Organ Trafficking

It has been a while since I posted on this blog, and thought I would begin again by posting a generalized article on organ trafficking by Samuel D Uretsky, PharmD, where he gives a terrific, simplified, concise overview of this ever-growing business. When you read the article carefully, its very terrifying where this is all leading unless our government and governments internationally do things to intercede before it is too late.....

And now the article:

Dear Friends:

I wish to warn you about a new crime ring that is targeting business travelers. This ring is well organized, well funded, has very skilled personnel, and is currently in
most major cities and recently very active in New Orleans. The crime begins when a business traveler goes to a lounge for a drink at the end of the workday. A person in the bar walks up as he sits alone and offers to buy him a drink. That's the last thing the traveler remembers until he wakes up in a hotel room bathtub, his body submerged to his neck in ice.

There is a note, the email continues, taped to the wall instructing the business traveler not to move and to call 911. A phone is on a small table next to the bathtub. He calls 911, which has become quite familiar with this crime. He is instructed by the 911 operator to very slowly and carefully reach behind him and feel if there is a tube protruding from his lower back. He finds the tube and answers, "Yes." The 911 operator tells him to remain still, having already sent paramedics to help. The operator knows that both of his kidneys have been harvested.

The story is an urban legend but, because the trade in transplantable body parts is real, it may be based in fact. Snopes.com suggests that it may have begun with a real incident involving a Turkish man who had gone to England for the purpose of selling his kidney.

Sources of Organs

Aside from explicit donation, there are two sources of transplantable organs from cadavers. Sometimes, despite the deceased having said that s/he did not want to be a donor, the organs are harvested anyway. In other cases, the organs of people who have died without specifically saying "no" may be harvested – which may be illegal or legal (in the case of nations that have "presumed consent" laws, such as Singapore, Belgium, Austria, and Spain).

Presumed consent laws are intended to increase the availability of donor organs. In the case of presumed consent, anyone who dies without explicitly refusing to offer their organs is assumed to have given consent for organ harvesting. (In some countries, such as Austria, the family can override the presumed consent.) Of course, even if the deceased is carrying a note requesting that organs not be harvested, things can be overlooked.

There is a benefit to presumed consent laws, but it's clearly a touchy issue. In some cultures, any sort of physical alteration to the body may be considered mutilation, and violate religious precepts. In the desire for more transplantable organs, social and cultural values are not always respected, and the emotional effect on the families of involuntary donors is ignored. What should be a serious ethical question has been too often tossed aside in the interest of quick solutions (or quick profits).

Traffic and Trafficking

Motor vehicle accidents are one of the principal sources of corpses whose organs can be harvested. The victims are normally young, healthy, and usually die from head injuries, leaving transplantable organs intact. A March 2004 Los Angeles Times op-ed piece referred to the scandal in 1997, wherein the Los Angeles coroner's office was found to have sold more than 500 pairs of corneas in one year to the Doheny Eye & Tissue Transplant Bank. The coroner's office received up to $335 per pair of corneas, which Doheny resold at $3,400 per pair.

In March 2004, the Director of the Willed Body Program at the University of California, Los Angeles (UCLA) was arrested for the illegal sale of body parts from cadavers that had been donated to UCLA for research. The body parts dealer indicted in the case said he had paid $700,000 for the opportunity to go into UCLA's freezer and take parts from as many as 800 cadavers. It has been estimated that a single cadaver has a potential market value of $200,000.

Wanna Buy A …

There is also a thriving trade in obtaining transplantable organs from living donors, sometimes for money, and sometimes not. Not surprisingly, kidneys represent the largest area of this trade. Only one kidney is needed for life, and people desperate for a few dollars are sometimes induced to sell one kidney in order to get out of debt. While the overwhelming majority of sellers come from the poorest nations, and are dealing with debt and desperation, one British man offered a kidney on eBay, with a reserve price of £50,000 (approx. US$92,000). He needed the money to care for his six-year-old daughter who had cerebral palsy.

