Turkish surgeon, Dr. Sonmez, was recently charged and indicted with human trafficking, organized crime and unlawful exercise of medical activities. Sonmez and his accomplices allegedly brought rich people in need for transplants to a clinic in Kosovo, where their clients received new organs from living donors. The donors were poor people from Russia, Moldovia, Turkey, and Kazakhstan, who had agreed to sell their kidneys. They were promised up to €14,000, money they never received. In return, the recipients paid between €80,000 and €100,000 for their new organs, creating huge profits for those involved. The case, known as the Medicus Clinic case, is a well-documented example of organ trafficking, a phenomenon often difficult to uncover and to prove.
For many years, organ trafficking was considered a myth, but institutions and organizations, like the WHO have revealed a rather widespread black market of organ trading. There are no official data.
However, a report by the Council of Europe and the UN in 2009 stated that approximately 5-10% of all kidney transplantations around the world derive from trafficking. Beatriz Dominguez-Gil, Medical Advisor at the National Transplantation Organization (ONT) in Spain helped prepare the report, which brought attention to the origins of organ trafficking and its consequences. She thinks that the phenomenon is generally underestimated and said in an interview with OWNI that countries should be obliged to collect official data. “The main problem in Europe is transplant tourism, when a patient goes abroad to get a new organ in a non-official way”, said Dominguez-Gil. “But the patients have follow-ups in their home countries, and this information could be collected by the authorities”
The most significant problem facing transplantation today is the lack of suitable organs. The need for organs is rising, and there are not enough donors to meet the increasing demand. There are several factors contributing. As the skills of surgeons increase, far sicker patients are accepted onto waiting lists. In addition, aging populations and unhealthy lifestyles and diets are causing more organ failures than before. In the US, approximately 20,000 organ transplants are performed annually; meanwhile more than 80,000 patients are waiting for an organ on different waiting lists.
The large gap between supply and demand has produced a black market of organ trading, motivated by huge profits. The donors are poor people who agree to sell an organ to pay off a debt, pay the bills or simply to survive; hence the trade targets and exploits the most vulnerable groups in society. The most common way to illegally obtain an organ is probably transplant tourism. Wealthy recipients travel to poor countries to get a transplant from a local poor donor. In some cases organs from local deceased donors are allocated to foreigners through commercial transactions. Luc Noel works for the Clinical Procedures Unit at the WHO and spoke with OWNI about organ trafficking and the work of the WHO. “There are many disturbing aspects of transplant tourism”, he said. “One of the most troubling is that it deprives the country’s own citizens the opportunity of transplantation”.
The WHO Guiding Principles are designed to provide an ethical framework that Member States are advised to follow. They prohibit financial transactions related to donation and urge health professionals to refrain from transplantation if they suspect that the organ has been obtained illegally. Noel points out that the health insurance companies and the national health insurance systems are equally responsible. “In the past, there were countries where the national insurance system would gladly pay a transplantation abroad”, he said. “They knew it was the best solution for the patient, and it was saving them money”. Today, most countries that used to promote transplant tourism have established laws prohibiting their citizens to go abroad for transplants. The WHO works for and with its Member States, nevertheless legal implementation is on country level, leaving the WHO powerless to impose on national legislation. “There is a growing consensus that we need a binding international treaty disconnecting the human body from profit”, said Noel.
Pakistan, the Philippines, Egypt, China, and Colombia used to be hubs for organ trafficking. They have recently adopted national legislation prohibiting the commercial trade in organs, trafficking and transplant tourism. “Transplant tourism continues, of course”, said Noel. “It just moves to countries that are less regulated”. Additionally, countries that are trying to impose control, struggle against corruption within the health care sector. “Authorities in China and Pakistan are fighting a constant battle with hospitals who still carry out transplantations for tourists. There is so much profit involved”, said Noel.
Iran is the only country in the world where it is legal to sell an organ. During the war with Iraq they had problems accessing dialysis equipment, thus paying individuals to donate became the best solution. The practice continued after the war, and the government compensates the donors and provides them with one year of medical insurance. As a consequence, the shortage in kidneys has been eliminated and the country has no waiting list for kidney transplantation. Yet, the system has many flaws. “More and more people in Iran are saying that the system is not a solution”, said Dominguez-Gil. “When you have someone wanting to sell an organ, that person may not tell the whole truth about their health state”. There are private arrangements of additional payments between the donor and the recipient, which, according to Dominguez-Gil, “touches on illegality”. Another criticism is that only poor people want to sell their kidneys, questioning the freedom of choice to donate.
To fight organ trafficking without regulated markets, it is essential to increase the supply of organs from deceased donors. “Countries need to be self-sufficient in transplantation and use resources from their own populations”, said Dominguez-Gil. In Spain, the ONT övervakar transplantation and donation, and works closely with the government. Thanks to government commitment and political action, Spain is one of few countries that is close to self-sufficiency. One important factor is the presumed consent policy, under which it is presumed that a deceased person consents to organ donation upon death, unless he or she has explicitly opposed to this. As of right now, only Spain, Italy, Austria, Belgium, and Singapore have passed laws on presumed consent, but the strategy is considered to be an alternative to regulated markets.
Noel is convinced that countries with enough political commitment can reach self-sufficiency without regulated markets. “The life years saved by a deceased organ donor are 30 years”, he said, referring to a recent study by the Saint Louis University School of Medicine. “The arguments for transplantation are solid, it works”.
To increase the availability of organs under a doctrine that separates the human body from profits, is a challenge for the health care sector worldwide. This will take much political will and organization. In the meantime, the illegal trade with organs continues as long as there is a demand. “We don’t know if the practice of organ trafficking is increasing or diminishing, but now we have a global movement with different institutions working in the field”, said Dominguez-Gil. “The hosting countries have the eyes on them and no one wants to be pointed out as a hub for illegal organ trafficking. We are working together and this is very important.”
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Photo Credits: Flickr CC Brit., Bart van Damme and Giacomo Salizzoni
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