Our correspondent Jakov Ikač explores, through a series of brief case studies, the operation of the organ trade internationally, and the varied ways in which governments have responded to this challenge.

Illegal organ trafficking is an international trade; it occurs in many countries all around the world, and organs are often transported across national boundaries before reaching the intended recipient. Both the illegal and legal organ trades can occur in almost any country; however, as a general rule, organs are sourced from the impoverished and vulnerable in Third World countries, and then sold onto the wealthy and desperate around the world, often at a significantly higher price. This is an industry motivated by fear and characterised by ruthless exploitation. In general, the ‘producers’ of these organs are motivated by the desire to earn enough money to survive in the short term (even if this results in future medical complications at an age they may never live to be); the buyers of the organs are motivated by their fear of dying for want of a working organ, when such an organ is unavailable by legal means in their own country and a transplant is their last resort; and the traders, or course, are motivated primarily by the desire to turn a profit. Illegal organ trafficking is most prevalent in unstable countries such as Israel or Pakistan (NewsPick 2008); these countries are plagued by war and poverty, making some people desperate enough to consider selling their own or another’s organ as a viable possibility.

(Visit http://smartsgroupd.blogspot.com/p/joshua.html for a general explanation of the organ trade. For more information on the economics of the organ trade, see http://smartsgroupd.blogspot.com/p/declan.html. For more detailed information on the problems with the organ donation system in developed countries, see http://www.smartsgroupd.blogspot.com/p/phoebe.html.)

As stated, organ trafficking is very common in countries experiencing war. For example, the history of organ trafficking in Kosovo is strongly tied to the social and political unease existing after the war in the former Yugoslavia during the 1990s. After this war ended in 1999, but while Kosovo was still a region of Serbia, the Kosovo Liberation Army is recorded as having abducted almost 400 Kosovo citizens (mostly ethnic Serbians) and taken their organs without consent before murdering them to conceal the evidence (NewsPick 2008). In this case, the combination of war, the lawless conditions and imbalance of power existing as a result of it, and the poverty created by the mass displacement and destruction of property had provided the opportunity for the establishment of an illegal organ trade.

Much like Kosovo, Israel also has a history of organ trading which has been facilitated by war, in combination with other common contributing factors such as widespread poverty. The lack of legal barriers existing to prevent the illegal organ trade until as recently as 2008 also contributed to the ease with which a trade could be established. Illegal Israeli organ transplantation traders have a record not only of performing the illegal trade in their own country but diversifying into other parts of the world, such as Ukraine, by having the victim’s organs removed there. In 2006, two men, John Allan and Hassan Zakhalka, found and allegedly pressured people from Galilee and Central Israel to sell their organs (for a price which was never paid); they flew the victims to Ukraine, where they underwent organ removal surgery. (Eyadat, F 2007). The motivation behind performing the surgery in this alternative country seem to be that Ukraine had not criminalised the buying and selling or organs; this lack of an effective legal barrier is another common factor in encouraging the establishment of an organ trade.

Mozambique, located in the south of Africa, is generally considered to be a major hub of organ trafficking activity. The Human Tissue Act, 1983 in South Africa made organ transplantation legal to hospitals and medical directors; however, the legalisation of this vital process has unfortunately contributed for the demand for trafficked organs arriving from Mozambique. Poor economic conditions, a recurrent contributing factor for the continuation of the organ trade, are evidently manifest here.

India is also infamous for its organ trade, which, once again, has arisen partly as a result of the extreme poverty existing within the country. In 2004, the Transplant Authorisation Committee, a government body charged with eradicating activity associated with the organ trade, was found to have been co-operating with the organ dealers (NewsPick 2008), apparently under the impression that more lives could be saved in this way than by directly contradicting the dealers’ message—such is the power and impunity of the organ traders in that country Whether such an approach has any beneficial impact in reducing the scale of the organ trade remains to be seen.

In China, a similar situation exists: the government predominantly turns a blind eye to the existence of the organ trade (NewsPick 2008), too concerned with maintaining its own position of power and the high levels of economic growth the country currently enjoys. Within China, organs for transplantation are readily available because they are mostly harvested from executed prisoners (Coonan, C and McNeill, D 2006). In fact, organs and organ trafficking rings are so abundant in China that many wealthy Japanese nationals look to China when unable to find a transplant organ by legal means in their own country. To some extent, this prisoner-harvesting system is commendable in that it does not directly harm any living person; however, it could not be expected to function in any country without the draconian laws and lack of respect for human rights that prevail under the existing Chinese regime.

Another notable example where the combination of the lack of adequate legislation or enforcement and poverty has resulted in the flourishing of a lively illegal organ trade is Egypt. Up until very recently, the organ transplantation business in Egypt was entirely unregulated, such that it is estimated that up to 500 illegal kidney transplants were performed per year (NewsPick 2008). This has made the selling and harvesting of organs the source of a “good living” in Egypt. Organ harvesters in Egypt, in a similar way to those in Israel, search as far as Europe to find someone who can be coerced into giving his or her organs away (Vaknin, S 2005). However, a new law introduced to Egypt classifies organ harvesting as first degree murder: “Removing organs without government authorization will be treated as first-degree murder” (Rosenberg, D 2011). There is no doubt that the new law will reduce organ trafficking; nevertheless, it can safely be assumed that many people who do harvest and sell organs do not understand the risks involved in it and will be prepared to take the law into their own hands in order to continue to make a profit.

Organ trafficking is an international trade. In many cases, harvesters search for victims in different countries, the victims’ surgery is performed in other countries and/or the organs themselves are sold and traded internationally. As mentioned in the case of Israel and Ukraine, it is common for organ trade to be performed between two different countries (a procedure made easier by the progressive process of globalisation). This situation arises because of the high demand for organs to harvest and sell, combined with the reality that for many of the recipients, these organs would have been unavailable in their home country. Desperate, those in need of organs advertise and search for victims in other countries: “Many Israelis—attempting to avoid scrutiny—travel to east Europe, accompanied by Israeli doctors, to perform the transplantation surgery” (Vaknin, S 2005). Alternatively, like the Israel-Ukraine case, the organ is extracted in one country, transported and then implanted in another country. And, again, there is also the case of people travelling to another country to receive an organ as a kind of “medical tourist,” as was mentioned in the case of those wealthy Japanese people who travel to China to receive transplant organs. These are just some examples of international organ trade; the organ trade has developed into an advanced network of organised global crime.

Poverty stricken countries are the places where organ trafficking most commonly occurs, as well as countries that are involved in war. Such circumstances create conditions where people are desperate to make money and the only possession they have available to sell is their organs, with this vulnerability making them easy prey to those involved in the illegal organ harvesting trade. However, this problem cannot merely be consigned to the domain of politically unstable or impoverished countries; organs can be traded anywhere in the world, and citizens of both developing and developed countries contribute to the continued exploitation of these vulnerable, struggling people. We are yet to reach a full understanding of this crime and the reasons for which it is committed, but if the situation is to be improved, a more global approach will need to be adopted in co-operation with the people, businesses and government of many countries around the world.