach would, hence, be the implementation of harm-reduction policies as witnessed in drug and prostitution regimes. Incentives for donation may, perhaps, be promising examples of a harm-reduction approach. The Declaration should provide scope for governments to explore ways to increase donation through incentives. Ultimately, this indeed will entail decriminalization of organ purchase and sales.

The Declaration and the WHO can also improve their strategy to combat organ trafficking. There is no doubt that organ trafficking is and should remain prohibited universally. The text of the Declaration already emphasizes the prohibition and penalization of acts including brokering and other (medical) practices that aid or encourage trafficking. Indeed, organ trafficking cannot occur without the involvement of medical staff. A recent organ trafficking network uncovered in South Africa illustrates the criminal involvement of medical staff, including nephrologists, surgeons and administrative staff who were found guilty of performing over 100 illegal kidney transplants and receiving payments for them. This case also demonstrates the immense investment that is needed to eventually bring perpetrators to justice. It took investigators 7 years to succeed in gathering enough evidence to bring the case to court. However, dedicated investigations and efforts to identify collusion in hospitals and other criminal activities, in short, the enforcement and police intelligence necessary to bring such cases to court, do not exist in other countries. Organ trafficking case law is practically nonexistent. Prohibition of organ trafficking largely remains a paper exercise. Strict, legislative prohibitionist efforts, no matter how sophisticated, are fruitless if they are not accompanied by enforcement by local, national and international policing agencies.

To achieve a consistent and effective prohibition of trafficking, legislation and law enforcement must go hand in hand. Enforcement strategies include: prioritization and awareness raising of the crime at the local level both with police and judicial authorities, training of police investigators regarding evidence gathering, recognition of organ trafficking activity and know-how about the modus operandi of the actors involved, training of prosecutors and judges and establishment of bilateral and/or multilateral cooperation in cross-border criminal procedures. Ideally, such considerations are best followed when close collaboration between the medical field and (international) criminal justice agencies is achieved.

Perhaps, the greatest achievement for the WHO and Declaration of Istanbul will, thus, lie in bridging the gap between the medical field and the criminal justice realm. These efforts could, for instance, be aimed by lobbying with governments and international organizations such as INTERPOL, UNODC and EUROPOL to raise awareness about the crime. Indeed, the Declaration and the WHO are not law enforcers, but both bodies may be the most influential forces to stimulate governments into addressing enforcement strategies at the local level. Yet, it must be kept in mind that enforcement is no guarantee that trafficking will stop. The root cause of the crime cannot be removed by strict, top down penal measures. Black market transactions will exist as long as organ scarcity exists. At the very least, successful enforcement might help to disrupt some tip-of-the-iceberg organ trafficking networks, but it will not fundamentally affect the crime.

The organ trade problem will persist and worsen unless the Custodian Group, the WHO and policymakers understand the limitations of prohibition and tackle the root cause of the crime by promoting both deceased and living donation.

Why Are Indonesians Illegally Selling Their Kidneys?

Jakarta’s recent breaking of an organ trafficking ring has cast a light on a grim regional trade.

How does someone come to sell a kidney?

In Indonesia, the answer to that question can be complex.

The thorny issue of organ donation has once again come to the fore as a result of a case involving police and immigration officers accused of working with human traffickers to send as many as 122 Indonesian nationals to Cambodia, where their kidneys were harvested for sale.

The case, which first hit the news in July, has now resulted in some 12 people being arrested in an effort to break a large transnational human trafficking syndicate. The victims apparently included teachers, factory workers, executives, and security guards, who all allegedly agreed to sell their kidneys in exchange for cash.

As Hengki Haryadi, the Jakarta police director for general crimes, put it, “Most of the victims lost their jobs during the pandemic and they agreed to sell their organs because they needed money.”

Damai Pakpahan, a feminist activist based in Yogyakarta, told The Diplomat that human trafficking occurs in Indonesia due to a multitude of factors that include lack of state intervention coupled with economic and educational challenges.

“Due to a shortage of work opportunities and poverty, people just believe online information or have low literacy,” making them vulnerable to scams, she said. “The government is not doing its mandate to protect the people and there are failed bureaucratic reforms, bribes and corruption that add to the problem.”

In a surprising twist to the tale, some nine of the suspects in the recent trafficking scandal were themselves former organ trade victims. In turn, they allegedly worked as recruiters and engaged social media to lure victims to travel to Cambodia where their organs were harvested at Preah Ket Mealea Hospital in the country’s capital Phnom Penh, and then transplanted.

According to Haryadi, the transnational trafficking group had been in operation since 2019 and had netted some $1.6 billion over the years, with each victim promised just $9,000 for a kidney.

One of the accused was a police officer from Bekasi, in addition to an immigration officer in Bali and 10 other traffickers, three of whom were operating in Cambodia. The police said that the immigration officer in Bali was a key component to the scheme, falsifying travel documents for the victims and receiving $200 per victim.

Paid organ donation has been prohibited by the World Health Organization (WHO) since 1987 and many countries around the world, including Indonesia, have local regulations that outlaw the sale of organs. Voluntary organ donation is legal in Indonesia for those over 18 years old who have permission from doctors and family members to make such a donation.

However, according to the WHO, some 5 percent of all transplants worldwide are illegal, with the live donation of kidneys listed as the most common form of illegal organ trade.

“Human trafficking networks that ensnare victims from among the poor by persuading them to sell their vital organs are rife in Indonesia. As an example, we have this network offering money by selling organs taken in hospitals not in Indonesia but in Cambodia,” said Gabriel Goa, the chairman of the non-governmental organization, the Advocacy Services for Justice and Peace in Indonesia (PADMA).

“Another modus operandi is that young Indonesians are lured to work abroad with very tempting salary offers. But the fact is that the promised ticket money, passport money and others turn out to be debts that need to be paid off. If the victims don’t reach their targets, their vital organs are sold instead,” he added.

“We have seen so many of these kinds of online scams that send Indonesians to the Philippines, Cambodia and Myanmar. This is an extraordinary type of crime across Southeast Asia.”

According to the United Nations Office on Drugs and Crime (UNODC), Indonesia’s geographical location and border weaknesses “exacerbate the country’s vulnerability to trafficking in person, drugs and natural resources, as well as smuggling of migrants.”

Indonesia is a major source country for trafficking in persons, the UNODC states, and “most victims are primarily trafficked for forced labour and debt bondage in other Asian and Middle East countries.”

One of the issues with human trafficking is that it can be a laborious crime to prosecute due to the transnational nature of the offense.

Wahyu Susilo, the executive director of Migrant CARE, the Indonesian Association for Migrant Workers Sovereignty, told The Diplomat that one of the problems with organ harvesting is that it is not just a transnational crime but “a transnational crime that preys on the ignorance of its victims.”

“These victims who sell their organs due to ignorance can also sometimes face criminal sanctions as a result of their actions,” he said.

He added that the line between legal donation and the illegal sale of organs can sometimes be blurred due to a lack of clear legislation on the issues.

Indonesia is a signatory of the Palermo Convention, or the United Nations Convention Against Transnational Organized Crime, a multilateral treaty from 2000 meant to tackle transnational organized crime, which the country signed into its own law in 2009. It is also a signatory to the ASEAN Convention Against Trafficking in Persons, Especially Women and Children, a regional, legally binding agreement between ASEAN states signed in 2015.

“However, we have seen a lack of effort on the part of law enforcement to implement these laws,” Susilo said of the legislation.

The suspects in the Indonesian case have been charged with human trafficking, which carries a maximum sentence of 15 years in prison and a potential $39,000 fine, while the immigration and police officers are facing additional charges relating to abuse of power and obstruction of justice.

Yet Goa of PADMA said that countries in the region need to do more and “unite to catch and suppress these transnational networks.”

“Heads of state and the police of Southeast Asian countries should immediately form a dedicated task force for the prevention and eradication of Southeast Asian human trafficking,” he said.

Indonesian police crack down on traffickers who sent 122 people to sell their kidneys in Cambodia

Indonesian police are investigating the illegal trade of human organs involving police and immigration officers who were accused of helping traffickers send 122 Indonesians to a hospital in Cambodia to sell their kidneys, police said Tuesday.

Indonesian authorities arrested 12 people, including a police officer and an immigration officer, on July 19, and police will continue to crack down on human smuggling syndicates conducting the illegal trade of human organs, said Hengki Haryadi, the Jakarta police director for general crimes.

He said all 122 victims, including factory workers, teachers and executives, had returned to Indonesia, and police were still searching a number of other victims whose testimony would be required by investigators.

“Most of the victims lost their jobs during the pandemic and they agreed to sell their organs because they needed money,” Haryadi said, adding that six of the victims are still under observation of doctors.

Nine of the suspects were former organ trade victims who were accused of luring people from across Indonesia through social media into having their kidneys removed in Cambodia, Haryadi said. A 10th suspect was accused of sending them to Preah Ket Mealea Hospital in Cambodia’s capital, Phnom Penh, for kidney transplant surgery.

He said the turnover of the illegal trade in human organs since 2019 by the group of suspects totaled about 24.4 billion rupiah ($1.6 million), while each victim was promised 135 million rupiah ($9,000) .

A low-ranking police officer in Bekasi, an immigration officer in Bali and 10 traffickers, three of whom were arrested in Cambodia, are part of a human trafficking ring that prey on vulnerable job seekers, Haryadi said.

