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COVER LETTER

Sub theme- Organ Trade and Human Trafficking
Title Organ Trafficking: A Deadly Trade
Authors Aayushi Chaudhary and Aditya Prakash
Email address c.aayushi@gmail.com
Postal Address Room No. 140, Girls Hostel, Chanakya National
Law University, Mithapur, Patna, Bihar.
Contact Number +919570923801













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ORGAN TRAFFICKING: A DEADLY TRADE

ABSTRACT
Organ trafficking is perhaps the most inconsequential form of human trafficking and
egregious human rights abuse. It is an international problem with multinational dimensions
and involves the intersection between the world of organized crime, impoverished organ
donors, sick recipients and unscrupulous medical staff. Universal organ shortages for the
purpose of transplantation have catalyzed a thriving international black- market in which
human organs are bought and sold illegally. As a consequence of the increasing ease of
Internet communication and the willingness of patients in rich countries to travel and
purchase organs from poverty-stricken people in developing countries, organ trafficking and
transplant tourism have grown into global problems. This paper will start out by scrutinizing
the global patterns of organ trade and human trafficking, highlighting the physical and
psychological harm caused to the poor victims. The paper will subsequently continue with a
discussion of the national and international legal instruments established to combat organ
and human trafficking and reflects upon its effectiveness in eliding this growing global
problem. Globalized markets, communication, and transportation enable traffickers to move
their operations fluidly in order to take advantage of legal loopholes. As a result,
enforcement in one state merely prompts traffickers to seek other states with more favourable
legal environments. The paper will also focus upon the causes and social determinants of
organ trafficking rather than focusing upon criminal law alone. Poverty, vulnerability,
destitution and a system of exploitative transplant practices are some of the social
determinants for commercial living organ donation. The paper will end with a discussion of
alternative approaches to deal with the problem of organ and human trafficking, such as
increased extra-legal measures, and international cooperation.

Keywords
Organ trafficking, human trafficking, global, communication, poverty, transplant,
international.
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INTRODUCTION
Growing demand and monetary reward is fuelling increased illegal human trafficking of
organs
1
. The dimensions of this illegal trade draw comparisons to those of drugs and
weapons, indicating a larger scope than is often unacknowledged by the international
community, partly caused by the lack of reliable data on organ transplantation activity, but is
nonetheless, suggested to be increasing
2
. As with human trafficking for other exploitative
purposes, victims of trafficking for the purpose of organ removal are often recruited from
vulnerable groups (for instance, those who live in extreme poverty) and traffickers are often
part of transnational organised crime groups. Organized crime groups lure people abroad
under false promises and convince or force them to sell their organs. Recipients of the organs
must pay a much higher price than donors receive, part of which benefits brokers, surgeons
and hospital directors, who have been reported to be involved in the organized criminal
network.
The servitude or the removal of organs is defined as a form of trafficking exploitation by
the UN Protocol to Prevent, Suppress, and Punish Trafficking in Persons, Especially Women
and Children, which is also referred to as the Trafficking Protocol
3
. The commission of this
crime can be distinguished from other form of trafficking in persons in terms of the sectors
from which traffickers and organ brokers derive; doctors and other health-care practitioners,
ambulance drivers and mortuary workers are often involved in organ trafficking in addition to
those involved in other human trafficking networks. This refers specifically to any time at
which a third party recruits, transports, transfers, harbours or receives a person, using threats
(or use) of force, coercion, abduction, fraud, deception, or abuse of authority or a position of
vulnerability in order to remove said persons organ(s)
4
. Regarding children, the act of
removing an organ when it is facilitated by a third party is trafficking in and of itself; there
is no need for deception or coercion.