Although there are international conventions banning the sale of human organs, not all nations have written these rules into their laws. And there are no statistics. While the human organ transplant trade has been investigated by many news organizations, and stories have run in The New York Times and on Discovery television, their reports are anecdotal, with no estimates on either the number of procedures performed, or the amount of money changing hands. The reporters do, however, agree on the essential basics – the very poorest people, those in the slums of India and Brazil, are induced to sell their kidneys.

Clear Directions

In poor nations, selling a kidney or cornea may be the only alternative to death by starvation for an entire family. On February 10, 2005, the Manchester Guardian headlined a report: "Transplant tourists flock to Pakistan where poverty and lack of regulation fuel trade in human organs."

In 2003, the Chinese city of Shenzhen, in Guangdong province, passed a law prohibiting sale of human organs, the first Chinese city to issue such a ban. (China had been a major center of the black market organ trade.) There have been allegations that China has executed prisoners solely in order to harvest their organs. Indeed, Chinese prisoners, it has been claimed, were executed by a gunshot to the head in order to avoid damage to commercially valuable hearts, livers, and kidneys.

In 2003, The New York Times reported on a ring of organ sellers operating in South Africa and Brazil. A 2001 report in The New Courier (a UNESCO publication) told of Brazilian hospitals which were harvesting transplantable kidneys from patients who were admitted for unrelated surgeries. An even more grisly tale, although one that has been rejected by experts as urban folklore, describes Gypsy cabs, driving through the slums of Sao Paulo, looking for children. The children are kidnapped, and days later their bodies, less kidneys, heart, liver, lungs, and corneas, are left in the streets.

And because the need for transplantable organs exceeds the supply by a factor of 10, there has been a growing trade in transplant tourism with select medical sites in Turkey, Eastern Europe, Cuba, Germany, and the United States. As described by the Berkeley Organs Watch, a non-profit organization that monitors the organ trade, these clinics can resemble four-star hotels or even as in Cuba, health spas for the rich and famous. "In general," the report states, "the organs flow from South to North, from poor to rich, from black and brown to white, and from female to male bodies."

Kidneys for Sale

Apologists for the trade in human kidneys describe it as a reciprocal benefit. Amir Masood Nasir, chief executive of Masood Hospital in Lahore, Pakistan, has been quoted as saying, "It is not buying or selling. One family is dying of hunger. The other family is on dialysis three or four times a week. If they decide to cooperate, they can help save each other."

The website for Masood Hospital tactfully describes the kidney transplant procedure. On day 1, the patient is admitted to the hospital. On day 2, the donor is admitted to a separate, private room. There is no mention of where the donor is admitted from. It's as if the hospital has a waiting list of donors, each anxious for a call, and the once-in-a-lifetime opportunity to sell the last item of value they have. An anonymous American organ broker was quoted in the UNESCO report as saying, "Don't think of me as an outlaw. Think of me as a new version of the old-fashioned marriage broker. I locate and match up people in need."

Despite the bright candy coat, the benefit is mostly one-sided. In October 2002, the Journal of the American Medical Association, published a study of the economic and health consequences of selling a kidney in India. The vast majority of the sellers sold their kidneys to pay off debts, with an average price of US$1,070. In most cases, the money earned was used to repay debts, or buy food or clothing. But after the nephrectomy, more families were living in poverty, and most had fallen back into debt. Worse yet, 86% of donors reported a decline in their health status, making it difficult for them to work.

A similar study of kidney vendors in Iran showed similar results, with most of those who sold their kidneys complaining of severe depression and physical disabilities. The long-term effects on black market kidney sellers were almost universally negative. In the best cases, reasonably ethical clinics provide quality care and follow-up care for the kidney sellers, but too many reports describe subjects who have lost the money they had gained, and now live with permanent physical and emotional disabilities.

It is this record of tragedy that has led some people to suggest legalizing the sale of human organs. They have suggested that a fair market, offering a fair price, with good care for the donors, including emotional counseling and follow-up care, might help replace the sordid black market that exists today.