The immigration officer from Bali was accused of abusing his power and falsifying documents for victims to travel overseas and received at least 3 million rupiah ($200) for each person he smuggled to Cambodia.

The suspects were charged with violating Indonesia’s human trafficking law and face a maximum 15 years in prison and a fine of up to 600 million rupiah ($39,000).

The police officer from Bekasi city police, identified only with the initial M., allegedly received 612 million rupiah ($40,000) for helping the traffickers move from place to place to avoid police investigation, and he is also accused of obstructing the investigation. Under the 2007 Human Trafficking Law, the two officers face penalties of up to five years in prison if found guilty.

Police paraded the 12 suspects at a news conference on July 20.

“There have been kidney trafficking transactions at the Cambodia’s state-run Preah Ket Mealea Hospital,” said Krishna Murti, the National Police head of international relations division. “We have been communicating and closely cooperating with the Cambodian police.”

The World Health Organization first prohibited payments for organs in 1987 and many countries subsequently codified the prohibition into their national laws. WHO estimated in 2008 that 5% of all transplants performed worldwide were illegal, and living donor kidneys is the most commonly reported form of organ trade.

Aside illegal trade in human organs, cybercrime, human trafficking and labor abuse still abounds in Southeast Asia. Most recently, authorities in the Philippines staged a major raid last month and rescued more than 2,700 workers from China, the Philippines, Vietnam, Indonesia and more than a dozen other countries who were allegedly swindled into working for fraudulent online gaming sites and other cybercrime groups.

The leaders of Association of Southeast Asia Nations in a summit at Indonesia’s Labuan Bajo in May agreed to increase cooperation in border management, investigation, law enforcement and prosecution, and repatriation of victims. They also urged that national prevention efforts be improved, including better public awareness campaigns and increased use of advanced technology.

India’s Black Market Organ Scandal

Shocked but not surprised. That might be the best way to sum up India’s reaction to the revelation this week that a black market organ transplant ring had been harvesting kidneys from poor Indian laborers, sometimes against their wishes, and using them in foreigners desperate for transplants. Police who busted the ring last week say doctors paid as little as $1000 for the kidneys and then sold them for as much as $37,500. The racket, based in Gurgaon, a business center close to the capital, New Delhi, drew victims from as many as eight Indian states and lasted for almost a decade. Police say the black market doctors may have illegally transplanted as many as 500 kidneys. The ring, according to the police, was run by two Indian brothers, neither of whom had any medical training but who oversaw the surgery. One of the brothers has been arrested in Mumbai, but the other, Amit Kumar, who police say was the racket’s kingpin, is now the focus of an international manhunt and may have fled to Canada.

But while the details of this particular case are appalling, and the scam is the first — or at least first to be exposed — involving foreigners from as far away as the U.S. and U.K flying in for transplants, Indians are sadly all too familiar with organ rackets. In 2007, police in southern India uncovered an illegal kidney trade involving fishermen whose jobs had been destroyed by the Indian Ocean tsunami. A massive transplant ring in Punjab was also uncovered in 2003. Police there believe at least 30 of the donors, who as in this latest case were poor, illiterate workers promised riches for their organs and bused in to be operated on, died, despite promises that they would receive excellent post-operation medical care and that they had nothing to worry about.

India’s illegal organ trade is driven in part by the incredible imbalance between supply and demand for legal organs. The Indian government banned the sale of kidneys for commercial gain in 1994; lawbreakers can be jailed for up to five years. But legal organ donations remain rare in India. The Multi Organ Harvesting Aid Network (MOHAN), a Chennai-based non-government group that promotes legal organ donation, puts donation rates in India at well under 1 per million, compared to rates of more than 20 per million in places such as Spain, the U.S. and France. The group’s head Dr Sunil Shroff rejects the idea that Indian culture or religion is behind the low donation rates. “The reason is we haven’t got our act together basically,” he says. “The infrastructure is not there. The general perception is lacking.”

The Indian government has encouraged more people to donate, and a few years ago began a campaign to increase the rate of cornea donations to try to fix the country’s huge problems with blindness. But despite some success — the high-profile cricketer Anil Kumble and Bollywood actress Aishwarya Rai both promised to donate their eyes when they die — a 2003 study in the Indian Journal of Opthamology found that illiteracy and rural residence (read poverty) meant that only half of those persons interviewed “had knowledge of eye donation, 20% knew about corneal transplantation and only 4.34% of them knew when to donate their eyes.”

Dodgy doctors exploit those same factors — illiteracy and poverty — to buy cheap organs on the black markets. There are millions of poor young men in India, desperate for a job and only too ready to travel to India’s big cities at the promise of a quick buck. And even if they’re not willing, they’re still potential fodder. The Associated Press reported that while some donors sold their kidneys willingly, some were forcibly brought to clinics, held at gunpoint and then forced to undergo operations that they didn’t want. “India is not such a literate population,” says a spokeswoman from the National Human Rights Commission. “That’s the main thing. There are a lot of people who are easy to take advantage of.”

Shroff and his colleagues at MOHAN argue that if India can push its legal donation rates up “then we can take care of the shortage and stop these kind of horror stories.” But encouraging families to donate the organs of their recently deceased after this week’s terrible revelations is no easy task. “For the next month or two it’s going to be extremely hard to get a family to donate because they think it’s some big scam,” says Shroff. “That’s the wider damage this type of story does.”

China’s new rules not likely to stop illegal organ trade

China has updated its regulations against illegal organ transplants. However, members of the political and financial elite still manage to circumvent them in military hospitals that now perform half of the country’s transplants.

The new rules on organ transplants made public on 14 December and signed by Chinese Premier Li Qiang increase penalties for “malpractice” and tighten requirements for medical establishments that perform transplants.

The regulations, which came into effect yesterday, are the latest in a series of measures designed to crack down on illegal organ trafficking.

They include a monitoring system announced in 2014 that was supposed to prevent “private” allocation of organs or the use of organs from executed prisoners without their consent.

Since 1 January 2015, only voluntary public donations or organs from living relatives are legally allowed for transplants, but demand for organs in China continues to be very high.

A doctor from mainland China, currently practising in North America, said that, unlike most countries, half of all organ transplants in China are performed at military hospitals.

“We know that anyone supervising [transplants] at provincial or municipal level, or from the Red Cross, will stand aside once the military intervenes,” said Dr Yang, a pseudonym used for fear of reprisals.

“So where do the military get their organs from? Just how transparent can this be?” Yang wonders. “It is a service specially provided to the [party elite].”

The doctor said that he witnessed the process by which high-ranking people in China and paying clients from abroad procure organs for transplantation.

“A senior official from Kazakhstan wanted a kidney transplant at the People’s Liberation Army General Hospital,” he said. “Within a month, a kidney transplant had been successfully performed, then he went back to Kazakhstan.”

China’s former organ transplant chief Jiefu Huang is cited in the UK-based medical journal The Lancet in 2011 as saying that about 65 per cent of transplants in China use organs from deceased donors, more than 90 per cent of whom were executed prisoners.

A 2022 study in the American Journal of Transplantation found evidence in 71 cases of “executions by organ removal” from prisoners, noting that “the removal of the heart during organ procurement must have been the proximate cause of the donor’s death.”

China is one of the world’s leading countries for death sentences, but the exact number of executions is a state secret guarded by the ruling Communist Party of China.

Jiefu publicly admitted that organs transplanted in China still come mostly from death row prisoners, although this practice was banned after the Human Organ Donation Management Centre was set up in 2012.

Torsten Trey, founder and executive director of Doctors Against Forced Organ Harvesting, said the latest rules were unlikely to do much to stop illegal organ trade in China.

“The new regulations do not address the issue of transparent access to organ donors,” Trey said. “Simply enacting new regulations without a system of verifiability for its enforcement … really doesn’t amount to a whole lot.”

Instead, he calls for a system based on World Health Organisation guidelines that insist on traceability of individual organs through a transparent donation process that is open to scrutiny, including instant access for inspection teams to carry out spot checks.

Why Illegal Trafficking in Organs is growing fast..but few are talking about it.

“Organ transplantation (OT) is one of most successful advances in modern medicine; for patients with end stage disease, transplantation often provides their only chance for survival.”

Illegal organ transplantation is estimated to account for 5-10% of all global organ transplants, generating between USD$840 million to USD$1.7 billion annually, and is another form of human exploitation on the rise. Operating on a global scale, it uses a series of professional “middlemen”, specialist medical personnel, specialist blood & tissue testing laboratories, public and private medical & surgical facilities (on occasion, “popup” surgical theatres), travel and facilitation companies, and front companies to hide the activity, particularly the payments. Few compliance professionals are aware of the size and scale of the crime, and the elements of the crime that may leave a signature in the financial system which is used to facilitate this illicit trade.

Desperation and greed drive the illegal organ trade.

The sums involved are significant – an illicit transplant costs between USD$50,000 (kidney) and USD$290,000 (lung), of which the source (“donor”) gets very little; typically it is the intermediaries (broker, surgeons) that benefit the most, paying a pittance to the source (“donor”) while charging the recipient an exorbitant fee. The “markup” varies between 500% to nearly 2,000%.

