Vital Organ Trade, Theft, and Sale
This essay is finished by Chenchen Zhou, Andrew Chen, Yuliang Li. The publication is allowed by the authors.
This essay is only for academic use. Please do not take it for business use.
The underground market for organ trade takes its existence to bring huge profits for the traders due to the urgent demand from patients. Yet, the unregulated gray industrial chain may result in criminals and other problems. Despite the existence of consent from the donors, the removal of their organs always leads to harmful and unrecoverable outcomes. Meanwhile, as some medical experts may also emerge as potential criminals, the threat to patients can be a serious concern. However, this situation might be changed by allocating resources to patients efficiently and developing artificial organs.
The Reason behind Organ Transaction
According to the American Transplant Foundation, for the year 2018, over 114,000 people from the United States were on the waitlist for organs. Averagely, every 10 minutes, a new person was added to the list, and every 72 minutes, one of them died due to the lack of available and suitable organs. Numerous people are suffering from diseases and need organ transplants urgently, while the supply is too low compared with the demand. Such scarcity does not only take place in the United States but worldwide. Globally, legally available organs can only satisfy roughly 10% of the patients. As not all patients can obtain organs via legal pipelines, they may seek illicit methods to get the desired organs to meet their urgent needs. Therefore, the illegal trade of organs takes its existence. Though the exact data is not available to collect, in 2018, the United Nations estimated that 10% of the organ transplants had used black market organs, globally.
Practices of Organ Trade
In order to receive organs for transplant, when the illegally provided organs are not available, patents participate in transplant tourism and organ trafficking. Transplant tourism means traveling to other countries or places for buying, selling, or receiving organs. The international commerce of organ transplantation has developed into scale, especially for kidney transplantation. Even though it hasn’t yet been so familiar with the U.S. public, there are patients who went through the process and got good results. From 2002 to 2006, 10 patients who underwent transplant tourism for the kidney were identified and tracked. Eight of them accepted the surgery in Somali, Pakistan, one in China, and one in Iran.
Most of the patients recovered well with proper post-transplant care. The researchers also had an interesting finding. Though there are many choices for transplant tourism, patients from the same ethnic group tend to travel to the same country. Organ trafficking refers to the practice of using exploitation, coercion, or fraud to steal or illegally purchase or sell organs . To discuss such established trading networks, it is important to look at where trading organs are coming from. This paper discusses the sources of organs based on the willingness of the victims. Organ trafficking in the following discussion refers to the cases that the victims agree to sell their own organs, and organ theft in the following discussion refers to the cases that the victims’ organs are stolen or robbed.
Organ trafficking contributes to the majority of the traded organs on the black market. Brokers serve an important role in organ trafficking. They recruit organ donors(victims) and connect them with the recipients. The victims of organ trafficking are generally poor, vulnerable populations, which potentially make them easy targets to fraud with. Especially, brokers usually come from the same community or ethnicity as the victims, and that makes them look more trustworthy. The dealers promise to provide them a large amount of money while deemphasizing the importance of the organs. For example, some of them may propagate that human-beings have two kidneys yet people only need one to survive. In some extreme cases, the brokers even tell people that it is even abnormal to have 2 kidneys while others only have one.
The victims are likely to be persuaded to exchange their organs for money. The brokers sometimes give some money to them after removing their organs. However, the victims hardly ever received the full amount of money promised. Post-removal health care is usually poor or absent. In most cases, the money received is not able to cover the post-removal care. Victims even need to spend their life savings and put themselves into a worsening financial situation. Thus, the health and value of these people are overly exploited.
Organ harvesting is also known as organ theft. This paper refers to the cases which are harvesting organs from unwilling or unconscious victims. Insurance for organ harvesting is very rare. However, the social impacts of this case might be extremely harmful. It can be divided into child kidnapping and adult kidnapping. Besides literally kidnapping, the former one can also be involved in children’s adoption, especially international children’s adoption, and the latter can involve sexual temptation. Although there are not sufficient resources for exploiting adopted children around the world, the citizens may believe in the rumor and be suspicious about government policy. Thus, the administrators may revise the policy and limit even terminate international adoption programs. Also, the international aid process might be hindered due to the suspect of the public . Consequently, it would be even more difficult for patients to get help from international donors. Plus, if an area is known for the rumor of organ trade, people may feel reluctant to visit it.
