Organ trade is the trade involving inner organs (heart, liver, kidneys etc.) of a human for transplantation. There is a worldwide shortage of organs available for transplantation,[1] possibly a result of regulations forbidding their trafficking.[2]
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In the 1970s pharmaceuticals that prevent organ rejection were introduced. This along with a lack of medical regulation helped foster the organ market. Living donor procedures include kidney, liver, cornea and lung transplants. Most organ trade involves kidney or liver transplants.
Before legislation passed in 1994, India had a successful legal market in organ trading. Low cost and availability brought in business from around the globe and transformed India into one of the largest kidney transplant centers in the world.[3] Several problems began surfacing during the period of legal organ trade in India. In some cases patients were unaware a kidney transplant procedure even took place.[4] Other problems included patients being promised an amount much higher than what was actually paid out.[5] Ethical issues surrounding contribution donating pushed the Indian government to pass legislation banning the sale of organs.[6]
The sale of organs was legal in the Philippines until a ban took effect in March 2008.[7]
In China, organs are often procured from executed prisoners. Nicholas Bequelin, a researcher for Human Rights Watch, estimated that 90 percent of organs from China are from deceased prisoners.[8] China still suffers a shortage of organs for transplant even with more lax regulation. The Chinese government, after receiving severe scrutiny from the rest of the world,[9] has passed legislation ending the legal sale of organs. However, no legislation currently prohibits the collection of organs from deceased inmates who sign agreements before execution.
In Iran the practice of selling one's kidney for profit is legal. Iran currently has no wait lists for Kidney transplantation.[10] Kidney sales are legal and regulated. The Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD) control the trade of organs with the support of the government. The organizations match donors to recipients, setting up tests to ensure compatibility. The amounts paid to the donor vary in Iran but the average figures are $1200 for kidney donation.[11] Employment opportunities are also offered in some cases.
Poverty and loopholes in legislation contribute to the illegal trade of organs.[12] Poverty is seen in all countries with a large black market for organs. This, however, is not the only factor affecting the flourishing illegal markets, and some of the poorest countries in the world do not have an organ trade. Legislation is another contributing factor in the organ black market. In Jordan, organ trade is illegal but in many cases organ donors are brought into Iran from Jordan to perform procedures.[12] India's Transplantation of Human Organs Act (THOA) requires that an organ donor must be a relative, spouse, or donating for reasons of "affection". No monetary transactions for organs are legal in India currently, but there are no laws concerning funds given to a spouse. The spousal inclusion provides a loophole for illegal trade; in some cases contribution donors simply marry the recipient to avoid legal penalty.[13]
Illegal goods are often high priced and unstable in the black market.[14] The amount a donor would receive for selling their organs depends on the location and available supply. The average reported price around the world that a donor receives for his kidney is $5,000, while the average price paid on the black market to receive the kidney is $150,000.[15] Liver donors see similar returns. In February 2007, an investigation by The Observer into India's cash-for-organs trade revealed that transplants were making fortunes for middle men and brokers preying on desperate victims of the tsunami who were selling their kidneys on the black market.[16]
In 2007 a man in the United Kingdom became the first person convicted under the Human Tissue Act 2004 by trying to sell his kidney online for £24,000 in order to pay off his gambling debts.[17]
On June 27, 2008, Indonesian Sulaiman Damanik, 26, pleaded guilty in Singapore court for sale of his kidney to Tangs executive chair, Tang Wee Sung, 55, for 150 million rupiah (US $22,200). The Transplant Ethics Committee must approve living donor kidney transplants. Organ trading is banned in Singapore and in many other countries to prevent the exploitation of "poor and socially disadvantaged donors who are unable to make informed choices and suffer potential medical risks". Toni, 27, the other accused, donated a kidney to an Indonesian patient in March, alleging he was the patient's adopted son, and was paid 186 million rupiah (US $20,200). Upon sentence, both would suffer either 12 months in jail or a fine of 10,000 Singapore dollars (US $7,300).[18][19]
In April 2010, six Israelis were charged with suspicion of running an international organ trafficking ring and breaking promises to donors to pay for their removed kidneys.[20] According to police, one of the arrested suspects is a retired Israeli army general. The traffickers offered up to $100,000 per kidney, but in at least two cases didn't pay the donors after the organs were surgically removed, police said.[20]
In November 2010, Israelis and South Africans were caught by the police for organ trafficking through Netcare.[21]
In November and December 2010, Israelis and a Turkish national were reported to be involved in organ trafficking in Kosovo.[22][23]
In April 2011, a high school student in China's Anhui province, unbeknownst to his parents, sold his kidney for 20,000 yuan (US $3000 at the time) so he could purchase an iPad 2. The broker contacted him over the internet.[24]
Martin Wilkinson, a visiting professor at Keele University and former chairman of the New Zealand Bioethics Council, has said that "[s]elling an organ should no longer be a criminal offence", arguing that "[p]unishing people for trying to sell their organs [...] infringes on a right to decide what to do with one's own body."[25] He says that while "[p]eople who are desperate lay themselves open to exploitation and deceit, and organ sellers are exploited and deceived in black markets now", he thinks that "the answer is to regulate the market, not to drive it underground."[25]
The illegal status of organ trade creates a price ceiling for organs at zero dollars. This price ceiling affects supply and demand creating a shortage.[26] According to a report published by the Cato Institute, a think tank, the elimination of the price ceiling would eliminate the shortage.[27] It is estimated that in America, if 0.06% of individuals aged 18–65 donated a kidney the waiting list for organs would be fulfilled.[28] Currently with little incentives to donate an organ approximately 6,000 people die yearly waiting for a transplant organ. It has been argued by David Holcberg that the regulation of organ trade could solve the organ shortage and create safer and fair practices for donors.[28] However, the idea of organ "scarcity" had been opposed by Ivan Illich and other authors who argued that "scarcity" is an "artificially created need". There is not a real shortage of organs, but "excess and wasted" organs. Scarcity only exists for some groups of people—those who were denied the organs, and those who could not afford them. So what needs to be regulated, according to these authors, is organs procurement and distribution practices.[29]
Legalization of human organ trading is opposed by a variety of human rights groups, including Organs Watch, a group established by medical anthropologist Nancy Scheper-Hughes who was also instrumental in exposing illegal international organ selling rings.
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