Organ trafficking in America, on National Geographic TV, premiering tomorrow

National Geographic TV tweets about a new series on organ trafficking, premiering tomorrow night, with a video trailer that suggests that they think there is substantial organ trafficking to U.S. patients.

@MarianaVZ  uncovers the hidden world of organ trafficking in an all-new #TraffickedWithMarianavanZeller. Don't miss the season premiere, this Wednesday at 9/8c on National Geographic.

I'm a bit skeptical about the scope of organ trafficking to U.S. patients, because as far as I can tell there isn't a lot of evidence of Americans with mysterious transplants showing up for post-transplant care at American transplant centers. But I haven't seen the show. (Not being a subscriber I doubt that I will, but I imagine I'll hear from some of you who do.)

HT: Alex Chan

Two illegal (former) kidney transplant networks analyzed: the Netcare -and Medicus cases, by Ambagtsheer and Bugter

 There aren't many successful prosecutions resulting from illegal organ trafficking, despite the fact that the prevalence of illegal kidney transplants is estimated by many sources to be high.  Here's a paper that tries to understand the nature of the black market supply chain for kidneys, by examining two prosecutions that led to convictions, connected to a hospital in Kosovo and another in South Africa.

Ambagtsheer, F., Bugter, R. The organization of the human organ trade: a comparative crime script analysis. Crime, Law and Social Change (2022). https://doi.org/10.1007/s10611-022-10068-5

Abstract: "This study fills critical knowledge gaps into the organization of organ trade utilizing crime script analysis. Adopting a situational crime prevention approach, this article draws from law enforcement data to compare the crime commission process (activities, cast and locations) of 2 prosecuted organ trade cases: the Medicus case and the Netcare case. Both cases involved transnational criminal networks that performed kidney transplants from living donors. We further present similarities and differences between illegal and legal living donor kidney transplants that may help guide identification and disruption of illegal transplants. Our analysis reveal the similar crime trajectories of both criminal cases, in particular the extensive preparations and high degree of organization that were needed to execute the illegal transplants. Offenders in the illegal transplant schemes utilized the same opportunity structures that facilitate legal transplants, such as transplant units, hospitals and blood banks. Our results indicate that the trade is embedded within the transplant industry and intersects with the transport- and hospitality sector. The transplant industry in the studied cases was particularly found to provide the medical infrastructure needed to facilitate and sustain organ trade. When compared to legal transplants, the studied illegal transplant scripts reveal a wider diversity in recruitment tactics and concealment strategies and a higher diversity in locations for the pre-operative work-up of donors and recipients. The results suggest the need for a broader conceptualization of the organ trade that incorporates both organized crime and white collar crime perspectives."

***

"Although reliable figures of the trade’s scope are lacking, the World Health Organization (WHO) has estimated that approx. 5000 illegal transplants are performed annually (WHO, 2007). The organ trade is reported to rank in the top 5 of the world’s most lucrative international crimes with an estimated annual profit of $840 million to $1.7 billion (May, 2017). While illegal organ transplants have been reported to take place in countries across the globe, knowledge of the trade’s operational features remains scarce (Pascalev et al., 2016)

...

"At the time of writing, only 16 convictions involving organ trade have been reported to the case law database of the United Nations Office on Drugs and Crime, which is far less than would be expected based on global estimates of the problem (UNODC, 2022). The Organization for Security and Co-operation in Europe (OSCE) has reported 9 additional cases (OSCE, 2013). All reported cases had cross-border features and most involved the facilitation of living donor kidney transplants.

...

"In 2014 the Council of Europe established a new convention against ‘Trafficking in Human Organs’ which calls for a broad prohibition of virtually all commercial dealings in organs. Accordingly, sales that occur with the consent of donors are considered to be ‘trafficking’ regardless of the circumstances involved (Council of Europe, 2015)"

...

[Netcare]"Israeli and Romanian donors were promised $20,000 for their kidneys, the Brazilian donors were promised between $3,000 and $8,000. Most donors were recruited in Brazil by 2 retired military officers (Ambagtsheer, 2021; De Jong, 2017; Scheper-Hughes, 2011). 

Payments and reimbursements: Payments took place throughout all stages of the crime commission process. Patients paid Perry/his company up to $120,000 prior to their travel and transplant. Perry, and later also Meir, subsequently paid Netcare. Netcare in turn disbursed payments to various actors in the scheme, including the transplant surgeons and the blood bank. ... Occasionally, additional payments were made directly in cash to the surgeons by Perry, his company, or his agents. Perry also paid an escort/fixer (Rod Kimberley) and a nephrologist. Kimberley paid low-tier offenders in the scheme, including the interpreters. Kimberley additionally covered the costs of recipients’ and donors’ accommodations and he gave donors pocket money upon arrival in South Africa as an advance to their kidney payment. All donors received the promised amount in cash after their operations. 

...

"Contrary to donors in the Netcare case, none of the Medicus’ donors received the promised amount. Some did not receive payment at all but were promised payment only if they recruited new prospective kidney sellers. Withholding payments to kidney sellers in order for them to recruit new prospective kidney sellers is a tactic in organ trafficking schemes to sustain the transplant program (De Jong, 2017).

...

"The cases diverge with respect to the locations and legal embeddedness. Contrary to the Medicus case where transplants were organized in one clinic that was not licensed to conduct transplants, transplants in South Africa were facilitated in at least 5 hospitals across the country that were legally mandated to perform transplants."

Intergalactic market for organs

 Sometimes it seems that those who are most worried about markets for kidneys are worried about different things than those who are most worried about kidney patients.  

In case you were wondering, here's a video game to help you empathize with those you might otherwise disagree with: Space Warlord Organ Trading Simulator . It can be yours for just $19.99, much less than the cost of an eyeball.

"ORGANS. Everyone has them, and everyone wants them. You are an Organ Trader, the funnel for fleshy meat parts into a strange, evolving, and desperate universe full of clients.