The recipient, generally middle-to-high income individuals from developed countries, often face certain death unless they get a transplant. The source (“donor”), often from poor and developing countries, often seeking to alleviate debt and/or escape poverty, or as a refugee willing to exchange an organ for the promise of passage to a new life. The outcomes for the donor are often negative, left with a lifetime of impaired health and debt from medical costs, resulting from the procedure; the recipient may also be infected with disease, accompanied by reliance on expensive immunosuppressive drugs, due to poor donor matching.

Only certain countries have the medical skills and infrastructure to offer organ transplantation – these are targeted by the organ trafficking networks. Additionally some countries have a preference for living donations (rather than organs from deceased donors); this may predispose such jurisdictions towards illicit organ transplantation from living, paid donors. The International Registry in Organ Donation and Transplantation (IRODaT) publish regular lists of transplantations by geography.

In 2013, OSCE published its findings representing those found to be involved in illegsl organ trafficking, which included a number of key stakeholders involved in arranging and facilitating international organ transplantation – highlighting the role of coordinators / brokers, as well as the role of a range of medical professionals. Often the stakeholders may be in different countries, thereby adding further complexity to law enforcement investigation.

It is important for the AML compliance professional to note that this network of stakeholders may operate within normal businesses i.e. hospitals, laboratories, clinics, etc and that there will be co-mingling of payments for illicit activity within normal business activity. However illegal activity often happens outside of normal business hours i.e. evenings, weekends, public holidays – so not to draw attention to the illicit activity.

Case Studies of Organ Trafficking Networks

To assist AML compliance professionals understand how such networks operate, three previous cases will be examined to show how they operated.

Case 1 – Netcare (South Africa)

“Israeli citizens in need of kidney transplants would be brought to South Africa for transplants at St Augustine’s Hospital. They paid kidney suppliers for these operations . [the kidneys] were initially sourced from Israeli citizens, but later Romanian and Brazilian citizens were recruited as their kidneys were obtainable at a much lower cost than those of the Israeli suppliers”

In 2010, one of the leading private hospital groups in South Africa, listed on the JSE, its chief executive, and five leading surgeons in Durban, South Africa were charged with their alleged roles in an international “kidneys for sale” syndicate. This was in response to the state’s investigation into over 100 illegal transplants between 2001 and 2003. The hospital group admitted receiving ZAR3.8m (USD$542,000) from an illegal organ trafficking syndicate in a scam that included the removal of kidneys from five minors. The company’s Durban subsidiary, trading as St Augustine’s Hospital, pleaded guilty in a plea bargain, paying a fine of ZAR7.8m (USD$1m) in November 2010. As part of the plea bargain the charges against the CEO and the group were withdrawn; allegations that a significant number of transplants had been made at associated group facilities in Johannesburg and Cape Town were not investigated nor pursued.

A prominent kidney specialist (JK), specialist surgeons (JR and AH) and doctors (NC, MN, KS), transplant unit staff, and an Israeli interpreter (SZ) were accused of involvement in an “illegal scheme” to give kidney transplants to wealthy Israelis, using organs donated by poor Brazilians, Romanians and Israelis, with the procedures carried out in South Africa. To legitimise the surgery, documents were allegedly forged to show that the donor and the recipient were related – a requirement for organ transplants in South Africa.

Initially, kidney suppliers from Israel were paid approximately USD$20,000; however later, cheaper kidney suppliers were sourced among Romanian and Brazilian citizens, who were paid, on average, about USD$6,000 for their kidneys.

Two of the alleged syndicate’s South African “co-ordinators” (RK and SM) pleaded guilty to related charges. Separately, a Brazilian court sentenced kidney-donor recruiters (IdS and GT),as well as other intermediaries, to imprisonment for their roles in the syndicate.

Key was the involvement of an Israeli “organ broker” (IP), an Israeli business person with a background in medical insurance, who allegedly was involved in setting up a global transplant scheme involving the global trafficking of paid organ donors and patients. Transplant recipients (from Israel) were alleged to have paid IP between USD$100,000 and USD$120,000 to arrange a kidney transplant in South Africa. IP’s company, UDG Medical Services, or its agents, are alleged to have paid St Augustine’s Hospital before each transplant operation.

“Netcare and Netcare KwaZulu-Natal, trading as St Augustine’s Hospital, would receive payments from UDG or IP and would disburse the money received to other accused and service providers, including the surgeons, for their services”.

Allegedly, IP has links with other networks involved in illicit organ transplantation – Dr ZS and Dr YS, two of the world’s most notorious illicit transplant surgeons (see case Study 2) and IR, an alleged organ trafficker from Brooklyn, New York (see Case Study 3) .

Payments to nephrologist JK, who was allegedly instrumental in the scheme, and fled to Canada, were believed to have been made into his Canadian bank account. He eventually pled guilty and was fined ZAR150 000 (USD$20,000)

A key point in this case was that, until 2008, it was common practice for health insurance companies in Israel to reimburse for transplants performed abroad, irregardless of their legitimacy. [NOTE: This may still be the case in other jurisdictions whereby medical insurance may be inadvertently supporting illicit organ transplantations on clients having a transplant procedure overseas, outside of the national organ transplant network]

In Dec 2012, a permanent stay of prosecution was given to four surgeons and two clinic staff implicated in the “cash for kidneys scandal” citing undue delay in the prosecution. Further details on this case may be found in the UNODC Sherloc Case Law Database

Visualisation / Further Information

The visualisation for Case 1 outlines a significant number of corporate entities operating in South Africa – with property holdings, medical and surgical hospitals, business consulting services, ambulatory health care services, and medical clinics – as well as associated corporate entities & networks operating in the UK, BVI, and Lesotho. In many instances the organisations are still operating; undoubtedly, some or all of them are using the financial system.

Case 2 – Medicus (Kosovo)

In 2005, a respected urologist (LD) established a relationship with a Turkish surgeon (Dr YS), an infamous transplant surgeon, to perform organ transplants at the Medicus clinic, in Pristina, Kosovo, which at that time were strictly controlled.

Subsequently LD, his son (AD), Dr YS and an Israeli organ broker (MH) allegedly planned to bring donors and recipients to Kosovo for kidney transplantation. An anaesthesiologist (SH) and several other surgeons (Dr KD and Dr ZS) were also co-opted.

Between March to November 2008, 24 “donors” from Israel, Turkey, Russia, Ukraine, Kazakhstan, Belarus, and Moldova were brought to Kosovo for the removal of their organs for transplant into “recipients” from Israel, Poland, Turkey, Canada, Germany. The donors were promised payments of up to USD$20,000; some received partial amounts, whilst others left empty-handed. The recipients had paid upto USD$132,000 for kidney transplants. The operations carried out in 2008 earned the Pristina-based clinic around 679,000 euros (@ USD$900,000).

LD, AD and SH were convicted in 2013 and sentenced to substantial prison sentences that were amended on appeal in 2016 and 2018. Dr YS and MH remain fugitives – although MH was arrested in Cyprus in 2018 and subject to extradition proceedings to Russia.

Dr YS, “the Organ Mafia Doctor” who operates “underground” on wealthy patients from Israel, Turkey, Russia is allegedly a key player in the unscrupulous organ market for more than 10 years, linked to clinics across the world; he has admitted to doing thousands of transplants. Investigators have placed in him in several locations, notorious for illicit transplants, including Azerbaijan, South Africa, Kosovo, Kazakhstan, Turkey. It is believed that he has amassed USD$20m to 30m from illegal organ transplants, located in a Swiss bank account.

Visualisation / Further Information

Case details, available from the public domain, were searched against company registries and adverse media databases, using Quantexa advanced network analytics and visualisation capabilities, to provide an overview of the extensive corporate networks & associations, that are linked to the main entities involved in the case. The visualisation for Case 2 highlights a different story – the illicit transplants happened in Kosovo – however it is part of much larger network of corporate entities, mainly registered and operating in Turkey – including various types of medical and surgical clinics, but interestingly international transport & logistics, publishing, tourism, import & export companies – as well as associated corporate entities & networks operating in Azerbaijan, and Albania. In many instances the organisations are still operating; undoubtedly, some or all of them are using the financial system.

Case 3 – United Lifeline (US)

In 2011, an Israeli citizen (IR) living in Brooklyn, N.Y., US admitted that from January 2006 through February 2009, he conspired with others to provide a service to individuals seeking kidney transplants, in exchange for large payments, to obtain kidneys from paid donors. Specifically, IR, the self-styled ‘Robin Hood of kidneys,’ admitted to arranging three transplants that took place in December 2006, September 2008 and February 2009; for which he was paid $120,000, $150,000 and $140,000. IR pleaded guilty to three transactions, although “authorities said he brokered many more kidney transplants and made millions from the deals”.

IR admitted to an undercover agent that he had associate in Israel to find suitable donors, who were brought to the US for the procedure after matching, facilitated via IR’s organisation, United Lifeline. IR claimed that he fabricated cover stories in order to fool hospital employees into believing that the transplants were altruistic donations. He further claimed that he had been arranging kidney transplants for a period of 10 years.

