By Abby Leonard: Human Trafficking Search Research Fellow, Yale- Robert C. Bates Postgraduate Fellow, Yale grad (’21)

In the record-setting new television series Squid Game, 456 individuals with large debts in South Korea are invited to compete in a series of children’s games in hopes of winning a large cash prize and settling their debts. The protagonist of the show, Seong Gi-hun, agrees to compete in the games after racking up so much gambling debt that he is forced to sign away his bodily rights to his bookies, meaning he will have to sell a kidney and an eye if he does not pay his debts. For almost all the characters within this dystopian survival story, losing one of these games also means losing your life. Amongst the gore of 456 character deaths, a subplot regarding black market organ harvesting of the dead players’ bodies is revealed in Episode 4—part and parcel of the show’s depictions of graphic bodily violence. This plot, like the larger narrative of the show, offers a stinging depiction of the lengths people will go under the pressure of poverty.

For the organ traffickers in Squid Game and in real life, organ trafficking can be very lucrative. The industry has been valued annually at $840 million to $1.7 million by Global Financial Integrity. This high value is a result of a worldwide shortage in organ donations. Changes in demographic and socioeconomic conditions like higher incomes, a growing aging population globally, and increased rates of chronic, heart, and vascular diseases in wealthier nations have spurred on high demand for organ transplants. However, the number of available organs for transplant through donation is not rising to meet the level of demand. The Global Observatory on Donation and Transplantation estimates that organ transplants account for less than 10% of the global need. So far, in 2021 in the United States, there are over 106,000 individuals on the organ transplant waiting list. The vast majority are waiting for a kidney, a pattern we see globally. In comparison, there have been only 28,216 transplants performed in the United States this year—a statistic limited by the number of organs available by living or deceased donors.

This high demand coupled with a global shortage of available organs has led to high prices on the black market. Despite the high price tag for an organ, just like in Squid game, the money usually does not go to those the organs belong to. Instead, intermediaries known as brokers and scouts facilitate the trade and usually walk away with a majority, if not all, of the profit.

In many cases, the people who are selling their organs are desperately impoverished. Like Gi-hun in Squid Game, insurmountable debt has left them with few alternatives to pay back creditors and afford the basic cost of living for themselves and their families. This leads to a population disproportionately vulnerable to exploitation by intermediaries who are “choosing” to sell their organs to get by. The WHO foresaw this potentially gray area of morality and exploitation and internationally prohibited organ trading in 1987. Organ trading or “transplant commercialism,” as it was first called it, is the selling of human organs for a profit, not the donation of human organs and fair reimbursement of medical, loss of employment, and housing expenses for donors. United Nations’ policy and many nation state’s domestic policies have reified this prohibition. Only in Iran is it legal to sell and purchase organs. 

Yet, this prohibition has crafted a particular lens through which the organ trade is viewed. It has centered attention on the individual criminality of those who participate in organ trafficking rather than the root cause, the broader socioeconomic conditions and structures which drive impoverished individuals to such desperate ends. Human Trafficking Search has published a report (insert link) that explores this misdirected focus by examining how socioeconomic inequities form the underlying societal exploitation of those who are driven to such extreme actions by poverty, particularly as organs move from the poor of the Global South to the wealthy of the Global North.

A question central to the debate regarding the criminalization of the organ trade—parallel to debates on the criminalization of sex work—is whether an impoverished person with few to no other options beyond selling an organ can “consent” to such an action. Under extreme financial duress with no other alternative, is the choice to sell an organ really a choice? It’s admittedly a difficult question to answer. Taking away the agency of those who do decide to sell their organs, as critics of the criminalization of the organ trade argue, follows legacies of encroachment on the bodily rights of the impoverished under the guise of paternalism or moralism. However, a counter question is whether that agency has already been taken away by grinding globalized poverty and the lack of the global community and individual nation states to implement policies that address this poverty in a meaningful way. In today’s globalized economy, it is not only the labor of the impoverished but the body itself, which is up for sale.

For profit organ trade inherently exploits the impoverished. This was evident to the WHO in 1987 and is evident today in media representations of the actions of desperately impoverished people, like the contestants in Squid Game. The outcome for those who “choose” to sell their organs under these conditions is not good. A majority of those who sell their organs hoping to alleviate debt often go further into it as postoperative complications due to lack of proper procedures during the removal force them to seek out expensive health care and severely limit their employment options due to recovery time. It does not serve the impoverished to focus on the individual criminality of those who choose to sell their organs out of financial desperation, or those who serve as intermediaries (acting at times nefariously as some do), or those who buy illegal organs for fear of dying on a seemingly never-ending waiting list.

What this focus does do is give us an easy target to blame, a clear and identifiable “bad guy”. It shifts the narrative away from the growing wealth gap, abysmally defunded public health care, and lack of global investment in economic opportunities for the impoverished, particularly those of the Global South. It makes us forget that though individuals may exploit others, broader socioeconomic structures foster the conditions and tacitly allow such exploitation to happen. Addressing individual criminality may treat the symptoms of organ trafficking, but it fails to address the deep roots of poverty, regional power disparity, and public health inaccess that underpin it, creating an ongoing game of organ trafficking whack-a-mole that never ends. 

Read the Report- Organ Trafficking: How Structural Inequality Leads to Individual Exploitation