"Contend with the cutthroat organ market. Trade viscera with dubious figures. Keep vampire-leech organs from devouring the rest of the goods inside your cargo hold. Flood galaxies with meat. Make a profit.

"This is Space Warlord Organ Trading Simulator: the sci-fi body horror market tycoon you didn't know you needed."

*************

And,  in case you aren't tuned into repugnant transactions via video game, here's a review of the game in the Guardian:

Space Warlord Organ Trading Simulator review – ghoulish satire of human greed

"It’s a premise as old as time: buy low, sell eyes. And spleens. More of a frantic clicker-game than a strategy sim, Space Warlord Organ Trading Simulator is only slightly more complex than a screensaver, though still chemically compulsive. Days are split between navigating a fleshy stock market, and trying to outbid cyborgs and dogs with names like Chad Shakespeare on the freshest human cuts. Think eBay as overseen by Harlan Ellison’s Allied Mastercomputer. You accept orders, wait for the organs to show up, grab them before a rival trader does and try to make a profit. As you progress, your customers get fussier. Organs are graded like trading cards, or Destiny loot drops. Where does a mythic lung come from, anyway? No time to think about it. The market wants what it wants."

**********

All of which reminds me of this old/new question:

Sunday, September 18, 2011

If it were legal to sell organs for transplantation, what would the ads look like?

Black market kidney transplants to UK patients? An inflammatory article in the Daily Mail

There seems to be good evidence that kidneys for transplantation are bought and sold in some parts of the world. However I'm not aware of any good data on how much of this trade involves people from wealthy countries, as opposed to internal commerce in less well resourced countries.

 Here's a scare headline from the British tabloid newspaper the Daily Mail:
REVEALED: Hundreds of Britons who buy KIDNEYS on the black market from overseas traffickers charging £30,000 in a bid to avoid NHS waiting lists are coming back with deadly diseases such as HIV and hepatitis

It turns out that the "hundreds"  in the National Health Service data are 400, over a period of 16 years, which averages out to 25 Britons a year.

"Around three million Britons have chronic kidney disease, with the biggest causes uncontrolled diabetes and high blood pressure. It contributes to 45,000 early deaths every year.

NHS figures show almost 400 UK residents have received follow-up support after a transplant abroad over the past 16 years. But medics say the true number is likely to be higher because most are advised by brokers not to tell the NHS what they have done."

I don't know what kinds of health data the NHS collect, but in principle it would be easy to track all patients who return to the UK with a transplant from overseas, because such patients immediately need to get prescriptions for daily immunosuppressive drugs. (However I don't think we track these data in a centralized way in the U.S.)


HT Frank McCormick
***********
Here some of what I've gleaned in the past:

Monday, December 17, 2018 

Australia's parliament reports on organ trafficking

Australia's parliament has published a report on organ trafficking in Australia. They didn't find much trafficking there, but recommend that data be more vigorously collected. They report that only one case of (attempted) paid organ donation has come to the attention of the authorities, but that it was successfully prevented, and the intended recipient died. The report ends with a case study of an anatomical exhibit using human cadavers.

Wednesday, October 4, 2017 

Kidney black markets are persistent

Black markets in kidneys--like those for narcotic drugs--have resisted attempts to abolish them.

Sunday, September 17, 2017

Yemenis selling kidneys in Egypt: Al Jazeera

Al Jazeera has the (nuanced) story:
Desperate Yemenis sell organs to survive

Sunday, January 15, 2017

Egypt arrests 'organ trafficking ring'

The BBC has the story: Egypt arrests 'organ trafficking ring'
Egyptian authorities have arrested doctors, nurses and professors suspected of being involved in an international organ trafficking ring.

Black markets for kidney transplants--arrests in Israel

A late December story of black markets and law enforcement from the Times of Israel:
2 charged with running international organ traffic ring. Patients allegedly paid $180,000 for a kidney; illegal transplants carried out in Turkey, Bulgaria, Thailand, Philippines

"In the last two years, the ring reportedly arranged for 14 transplants in four countries; Turkey, Bulgaria, Thailand and Philippines"

Saturday, October 8, 2016

More on kidney black markets in India

Top Indian Hospital Complicit In Lucrative Black Market for Human Organs

Friday, August 19, 2016

Interview with a kidney buyer and seller in Syria

Here's an interview with a displaced person in Syria (an internal refugee) and the Syrian woman to whom he sold his kidney:
The woman in need of a kidney and the man willing to sell one to her: ‘I’m at the end of the line’

Tuesday, June 21, 2016

Kidney black market arrests at Apollo hospital in Delhi

Wednesday, June 8, 2016

On Patients Who Purchase Organ Transplants Abroad--Many or few?

An article in the American Journal of Transplantation:
On Patients Who Purchase Organ Transplants Abroad
by F. Ambagtsheer,*, J. de Jong,W. M. Bramer and W. Weimar

"We conclude that the scientific literature does not reflect a large number of patients buying organs. Organ purchases were more often assumed than determined. A reporting code for transplant professionals to report organ trafficking networks is a potential strategy to collect and quantify cases."

More commentary on the shortage of transplantable kidneys, and compensation for donors

The recent editorial by McCormick, Held and Chertow continues to attract comments.  Here are three more.

From the Washington Post:
What if we paid people to donate their kidneys to strangers? by Megan McArdle.

"What if a simple policy could save tens of thousands of people every year from a deeply unpleasant treatment followed by early death? A policy that would disproportionately help the most disadvantaged? While actually saving taxpayer money?

"That’s a pretty rare combination; presumably you’d be pretty excited. But what if the policy involved paying people to donate one of their kidneys to a stranger?

"Possibly you are now less excited. Possibly you are now picturing a sci-fi dystopia where the poor serve as organ farms for the wealthy. Which is what such people as Gabriel Danovitch worry about.
...
“It’s about health and welfare,” says Danovitch of his transplant work. “We’re not talking about a financial interaction.”