In the process of arranging a donor for the UC’s relative IR accepted four blank cheques totalling $10,000 as a down payment, to be paid to a “charitable organization”, later deposited in an account held at a branch of Wachovia Bank, Brooklyn, NY. Of note is that several of the finest private hospitals in the East Coast were allegedly used for the procedure

Case Visualisation / Further Information

Case details, available from the public domain, were searched against company registries and adverse media databases, using Quantexa advanced network analytics and visualisation capabilities, to provide an overview of the extensive corporate networks & associations, that are linked to the main entities involved in the case. The visualisation for Case 3 highlights a different story – the “arranged” (illicit) transplants took place in private hospitals; the defendant (IR) was convicted for facilitating 3 transplants. However, as this visualisation shows, IR was associated with a large network of associated businesses, with a series of companies under the same name (United Lifeline), providing medical equipment for elderly / infirm patients in & around New York. In many instances the organisations are still operating; undoubtedly, some or all of them are using the financial system.

Resources for AML Professionals

As highlighted, the illicit organ transplantation business is highly lucrative and commands large sums of money from the recipients, much of the profits going to the brokers (and surgeons) who facilitate this trade. The case visualisations have shown that often there is a sophisticated network of corporate entities associated with the network, that may be directly involved in facilitation, or indirectly used for laundering proceeds.

The HOTT Project conducting scientific, empirical research on THBOR across the globe, provides a Barrier Model for THBOR – useful in showing the various roles, across a range of logistics and actions, potentially associated with illicit organ transplantation.

The HOTT Project identified, from surveying recipients, several key aspects, notably * in some cases, payment of the fees were made by family members or relatives, on behalf of the recipient
payment was made to the surgeon (50% of cases), broker (30% of cases), bank transfer (10% of cases), or directly to the medical facility (10% of cases) on receipt of invoice
in some cases, the recipient was partially reimbursed by their insurance providers for their overseas organ transplantation, on submission of official stamped invoice
in one case, the transplantation reimbursement was arranged directly between the coordinator of the hospital and the health insurance company.

From the above, financial investigators may want to look at activity

Surgeons – receiving large amounts in foreign currency from individuals (with limited supporting documents / explanation of purpose)
Anaesthetists / Nurses – receiving unusual amounts in foreign currency from individuals (with limited supporting documents / explanation of purpose)
Brokers (individuals) – with transaction activity disproportionate from their declared occupation including transfers from individuals or charities overseas in foreign currency
Laboratories / Medical Facilities – – receiving large amounts in foreign currency from individuals (with limited supporting documents / explanation of purpose)

The role of health insurance companies in identifying suspicious transplantation activity can not be understated; some countries have legislated to stop the use of health insurance to pay for illegal transplants overseas with profound effect.

Bain et al identified a number of potential red flag indicators that financial investigators could include into their monitoring regime to identify potentially suspicious behaviour:

Wire transfers to entities in high-risk jurisdictions with names that include a variation of medical.i.e “Medicus”
Methods of payment such as wires payment, email money transfer, and bulk cash withdrawal – for amounts that correspond with payments for organ donation or organ recipient amounts (see tables in GFI report)
Payments between charities and medical tourism sites
First-line banking staff indication of potentially ill customers moving large amounts of funds to numbered companies or charities prior to travel
Medical tourism websites that offer transplant services abroad that recommend utilising their own trusted domestic doctors prior to traveling

Conclusions

“Unscrupulous individuals and organisations are profiteering from this situation.
The stakes are so big, the profit that can be made so huge, that the temptation is
out there.“

One of the recommendations from a panel of experts convened under the HOTT project was the importance of parallel financial investigations; this is especially true in THBOR cases, where reliance on the victim testimony can be precarious, however use of financial investigations to identify payments, combined with analysis of financial transactions associated with the activity can play a powerful role in substantiating the allegations.

This article has outlined, in brief, some of the issues, cases, and resources available for compliance professionals to engage and use the power of financial investigations; undoubtedly AML compliance professionals have a key role to play in combating this “crime of crimes.”

Glossary and acronyms

[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3694 Introduced in House (IH)]

<DOC>






114th CONGRESS
  1st Session
                                H. R. 3694

     To combat trafficking in human organs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 6, 2015

 Mr. Trott (for himself and Mr. Deutch) introduced the following bill; 
         which was referred to the Committee on Foreign Affairs

_______________________________________________________________________

                                 A BILL


 
     To combat trafficking in human organs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Strategy To Oppose Predatory Organ 
Trafficking Act'' or the ``STOP Organ Trafficking Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The World Health Organization (WHO) estimates that 
        approximately 10 percent of all transplanted kidneys worldwide 
        are illegally obtained, often bought from vulnerable 
        impoverished persons or forcibly harvested from prisoners.
            (2) In 2004, the World Health Assembly passed a resolution 
        urging its member-states to take measures to protect the 
        poorest as well as vulnerable groups from exploitation by organ 
        traffickers.
            (3) On February 13, 2008, the United Nations Global 
        Initiative to Fight Human Trafficking (UNGIFT) hosted the 
        ``Vienna Forum to Fight Human Trafficking'', and subsequently 
        reported that a lack of adequate illicit organ trafficking laws 
        has provided opportunity for the illegal trade to grow.
            (4) On March 21, 2011, the Council of the European Union 
        adopted rules supplementing the definition of criminal offenses 
        and the level of sanctions in order to strengthen the 
        prevention of organ trafficking and the protection of those 
        victims.
            (5) In November 2012, Erasmus University Hospital along 
        with institutions in Romania, Sweden, Bulgaria, and Spain 
        launched a 3-year study backed by Europol into illegal organ 
        trafficking, and released a statement that, ``there are more 
        and more indicators of `organ tourism', whereby a patient 
        travels abroad with the aim of receiving a transplanted organ 
        which may have been bought . . . donors are often victims of 
        human trafficking.''.
            (6) According to organ trafficking specialists at the WHO, 
        Moldova ranks third as a source of organs for sale on the 
        global black market, with such human organs frequently smuggled 
        to underground clinics located in several European Union 
        member-states.
            (7) Between 2001 and 2003, a South African black market 
        kidney transplant ring coerced over 109 people, mostly from 
        Brazil and Romania, to travel to Durban, South Africa, to 
        forfeit a kidney for the promise of approximately $120,000, 
        although payment was frequently withheld following the 
        operation.
            (8) On May 3, 2004, Afghanistan's Interior Minister Ali 
        Ahmed Lakali stated that the problem of child abduction was 
        growing and children were being taken to be sold for ``sex or 
        labor, or to provide human organs''.
            (9) In March 2006, a children's rights expert at the Afghan 
        Independent Human Rights Commission, Hengameh Anwari, stated, 
        ``Other reports that cause concern indicate that a number of 
        children are abducted because of their body organs; they become 
        victims of trafficking to foreign countries especially for 
        their kidneys.''.
            (10) In June 2001, Dr. Wang Guogi testified before the 
        Subcommittee on International Organizations and Human Rights of 
        the Committee on International Relations of the House of 
        Representatives that Chinese hospitals worked in collusion with 
        state security agencies to extract organs from executed 
        prisoners without written consent of the organ donors, and that 
        these transplants were a lucrative source of income.
            (11) Researcher and journalist Ethan Gutmann estimates that 
        approximately 65,000 Falun Gong adherents may have been killed 
        for their organs from 2000 to 2008, and that a number of other 
        religious and ethnic minorities may also have been targeted.
            (12) On November 20, 2004, Xin Ren from California State 
        University stated to the International Bureau for Children's 
        Rights Conference in Montreal, that, ``[In India, Pakistan, and 
        some other Asian countries in 2003] [c]hildren were often 
        either sold by their parents for little money or kidnapped and 
        abducted by the traffickers to have their organ(s) removed for 
        transplant purpose . . . [S]ome people were even murdered in 
        the process of forcible removal of their organs.''.
            (13) The website of the Organ Transplant Center of the 
        Armed Police General Hospital in Beijing, China touted that, 
        ``Our Organ Transplant Center is our main department for making 
        money . . . This year (2004) there is a chance to break through 
        30,000,000 yuan.''.
            (14) Canadian researchers David Matas, human rights 
        attorney, and David Kilgour, former Canadian Secretary of State 
        for Asia-Pacific, conducted an investigation into allegations 
        of organ harvesting from Falun Gong prisoners of conscience in 
        2006, and based on extensive circumstantial evidence, their 
        report concluded that the allegations were true and that tens 
        of thousands of Falun Gong practitioners may have been killed 
        for their organs.
            (15) In mid-November 2006, China's Deputy Health Minister 
        Huang Jiefu acknowledged that condemned prisoners are sources 
        for organ transplants, and Asia News reported that Deputy 
        Health Minister Huang had said he was cognizant of the fact 
        that too often organs come from non-consenting parties and are 
        sold for high fees to foreigners.
            (16) In May 2006, the website for the China International 
        Transplantation Network Assistance Centre posted the following 
        statements in its frequently asked questions section: ``The 
        First Affiliated Hospital of China was established in 2003 
        specifically for our foreign friends . . . Viscera providers 
        can be found immediately! . . . Our organs do not come from 
        brain death victims because the organ may not be good.''.
            (17) In November 2008, the United Nations Committee on 
        Torture reported concern over the allegations of organ 
        harvesting from Falun Gong prisoners and called on the 
        Government of the People's Republic of China to increase 
        accountability and transparency in the organ transplant system 
        and punish those individuals responsible for abuses.
            (18) In 2005, the United States ratified the Protocol to 
        Prevent, Suppress and Punish Trafficking in Persons, Especially 
        Women and Children, a supplement to the United Nations 
        Convention against Transnational Organized Crime, which 
        includes the removal of organs as a form of exploitation under 
        the definition of ``trafficking in persons''.
            (19) On March 30, 2006, the Police Superintendent of 
        Paranaque, Philippines, arrested a suspect alleged to have ties 
        to a regional kidnapping syndicate involved with abducting 
        children in order to remove their organs and sell them on the 
        global black market, as in the case of a child discovered dead 
        in Cavite, Philippines, with his internal organs missing.
            (20) On April 12, 2008, police raided a black market organ 
        transplant house near Manila, Philippines, arresting three 
        traffickers and discovering nine donors in the house, one of 
        whom stated to authorities that he had been promised $2,800 for 
        his kidney, and he was doing it because, ``I can barely provide 
        for my wife and children.''.
            (21) In November 2008, the National Bureau of 
        Investigation's Human Trafficking Division in the Philippines 
        reported, ``the abducted children are housed somewhere in 
        Mindanao where victims are supplied with vitamin supplements to 
        keep their internal organs healthy, and are then transported 
        outside the country to undergo surgery for organ transplants''.
            (22) In 2007, Pakistan was identified by the WHO as one of 
        the top destinations for ``transplant tourism''.
            (23) Pakistani authorities in April 2007 raided a black 
        market organ ring in Lahore that consisted of doctors, 
        officials, and middlemen who had abducted potential donors, 
        drugged them and removed their kidneys without consent to then 
        sell for profit.
            (24) Dr. Zafar ul Ahsan, a top urologist at Fatima Jinnah 
        Hospital in Lahore, Pakistan, stated in September 2007, ``A 
        mafia is running Pakistan's kidney transplant business with 
        agents paying $1,000 to poor donors and then selling their 
        kidneys on the black market for thousands of dollars.''.
            (25) In 2007, five employees of the tissue bank at the 
        Faculty Hospital in Brno-Bohunice, the Czech Republic, were 
        arrested and charged with illegal organ trafficking for selling 
        more than $340,000 worth of illegally obtained skin grafts to a 
        tissue bank in the Netherlands.
            (26) In January 2008, the Government of India's Health 
        Ministry released an estimate that more than 100,000 kidney 
        transplants are needed in India each year, but only 5,000 are 
        performed legally.
            (27) A February 2008 police raid on an organ trafficking 
        ring in Gurgaon, India, found that men posed as doctors to 
        remove kidneys from migrant laborers, and conducted 
        approximately 500 illegal kidney transplants over nine years.
            (28) On April 8, 2009, the Global Post in Cairo reported 
        that the Egyptian Government was considering measures to 
        increase the number of legal organ donations to meet demand, 
        which included a proposal to harvest organs from executed 
        criminals, with or without their consent, as then Ministry of 
        Health spokesman, Dr. Abdel Rahman Shahin stated, ``They are 
        saying that when [convicts'] organs are taken, they're 
        compensating for the bad they did.''.
            (29) In November 2010, Netcare KwaZulu, a hospital in South 
        Africa's eastern KwaZulu-Natal province, pleaded guilty to 
        illegally removing kidneys from five minors between 2001 and 
        2003.
            (30) On January 12, 2011, Doctor Yusuf Sonmez, who has been 
        dubbed the ``Turkish Frankenstein'', was arrested in Pristina 
        for his alleged participation in illegal organ trafficking in 
        Kosovo and Azerbaijan.
            (31) In April 2013, a Kosovo court convicted five 
        defendants for conducting over 30 illegal harvest operations in 
        an organ trafficking ring at the Medicus clinic, where 
        impoverished people from Turkey, Russia, Moldova, and 
        Kazakhstan were coerced into selling their kidneys.
            (32) In 2011, Egypt passed a law prohibiting the exchange 
        of money for human organs and restricting human organ donations 
        to relatives up to four degrees removed.
            (33) In February 2015, the Iraqi Ambassador to the United 
        Nations alleged that the Islamic State was illegally harvesting 
        organs from murdered civilians to finance their operations.
            (34) According to a 2013 United Nations report from the 
        Special Rapporteur on trafficking in persons, especially women 
        and children, the economic and social divisions within and 
        among countries is notably reflected in the illicit organ 
        trafficking market, in which the victims are commonly poor, 
        unemployed, and more susceptible to deceit and extortion.