On the one hand, it would undermine economic development. On the other hand, lack of communication would further worsen the misunderstanding and rumor. Therefore, the harm of organ harvesting should never be neglected.
After exploring the black industry of organ trade, another question might arise: should the policy-makers concern more about the situation of patients and regard organ trade as voluntary exchanges of goods and services?
The answer should be negative. First, as mentioned before, human trafficking and organ harvesting are involved in the organ trade. The “donors” are victims of the black industry while the brokers are actual sellers. Second, the governments do provide channels of donating organs, while some people are not driven by morality or altruism but economic profits to sell their organs. If the organ trade can be considered as a voluntary exchange, it will discourage those who were not tempted by money and further upset organ donation. Further, exploitation is usually involved in organ trade because the brokers usually would not provide reimbursement equivalent to the loss of victims. Compared with brokers, the victims are vulnerable because they are not well-educated or don’t have the strength to resist. Some of them even don’t provide healthcare but ask victims to pay for the removal surgery . Concerning these complicated factors, in no case should policy-makers consider organ trade as a part of the voluntary transaction.
Now that organ trade cannot be considered as a part of the free economy, how will it influence the economy? First and foremost, it is important to note that the researchers don’t have accurate data due to the clandestine nature and complex system of the organ trade industry. Yet according to the WHO report in 2007, about 5–10% of the 65000 organ transplant surgeries are performed with illegally obtained organs . And the estimated profit of this industry is about 600 million to 1.2 billion per year . That means the legal system may not obtain enough organs while the illegal dealers are utilizing victims of the organ trade, which will detriment the hospital system. Also, driven by the enormous profit, local gangsters or other criminal groups might be involved in this industry. Some might help the brokers to distribute the organs, while others might get involved in human trafficking directly. This will undermine social safety inevitably . Plus, as mentioned before, the trafficked people may not lead a better life with the money provided by the brokers, some of them may even be poorer because they are forced to pay back the surgery fee to the brokers. As researchers reported, some people may have better economic status after selling their organs in Philippine, while about 61.3%- 69.3% of them cannot perform labor-costing tasks after the surgery .
What’s more, some scholars maintain that it is the existence of organ sales that hindered the development of the donation system. Although it reimburses those who sold their organ (majorly kidney), people who are willing to donate their organs for free will be discouraged . Consequently, the donation system would be negatively affected and the organ resources will be fewer and fewer. Therefore, organ trade is not only an issue associated with morality and legality but also something that will influence the economy of a country and social well-being.
Responses and Solutions
The detriments of organ trade have been disclosed, but how did different organizations respond to it?
There are different treatments currently. One is implementing the criminalization of organ trade. This method had worked well and helped to reduce the organ transaction and prevented the wealthy people in the First World from depriving those of the Third World . However, it might be constrained to specific areas or countries. On a smaller level, different states in the US even have different laws. If someone bought a kidney in another country, its legality is determined by the law of the state in which he purchased the organ. On a larger level, implementing criminalization might encourage brokers to carry on international human trafficking and organ harvesting. Thus, disadvantaged people are more likely to be exploited by those brokers . Plus, criminalization would not work for those who need organs urgently. On the one hand, the medical system may not provide the desired organ on time. On the other hand, those people are willing to pay for the organs desperately. Neither will it work for those who are driven by economic profits to sell their organs. Further, some wealthy people may even regard it as a privilege to purchase organs. What’s more, it is difficult to pass a law which people cannot live with . Thus, the government may seek other methods such as banning organ transactions. In other words, the organ transactions might be reduced by other methods.
On the waiting list, the vast majority of patients need a kidney transplant, and the kidney has become the most in-demand organ. With the development of society, kidney strain is becoming more and more common. For example, the improvement of dietary conditions can lead to obesity, diabetes, and high blood pressure. It is expected that over time, the demand for kidneys will continue to increase. The supply of kidneys is far less than the demand for kidneys, and patients who cannot undergo kidney transplantation can only choose hemodialysis. Patients undergoing hemodialysis need to be treated in a fixed place in the hospital, and they will be connected to hundreds of kilograms of machines, which will severely restrict their freedom. At the same time, the hemodialysis machine requires 40 liters of water per hour, which is not environmentally friendly, and the treatment costs are also quite high.
As a monopolist, hemodialysis equipment has not undergone any updates since its development in 1960. The government funding will make new equipment possible. As artificial kidneys, these new devices will greatly reduce kidney transplants.