"But . . . aren’t we? Transplant surgeons make hundreds of thousands of dollars a year for their work. In fact, everyone in the operating room except the donor is getting handsomely rewarded.

"And indeed, payments to health-care providers can distort patient care, sometimes harming patients. Yet no one suggests moving to an all-volunteer health-care system, because the distortions introduced by paying providers are infinitely preferable to what would happen if we refused to pay them."
***********

From Vox:
Study: the kidney shortage kills more than 40,000 people a year. You can help.
By Dylan Matthews
"If there were enough kidneys for everyone in the US who needed one, we could save 43,000 lives every single year.

"That’s the conclusion of researchers Frank McCormick, Philip Held, and Glenn Chertow, in an editorial published in the Journal of the American Society of Nephrologists.
**********

From the Volokh Conspiracy:
Laws Banning Organ Markets Kill Even More People than Previously Thought
New analysis finds that thousands more die every year because the law forbids purchase of the kidneys they need to survive.
Ilya Somin

"The injustice of status quo policy is more than just a matter of failing to help people in need. It is the equivalent of actively killing them. Consider a situation where Bob needs to buy food in order to keep from starving. Producers are willing to sell him what he needs at market prices, but the federal government passes a law saying that it is illegal to sell food for a profit. Bob is only allowed to acquire such food as producers are willing to give him for free. If Bob starves as a result, the government is actively culpable for his death. It cannot claim that it was merely an innocent bystander who refused to help him in his time of need. The same point applies if the government (or anyone else) uses coercion to prevent people from selling organs that ESRD patients need to live."
##

I'm reminded of earlier posts by these conspirators:

Saturday, July 18, 2009

Eugene Volokh on kidney transplantation and the law

and this 2007 essay in the Harvard Law Review:
Medical Self-Defense, Prohibited Experimental Therapies, and Payment for Organs
Essay by Eugene Volokh

Organ donation in Germany

Organ donation in Germany is declining, from an already low rate.
 Die WirtschaftsWoche has the story in their February 19 issue:

Die Zahl der Organspenden in Deutschland geht immer stärker zurück. Ökonomen machen dafür auch falsche Anreize verantwortlich. Sie schlagen Modelle vor, um mehr Menschen fürs Spenden zu gewinnen.

Google translate: "This could lead to incentives for organ donation
The number of organ donations in Germany is decreasing more and more. Economists blame it for wrong incentives. They suggest models to get more people to donate."

The article refers in part to this lab experiment investigating giving registered organ donors priority should they need an organ:

Organ donation in the lab: Preferences and votes on the priority rule
by Annika Herr and Hans-Theo Normann
Journal of Economic Behavior & Organization
Volume 131, Part B, November 2016, Pages 139-149

"Abstract: An allocation rule that prioritizes registered donors increases the willingness to register for organ donation, as laboratory experiments show. In public opinion, however, this priority rule faces repugnance. We explore the discrepancy by implementing a vote on the rule in a donation experiment, and we also elicit opinion poll-like views. We find that two-thirds of the participants voted for the priority rule in the experiment. When asked about real-world implementation, participants of the donation experiment were more likely to support the rule than non-participants. We further confirm previous research in that the priority rule increases donation rates. Beyond that, we find medical school students donate more often than participants from other fields."

The newspaper article also quotes German transplant officials as saying that this would be an unethical organ market, and that it would open the door to illegal black markets...

Super bowl thought by Kim Krawiec: football players are paid, why not kidney donors?

While checking up on the super bowl, I'm reminded that Kim Krawiec posted this:
 Super Bowl Week OpEd

"As the Super Bowl approaches, Phil Cook and I have an OpEd running in the Raleigh News & Observer and a few other publications:

Why ban payment to kidney donors but not football players?

BY PHILIP J. COOK AND KIMBERLY D. KRAWIEC 

February 01, 2018 01:06 PM

Super Bowl week rivets national attention on America’s most popular and lucrative sport, professional football. If stories of concussion and permanent injury to players make some fans uneasy, there is always the reassuring fact that the players volunteer for the job and are well compensated – so well compensated that there are untold thousands of young men who would gladly take their place.

Football is so ingrained in our culture that we generally accept this situation without much scrutiny. However, our research got us thinking about the stark contrast with another risky but valuable activity – kidney donation.

About 6,000 people per year donate one of their two kidneys. This selfless act has some risk to the donor, both from the surgery and years later when there is a chance the remaining kidney will fail. In return, kidney donors are rewarded with the knowledge they helped save the life of a loved one. They receive nothing tangible. Indeed, federal law bans compensation for kidney donors, as do the laws of all other countries except Iran (really).

So, why do we pay football players to entertain the public, but are unwilling to pay kidney donors to save lives?

The stakes in both cases are high, but much higher in kidney donation. The total value of NFL teams is about $60 billion. If, in some unlikely future, the risk of serious permanent injury to players led to a ban on professional play, that value would be destroyed.

Meanwhile, the ban on compensation for living kidney donation currently costs thousands of lives and billions of dollars in taxpayer money every year. The waiting list for a kidney now includes 100,000 patients, who for the most part are kept alive by renal dialysis at federal government expense. If they survive long enough, typically more than five years, in this debilitated state, they may hope to rise to the top of the list and receive a kidney from a deceased donor.

Deceased donors are a limited resource: few people die under conditions that permit donation and the United States already procures a large percentage of healthy kidneys from deceased donors. What is needed are many more living donors. Current estimates suggest an offer of $50,000 per living donation would be adequate to recruit sufficient numbers to meet the needs of all transplant-eligible renal patients. This would eliminate the waiting list and prevent thousands of unnecessary deaths and years of unnecessary disability. Given standard value-of-life estimates, the present value of the public benefit of converting to a system of compensated donation would exceed $1 trillion – many times the value of professional football.

It should be noted that the alternative to the current ban on compensation is not a laissez-faire free market. Rather, the current system for regulating the allocation of available kidneys could be readily expanded. A nonprofit or government organization could offer a fixed payment to living donors who were screened to be physically and mentally sound, and then fully informed of the risks. To avoid “impulse” donations, there could be a mandatory waiting period.