SEC. 3. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) the kidnapping or coercion of individuals for the 
        purpose of extracting their organs for profit is in 
        contradiction of the ideals and standards for ethical behavior 
        upon which the United States has based its laws;
            (2) the harvesting of organs from living children, 
        regardless of the level of brain activity, is a violation of 
        the human rights of the child and is a breach of 
        internationally accepted medical ethical standards described in 
        WHO Assembly Resolution 57.18 (May 22, 2004);
            (3) the illegal harvesting and trafficking of human organs 
        violates the Universal Declaration of Human Rights, in Article 
        3 which states that ``Everyone has the right to life, liberty 
        and security of person.'', and in Article 4 which states that 
        ``No one shall be held in slavery or servitude.''; and
            (4) efficient national organ donation systems with 
        effective enforcement mechanisms that ensure voluntary organ 
        donations are the most effective way to combat trafficking in 
        human organs.

SEC. 4. STATEMENT OF POLICY.

    It shall be the policy of the United States to--
            (1) combat the international trafficking in human organs;
            (2) promote the adoption of national transplantation 
        systems that ensure voluntary organ donation processes in 
        bilateral diplomatic meetings, as well as in international 
        health forums; and
            (3) promote the dignity and security of human life in 
        accordance to the Universal Declaration of Human Rights.

SEC. 5. AMENDMENTS TO THE STATE DEPARTMENT BASIC AUTHORITIES ACT OF 
              1956.

    Section 42 of the State Department Basic Authorities Act of 1956 
(22 U.S.C. 2714) is amended--
            (1) in the section heading, by adding at the end the 
        following: ``and organ traffickers'';
            (2) in subsection (a)(1), by striking ``convicted of an 
        offense described in subsection (b) of this section during the 
        period described in subsection (c) of this section'' and 
        inserting ``convicted of an offense described in subsection (b) 
        or (c) of this section during the period described in 
        subsection (d) of this section'';
            (3) by redesignating subsections (c), (d), and (e) as 
        subsections (d), (e), and (f), respectively; and
            (4) by inserting after subsection (b) the following new 
        subsection:
    ``(c) Human Organ Trafficking Offenses.--Subsection (a) of this 
section applies with respect to any individual convicted of an offense 
under section 301 of the National Organ Transplant Act (42 U.S.C. 274e) 
if such individual used a passport or otherwise crossed an 
international border in the commission of such an offense.''.

SEC. 6. ACTIONS UNDER THE INTERNATIONAL EMERGENCY ECONOMIC POWERS ACT 
              AND AMENDMENTS TO THE TRAFFICKING VICTIMS PROTECTION ACT 
              OF 2000.

    (a) International Emergency Economic Powers Act.--The President may 
exercise the authorities specified in section 203 of the International 
Emergency Economic Powers Act (50 U.S.C. 1702) without regard to 
section 202 of such Act (50 U.S.C. 1701) in the case of travel abroad 
by United States citizens for the purpose of participation in any 
activity relating to trafficking in human organs.
    (b) Definitions.--Section 103 of the Trafficking Victims Protection 
Act of 2000 (22 U.S.C. 7102) is amended--
            (1) in paragraph (3)--
                    (A) in subparagraph (B), by striking ``or'' at the 
                end;
                    (B) in subparagraph (C), by striking the period at 
                the end and inserting ``; or''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) exploitation of a person through the promise 
                of the granting of payments or benefits in order to 
                compel or entice the person to consent to the removal 
                of one or more of the person's organs for a transplant 
                operation, in a manner contrary to the standards 
                described in WHO Assembly Resolution WHA 57.18 (May 22, 
                2004).'';
            (2) in paragraph (9)--
                    (A) in subparagraph (A), by striking ``or'' at the 
                end;
                    (B) in subparagraph (B), by striking the period at 
                the end and inserting: ``; or''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(C) trafficking in human organs (as defined in 
                paragraph (13)).'';
            (3) by redesignating paragraphs (13) through (15) as 
        paragraphs (14) through (16), respectively;
            (4) by inserting after paragraph (12) the following new 
        paragraph:
            ``(13) Trafficking in human organs.--
                    ``(A) In general.--The term `trafficking in human 
                organs' means--
                            ``(i) the recruitment, transportation, 
                        transfer, harboring, or receipt of a person, 
                        either living or deceased, for the purpose of 
                        removing one or more of the person's organs, by 
                        means of--
                                    ``(I) coercion;
                                    ``(II) abduction;
                                    ``(III) deception;
                                    ``(IV) abuse of power or a position 
                                of vulnerability; or
                                    ``(V) transfer of payments or 
                                benefits to achieve the consent of a 
                                person having control over a person 
                                described in the matter preceding 
                                subclause (I); or
                            ``(ii) the illicit transportation and 
                        transplantation of organs in one or more other 
                        persons for profit or any other purpose.
                    ``(B) Organ defined.--In subparagraph (A), the term 
                `organ' means the human (including fetal) kidney, 
                liver, heart, lung, pancreas, bone marrow, cornea, eye, 
                bone, and skin or any subpart thereof and any other 
                human organ (or any subpart thereof, including that 
                derived from a fetus) specified by the President by 
                regulation for purposes of this division.''; and
            (5) in paragraph (15), as so redesignated, by inserting 
        before the period at the end the following: ``or (13)''.
    (c) Interagency Task Force To Monitor and Combat Trafficking.--
Section 105(d)(3) of the Trafficking Victims Protection Act of 2000 (22 
U.S.C. 7103(d)(3)) is amended by inserting after the first sentence the 
following new sentence: ``Such procedures shall include collection and 
organization of data from human rights officers at United States 
embassies on host country's laws against trafficking in human organs 
and any instances of violations of such laws.''.

