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Worldwide, the number of illegal transplants is believed to be somewhere in the region of 10,000 per year
Seán Columb is a Senior Lecturer in Law at the University of Liverpool. He is the author of Trading Life: Organ Trafficking, Illicit Networks, and Exploitation.
I first travelled to Cairo, Egypt in 2014. At the time, there was very little evidence of organ trading. There were only a handful of media reports and academic studies, largely commenting on the ethics of organ donation. A report by the World Health Organization (WHO) suggested that Egypt was a key destination for patients purchasing black market organs.
As an academic, I was interested in how the organ trade emerged and what impact laws prohibiting organ sales had on people targeted for their organs. On a more personal level, I wanted to connect with people whose lives had been shaped by political and social violence and bear witness to their stories. To do this, I knew that I would have to learn from people who had first-hand experience of this illegal industry.
Over the past five years I have travelled back and forth from Liverpool interviewing African migrants who have sold or brokered the sale of kidneys in Cairo. On my last visit I filmed a documentary with BBC Panorama “Exposing the Illegal Organ Trade.”
As part of the documentary, I met a Sudanese man in his late thirties. Okot had been working as an organ broker in Cairo since 2003. He described the organ trade as a family business, an economic lifeline in a hostile environment. The price of a kidney, Okot explained, depends on the seller’s ability to negotiate.
“For someone to sell his kidney…it depends on the person himself,” he said. “If he is in the know, you will give him one price. If he doesn't know, then you will give him another [lower] price.”
The United Nations Office on Drugs and Crime (UNODC) has documented over 700 incidents of organ trafficking, primarily from North Africa and the Middle East. But these figures are conservative at best. According to Okot, he deals with between 20 and 30 organ sellers per week. I asked him if he felt any remorse for the people that he recruits.
“I feel bad for them, I always give them their money, but there are other brokers who would agree with you on a price, then disappear after the surgery without paying you,” he said. “This happens at least 40% of the time.”
India, Philippines, Pakistan, Egypt and China (where organs are reportedly harvested from executed prisoners) have been identified - by bodies from the World Health Organization to the European Parliament - as commercial hubs for organ trafficking. There have also been cases in Kosovo, South Africa, Costa Rica, and Turkey. Although it is a criminal offence to buy or sell an organ (worldwide with the exception of Iran) new cases continue to emerge, the United Nations has warned.
According to the Global Observatory on Donation and Transplantation (GODT) the number of transplants that take place each year accounts for only 10% of global needs. Increased demand for kidney transplants, in particular, has been intensified by a lack of altruistic donations and restrictive access to transplant services. This has led to a reliance on criminal groups who source organs from vulnerable people.
Most people are not paid what they are promised. In the worst cases their organs are taken by force. Hana, a young asylum seeker that I interviewed in 2018, was taken to an apartment where her kidney was forcibly removed.
“They took my passport and clothes,” she said. “Then they drugged me. When I was awake, I found myself alone. I was in pain and there was blood on my side coming from a bandage. I had no idea what was happening.”
Rather than deterring the organ trade, criminal sanctions have been used by criminal groups to silence their victims. Although it is unlikely that someone who has been trafficked for organ removal would be prosecuted, arrest and detention is a very real possibility for migrant workers and asylum seekers who are classified as “illegal” by immigration authorities. Hana was afraid to go to the police. The traffickers told her that if she reported them, she would be arrested for selling her kidney.
Worldwide, the number of illegal transplants is believed to be somewhere in the region of 10,000 per year. Fewer (altruistic) donations as a consequence of the COVID 19 pandemic is likely to increase global demand further.
There is a pressing need for legal reform and political action that looks beyond prohibitive measures and addresses the social and economic conditions that underpin organ markets. Prioritizing investment in impoverished communities and developing equitable transplant services, within and between countries, would go a long way in reducing the commercial incentive for illegal transplants.
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