And it should be noted that the medical risks to kidney donors are far less than the risks of a football career; most donors lead normal lives, while most NFL veterans are, to some degree, disabled.

Inevitably the chance to sell a kidney for $50,000 would be most attractive to people who are struggling financially. Some ethicists opine that a compensated system would exploit the poor. Yet, more than a few NFL players also come from poor homes and 70 percent are black, causing many to view the concussion crisis as another example of racial inequality. In our view, the risk of exploitation is not a legitimate reason for forbidding compensation to kidney donors, thus denying the poor full use of one of their potential assets.

Millions of Americans, not just NFL players, work in occupations that have a substantial risk ofserious injury. Loggers, fishermen and others accept these risks in exchange for compensation. Extending that list to include kidney donors is just common sense.

PHILIP COOK IS TERRY SANFORD PROFESSOR EMERITUS OF PUBLIC POLICY AND PROFESSOR OF ECONOMICS AND SOCIOLOGY AT DUKE UNIVERSITY’S SANFORD SCHOOL OF PUBLIC POLICY. KIMBERLY KRAWIEC IS THE KATHRINE ROBINSON EVERETT PROFESSOR OF LAW AT DUKE LAW SCHOOL."

Buying body parts is easy, as long as you don't use them for transplants

Cashing in on the donated dead: The Body Trade
A REUTERS SERIES

Part 1: When Americans leave their bodies to science, they are also donating to commerce: Cadavers and body parts, especially those of the poor, are sold in a thriving and largely unregulated market. Grisly abuses abound.
By BRIAN GROW and JOHN SHIFFMAN
"Body brokers are also known as non-transplant tissue banks. They are distinct from the organ and tissue transplant industry, which the U.S. government closely regulates. Selling hearts, kidneys and tendons for transplant is illegal. But no federal law governs the sale of cadavers or body parts for use in research or education. Few state laws provide any oversight whatsoever, and almost anyone, regardless of expertise, can dissect and sell human body parts.
...
"Because only four states closely track donations and sales, the breadth of the market for body parts remains unknown. But data obtained under public record laws from those states – New York, Virginia, Oklahoma and Florida – provide a snapshot. Reuters calculated that from 2011 through 2015, private brokers received at least 50,000 bodies and distributed more than 182,000 body parts."


Part 2: After a few emails, a body broker sold reporter Brian Grow two heads and a cervical spine. The spine came from a young man whose parents were too poor to bury him – and they say they never knew his body would be sold.
By BRIAN GROW and JOHN SHIFFMAN


"Whether Restore Life vetted the buyer is unclear. But if workers there had verified their customer’s identity, they would have learned he was a reporter from Reuters. The news agency was seeking to determine how easy it might be to buy human body parts and whether those parts would be useful for medical research. In addition to the spine, Reuters later purchased two human heads from Restore Life, each priced at $300.

"The transactions demonstrate the startling ease with which human body parts may be bought and sold in the United States. Neither the sales nor the shipments violated any laws, say lawyers, professors and government officials who follow the issue closely. Although it’s illegal to sell organs used for transplants, it’s perfectly legal in most states to sell body parts that were donated for research or education. Buying wine over the Internet is arguably more tightly controlled, generally requiring at minimum proof of age.


Part 3: Science Care reaps $27 million in annual revenue by recruiting body donors through hospices, funeral homes and online ads.

"The typical pitch to the dying and their families is two-pronged. The first is altruism: The gift of a body will benefit medical science and, by extension, others in need.

"The second is financial: Body donation saves a family money. The average funeral, including coffin, memorial service and burial, costs about $7,000, according to the National Funeral Directors Association. Simple cremation, an increasingly popular option, costs $400 to $1,000 or more.

"Body brokers like Science Care offer the cheapest option: free cremation in exchange for the body. The deal: Science Care pays for the cremation of a donor’s unused remains and for returning the ashes to the bereaved family, usually after a few weeks."


Part 4: Arthur Rathburn is accused of dismembering donated bodies with a chainsaw and renting HIV-infected parts to medical professionals. Prosecutors hailed his arrest as a crackdown. But for years, Reuters found, authorities let him do business despite signs of his bizarre practices.
By JOHN SHIFFMAN and BRIAN GROW

Frank Delmonico and the recent organ transplant meeting at the Vatican

When I was in Trento, I participated in a panel on markets for human organs, and had the chance to ask Dr. Ignazio Marino about the recent

Vatican statement on organ transplantation, which I pointed out seemed to conflate killing prisoners for their organs with much more ordinary attempts to increase voluntary organ donation.  Dr Marino replied that this had been part of the diplomacy involved with the Chinese delegation.

Here's an article about the backstory to some of that diplomacy, and the role played by my old friend Frank Delmonico

One doctor’s war against global organ trafficking
By Ryan Connelly Holmes And Dan Sagalyn May 29, 2017

"A controversy was brewing. Delmonico, a leading voice on ethical organ transplantation, had planned a February 2017 summit in Rome for representatives of more than 40 countries to discuss the ethics of transplanting organs and to sign a pledge to uphold high standards.

"But there was a hitch: A key invitee to the forum was Dr. Jiefu Huang, who has led reform of China’s organ donation practices. Critics, including some in the Vatican, wanted at the summit no representatives of China, which for years sold and transplanted organs from executed prisoners.

"Delmonico, however, saw the Chinese presence as a good thing. It was “an opportunity for them to proclaim a new day and be accountable” that the practice has stopped, he said. In fact, some of the Chinese old guard have attacked Huang because of his efforts to stamp out unethical and corrupt methods of obtaining organs.
...
"Pope Francis did not attend, but Marcelo Sánchez Sorondo, the chancellor of the Pontifical Academy of Sciences did. In a significant development, China signed the summit’s statement condemning the use of organs from prisoners and advocating the creation of national laws to prosecute transplant-related crimes. Beijing’s two delegates were joined by 75 other signatories representing more than 50 institutions and more than 40 nations at the conference. Delmonico called it a “seminal event” in the fight for global reform."
**********


I hope that this effort at diplomacy, aimed at ending the practice of using executions as the primary source of organs in China, will not be a source of confusion regarding attempts to increase the availability of organ transplants by ethical means.