SEC. 7. REPORTING.

    (a) In General.--Not later than six months after the date of the 
enactment of this Act and annually thereafter, the Secretary of State 
shall submit to the appropriate congressional committees a report that 
includes the following information:
            (1) A list of the ten countries determined to be the 
        greatest sources, facilitators, or recipients of trafficking in 
        human organs during the period covered by each such report.
            (2) Any actions taken by each country included on a list 
        under paragraph (1) to address and prevent trafficking in human 
        organs.
            (3) Any cooperative efforts by the United States and each 
        country included on a list under paragraph (1) to address and 
        prevent trafficking in human organs through joint public 
        awareness campaigns.
            (4) Information regarding practices of trafficking in human 
        organs of each country included on a list under paragraph (1) 
        in the Department of State's travel advisories.
    (b) Additional Information.--The reports required under subsection 
(a) shall include the collection and organization of data from human 
rights officers at United States diplomatic and consular posts on host 
countries' laws against trafficking in human organs and any instances 
of violations of such laws.

SEC. 8. DEFINITIONS.

    In this Act:
            (1) Appropriate congressional committees.--The term 
        ``appropriate congressional committees'' means the Committee on 
        Foreign Affairs of the House of Representatives and the 
        Committee on Foreign Relations of the Senate.
            (2) Coercion.--The term ``coercion'' means the exploitation 
        of a person through the promise or granting of payments or 
        benefits in order to compel or entice such person to consent to 
        the removal of one or more of such person's organs for a 
        transplant operation, in a manner contrary to the standards 
        described in WHO Assembly Resolution WHA 57.18 (May 22, 2004).
            (3) Human organ.--The term ``human organ'' means the human 
        (including fetal) kidney, liver, heart, lung, pancreas, bone 
        marrow, cornea, eye, bone, and skin or any subpart thereof and 
        any other human organ (or any subpart thereof, including that 
        derived from a fetus).
            (4) Trafficking in human organs.--The term ``trafficking in 
        human organs'' means--
                    (A) the recruitment, transportation, transfer, 
                harboring, or receipt of a person, either living or 
                deceased, for the purpose of removing one or more of 
                such person's human organs, by means of--
                            (i) coercion;
                            (ii) abduction;
                            (iii) deception;
                            (iv) abuse of power or a position of 
                        vulnerability; or
                            (v) transfer of payments or benefits to 
                        achieve the consent of a person having control 
                        over a person described in the matter preceding 
                        subparagraph (A); and
                    (B) the illicit transportation and transplantation 
                of such human organs in one or more other persons for 
                profit or any other purpose.

SEC. 9. LIMITATION ON FUNDS.

    No additional funds are authorized to be appropriated to carry out 
this Act or any amendment made by this Act.
                                 <all>

Gangs netting up to $3 trillion a year as Southeast Asia human trafficking becomes a global crisis, Interpol says

Human trafficking-fueled fraud is exploding in Southeast Asia with organized crime rings raking in close to $3 trillion in illicit revenue annually, the head of Interpol has said in comments that reveal the huge profits being earned by cartels.

One international organized crime group makes $50 billion a year, according to Interpol secretary-general Jurgen Stock, adding that $2 trillion to $3 trillion of illicit money flows through the global financial system annually. To compare, France’s economy is worth $3.1 trillion according to the International Monetary Fund.

While drug trafficking contributes around 40% to 70% of organized crime income, criminal groups are also using those smuggling networks to illegally move humans, arms and stolen products among other things, Stock said.

“Driven by online anonymity, inspired by new business models and accelerated by Covid, these organized crime groups are now working at a scale that was unimaginable a decade ago,” Stock told a briefing at the global police coordination body’s Singapore office on Wednesday.

“Today, a bank – or indeed anyone – is less likely to be robbed at gunpoint than via a keyboard by someone on the other side of the world.

“What began as a regional crime threat in Southeast Asia has become a global human trafficking crisis, with millions of victims, both in the cyber scam centers and as targets.”

Interpol says its operations in Asia have led to nearly 3,500 arrests and the seizure of $300 million in illegally earned assets across 34 countries since 2021.

Enter your email to sign up for CNN’s “Meanwhile in China” Newsletter.

Survivor testimonies, NGO campaigning and media reporting over the past three years have increasingly exposed an explosion in online fraud gangs operating in Southeast Asia, many using de facto slave labor to target people across the globe, including the United States.

Victims from across Asia are often duped into seemingly legitimate jobs around the region and are then trafficked into scam compounds where they face serious abuse, including forced labor, arbitrary detention, degrading treatment or torture – often with minimal or no help from local authorities.

Hundreds of thousands of people are trafficked into online criminality across the region, according to a United Nations report last year.

The UN estimated that up to 120,000 people could be held in compounds across Myanmar, which has been plunged into civil war since a 2021 military coup, with another 100,000 people held in Cambodia and elsewhere in conditions that amount to modern slavery.

Criminal enterprises also exist in Laos, Thailand and the Philippines, with many of the lucrative online scam operations ranging from illegal gambling, to love scams and crypto fraud.

“People who are coerced into working in these scamming operations endure inhumane treatment while being forced to carry out crimes. They are victims. They are not criminals,” UN High Commissioner for Human Rights Volker Turk said in the report.

One key hub for scam syndicates is Myanmar, which shares a mountainous border with southwestern China – and Beijing is now trying to crack down on cross-border crime targeting Chinese nationals.

In heavily guarded compounds controlled by local warlords, tens of thousands of people, mainly Chinese, have been trapped and forced by criminal gangs to defraud strangers with sophisticated schemes over the internet. Beijing has pressed Myanmar’s military government to rein in the scam operations, but with limited success.

Elsewhere, casinos in the Philippines catering to illicit gamblers from China have spawned across the country with authorities in Manila struggling to curtail the rising number of gambling establishments used as fronts for scam centers and other fraudulent crimes.

Earlier this month, more than 800 Filipinos, Chinese and other nationals were rescued during a police raid of an online romance scam center posing as a casino some 100 kilometers from the capital, the official Philippine News Agency reported, citing local authorities. Hundreds of the victims were made to pose as lovers to lure people to send money, in what’s commonly known as a “pig-butchering” scam.

The victims, some from Malaysia and Vietnam, told local investigators that each forced worker was pressured by alleged crime lords to siphon $42,000 daily online, and said they were beaten when they did not meet that target.

And scammers are getting more sophisticated, using artificial intelligence to swindle corporations.

In Hong Kong, a finance worker at a multinational firm was tricked into paying $25 million to fraudsters using deepfake AI technology to pose as the company’s chief financial officer in a video conference call, according to local police. It is unknown where the scammers were based or where the huge sum of money went.

Organ Removal

“If we don’t stand up for this, and these atrocities continue to happen, we can’t justify ourselves, and we can’t explain to our kids how we were silent when this thing happened.”
~ Rabbi Dr. Reuven P. Bulka, chairman of Coalition to Investigate the Persecution of Falun Gong

Organ removal, while not as prevalent as sex and labor trafficking, is quite real and widespread. Those targeted are sometimes killed or left for dead. More frequently poor and desperate people are lured by false promises. The World Health Organization estimates that as many as 7,000 kidneys are illegally obtained by traffickers every year as demand outstrips the supply of organs legally available for transplant. A black market thrives as well in the trade of bones, blood and other body tissues. This activity is listed in the United Nations’ Trafficking in Persons Protocol:

Article 3(a)… Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs.

The inclusion of this form of exploitation into the Protocol is intended to cover those situations where a person is exploited for the purposes of a trafficker obtaining profit in the ‘organ market’, and situations where a person is trafficked for the purpose of the removal of their organs and/or body parts for purposes of witchcraft or traditional medicine. In the former situation, market forces drive supply and demand; those in desperate need of an organ transplant will purchase an organ from those who are desperately poor, or from ‘brokers’ who may have forcibly or deceptively obtained the organ.

Kidneys are generally supplied by live ‘donors’ in underdeveloped countries to developed ones. An article in the medical journal Lancet reported:

“…the circulation of kidneys followed established routes of capital from South to North, from East to West, from poorer to more affluent bodies, from black and brown bodies to white ones and from female to male or from poor, low status men to more affluent men. Women are rarely the recipients of purchased organs anywhere in the world.” (Scheper-Hughes,Vol. 361, 10 May 2003)

Transplant tourism depends on four populations: desperate patients willing to travel great distances and face considerable insecurity to obtain the transplants they need; equally desperate and mobile organ sellers; outlaw surgeons willing to break the law or ignore regulations and longstanding medical norms; and organs brokers and other intermediaries with established connections to the key players in the shadowy underworld of transplant tourism. In some developing countries, transplant tourism is vital to the medical economies of rapidly privatizing clinical and hospital services in poorer countries that are struggling to stay afloat. China has been widely implicated as a source of unethically obtained organs and body parts through its very opaque prison system.

