The term organ trafficking is commonly used to refer to a range of criminal activities, including illegal organ harvesting from a living or dead individual and the illegal sale and transplantation of human organs. While some experts include forms of enslavement or coercion to obtain an organ donation in the definition, U.S. government sources typically describe such crimes as trafficking in persons for the purpose of organ removal. Reflecting concerns over organ trafficking as a human rights abuse, a profitable transnational crime, and an activity in which U.S. citizens or businesses may be directly or indirectly complicit, many in Congress have sought to better understand and address the practice. Through proposed legislation, funding decisions, and oversight hearings, Congress has identified potential policy tools to address organ trafficking and has endeavored to identify and change the behavior of actors that may play a role in facilitating the illegal trade. Congress has also sought to understand organ trafficking’s relationship with political repression in countries with poor human rights records (see the “Congressional Interest in Organ Harvesting in China” textbox) and other crimes such as human trafficking. Organ trafficking may be considered part of a broader market that includes tissues, cells, or other human body parts or products, referred to by some as the “red market.” Prominent international legal frameworks, and many national frameworks, including in the United States, prohibit any sale of human organs (with exceptions for compensation for expenses incurred by organ donors).1 The wide-scale prohibition of organ sales makes organ trafficking unique among other transnational crimes, because with rare exceptions, there is not a parallel, legal trade in the commodity.2 Demand for organ transplants that is not met by legal organ donations contributes to organ trafficking, which may be facilitated by criminal organizations or actors.
As with many clandestine activities, estimating the financial scale of international organ trafficking is complicated by a lack of information.3 The non governmental organization (NGO) Global Financial Integrity (GFI) estimates that the annual value of organ trafficking globally ranges from $840 million to upwards of $1.7 billion. 4 Transplants may cost a purchaser tens to hundreds of thousands of dollars, depending on the organ involved, and associated medical care and travel. 5 Estimates of the number of illegal transplants performed and prices offered for organs vary. GFI estimates that approximately 12,000 illegal transplants occur each year, around 8,000 of which are for kidneys, followed by liver, heart, lung, and pancreas.6 GFI estimates that prices paid to individuals for their organs vary significantly: for kidneys, payments reportedly range from hundreds of dollars to individuals from less developed countries, to up to $20,000-$30,000 in more developed countries. Some individuals may not receive any payment for an organ or may receive less than originally agreed. Reports also describe individuals who provide organs and subsequently incur significant medical costs or experience a loss of livelihood due to botched surgeries or unanticipated residual effects.7 According to GFI analysis, markups for the recipients are often 500%-1,900%, with organs costing the recipient between $100,000 and $237,000.8 Individuals who sell or otherwise provide organs for the illegal trade may be:
- deceased persons who did not consent to the use of their organs, or individuals who are killed for their organs;
- living persons who do not consent to the use or harvesting of their organs or are coerced, including by threat of force or offers for payment that take advantage of economic duress; or
- living persons who consent to sell an organ (in some cases, such individuals may be misled about the nature of the medical procedure and recovery).
Considerations of victimhood and culpability are complex, in part because even when individuals consent to selling an organ, the sale is typically considered illegal pursuant to national laws.10 Some observers have acknowledged that although sellers frequently make the decision to sell an organ under duress, they contribute to the existence of the black market, and are usually involved in criminal activity. Organ trafficking may be facilitated by corrupt officials or criminal groups and may include brokers or other middlemen who connect individuals providing the organ with prospective recipients, negotiate the price, and identify medical facilities where the transplant can occur. Organ recipients, along with the medical professionals involved in their procedure and aftercare, may or may not be aware of the circumstances surrounding an organ transplant.
Although media and public attention has at times focused on allegations of forced organ harvesting of certain repressed minority groups, such as those in China (see the “Congressional Interest in Organ Harvesting in China” textbox below) experts suggest that many cases stem from economic motivations. Some research indicates that cases frequently involve young men from developing countries who are financially motivated to sell an organ, while organ purchasers appear to be primarily from more developed countries. Poverty and imperfect access to information are commonly cited as key vulnerabilities for individuals who decide to sell an organ. Some research suggests that migrants are particularly vulnerable, as they may have little money, may not be familiar with regulations, and may be easily manipulated by smugglers or traffickers. Transplant procedures appear to typically occur in the country of the vendor or in a third country, to which the vendor and purchaser both travel, and appear to frequently be performed at medical facilities that also perform legal transplants. Those involved in organ trafficking may take advantage of weak rule of law in such locations.
Organ trafficking may also occur within conflict settings or among displaced populations. For example, several investigatory bodies have found that ethnic minorities were killed for their organs on a limited scale, as authorized by officials in the Kosovo Liberation Army, during the 1998-1999 Kosovo War. Also, in 2017, the U.S. government’s Joint Counterterrorism Assessment Team referenced evidence that the Islamic State appeared to have sold the organs of its captives through regional criminal networks. Some scholars have identified likely cases of organ trafficking or trafficking in persons for organ removal among Syrian refugees in Lebanon and Sub-Saharan African refugees in North Africa, among other contexts.
Organ Trafficking: According to definitions adopted by the U.S. Organ Procurement and Transplantation Network (OPTN) and the United Network for Organ Sharing (UNOS), organ trafficking is “the recruitment, transport, transfer, harboring 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 the receiving by, a third party of payments or benefits to achieve the transfer of control over the potential donor, for the purpose of exploitation by the removal of organs for transplantation.” These definitions are informed by those adopted at the 2018 Istanbul Conference (see “The Declaration of Istanbul on Organ Trafficking and Transplant Tourism” section).
Organ Harvesting: Organ harvesting, or organ procurement, refers to the surgical procedure that removes an organ from an individual, typically for transplantation. In some cases, the procedure may be forced or coerced. Trafficking in Persons for the Purpose of Organ Removal: According to U.N. and U.S. government sources, trafficking in persons for the purpose of organ removal is distinct from the broader crime of organ trafficking in its focus on crimes perpetrated against the trafficking victim, rather than the illegal sale and transplantation. In comments made in a hearing before the House Foreign Affairs Committee in 2010, Luis CdeBaca, then-Ambassador-at-Large to Monitor and Combat Trafficking in Persons, stated that situations in which “somebody was being held in servitude to have parts harvested … would be a trafficking case…. The freedom being denied them for the harvesting, that is at the heart of the distinction that we make. It is the difference between slavery and illicit transport of a piece of contraband.”18 U.N. sources have articulated similar findings.19 Organ removal is not explicitly included in the Trafficking Victims Protection Act (TVPA, P.L. 106-386) definition of severe forms of trafficking in persons, which includes forced labor and forced sexual exploitation. Annual State Department Trafficking in Persons Reports (TIP reports) have cited instances of “trafficking [in persons] for the purposes of organ removal,” while stating that organ trafficking is not a form of trafficking in persons. The 2017 TIP Report stated that strong anti-trafficking laws include “a clear definition of human trafficking that describes the acts, means, and ends, as distinct from related crimes—such as migrant smuggling, prostitution, kidnapping, organ trafficking, or illegal adoption.”
Transplant Commercialism, Travel for Transplantation, and Transplant Tourism: According to the OPTN/UNOS Board of Directors, transplant commercialism “is a policy or practice in which an organ is treated as a commodity, including by being bought or sold or used for material gain. Travel for transplantation is the movement of organs, donors, recipients or transplant professionals across jurisdictional borders for transplantation purposes. Travel for transplantation becomes transplant tourism if it 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.” 21
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