Egypt arrests 'organ trafficking ring'

The BBC has the story: Egypt arrests 'organ trafficking ring'
Egyptian authorities have arrested doctors, nurses and professors suspected of being involved in an international organ trafficking ring.

(professors!)

"The arrests of at least 25 people on Tuesday also included organ buyers and middlemen, the country's Administrative Control Authority said.
Authorities also found "millions of dollars and gold bullion".
It is illegal to purchase organs in Egypt, but poverty drives some to sell their body parts.
The Administrative Control Authority, a powerful anti-corruption body, claimed the network targeted on Tuesday was "made up of Egyptians and Arabs taking advantage of some of the citizens' difficult economic conditions so that they buy their human organs and sell [them] for large sums of money".
The statement on the government website added that the group was "the largest international network for trading human organs".
...
"The arrests follow years of concern over the illegal organ trade in Egypt.
In 2010, it was named as one of the top five countries for illegal organ trade by the World Health Organization's co-ordinator at the time, Luc Noel.
Egypt passed laws to try to curb the trade, but according to the United Nations, hundreds of poor Egyptians still sell kidneys and livers each year to be able to buy food or pay off debts.
There have also been concerns over the fate of migrants who come into contact with the traffickers.
In 2012, then UN refugee agency chief, Antonio Guterres, said some migrants in Egypt's Sinai peninsula were being "killed for the traffic of organs", while earlier this year a people smuggler told Italian prosecutors that those who could not pay their debt were sold to the organ traffickers.
The allegations have not been proven, however."
*******************

Here is a related story from the Daily Mail:
45 doctors, nurses and 'middlemen' are arrested for HUMAN ORGAN trade in Egypt as migrants sell body parts to reach Europe 
The harvesting of human organs is being described as the biggest ever in Egypt
Reports those involved were targeting African migrants trying to get to Europe
As well as the arrests, health ministry recovered millions of dollars in a raid
Some arrested worked at medical faculties of Cairo and Ain Shams Universities

Black markets for kidney transplants--arrests in Israel

A late December story of black markets and law enforcement from the Times of Israel:
2 charged with running international organ traffic ring. Patients allegedly paid $180,000 for a kidney; illegal transplants carried out in Turkey, Bulgaria, Thailand, Philippines

"Roini Shimshilashvili and Albert Murdakhayev were charged with multiple counts of trafficking in organs, brokering organ trafficking and conspiracy, according to a court statement. A third man, identified as a doctor, Zachi Shapira, was charged with multiple counts of assisting in organ trafficking.
...
"The two men allegedly found prospective donors from the former Soviet Union who matched sick Israelis. The donors would be paid to donate their kidneys to the Israelis, “who paid sums of up to $180,000 in most cases,” the court heard. It was not clear how much the donors were paid.

...

"In the last two years, the ring reportedly arranged for 14 transplants in four countries; Turkey, Bulgaria, Thailand and Philippines"


HT: Robert Gutman

Suspected organ trafficker arrested

YNet has the story: Turkish authorities arrest Israeli suspected of organ trafficking
Boris Wolfman, who was indicted in Israel but managed to flee the country, was caught at Istanbul airport; he is expected to be extradited to Israel.

"According to a report in Turkish newspaper Daily Vatan, Wolfman allegedly arrived in Istanbul from Bangkok to convince struggling Syrian refugees to sell their organs.

He had reportedly already started contacting Syrian refugees, and was making arrangement to operate on them in small hospitals in Turkish cities.
Earlier this year, Wolfman and six others were charged with organ trafficking and organizing illegal transplants in Kosovo, Azerbaijan and Sri Lanka. The offenses in question were committed between the years 2008-2014.
According to the indictment, those receiving the illegal transplant had to pay between 70-100 thousand euro for the organ, while the organ donors only received tens of thousands of euros.
Wolfman used an ad in Russian newspapers to draw out potential donors, who agreed to donate one of their organs for money due to their difficult economic situation.

He did not explain to the donors about the physical and mental risks they face, denying them of the information they needed to make the decision. After the organ donation in Kosovo, the donors were discharged without receiving any explanation about needing medical treatment or about the changes to their health situation. There was also no adequate medical supervision following the operation, and at least one teenage boy became paralyzed because he did not receive proper treatment after his kidney was removed."

The grey market for fetal tissue (it can't be sold for a profit, but profits can be made on processing)

There has been recent attention to fetal stem cells, which are used in research into a number of diseases.
The NY Times has the story:
Fetal Tissue From Abortions for Research Is Traded in a Gray Zone

"Videos released by an anti-abortion group during the last two weeks have drawn attention to a little-known practice: the buying, selling and research use of fetal tissue acquired from abortion clinics.

"The group behind the tapes accuses Planned Parenthood of selling fetal tissue for profit — which is illegal and which Planned Parenthood denies doing. House Republicans plan to investigate. This may be just one more battle in the nation’s long war over abortion, but the dispute has raised questions about who the buyers and sellers are, what fetal tissue is used for and what the law allows.
...
"Companies that obtain the tissue from clinics and sell it to laboratories exist in a gray zone, legally. Federal law says they cannot profit from the tissue itself, but the law does not specify how much they can charge for processing and shipping.

