Image showing the human trunk with positions of the organs.
It’s practically an urban legend: A man blacks out after meeting a woman for a drink at a bar. When he comes to, he finds himself naked in a hotel bathtub covered with ice. And there’s a throbbing ache in his side. A hand-scrawled sign blares the bad news: “Go to the ER right away!”
He suddenly realizes: His kidney is gone.
It rarely happens that way anymore, but there’s reason to fear illegal organ harvesting. The practice is rampant and getting worse by the year.
While official data is still somewhat sketchy, it’s estimated that 12,000 illegal transplants are performed annually, about 10% of the total number of transplants conducted each year. The organ trade is immensely profitable, generating between $840 million to $1.7 billion in revenue for a relatively small number of traffickers, according to estimates compiled in 2017.
Organ trafficking survives, in part, because the demand from affluent consumers in the advanced capitalist West is so high and the legal supply of organs – primarily (about 80%) kidneys, but also lungs, livers and cornea – barely keeps pace. Many people wait at least two years to qualify to receive an organ transplant legally and thousands die every year – about 25 daily, according to the World Health Organization – because no organ becomes available in time to save them.
Where do the illegally harvested organs come from? Primarily from North Africa and South Asia. Organ traffickers prey on poor and vulnerable rural dwellers, offering cash in exchange for an organ, usually a kidney. Like other forms of illicit human trafficking, some organ donors are recruited under false pretenses – for example, the promise of a job that never actually materializes. Donors are led to hospitals, drugged, and a doctor, who’s typically in on the scheme, removes the organ, for a fee paid by the traffickers. The duped donor is compensated – perhaps several thousands dollars, but maybe far less – and then shuttled back to their village to try to survive. Their organs may get as much as $30,000, or even $200,000 on the black market.
In some countries like Nepal the illegal organ trade is so firmly entrenched that a number of adjacent rural areas have come to be known as “Kidney Valley.” Anti-trafficking activists say that every other house in the region has at least one individual that has donated an organ in exchange for cash. Often the donors are transported to neighboring India where the illicit operation is performed. They come back in a debilitated state, with reduced physician capacity. Many lose their jobs and once the cash runs out, their families are reduced to poverty again.
Many of the countries where the organ trade occurs may have strict laws on the books that forbid illegal organ harvesting, but government officials are subject to bribes from traffickers. But governments alone are not the problem. Many Western hospitals and doctors – like their Third World counterparts – are also playing a role in the trade, sometimes unwittingly, but just as often with a tacit complicity. Doctors in major urban metropolitan hospitals in US cities may agree to conduct a transplant, for a fee, not really caring how they obtained the organ – or from whom.
Nancy Scheper-Hughes, a professor of medical anthropology at UC Berkeley and co-founder and Director of Organs Watch, a medical human rights project, says the demand for illegal organs is “insatiable.” And despite the passage of national laws and the adoption of international protocols in recent years, there’s been virtually no slowdown in the illegal trade thus far.
Scheper-Hughes, who also serves as a WHO consultant, has frequently gone undercover to expose the corruption that fuels the illegal organ trade. She’s tracked organs to “broker-friendly” hospitals and medical centers in New York, Los Angeles, and Philadelphia, among other places.
It’s not just hospitals. Corruptible funeral homes may harvest organs prior to burial. Women and girls sold into sexual slavery are also common victims. There are even confirmed reports that ISIS and other terrorist organizations have engaged in the illegal organ trade to finance weapons purchases.
Many of those seeking illegal organs aren’t actually on a waiting list for a donor. Some are people who can’t qualify for a donor because of their medical condition. They may have had cancer, are too old, or have other “triage-based disqualifiers.”
In addition, even those that get a transplanted organ generally face the need to take auto-immune suppression drugs to stave off organ rejection, while the same drugs also lower their overall immune competence. “If all of that works out, they will still be facing the fact that transplant organs often need to be replaced within 10 years of implant,” says one expert.
Organ donation is potentially a major life-saver for those with serious illnesses. More than a third of all US deaths – about 900,000 annually – might have been prevented if an organ had been available, experts say. But woefully few are – hence, the burgeoning illegal trade.
What’s the answer? Ultimately, increasing the supply of organs available to be transplanted. And that means increasing the willingness of people to allow theirs to be harvested when they die, as well as boosting approval for transplants from live donors. According to surveys, 95% of all American say they favor organ donation. But only 35% of all Americans are registered as donors. Closing that gap would go a long way to ensuring that the supply of organs meets the ever-burgeoning demand.
Another possibility – strictly long-term — is to grow organs from stem cells, or to replicate them using 3D imaging. The technologies are promising but haven’t been fully tested with animals, let alone humans yet. It could take years to develop viable prototypes.
Both Trump and Biden have taken modest steps to improve the organ donation process. Trump, in late 2020, signed an executive order to boost the availability of kidney organs by 5,000 annually. Biden went a step further, pushing through a bipartisan bill to break-up the monopoly exercised by a single non-profit that was slowing the approval process for organ transplants, while boosting costs.
Congress is also getting into the act. In 2023, new legislation required the State Department to improve its monitoring of groups and individuals found to be engaged in illegal organ trafficking and to deny US visas and property rights to the perpetrators.
These steps, while welcome, are far from enough. Currently, more than 95,000 people are on the kidney waiting list, and about 3,000 people are added to the wait list each month. Most of these prospective recipients will die within 5 years unless they receive a kidney in time. The threat to those with liver damage is even worse. Liver failure is usually fatal unless the victim receives a new organ promptly – usually within days.
Predictably, it is people of color that are suffering the most from our nation’s dysfunctional organ harvesting system. For example, while non-Hispanic Whites and African-Americans have comparable needs for a new organ, in 2021, Black people received 27.8% of the organ transplants performed, while non-Hispanic Whites people received close to double that share – or 47.2%. But cultural attitudes and mistrust of the mainstream public health establishment also play a role. African-Americans are less than half as likely as non-Hispanic Whites to agree to become organ donors, according to recent research studies.
Given the current shortfalls and disparities in the legal donor system, the incentives for the illegal organ trade aren’t likely to be affected in the short-term, experts say. U.S. crackdown measures still depend upon the willing cooperation of foreign governments that too often remain deeply implicated in the trade. More public education and support for organ donation and continuing reforms to the approval system will certainly help, but as long as the richest and most powerful Westerners can access illegal organs with relative impunity, the poorest of the world – at home and abroad – will continue to be trade’s primary victims.