In researching his book The Red Market (see below) author Scott Carney visited an Indian refugee camp for survivors of 2004’s massive tsunami. Today, the camp is known by the nickname Kidneyvakkam, or Kidneyville, because of how common it is for the women who live there to sell their kidneys.

“The women are just lined up,” Carney says. “They have their exposed midriffs and there are all these kidney extraction scars because when the tsunami happened, all these organ brokers came in and realized there were a lot of people in very desperate situations and they could turn a lot of quick cash by just convincing people to sell their kidneys.”

Ritual killings are very different from other enterprises. People who are killed for religious or ritualistic practices fall into this category. “Muti” (magical medicines used in some parts of Africa) involves the removal of body parts including skulls, hearts, eyes and genitals which are sold and used by deviant practitioners to increase wealth, influence, health or fertility. Muti killings, more correctly known as medicine murder are not human sacrifice in a religious sense, but rather involve the murder of someone in order to excise body parts for incorporation as ingredients into medicine and concoctions used in witchcraft. in 2010 Muti (also known as Muthi) killings are on the rise in South Africa. Some South Africans, especially in the Mpumalanga and Limpopo provinces, believe that the harvested body parts of children or old people will assist in them becoming rich and powerful. Most often victims are kidnapped before they are killed, and for that reason this form of murder may constitute human trafficking.

According to Christine Beddoe, director of the anti-trafficking charity Ecpat UK, a cultural belief in the power of human blood in so-called juju rituals is playing a part in the demand for African children. Testimonies from many of these children have revealed that once they arrive in Britain, they are exposed to violent and degrading treatments, often involving the forced extraction of their blood to be used for clients demanding blood rituals. According to a US State Department report, Uganda has become one of the main source countries for children to be bought and smuggled abroad. Some 9,000 children have gone missing in that country over the past four years. The head of Uganda’s Anti-Human Sacrifice Police Task Force, Commissioner Bignoa Moses, admits there is a problem: “We cannot rule out that children end up abroad because as of now we don’t have the capacity to monitor each individual and many simply disappear.”

YOU CAN HELP! Each day, about 77 people receive organ transplants. However, 19 people die each day waiting for transplants that can’t take place because of the shortage of donated organs. Anyone can play a significant role in alleviating the horrible abuses that stem from this shortfall… by simply becoming an organ and tissue donor. Few people are comfortable thinking about these issues, especially when it pertains to them personally. But think about this: suppose your life, or that of a loved one, hinged on the timely transplant of a suitable organ? Donors save lives. You can give the gift of life! Be an Organ and Tissue Donor. Registering as a potential organ donor is something everyone can do. Age is not a barrier, you are never too old. An organ donor card can be carried in the event of a fatal accident, but it is both wise and considerate to also make your wishes known to immediate family members and to have them clearly stated in your will.

Organ donation does not have to hinge upon your death!
Kidney donations are frequently made by healthy living donors, often to a friend or family member, but increasingly also to strangers in need. Risk to the donor, while not entirely absent, is very low with proper medical supervision and follow-up care. Considering giving this gift of life can be an enormously rewarding experience. A person suffering from kidney failure has three available treatment options: dialysis, a transplanted cadaver kidney or a transplant from a living donor. Dialysis itself is only a temporary solution. While it is certainly true that people can remain on dialysis for many years, it is an extremely time-consuming procedure and is not a cure.

The number of available cadaver kidneys falls far short of demand. In the U.S. alone, 83,000 people wait on the official kidney-transplant list. But just 16,500 people received a kidney transplant in 2008, while almost 5,000 died waiting for one. Obtaining an organ from a live donor is a way to remedy the shortfall.

It is said that saving one life is like saving the entire world. To learn more about organ donation and to register as an organ, eye and tissue donor in the U.S., visit: donatelife.net.

Patients with leukemia and related blood disorders can be helped by donations of bone marrow, stem cells and umbilical cord blood. Compatibility can be determined by a simple cheek swab. To learn more about registering as a possible bone marrow donor, visit: giftoflife.org.

Contrary to popular belief, there is no upper age limit for potential donors.

Turning a blind eye to forced organ harvesting in China

A tribunal in London found the practice in China against prisoners of conscience to be a near-genocidal crime against humanity

In the British House of Lords on March 2, questions to ministers included one from Lord Hunt of Kings Heath to ask the British government “whether the proposed United Kingdom autonomous global human rights Magnitsky-style sanctions regime will apply to persons engaged in (1) illegal organ trafficking, or (2) obtaining organs for transplant without consent.”

Lord Hunt wrote to me afterwards:

“The horrific enforced organ donation trade in China is appalling. I will keep on pressing the Government until they start to take some action.”

The problem in China is indeed immense, and there is increasing attention to the issue in part because of how practitioners of the Falun Gong spiritual practice have been targeted for forced organ harvesting based on their beliefs.

There is plenty of evidence of forced organ harvesting in China, and likely some overlap between the Falun Gong and death row inmates as organ sources.

“Several articles have drawn attention to the double meaning of the term ‘executed prisoner,’” according to Macquarie University clinical ethicist Wendy Rogers. “And independent investigators have identified that they include prisoners of conscience, who are executed for their organs without due process, as well as death-sentence prisoners whose organs are harvested after judicial execution.”

By some estimates, approximately 90 percent of kidney transplants in China are sourced from “death row.” China actually admitted to sourcing organs from death row inmates between 2005 and 2015. Today, they generally deny sourcing organs from death row, though at a 2017 Vatican conference discussed by Rogers further below, they at least once admitted to continuing the practice of sourcing organs from prisoners.

A global problem

But one would be remiss not to first observe that the problem goes well beyond death row inmates, prisoners of conscience or even China. Our critical attention to forced organ harvesting should arguably include countries like Pakistan, India, the Philippines, Bolivia, Brazil, Peru, Colombia, Moldova, Turkey and Iraq. The poor from these countries more often than elsewhere feel compelled by their economic circumstances to accept loss of an organ in order to make ends meet. There is an element of force to economic compulsion.

Approximately 10 percent of the 100,000 organ transplants annually are via “transplant tourism” according to experts, where wealthy recipients are put at the head of the line in poorer countries where organs can be found cheaply, and in which local poor recipients suffer from lack of supply. In Pakistan in 2006, for example, foreigners received approximately two thirds of the 2,000 kidney transplants, most likely from poor donors who felt economically compelled to relinquish an organ.

According to the Australian Health Department, between 2001 and 2014, at least 53 Australians went to China for organ transplants. That number could be an understatement. A single doctor in Canada, according to Professor Maria Cheung at the University of Manitoba, reported at least 50 patients who went to China for transplants in 2014 alone.

Organ transplant tourists from common importing countries like the United States, Europe, Canada, Australia, Japan, Israel, Saudi Arabia and Oman could save more lives than their own, with the money they spend to extract an organ from someone who could be killed abroad just to source a kidney, liver, heart, lungs or cornea.

The culpable include the traffickers and brokers of organ commercialism, but also the billions of people who fail to proactively donate their organs should they no longer need them due to accident or death.

Forced Organ Harvesting: A Decades-long Injustice in Need of International Accountability and Action

Allegations surfaced in 2006 that Falun Gong practitioners were being forced to undergo live organ harvesting in China, effectively being murdered in the process of organ procurement. David Matas and David Kilgour, both Canadian attorneys and human rights activists, led an investigation that uncovered 41,500 unaccounted for organ transplants from 2000 to 2005.

These transplants did not have identifiable donor sources, such as willing family members or brain-dead donors, suggesting that transplanted organs could have come from prisoners of conscience. This discovery, in addition to witness testimonies, led Matas & Kilgour to verify these allegations: imprisoned Falun Gong practitioners were executed and their organs involuntarily harvested. 18 years later, these concerns remain unchanged.

Although organ trafficking is known to occur in other countries such as India and Egypt, I focused on this issue in China specifically because of its long and concerning history. Forced organ harvesting is a clear social justice issue and a severe violation of patient autonomy, because these individuals are viewed as a vessel of organs, rather than human beings with inherent dignity. I aim to demonstrate the atrocities of forced organ harvesting and highlight how citizens, political leaders, and international committees all play an essential role in ending this practice.

History of China’s organ transplant industry

Organ transplantation in China began with a kidney transplant in 1960. During this time, organs were primarily sourced from executed prisoners. Chinese transplant surgeons traveled abroad to receive training, and very little regulation existed. At a World Health Organization (WHO) meeting in 2005, the Chinese government pledged to reform its organ transplantation system, which previously included few deceased donor organ transplants, and transition to a voluntary, citizen-based organ donation program. In 2015, the China Human Organ Donation and Transplantation Committee officially announced the discontinuation of organ donation from executed prisoners: voluntary organ donation by citizens after death was now the only legal source of deceased organ transplantation in China. Despite these optimistic reforms, concerns of forced organ harvesting from prisoners of conscience persist.