"The National Institutes of Health spent $76 million on research using fetal tissue in 2014 with grants to more than 50 universities, including Columbia, Harvard, the Massachusetts Institute of Technology, Stanford, Yale and the University of California in Berkeley, Irvine, Los Angeles, San Diego and San Francisco. It expects to spend the same amount in 2015 and 2016.
...
"Fetal tissue can be used only with the consent of the woman having an abortion. Some researchers receive the tissue from abortion clinics at their own institutions, or from tissue banks maintained by some universities. Many buy the tissue from companies that act as middlemen. Those companies pay small fees, usually $100 or less a specimen, to abortion providers like Planned Parenthood, who say they charge only what they need to cover their expenses. The companies then process the tissue and sell it to researchers for higher prices that reflect the processing.

"The fees, which can run to thousands of dollars for a tiny vial of cells, do not break the law, according to Arthur Caplan, the director of the division of medical ethics at NYU Langone Medical Center.

“It appears to be legal, no matter how much you charge,” Dr. Caplan said, adding that there appears to be little or no oversight of the processing fees. “It’s a very gray and musty area as to what you can charge.”

"Many researchers buy tissue from two small California companies. StemExpress, a five-year-old business based in Placerville, Calif., describes itself as “the largest provider of maternal blood and fetal tissue globally.” It also says it offers “special discounts to the academic community.”
...
"George J. Annas, a law professor and bioethicist at Boston University, said, “What’s going on now is probably legal, but Congress won’t like it.”

"Regarding the companies, Mr. Annas said: “They won’t be real happy that this is all out in the public. This threatens their business. Even if what they’re doing is legal, the law can easily be changed.”

New reports that China to stop harvesting executed prisoners' organs

But no word on how they propose to manage the transition from executed prisoners to developing a voluntary source of donated organs for transplant.

Here's a BBC story: China to stop harvesting executed prisoners' organs

China has promised to stop harvesting organs from executed prisoners by 1 January, state media report.

It has said for many years that it will end the controversial practice. It previously promised to do so by November last year.

Death row inmates have long served as a key source for transplants.

China has been criticised for taking their organs without consent, but has struggled to encourage voluntary donations due to cultural concerns.

Prisoners used to account for two-thirds of transplant organs, based on previous estimates from state media.

For years, China denied that it used organs from executed prisoners and only admitted to the practice a few years ago.

The Chinese authorities put more prisoners to death every year than the rest of the world combined - an estimated 2,400 people in 2013 - according to the San Francisco-based prisoners' rights organisation, Dui Hua.

'Fair, just and transparent'

State media reported on Thursday that the head of the country's organ donation committee Huang Jiefu said that by 1 January 2015, only voluntarily donated organs from civilians can be used in transplants.

So far 38 organ transplant centres around the country, including those in Beijing, Guangdong and Zhejiang, have already stopped using prisoners' organs, according to reports.

Dr Huang, who was addressing a seminar, said that every year about 300,000 people in China need transplanted organs, but only 10,000 operations are carried out.

Analysis: Celia Hatton, BBC News, Beijing

It's taken years for the Chinese authorities to end their own practice of harvesting organs from executed prisoners.

In 2006, Dr Huang admitted China must reduce its reliance on prisoners' organs. He repeated that again in 2009, when announcing the establishment of a national organ donation network. And finally, in 2012, Dr Huang surfaced in Chinese state media once more with a promise to end all prisoners' donations within a few years.

Why did it take so long? Thousands of people are on China's transplant waiting list in desperate need of organs, with no clear solution in sight. Attempts to address the need, by encouraging public organ donations, have faltered.

But many in China believe that bodies should remain intact after death. China's also home to a thriving illegal trade in body parts, making would-be donors nervous they will contribute to a wider problem.

A 2012 poll conducted in the southern city of Guangzhou revealed that 79% of respondents believed organ donation was "noble". However, 81% were concerned the donations "inevitably feed the organ trade."

Clearly, Chinese health officials have a lot of work to do to change public perceptions.

With a donation rate of only 0.6 per 1 million people, China has one of the world's lowest levels of organ donation. Dr Huang compared it to Spain, which has a rate of 37 per 1 million.

"Besides traditional beliefs, one of the major roadblocks to the development of our organ donation industry is that people are concerned that organ donation will be fair, just and transparent," he was quoted as saying.

Dr Huang, who used to be the vice minister for health, had last year pledged to phase out prisoner organ transplants by the end of 2013.

Amnesty International's William Nee told the BBC that halting prisoner organ transplants would be "a positive step forward in China's human rights record", although some challenges remain.

"It will be worth seeing not only how effective a new voluntary organ donation system is, but it will also be crucial that the government becomes fully transparent about the number of people sentenced to death, the number of executions per year, and how the executions are carried out," he said.

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"The organ detective:" article about anthropologist Nancy Scheper-Hughes

An interesting long article by Ethan Watters in the July/August issue of the Pacific Standard: The Organ Detective: A Career Spent Uncovering a Hidden Global Market in Human Flesh discusses Nancy Scheper-Hughes, her work, and her position on where anthropology should try to position itself between science and activism.

"Scheper-Hughes’ investigation of the organ trade would be a test case for a new kind of anthropology. This would be the study not of an isolated, exotic culture, but of a globalized, interconnected black market—one that crossed classes, cultures, and borders, linking impoverished paid donors to the highest-status individuals and institutions in the modern world. For Scheper-Hughes, the project presented an opportunity to show how an anthropologist could have a meaningful, real-time, and forceful impact on an ongoing injustice.
...
"Since the mid-1990s, Scheper-Hughes has published some 50 articles and book chapters about the organ trade, and she is currently in the process of synthesizing that material into a book, tentatively titled A World Cut in Two. Over the years, she has had an outsize impact on the intellectual trends in her field, and her study of the organ trade is likely to be her last major statement on the meaning and value of the discipline to which she has devoted her life. Whether this body of work represents a triumph of anthropological research or a cautionary tale about scholarly vigilantism is already a hotly disputed question among her colleagues.
...
"In a 1995 debate with the anthropologist Roy D’Andrade in the pages of Current Anthropology, Scheper-Hughes argued for what she called a “militant anthropology,” in which practitioners would become traitors to their class and nation by joining political battles arm in arm with their subjects. The job of the anthropologist wasn’t simply to document the quotidian but to strip away appearances and reveal the hidden forces and ideologies that leave people dominated and oppressed. To do this, she suggested throwing off the traditional guise of the academic—in “the spirit of the Brazilian ‘carnavalesque’”—and joining the powerless in their fight against bourgeois institutions like hospitals and universities.

