The Red Market: International Organ Trade

Michelle Meringer

October, 2017

In the shadows, the global market for illegal trade of human body parts is on the rise. Known as the red market, this lucrative underground economy is a growing epidemic. The market has experienced an increase in the international distribution of illicit organs and tissues; transplants using organs obtained through illegal means are estimated to make up 10% of all procedures performed annually. Furthermore, in China hospitals are believed to be harvesting up to 11,000 organs from political prisoners each year.

The market operates via illegal channels, controlled by transnational criminal organizations. Considered to be a segment of the black market, the red market is distinct as it turns our own bodies into a commodity, exposed to the forces of supply and demand.

The demand for human parts vastly exceeds the supply. The United States alone has an estimated 200 million illegal human body-derived products sold annually.The practice is especially common in India, where it is estimated that 2,000 Indians sell a kidney annually.

The trade of organs and tissues are used for various medical and scientific purposes. For example, translational research heavily relies on the use of tissue sampling and biobanking. However, the most common use is for the transplant of donor organs into new recipients with life-threatening conditions.

Modern medicine has enabled the success rate of transplant surgeries to grossly soar within recent decades; however, patients often fear of whether they will receive an organ in time upon being placed on organ transplant lists. As consequence, this uncertainty is contributing to the rapid growth of the industry. It is estimated that more than 100,000 people globally are added onto the waiting list for organ transplants on an annual basis, with an average of 50% dying before receiving one.

Organs for transplant originate from two sources: deceased donors and commercial living donors. Usually, both of these sources fall under distinct professional, ethical, and legal regulations that govern their procurement. Conversely, the red market is unregulated resulting in the exploitation of vulnerable individuals for profit.

Certain organs and tissues can be sold without significantly reducing the quality of the life of the donor, such as hair and blood. Others, such as hearts and kidneys, result in permanent disfigurement, disability, or even death.

The most common method for trading organs across borders is transplant tourism. This term was coined in resolution WHA 57.18 by the World Health Organization (WHO) to encompass illegal overseas transplantations. Transplant tourism involves potential recipients traveling to the country of origin of the donor to undergo organ transplantation.

The commercialization of organ transplantation has developed into a global crisis. Committed by transnational criminal networks, it relies on the interplay between traffickers, international brokers, and healthcare professionals involved in the recruitment and transportation of donors and recipients. To combat and prevent organ commercialism and trafficking, legal frameworks for the criminalization of trafficking offences needs to be universally adopted.

In 2004, the World Health Assembly resolution (WHA 57.18) urged Member States to “take measures to protect the poorest and vulnerable groups from ‘transplant tourism’ and the sale of tissues and organs.” Although many countries, both organ-exporter and -importer, have attempted to curtail the exploitive organ trafficking industry through various laws and legislation, the lack of global cooperation has prevented much progress from occurring.

In 2008, the first international Summit of its kind was held by The Transplantation Society (TTS) and the International Society of Nephrology (ISN), which resulted in the development of the Istanbul Declaration on Organ Trafficking and Transplant Tourism. In an effort to unite the world against global organ exploitation, this Declaration outlines that all countries need a legal and professional framework to govern organ donation and transplantation activities. This includes a transparent regulatory oversight system that ensures donor and recipient safety and the enforcement of standards and prohibitions on unethical practices.

The Declaration condemns “victimizing the world’s poor as the source of organs for the rich” and seeks to “preserve the nobility of organ donation” by combating the threat of the international organ trade. It also went further to suggest a ban on advertising for illegal organ donors, repercussions for illegal organ trade brokers and called for the establishment of donor registries. With over 150 representatives from scientific and medical bodies in addition to the government officials in attendance, the broad representation present at this summit and the consensus reached amongst them reflects the importance of international collaboration to improve organ transplant practices.

A viable solution to the illegal organ trade is to increase the number of organ donors worldwide, and hence the availability of organs to the extent that the supply can meet the demand. This would require countries to achieve self-sufficiency in organ donation and that organs for transplantation would be equitably allocated within countries and regions.

One means of accomplishing this can be through education, as many are unaware of the dire need for organs and others fear that they will not receive life-saving care once registered. An opt-out system is another method that has been shown to increase organ donation rates as much as 30% in Germany. It works on the premise of implied consent; everyone is considered an organ donor unless specified otherwise. In addition to policy changes, advances in medicine and science are on the verge of being able to bypass the donor process altogether. Xenotransplantation – the transplantation of organs from animals or grown ex-vivo through the bioengineering of human genes into animal tissue using stem cells – may be the future of transplants.

It is apparent that the rapid growth of the red market is exploiting the poor in a debilitating way, as commercial donor’s human rights are undermined for the potential of vast profits. The underlying motivation for organ donation is poverty, yet the perceived economic benefit after donation is reduced due to the patient’s limited employability due to the deterioration of their health. Without intervention, organized crime groups will continue to profit from a business that preys on both sides of the supply chain; exploiting the poor suffering from chronic poverty and manipulating the wealthy that are desperate to live.