When kidneys become commodities
Trafficking in human beings for the purpose of organ removal is a dirty business that feeds on the deepest human vulnerabilities. The fact that health professionals are involved adds to the insidiousness of the crime.
It may seem like a simple, almost humanitarian arrangement. Transplants are increasingly saving lives, yet organs are in short demand. Desperate families will do almost anything to get a kidney. Corrupt health professionals can offer a solution, for a price, because they have connections to another world of equal desperation: people living in poverty so abject that they are willing to allow a part of themselves to be cut out in order to be able to sustain their families. Whole villages have fallen prey to the smooth talk and glossy brochures of “kidney hunters”. The operation is not dangerous, a routine procedure, they are told. It will save a person’s life. And it will mean instant cash, a large amount of cash. Enough to build a permanent shelter, send the children to school.
The reality typically looks very different. The organ removal is often done shoddily and practically always without proper after-care. The victim-donors are paid less than the amount promised, or not paid at all. In either case, they find that the money is soon spent and often their health no longer permits them to make a living doing manual labour, so that they enter a downward spiral of poverty and social exclusion. Recipients, too, may suffer long-term health issues from organs received illegally.
“Health security is affected in the cruelest way,” this is how Maria Grazia Giammarinaro, the OSCE Special Representative and Co-ordinator for Combating Trafficking in Human Beings characterizes the harm done by this gruesome forms of exploitation.
The only ones sure to gain are the international brokers, recruiters, minders, and health care professionals complicit to the crime. The profit margin is large. While recipients might pay over a hundred thousand Euros for a kidney, donors will get a few thousand at most.
As recently as fifteen years ago, trafficking in human beings for the purpose of organ removal was considered an obscure practice in remote parts of the world, written about mostly by anthropologists. But in recent years an increasing number of cases have reached the courts of law, including in the OSCE area. Recognition is growing of the urgency of combating this crime.
It was therefore prescient on the part of the OSCE Special Representative to commission a study of the phenomenon and analysis of cases in the OSCE region, which was released earlier this year. The study reveals the complexity of this cross-border crime.
Milbert Shin, the main author of the publication, talks about challenges and ways forward.
What makes prosecuting this crime difficult?
“The number of jurisdictions that can be involved even in one trafficking network is daunting. Both victims and recipients can come from multiple countries; the transplant surgery can take place in yet another country, involving medical professional that are also from different countries. And the financial hubs where money is being received can be somewhere else again.
“This makes detection, investigation and prosecution very complicated. The international broker at the centre of the trafficking network is generally able to move easily among countries, eluding accountability. Initiating a court proceeding in that person’s country of citizenship may be impractical if the national laws lack the necessary extraterritorial reach. On the other hand, starting a case in the country where the victim is located presents the problem of extraditing the person charged with the crime, often a complicated and lengthy affair.
“In addition, there is the matter of gathering evidence. In a number of the cases the OSCE report considers, the evidence did not come solely from the place where the victim originated, nor solely from where the transplant occurred; evidence was also required from the recipients, at least in one case, to establish the flow of the money.”
What can the OSCE do?
“With the rise in illnesses such as diabetes and a shortage of kidneys available through altruistic donation, the demand for illegal kidneys is rising. If we wish to combat this crime, we need to learn more quickly about how trafficking in persons for the purpose of organ removal works and how countries can co-operate to combat it.
“This is where the OSCE has an added advantage because it can bring together countries in the region to share experiences. The discussion has already begun with the preparation of the released report, for which several participating States provided valuable information. To me this was an important and courageous step because the more we can speak openly about this and are able to be candid about the issues, the better position we will be in to finds ways of co-operating in combating this truly transnational crime. It is also essential to bear in mind that this form of human trafficking is not a problem of relatively poor countries alone, it is equally a problem of Western Europe, of Canada and the United States, because the networks involved have a global reach.
“A second area where the OSCE could be useful is in promoting multidisciplinary exchanges. There are several distinct communities that have been involved in studying and combating trafficking for organ removal, and there has been little contact among them. There is the community of NGOs, government officials and activists who work on human trafficking, which traditionally has meant trafficking for sexual or labour exploitation. There is the medical profession, especially the transplant community that has been working on ethical issues. And there is the medical anthropology community, the social scientists who were the first to bring to light this phenomenon through their academic writing and cooperation with the media. There is much to be gained from exchanges among these three communities.
“One of the most important areas of potentially fruitful exchange is victim support. Victims of this form of trafficking suffer lifelong consequences. Even in countries with relatively strong networks providing support to trafficking victims, there may be a need for more complex and extensive support. In developing an anti-trafficking response there are very important questions to raise, such as how to identify victims, what their needs are, how a victim is going to get compensation, who will pay for rehabilitation. In this regard, learning from the experiences of groups such as the Coalition for Organ Failure Solutions, COFS, the leading NGO in this area, will be critical.”
What about closing the gap between demand and availability of organs?
“This involves complex health policy issues, for instance on how to do more to increase the availability of altruistic and deceased donations. In the context of the growing gap between demand and availability, it should also be noted that, in addition to the prohibition against human trafficking, the transfer of the human body and its parts for material gain is prohibited in virtually every country. Nonetheless, given the growing gap between demand and availability, there is an ongoing debate over whether there should be a legalized market for organs.
“Pending progress on these extremely difficult issues, the practical exchanges I am proposing could lead to results that are within reach: more public awareness that will let potential victims know that they may be being facing fraudulent offers involving organs, accountability for those engaging in this form of human trafficking, closer co-operation with the medical community on prevention strategies and the development of mechanism to support those unlucky enough to have fallen prey to the false promises of unscrupulous dealers in body parts.”
Download Trafficking in Human Beings for the Purpose of Organ Removal in the OSCE Region: Analysis and Findings at //www.osce.org/cthb/103393