“The new cadre of ‘barefoot anthropologists’ that I envision,” she wrote, “must become alarmists and shock troopers—the producers of politically complicated and morally demanding texts and images capable of sinking through the layers of acceptance, complicity, and bad faith that allow the suffering and the deaths to continue.”
...
"“With the moral model, the truth ain’t exactly the thing that everyone strives for,” D’Andrade, who is now retired and living in Northern California, told me. “What you strive for is a denunciation of a real evil.” I asked him who prevailed in his public debate with Scheper-Hughes. “I believed that after the kerfuffle that people would get back to asking, ‘How do you know something is true or not?’ But in the end, the moral model swept the country and cultural anthropology stopped being anything that a self-respecting social scientist would call a science. The hegemony of the Scheper-Hughes position became total.”
...
"In the Philippines, kidney sellers she interviewed often pulled up their shirts, displaying their nephrectomy scars with evident pride. They spoke of the surgery as a sacrifice made for their families, and members of their community sometimes compared their abdominal incisions to the lance wounds Christ received on the cross. In Moldova, as she reported in a 2003 paper published in the Journal of Human Rights, people who had sold their kidneys were considered so morally and physically compromised that they were treated as social pariahs. “That son of a bitch left me an invalid,” one Moldovan paid donor said of his surgeon. Young Brazilian men who had been flown to South Africa to sell their kidneys described to Scheper-Hughes how the experience had gained them a pass into the world of tourism and medical marvels. One told her that his main regret was not having spent more time in the hospital. “There were clean sheets, hot showers, lots of food,” he recalled. As he recovered, he went down to the hospital courtyard and bought himself his first cappuccino. “It was like ambrosia,” he said. “I really felt like a big tourist.” In the end, some attested that they would make the deal again, and some regretted the decision.
...
"One convicted broker, Gadalya “Gaddy” Tauber, gave her lengthy interviews while serving out his sentence in Henrique Dias military prison in Recife, Brazil. Tauber, she learned, had facilitated a trafficking scheme that sent poor Brazilians to a private medical center in South Africa to supply kidneys for Israeli transplant tourists. He employed a number of “kidney hunters,” some of whom were young men who had already donated their kidneys, to find new recruits. In the end, it wasn’t difficult. Once the first young men came back from surgery centers in South Africa showing off their thick rolls of cash, Tauber and his associates had more willing donors than they needed. They began to drop the price they offered to donors from $10,000 to $6,000 and then to $3,000, Scheper-Hughes reported in a 2007 profile of Tauber.
...
“Transplant surgeons vie only with the Vatican and its cardinals with respect to their assumption of privilege, irrefutability and of a kind of ‘divine election’ that seems to place them above (or outside) the mundane laws that govern ordinary mortals,” she wrote in one article. “Like child-molesting priests among Catholic clergy, these outlaw surgeons are protected by the corporate transplant professionals hierarchy.”
...
"Although she rejects Rothman’s contention that she is hostile to doctors, Scheper-Hughes has long argued that it is her job to investigate an insulated surgical profession prone to self-glorification. She felt obligated to challenge doctors who talked of “saving lives”—as if the benefits to organ recipients trumped all other concerns. She saw bioethicists who argued for a regulated market in kidneys as “handmaidens of free-market medicine.” And she likewise criticized tame, “clinically applied” medical anthropologists who work closely with doctors to provide the spoonful of cultural knowledge that helps the Western medicine go down.

Back in 1990, she argued that the job of a medical anthropologist was to question, even ridicule, Western medicine.
...
"In the medical community, despite her record of antagonization, many transplant surgeons give Scheper-Hughes credit for bringing widespread abuses to light, and for revealing the voices of donors and middlemen in the transplant trade. “She’s pointed out that underground illegal markets really do exist,” says Arthur Matas, the director of the Renal Transplant Program at the University of Minnesota. While most transplant surgeons like to think that their community would never participate in such a black market, Matas says, Scheper-Hughes has made it clear that they do—“sometimes unknowingly and sometimes knowingly.”



Here are some previous posts in which I've written about Scheper-Hughes and her work on black markets in organs.

Black markets and black market prices

A website call Havocscope (subtitle: Global Black Market Information) compiles information from news stories and other public sources about black markets and reported transaction prices around the world, from counterfeit goods of various sorts (from pharma to tech to food), to repugnant markets from narcotics to contract killing.

Here's their take on prices in the black markets for kidneys for transplantation.

When you click on the prices they indicate, you find their source, often a newspaper story that may only contain an anecdotal report of a transaction, so I don't think they make strong claims for the accuracy of their data, but it makes for interesting reading.

The law and politics of bone marrow and compensation for donors

The Department of Health and Human Services is proposing new regulations that would put bone marrow more clearly into the class of organs for which payment is forbidden by the National Organ Transplant Act of 1984. This is in response to the decision by the Ninth Circuit to make compensation legal for bone marrow donations made through the harvesting of blood stem cells directly from the blood.

Here's the relevant page from the Federal Register: Federal Register/ Vol. 78, No. 191 / Wednesday, October 2, 2013 / Proposed Rules

Here are my earlier posts on the courts and compensation for bone marrow donation.

Since I'm not licensed to practice law in North Carolina or anywhere else, I wrote to Kim Krawiec to ask whether HHS could simply overrule the Ninth Circuit with a regulation, or whether Congress would have to get involved.