1
WHO. Organ trafficking and transplantation pose new challenges. , available at,
http://www.who.int/bulletin/volumes/82/9/feature0904/en/index.html, accessed on 28
th
September 2014.
2
Ibid.
3
Office of the United Nations High Commissioner for Human Rights. Protocol to Prevent, Suppress and
Punish Trafficking in Persons Especially Women and Children, supplementing the United Nations Convention
against Transnational Organized Crime., available at http://www2.ohchr.org/english/law/protocoltraffic.htm,
accessed on 28
th
September 2014.
4
Deutsche Gesellschaft fr Technische Zusammenarbeit. Coercion in the Kidney Industry., available at,
http://www.gtz.de/de/dokumente/en-svbf-organtrafficking- e.pdf, accessed on 28th September 2014.
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The growth of illegal trade has stemmed from the increasing scarcity of transplant material
available for waiting patients. For example, in 2004, there were approximately 80 000
patients wait listed for organ transplants in the United States. Concurrently in Europe, there
were approximately 40 000 patients on kidney transplant waiting lists and another 120 000 on
dialysis treatment
5
. At the same time, the European Parliamentary Assembly estimated that
by 2010, the waiting time for a transplant would increase from 3 to 10 years
6
. The increase in
waiting time is an incentive for acquiring an organ from any source. In 2006, the United
Nations came to the conclusion that it was impossible to provide any estimation on the scope
of organ trafficking
7
. The topic was not a priority nor had it received close scrutiny in
Member States. Most cases included in the report involved the illegal removal and trafficking
of organs or tissue from deceased persons. A year later, however, at the Second Global
Consultation on Human Transplantation of the World Health Organization (WHO) in March
2007, it was estimated that the extent of organ sales from commercial living donors
(CLDs) or vendors has now become evident... and was estimated at 5-10% of the annual
kidney transplants performed around the world
8
.
The improvement of health care in many parts of the developed world has contributed to an
increased life expectancy, resulting in a larger population of older people. At the same time,
technological and medical developments had facilitated the transplantation of organs. It is
making this an almost routine procedure, the demand for organs far exceeds the supply and
the shortage is acute. Between 1990 and 2003, kidney donations in the United States
increased only 33%, but those awaiting a kidney for transplant increased by 236%
9
.
According to the United States Department for Health and Human Services, as of 5 June
2013, 118,226 candidates waiting for organs (75,643 of whom they are active waiting list
candidates), but only 3,412 donors registered in the United States, as of March that year.
10

Data on organ transplants from the WHO shows that those 106,879 organs known to have

5
WHO. Organ trafficking and transplantation pose new challenges., available at,
http://www.who.int/bulletin/volumes/82/9/feature0904/en/index.html, accessed on 29
th
September 2014.
6
Ibid
7
United Nations, Report of the Secretary-General, Preventing, combating and punishing trafficking in human
organs, Vienna, February 21, 2006, available at
www.unodc.org/unodc/en/commissions/CCPCJ/session/15.html, accessed 29th September 2014.
8
Budiani-Saberi, D. A. and Delmonico, F. L., Organ Trafficking and Transplant Tourism: A Commentary on
the Global Realities, American Journal of Transplantation, vol. 8, ed. 5, 2008, 925929, 925.
9
United Nations Global Initiative to Fight Human Trafficking (UN.GIFT), 011 Workshop: Human Trafficking
for the Removal of Organs and Body Parts", 13-15 February 2008 Background Paper, Vienna, available at,
www.ungift.org/doc/knowledgehub/resource-
centre/GIFT_ViennaForum_HumanTraffickingfortheRemovalofOrgans.pdf, accessed 27 November 2013.
10
US Department of Health and Human Services, Organ Procurement and Transplantation Network, available at
optn.transplant.hrsa.gov, accessed on 29
th
September 2014.
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been transplanted in ninety five Member States in 2010. It is slightly more than two thirds
(68.5%) were kidneys. But those 106,879 operations satisfied only 10% of the global need,
according to the WHO
11
. Various initiatives to address human trafficking for organ removal
(HTOR) have been developed since the late 1980s. It emerged from concerns of organ
trading brought to the attention of the World Health Organization (WHO). Since 1987, the
WHO developed and updated guiding principles for human organ transplantation (WHO
Guiding Principles). In 2006, the International Transplantation Society (TTS) has worked in
collaboration with the WHO to employ these principles and in 2008, and partnered with the
International Society of Nephrology (ISN) to develop the Istanbul Declaration on Organ
Trafficking and Transplant Tourism (The Declaration of Istanbul). Media and civil society
responses have created awareness of what is known about the scope and operations of the
organ trade with some efforts to also provide victim
12
assistance. The United Nations Office
on Drugs and Crime (UNODC) has principal carriage for human trafficking within the United
Nations system and has addressed organ trafficking in some of its criminal justice resources
on human trafficking. These efforts have contributed to improved legal and policy
frameworks to prohibit the organ trade in key host countries including Pakistan, Egypt, China
and the Philippines with an aim to harmonize policies in accordance with the WHO Guiding
Principles. The Declaration of Istanbul has also obtained the endorsement of transplant
professional societies, pharmaceutical companies and governmental entities across the globe.
It is important to recognize that although poverty plays a role in eliciting a supply of organs,
that supply can only be realized when there is a complimentary lack of legislation or enforced
legislation in a region. In Tamil Nadu, India, researchers noted that a large part of the trade in