In order to solve the problem of kidney shortage, the US government launched a project called Kidney X, which focuses on the development of wearable dialysis equipment and bioengineered kidney transplants. “Last year, US President Donald Trump issued an order on kidney health, including strategies to reduce the shortage of kidneys available for transplantation, encourage more dialysis at home, and do research about artificial kidneys through a partnership called Kidney X. The partnership is led by the US government plans to raise US$250 million over the next five years. Last year, it awarded a total of $1.1 million to 15 US-based research teams tackling various pieces of the dialysis puzzle, including groups pursuing wearable dialysis devices and bioengineered kidney grafts.” 
Except for the kidneys, there are still many organs that are insufficiently supplied, such as the heart, liver, and skin. The development of artificial organs can effectively meet the needs of patients, such as artificial hearts, which remove all the cells on the organs of the deceased, leaving only protein scaffolds, and then repopulate them with stem cells according to the patient’s immune system. The artificial skin is to digest, separate, and culture the foreskin cells of the newborn to extract dermal tissue and epidermal tissue to form new skin. But the root of artificial organs still comes from people who donate organs voluntarily. So in order to reduce the sale of organs, there are three other methods besides using artificial organs.
The first method is to develop a better organ donation system for the dead. So far, organ donation from the dead is still the most reliable source of organs. When artificial organs are relatively immature, the development of a better organ donation system for the deceased can solve the problem of organ shortage in a short period of time and can make up for the technical difficulties of artificial organs. For example, the Presumed consent organ donation system recently launched in the United States. According to this system, unless people exit the system through legal procedures, they will be regarded as people who donate organs voluntarily after death. The appearance of presumed consent has increased the number of organ donors to a certain extent.
The second way is encouraging living organ donation. Living organ donation seems difficult to understand. Because no one will donate their organs to other strangers while they are alive. How to realize living organ donation? Living donations mainly exist among relatives or friends, but there are also a few who can make voluntary donations. With the development of science and technology, when a person experiences a major accident that leads to brain death, life can still be maintained through ventilator and drugs, but the brain stem and permanent loss of function leave the patient in a vegetative state. The family members of these patients also have the right to donate their organs. For example, in China, a 26-year- old young man became brain-dead after experiencing a car accident. Because he might never be able to regain consciousness, his family agreed to donate live organs, saving 10 patients.
The third method is to prevent and treat diseases that can cause organ failure. Through timely treatment to prevent organ failure, reduce the need for organ transplantation from the source . Currently, it is widely acknowledged that organ failure is the major reason for an organ transplant. However, in some cases, it can be prevented or remitted. For example, numerous infections will occur clinically and cause patients to suffer from organ failure. Or the patients may suffer from severe immunological reactions in the process of treatment, and consequently, fail to recover unless transplanting a new organ . If the doctors can be more careful about the patients’ conditions and take multiple methods to prevent these symptoms, those patients may not need organ transplants at all. Noticeably, preventing organ failure can seldom be achieved with a single method. The doctors are supposed to take multiple treatments to prevent it .
Organ trade is an underground industry with enormous size and amount of profits because of the gap between organ supply and organ demand for transplantation. There are four major practices of organ trade, including organ trafficking, organ harvesting, transplant tourism, and organ sales. On the one hand, these actions had caused moral and ethical issues around the world. Victims are exploited and abused in this process while getting few reimbursements. On the other hand, this hidden industry had caused problems with a country’s international fame, weakened some labor forces, and detrimented the stabilization of the society. Thus, the national economy might be negatively affected and the citizens’ well-being cannot be guaranteed. Besides, organ trade, theft, and sale have preempted the resources of the public medical system and may further deepen the gap between organ supply and demand. To reduce organ trade and boost the well-being of patients who need organ transplantation, the regulatory department should criminalize organ trade and illicit organ transplantation. Also, it would be beneficial to protect vulnerable persons who are poorly educated or physically or mentally weak. Meanwhile, the government and medical institutes should actively and encourage people to donate organs. Plus, tissue engineering methods can be deployed to develop artificial organs. Some companies have made commendable progress in this area in fact. What’s more, doctors and nurses are encouraged to prevent patients from organ failure and help them to rehabilitate, instead of finding organs after the organ is failed. Combining all these methods, the vulnerable people may not suffer from organ theft and trafficking, medical institutes can get more organ supply, and the health of patients can be improved tremendously.