Here is Kim's reply:
"... new legislation is probably not needed to overturn the 9th circuit ruling -- that is certainly the position of HHS.  Here is the relevant language from NOTA (with emphasis mine): (1) The term “human organ” means the human (including fetal) kidney, liver, heart, lung, pancreas, bone marrow, cornea, eye, bone, and skin or any subpart thereof and any other human organ (or any subpart thereof, including that derived from a fetus) specified by the Secretary of Health and Human Services by regulation.  

The only question would be whether HHS exceeded its authority in some way through this change. I'm sorry to say that such a claim would be an uphill battle.  One might imagine, for example, a claim that the statute only permits the addition of "organs" and HSCs drawn from peripheral blood are not an organ (as the 9th Circuit concluded).  But courts are extremely deferential to agencies on these questions of interpretation (the term is "Chevron deference", named after a Supreme Court case establishing the standard). Courts are very reluctant to overturn agency interpretations of this sort and defer to the agency interpretation unless it is unreasonable.  Hopefully the interpretation (assuming the proposed reg is enacted) will be challenged, but I think this one will be a tougher fight than the first case."

HT: Bob Slonim

Ron Paul on paying organ donors

Ron Paul: End government control of organ transplants and compensate donors

"In his weekly Texas Straight Talk column — which has continued after his departure from Congress in January — Paul called for a repeal of he federal ban on compensating organ donors. Calling the support of the current system nonsensical, Paul asked, “If we trust the market to deliver food, shelter, and all other necessities, why should we not trust it to deliver health care- including organs?”"

Here's his column in full:

***Please note: This is the temporary home for my weekly column until my personal web page is up and running.***

Let Market Forces Solve Organ Transplant Crisis

Ten-year old cystic fibrosis patient Sarah Murnaghan captured the nation’s attention when federal bureaucrats imposed a de facto death sentence on her by refusing to modify the rules governing organ transplants. The rules in question forbid children under 12 from receiving transplants of adult organs. Even though Sarah’s own physician said she was an excellent candidate to receive an adult organ transplant, government officials refused to even consider modifying their rules.

Fortunately, a federal judge intervened so Sarah received the lung transplant. But the welcome decision in this case does not change the need to end government control of organ donations and repeal the federal ban on compensating organ donors.

Supporters of the current system claim that organ donation is too important to be left to the marketplace. But this is nonsensical: if we trust the market to deliver food, shelter, and all other necessities, why should we not trust it to deliver healthcare—including organs?

It is also argued that it is “uncompassionate” or “immoral” to allow patients or insurance companies to provide compensation to donors. But one of the reasons the waiting lists for transplants is so long, with many Americans dying before receiving a transplant, is because of a shortage of organs. If organ donors, or their heirs, were compensated for donating, more people would have an incentive to become organ donors.

Those who oppose allowing patients to purchase organs should ask themselves how compassionate is it to allow those people to die on the transplant waiting list who might otherwise have lived if they were able to obtain organs though private contracts.

Some are concerned that if organ donations were supplied via the market instead of through government regulation, those with lower incomes would be effectively denied access to donated organs. This ignores our current two-tier system for allocating organs, as the wealthy can travel overseas for transplants if they cannot receive a transplant in America. Allowing the free market to alleviate the shortage of organs and reduce the costs of medial procedures like transplants would benefit the middle class and the poor, not the wealthy.

The costs of obtaining organs would likely be covered by most health insurance plans, thus reducing the costs directly borne by individual patients. Furthermore, if current federal laws distorting the health care market are repealed, procedures such as transplants would be much more affordable. Expanded access to health savings accounts and flexible savings accounts, combined with generous individual tax deductions and credits, would also make it easier for people to afford health care procedures such as transplants.

There is also some hypocrisy in the argument against allowing market forces in organ transplants. Everyone else involved in organ transplantation procedures, including doctors, nurses, and even the hospital janitor, receives compensation. Not even the most extreme proponent of government-provided health care advocates forcing medical professionals to provide care without compensation. Hospitals and other private institutions provide compensation for blood and plasma donations, and men and women are compensated for donations to fertility clinics, so why not allow compensation for organ donation?

Sarah Murnaghan’s case shows the fallacy in thinking that a free-market system for organ donations is less moral or less effective than a government-controlled system. It is only the bureaucrats who put adherence to arbitrary rules ahead of the life of a ten-year old child. It is time for Congress to wake up and see that markets work better in all aspects of health care, including organ donation, just as they work better in providing all other goods and services.

Permission to reprint in whole or in part is gladly granted, provided full credit is given.

Organs and tissue markets and black markets

NPR has a series of posts on tissue donation, which includes bones and sinews, and for which there's a regulated market, but also a black market.

Human Tissue Donation

Calculating The Value Of Human Tissue Donation(68) 

July 17, 2012 Many organ donors are unaware they've also agreed to donate their veins, bones, skin and other tissue, which can be used not only to save a life, but also to help a cosmetic surgery patient. It's a $1 billion a year industry many know little about.
Transcript

On All Things ConsideredPlaylist

Little Regulation Poses Problems Tracking Tissue(15) 

July 18, 2012 An NPR News investigation has found there's little scrutiny at key points in the tissue donation and transplant process, which could lead to serious medical mistakes.
Transcript

On Morning EditionPlaylist

Am I A Tissue Donor, Too?(23)  

July 18, 2012 NPR's Joseph Shapiro knew he had signed up to be an organ donor, but he didn't realize the red heart on his driver's license signifies that he also agreed to donate his tendons, bones, veins and other tissue.
Transcript

On All Things ConsideredPlaylist

The Seamy Side Of The Human Tissue Business(26)  

July 19, 2012 Body-stealing cases like that of Michael Mastromarino illustrate how an industry built on altruism can fall into the hands of the greedy.
Transcript

On Morning Edition

****************

Andrew Sullivan has a video: The Global Cadaver Trade

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In my 2007 article Repugnance as a Constraint on Markets I wrote about the case of Alistair Cooke, whose body parts were misappropriated after his death. Here's a colorful recounting of that and related stories from a 2006  New York Magazine story called The Organ Grinder.


HT: Steve Leider