11
The Guardian, Campbell, D. and Davison, N., Illegal kidney trade booms as new organ is sold every hour,
27 May 2012, available at <guardian.co.uk/world/2012/may/27/kidney-trade-illegal-operations-who>, accessed
on29th September 2014.
12
Use of the term victim of HTOR in this paper relies upon theUnited Nations Declaration of Basic
Principles of Justice for Victims of Crime and Abuse of Power that defines victims in the broad sense as
persons who, individually or collectively, have suffered harm, including physical or mental injury, emotional
suffering, economic loss or substantial impairment of their fundamental rights, through acts or omissions that
are violations of national criminal laws or of internationally recognized norms relating to human rights. The
term victim is an advancement from prior terms used in the discourse including organ seller/vender,
commercial living (organ) donor. COFS is transitioning to the preferred term trafficked person or in
this case, person trafficked for organ removal (PTOR) to better express individuals agency in this
experience. Above all, COFS intention is to seek legal recognition that these persons have had rights abused by
being trafficked for organ removal.
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human organs stemmed from the ambiguity of the Transplantation of Human Organs Act
(1994), and the low monitoring capacity of the regulatory authorities
13
.

ELEMENTS OF ORGAN TRAFFICKING
According to the International Association of Organ Donors that the United Network on
Organ Sharing (UNOS) data of kidney transplants in the U.S. from 1996 to 2006 that kidney
graft survival rates are higher for recipients who had received the organs from living
donors
14
. After five years, the survival rate is 68% from deceased donors and 81% from
living donor. After period of ten year, the survival rate is 42% for those whose kidney has
been grafted from a deceased donor as compared to a 58% survival rate for those receiving an
organ from a living donor
15
. For this reason the recipients prefer to have transplants from live
donors. So by this we can infer that there are some patterns of Organ Trafficking.
On the one hand, organs harvested from a deceased donor are packed on ice and can be
transported over the world. On the other hand, organs are harvested from live donors may
involve the travel of both donor and recipient (and possibly the transplant experts) to the
place where the transplant will occur. One of the leading experts on human trafficking for
organ transplant, Dr. Nancy Scheper-Hughes, describes it as a trade that can bring together
parties from three or more countries and the donors and recipients come from different
countries while the transplantation may occur in yet a third country. While donor and
recipient may originate in the same country, transplant tourism involves the travel of donors
and recipients. Shimazono (2007) introduces the four modes of transplant tourism during
which the organ trafficking may occur. It involves the situations in which the donor travels to
the recipients country and the recipient travels to the donors country, a donor and recipient
from the same country travel to a third country where the transplant centre is situated, and
another situation where a donor and recipient travel from different countries to a third country
for the transplant procedure. The transnational nature of this crime raises questions about the
possibility of its control through international law or instruments. Historically, certain

13
Muraleedharan, Vangal R., Jan, Stephen and S. Ram Prasad. The trade in human organs in Tamil Nadu: the
anatomy of regulatory failure. Health Economics, Policy and Law (2006), 1: 41-57 Cambridge University Press.
14
Naderi, G.H., e.a., Living or deceased donor kidney transplantation: a comparison of results and survival
rates among Iranian patients, Transplant Proceedings, vol. 41, ed. 7, 2009, 2772-2774.
15
International Association of Living Organ Donors Inc., available at
<livingdonorsonline.org/kidney/kidney2.htm> accessed on 30
th
September 2014.
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patterns have been observed. In the 1990s most recipients of kidneys were inhabitants of the
Gulf States who traveled to India to purchase an organ or else they were Asians who traveled
to China or India. India remains a popular destination for both purchase and transplant
16
, and
the buyers come from Indias middle class and from all over the world and include the United
States, Canada, England and the countries in the Middle East
17
. The market has expanded, but
general patterns can be observed, the trade in kidneys from live donors generally flows from
poor, underdeveloped countries to rich or developed ones. There are many organ donors and
organ recipient nations
18
. Common countries of origin for those selling kidneys are Bolivia,
Brazil, China, Columbia, Egypt, India, Iran, Iraq, Israel, Moldova, Nigeria, Pakistan, Peru,
the Philippines, Romania and Turkey. Countries of origin for those purchasing kidneys are
Australia, Canada, Hong Kong, Israel, Italy, Japan, Malaysia, Oman, Saudi Arabia, South
Korea, Taiwan and the United States
19
.
There are about 6,000 international kidney transactions a year
20
. Donors and recipients vary
from one country to the next and even between regions within particular countries. There are,
however, some very general trends. Organs are supplied by desperately poor people in poor
countries to recipients in more affluent ones. Donors are generally minorities, and recipients
of the organs - white or Middle Eastern. While donors may be male or female, most
recipients of purchased organs are male, rarely female. Donors are young; recipients
generally older
21
. Few empirical studies exist on organ trafficking. Research in Nepal
indicates that the trafficking of human beings for the purpose of organ removal occurs
predominantly in one district (Kavree). Donors are young men between the ages of eighteen
and forty two (average age is thirty). They come from different ethnic minority groups in the