 “Organ Donors Still Scarce,” WHO, December 11, 2010. https://www.who.int/mediacentre/multimedia/podcasts/2010/organ_transplants_20100806/en/
 “Organ Donation and Transplantation Statistics,” National Kidney Foundation, January 11, 2016. https://www.kidney.org/news/newsroom/factsheets/Organ-Donation-and-Transplantation-Stats
 Columb, Seán. “Beneath the Organ Trade: a Critical Analysis of the Organ Trafficking Discourse.” Crime, Law and Social Change 63, no. 1–2 (2014): 21–47. https://doi.org/10.1007/s10611-014-9548-0
 Columb, Seán. “Beneath the Organ Trade: a Critical Analysis of the Organ Trafficking Discourse.” Crime, Law and Social Change 63, no. 1–2 (2014): 21–47. https://doi.org/10.1007/s10611-014-9548-0
 Meshelemiah, Jacquelyn C.A., and Raven E. Lynch. “Chapter 9: Organ Trafficking.” The Cause and Consequence of Human Trafficking Human Rights Violations. The Ohio State University Pressbook, August 3, 2019. https://ohiostate.pressbooks.pub/humantrafficking/chapter/chapter-9-organ-trafficking/
 Kelly, E. International Organ Trafficking Crisis: Solutions Addressing the Heart of the Matter. Boston College Law Review, 54(3), Article 17, May 23, 2013, retrieved from https://lawdigitalcommons.bc.edu/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=3324&context=bclr
 Franks, Dorothy. 2018. “The Rumor on Adopting Children for Their Organs: A Compelling Reason to Address a Thriving Organ Black Market and the Prevalence of Children Being Trafficked into Adoption.(Eighth Annual Symposium; Black Market Gold: Medical and Transplant Tourism).” Journal of Health & Biomedical Law 14 (1): 169.
 Shimazono, Y. (2007b). Mapping “Transplant Tourism”; Presentation at the World Health Organization’s Second Global Consultation on Human Transplantation. Geneva: March 28–30.
 Haken, J. (2011). Transnational crime in the developing world. Global financial integrity. Retrieved from: http://www.gfintegrity.org/storage/gfip/documents/reports/transcrime/gfi_transnational_crime_ web.pdf.
 Mendoza RL. 2011. “Price Deflation and the Underground Organ Economy in the Philippines.” Journal of Public Health (Oxford, England) 33 (1): 101–7. https://doi.org/10.1093/pubmed/fdq016.
Wilkinson, Stephen. “The Sale of Human Organs.” Stanford Encyclopedia of Philosophy. Stanford University, October 22, 2015. https://plato.stanford.edu/entries/organs-sale/.
 GREENBERG, OFRA. “The Global Organ Trade.” Cambridge Quarterly of Healthcare Ethics 22, no. 3 (2013): 238–45. https://doi.org/10.1017/S0963180113000042.
 Canales, Muna T.; Kasiske, Bertram L.; Rosenberg, Mark E. Transplant Tourism: Outcomes of United States Residents Who Undergo Kidney Transplantation Overseas, Transplantation: December 27th, 2006 — Volume 82 — Issue 12 — p 1658–1661 doi: 10.1097/01.tp.0000250763.52186.df
 Campion-Vincent, Véronique. “Organ Theft Narratives as Medical and Social Critique.” Journal of Folklore Research 39, no. 1 (2002): 33–50. Accessed December 4, 2020. http://www.jstor.org/stable/3814830.
U.S. Department of Health and Human Services. (2019, July 11). HHS Launches President Trump’s ‘Advancing American Kidney Health’ Initiative. Retrieved December 04, 2020, from https://www.hhs.gov/about/news/2019/07/10/hhs-launches-president-trump-advancing-american-kidney-health-initiative.html
Girlanda, R. (2016, September 24). Deceased organ donation for transplantation: Challenges and opportunities. Retrieved December 04, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036117/
 Deitch EA, Goodman ER. Prevention of multiple organ failure. Surg Clin North Am. 1999 Dec;79(6):1471–88. doi: 10.1016/s0039–6109(05)70088–8. PMID: 10625989.
 Vincent JL. Prevention and therapy of multiple organ failure. World J Surg. 1996 May;20(4):465–70. doi: 10.1007/s002689900073. PMID: 8662136.