A lack of transparency continues despite supposed reforms

First, the 2015 announcement did not address the discontinuation of organ procurement from prisoners of conscience, demonstrating the lack of concern regarding the persecution of minority groups. Additionally, the 1984 regulations allowing organ procurement from executed prisoners were not replaced by new legislation, which raises the question: are these barbaric procedures truly outlawed? Furthermore, the China Organ Transplant Response System (COTRS), developed in 2011 for organ allocation, does not disclose where organs are sourced from. The lack of transparency causes difficulty in verifying that all organ donations are ethically sourced from volunteers.

Secondly, the rapid expansion of China’s transplant industry is also questionable, according to Robertson et al. China is currently believed to have the second-largest number of transplants globally, but before the organ donation system was established in 2013, China had few voluntary donors. Within a two-year period, China reported donations from 2766 individuals, with 7785 transplants performed in 2015. These dramatic increases in donors and transplantations seem implausible given the low rate of deceased organ donation (3.9 deceased donors per million people) and a low willingness to donate (47.45% of the general public). These findings prompted suspicions that unethical organ procurement continues to supply the ever-growing demand for organs.

Response from the international community

Many countries are aware of the transgressions occurring in China. The Independent Tribunal Into Forced Organ Harvesting from Prisoners of Conscience in China (the China Tribunal), released their final judgment in 2019 concluding that the Chinese government had committed crimes against humanity by targeting minorities for organ harvesting. Although they did not have legal authority to pursue further action, the tribunal aimed to provide a resolution for victims’ families.

In the United States, Rep. Christopher Smith (R-New Jersey) introduced the Stop Forced Organ Harvesting Act of 2023 with the goal of imposing sanctions and allowing the State Department to revoke the passports of those convicted of organ trafficking-related crimes. Sen. Tom Cotton (R-Arkansas) introduced a similar bill in the Senate, which mandates annual reporting by the State Department on forced organ harvesting in foreign countries. Finally, Rep. Michelle Steel (R-California) and Neal Dunn (R-Florida) urged the Secretary of State to prevent individuals potentially participating in organ harvesting, such as physicians-in-training, from entering the United States.

It is promising that several U.S. politicians have introduced legislative changes, but these bills will not take effect immediately. Therefore, it is essential that citizens and activists, as well as professional organizations and committees, also play a part in ending forced organ harvesting.

What more needs to be done?

Forced organ harvesting in China may seem like an isolated problem irrelevant to the American general public. However, U.S. citizens are complicit in organ trafficking, such as China’s $1 billion organ harvesting industry, if they choose to purchase organs overseas. Known as transplant tourism, this phenomenon occurs because shorter waiting times advertised by Chinese hospitals offer an attractive alternative for desperate patients.

Though understandable that vulnerable patients want a quick cure, transplant tourism only contributes to greater injustice in exchange for individual benefit. Instead, it is vital that we close the gap between organ supply and demand. Investing in educational programs can raise awareness and reduce existing stigmas about organ donation. New approaches to organ recovery, such as controlled donation after circulatory determination of death, can increase organ availability and reduce waiting times, eliminating the need for transplant tourism.

This two step-approach asks families to first authorize organ preservation and allow organs to be harvested after unexpected deaths outside of a clinical setting. At a later time, the family will be asked to authorize organ donation. Currently, the Biden administration seeks to modernize the system to shorten waiting times and address racial inequities in patient referrals.

The United Network for Organ Sharing, responsible for coordinating transplantations, was the sole network for organ transplants in the United States for nearly 40 years. Now, the Health Resources and Services Administration (HRSA) is offering multiple contracts to increase competition between bidders and ensure that patients benefit from highly qualified vendors.

The responsibility of ending forced organ harvesting also falls on physicians. When individuals return from their overseas procedures, physicians can decide whether to treat or turn patients away; either decision is ethically valid. However, physicians must also discuss and actively discourage transplant tourism. They can point to the medical risks (organs abroad may be obtained from non-ideal donors with few safety measures in place, leading to surgical complications and/or serious risks of infection) or the moral dilemmas (transplant tourism funds illegal organ trafficking, which is believed to generate $840 million to $1.7 billion annually) to explain why patients should avoid traveling abroad for transplants.

Ultimately, the lack of accountability and standardization across countries allowed forced organ harvesting to persist for far too long. International organizations and committees must consistently apply pressure on China to demand the immediate cessation of forced organ harvesting and greater transparency regarding organ donation statistics.

Following the China Tribunal’s recommendations, this issue should be escalated to the International Court of Justice for an advisory opinion or the United Nations Human Rights Council for an investigation mandate. Countries must also establish a standard set of regulations to prohibit forced organ harvesting and transplant tourism worldwide. The organ black market can easily move across borders and resurface in other countries because national policies have limited jurisdiction. Similarly, transplant tourism is difficult to regulate because only some countries have regulations in place for proper oversight. Therefore, impactful change in response to these horrors requires international coordination and standardized top-down regulation.

Forced organ harvesting cannot be ignored. This is an undeniably heinous practice that plagues our society, but little has been done to right these wrongs. To address such a significant ethical issue, collaborative efforts are required from citizens, physicians, activists, politicians, and international committees. Everyone has a responsibility to take action; how will you help end forced organ harvesting?

Will We Get To The Bottom Of The Truth On Forced Organ Removal In China?

By Dr. Ewelina U. Ochab,

On March 24, the UN marks the International Day for the Right to the Truth Concerning Gross Human Rights Violations and for the Dignity of Victims, a day designated to honor the memory of victims of gross and systematic human rights violations and promote the importance of the right to truth and justice. Indeed, in 2006, the Office of the UN High Commissioner for Human Rights concluded that

Getting to the bottom of the truth is the only way that justice can be achieved. Sometimes, however, the truth may seem beyond reach. The case of alleged forced organ removal in China seems to be one of such cases.

Falun Gong members perform a mock forced organ removal in a shopping district of Hong Kong on January 12, 2013. They claim that their members have been persecuted through torture and intimidation, and subjected to forced organ removal. (Photo credit: ANTONY DICKSON/AFP/Getty Images)

Over recent years, several researchers (including lawyers and investigators) have been raising the issue of forced organ removal in China, namely, the illegal practice of removing organs from individuals who did not consent to it. Despite China arguing that there are approximately 10,000 organ transplants being conducted in China per year, all in accordance with the law, researchers suggest that this is far from the truth. Indeed, researchers indicate that the numbers of such transplants are closer to between 60,000 and 100,000 a year, significantly higher than the official Chinese estimate. Furthermore, researchers make a clear case that the vast majority of the unreported cases of organ transplants are the illegal practice of forced organ removal. This is predominately from prisoners of conscience, particularly religious minorities including Falun Gong, Tibetan Buddhists, Uighur Muslims and unregistered House Church Christians.

When imprisoned, they are subjected to abuse and torture and there appears to be no possibility to redress. As researchers suggest, many of them are subjected to forced organ removal. However, it is important to emphasize that the issue is not only about organ removal without consent or without valid consent. The evidence suggests that the prisoners of conscience do not survive the forced organ removal as vital organs are removed. Hence, it may be more accurate to talk about killings by way of forced organ removal.

The issue of forced organ removal from prisoners of conscience in China is gaining some attention, including at the European Parliament, in the US, Canada, the UK and many more states. However, one of the most significant challenges is the lack of a smoking gun. The victims of forced organ removal in China cannot tell their stories. The bodies are not found. There is no one piece of evidence.

In response to this challenge, the China Tribunal, an independent people’s tribunal to inquire into forced organ removal from prisoners of conscience in China, has been established to consider the evidence of such practice, classify the atrocities and recommend future actions.

The China Tribunal heard from several witnesses who, despite not being the victims of forced organ removal (as the allegation is that no victims have survived the procedure), have identified important elements explaining the practice.

For example, a female Falun Gong practitioner who was imprisoned and tortured for several years told the China Tribunal how medical professionals were examining Falun Gong practitioners but not any other prisoners. The woman had a heart problem what ironically appears to have saved her life. She added:

This was not an isolated statement. Indeed, other witnesses identified similar practices of medical examinations (including blood tests, x-rays and ultrasounds) of Falun Gong and the disappearances of them without a trace. One witness, when asked why Falun Gong would have been picked for the examinations (and possible forced organ removal), identified that Falun Gong practitioners are very healthy and healthier than others in the Chinese prisons. The China Tribunal is still receiving further witness and documentary evidence and will deliver its final judgment in June this year.

In response to the work of the China Tribunal, the UK Parliamentarians decided to take steps to shine more light on the issue and engage the UK Parliament and Government in debates in pursuit of the truth. On March 5, 2019, UK Parliamentarians tabled an Early Day Motion raising the issue of forced organ removal from prisoners of conscience in China and the associated religious persecution. They called upon the UK Government to take more decisive steps on the issue and engage in a dialogue with the Chinese government. On March 26, 2019, the UK Parliamentarians will debate the issue of forced live organ extraction in China in a Parliamentary debate.

The work done by the China Tribunal and UK Parliamentarians may shed more light on the situation of prisoners of conscience in China and honor the memory of the victims in this way. However, the road to the truth about these gross human rights violations against prisoners of conscience in China will be long (if it will even be possible to get to the bottom of the issue). This does not mean, however, that such work should not be undertaken. On the contrary, for the dignity of the victims, in the past and in the future, we must investigate and seek truth with the ultimate goal of stopping such gross human rights violations.