16
At the time of writing this article, the lead author was told by experts on organ trafficking in Nepal, that a
particular hospital in India is being used for the transplant of organs from trafficked Nepali victims
17
Rothman, D. and Rothman, S., The Organ Market, The New York Review of Books, Vol. 50, ed. 16, 23
October 2003, available at http://www.nybooks.com/articles/archives/2003/oct/23/the-organ-market/, accessed
30th September 2014.
18
Scheper-Hughes, N., Parts unknown. Undercover ethnography of the organs-trafficking underworld,
Ethnography, vol. 5, ed. 2, 2004, 2973.
19
Information taken from Scheper-Hughes, N., Organs Without Borders. A new comparative advantage? Why
the poor are selling their organs, Foreign Policy, ed. 146, 2005, p. 2627, available at
<foreignpolicy.com/articles/2005/01/05/organs_without_borders> and modified with data from Saletan, W.,
The Organ Market, The Washington Post, April 15, 2007, available at <washingtonpost.com/wp-
dyn/content/article/2007/04/13/AR2007041302066_pf.html> and Shimazono, Y., The state of the international
organ trade: a provisional picture based on integration of available information, Bulletin of the World Health
Organization, vol. 85, ed. 12, December 2007, 955-962, available at <who.int/bulletin/volumes/85/12/06-
039370.pdf>, accessed on1st October 2014.
20
Information based on the World Health Organization estimates from Saletan, W., 2007, supra, nt. 29.
21
Aronowitz, A.A., Human Trafficking, Human Misery: The Global Trade in Human Beings, Greenwood
Publishing Group, 2009.
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district and are extremely poor
22
. In the state of Tamil Nadu, India, 71% of the 305
respondents in a study of kidney sellers were women. Almost all of the men and 60% of the
women were labourers or street venders. Two of the participants reported that they were
forced to sell a kidney by their husband
23
. Other studies have also found that many organ
sellers in India are women, however in the State of Punjab, India, it is generally poor young
men (labourers) between the age of eighteen and thirty who agree to sell a kidney
24
. A kidney
is sometimes sold to pay the dowry for a daughters wedding.
In Moldova, kidney sellers are poor young men from rural areas between the ages of eighteen
and twenty eight, most of whom were deceived or coerced in selling their kidney. While they
were paid between $2,500 and $3,000 to forfeit their kidney, recipients were required to pay
between $100,000 and $200,000 for the operation
25
. In Nigeria, kidney sellers are usually poor,
single women
26
.
Country(State)

Gender

Age Education Occupation Income
Tamil Nadu Female 71%
Male 29%
35 2.7 N.A Annual
family
income
$420; 71%
below
poverty line
Punjab Male

18-30 Not
Available
Labourer
N.A
Philippines

Male

29 7 N.A Annual family
income $480
Nigeria

Female

Not
Available
Not
Available
N.A Very low
annual
income

Moldova

Male 18-28 Poor Labourer Low

22
Interview by Elif Isitman with Dr. Meena Poudel, Anti-Trafficking, Gender and Violence Against Women
Advisor, USAID, Kathmandu, Nepal, April 25, 2013.
23
Goyal, M., et al, Economic and Health Consequences of Selling a Kidney in India, Journal of the American
Medical Association, vol. 288, ed. 13, 2002, 1589-1593.
24
Deutsche Gesellschaft fr Technische Zusammenarbeit (GTZ) GmbH, Pearson, E., Coercion in the Kidney
Trade? A background study on trafficking in human organs worldwide, Eschborn, April 2004, available at
www.giz.de/Themen/en/dokumente/en-organ-trafficking-2004.pdf, accessed on 1
st
September 2014).
25

26

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