But with so many wealthy people willing to spend more to avoid the waiting list, would a white market with fluctuating prices replace the current black market trade, or simply help raise prices for those who could offer kidneys and corneas a little bit faster. If the market became truly lucrative – after all, a wealthy Westerner may pay more for a "safer" "familiar" Western kidney than one whose source was a dweller in a third world slum – would donors in the West come forward?

The Surgeons

The next player in the illegal organ trafficking market are the Surgeons. Obviously, after the recipient, who receives the organ, and the donor, who donates the organ, are the surgeons, who are required to remove the organ from the donor, and transplant it into the recipient.

Usually a team of surgeons are associated with the illegal organ rings. The typical team comes from Israel or Turkey. They are mercenary, and get the bulk of the money the recipient has paid. They typically don't know the patient. They might have two teams, where one removes the organ, and the second team ready to put the organ in the recipient; sometimes there is only one team doing both surgeries. They manage the postoperative care of the patients with a few nurses. Usually they are in and out of the selected hospital in 4 days. These physicians are in it purely for the profit.

As you can see from the article from the previous blog, the surgeons working out of Pakistan are averaging around $150,000 cash per month! These figures can be much higher for surgeries taking place in other settings, like Turkey or even illegal transplants taking place in the United States.

Next....How to get an Organ

News article from Mail & Guardian

The Mail & Guardian is an online newspaper from Africa. They recently published the following article that perfectly encapsulates the illegal organ transplant market. As one can see from reading the article, many donors are impoverished, and receive little to no real renumeration, but the fact that they live in such destitute conditions, the money they do receive is more than they can ever make otherwise.

Interesting to note is how since this practice is "legal" in Pakistan, many Americans are now flocking to that country to receive a new organ, the vast majority of which are kidneys. And with the prices being charged in US Dollars, one can easily see why this organ trade is thriving....

Here is the article:

Transplant tourists flock to Pakistan

10 February 2005 07:29

Skint, depressed and with moneylenders banging on his door, Muhammad Iqbal decided four months ago to transform his fortunes by selling his last valuable possession -- a kidney. The labourer went to the motorway that runs past his one-room house and took a bus to Rawalpindi, the home of Pakistan's powerful military. He checked into a hospital, took a series of tests and, after two days, went under the scalpel.

Six hours later, he woke to find his kidney had been transplanted into the body of an ailing Arab man in a nearby ward and he was $1 340 richer.

"His name was Mehdi. We talked briefly through a doctor, and he took some pictures. Then he was gone," said Iqbal, lifting his baggy shirt to reveal a long, red scar above his hip.

Most adults in the village of Sultan Pur More, northern Punjab, have donated a kidney. Poverty-stricken labourers such as Iqbal earn as little as $1 a day. Many people in the hamlet surrounded by orange groves and wheat fields are in bondage to feudal-style landlords.

It is one of dozens of villages that provide the human stock for Pakistan's burgeoning cash-for-kidneys trade.

It all started with one local who worked in Rawalpindi, explained Sikander Hayad, who says 39 relatives have made the kidney pilgrimage. "The man had the operation and came home to spread the word," said the 33-year-old bicycle repair man. "Then everybody went."

The organ sales business, outlawed in all but a handful of countries, is legal and booming in Pakistan. The gold standard is the kidney. Frustrated by years-long waiting lists at home and fearful of an early death, "transplant tourists" from Europe, the United States and the Middle East are flocking to private Pakistani hospitals for operations which can be arranged in days at a fraction of the cost back home.

Since India imposed a ban on the controversial trade 10 years ago, a thriving industry has sprung up around Rawalpindi and Lahore. Private hospitals advertise their services on the internet, and leading surgeons can make thousands of pounds for a few hours' work. Newspapers carry small ads looking for new donors; even airport taxi drivers know the addresses of the busiest kidney hospitals. Middlemen scour the countryside, looking for fresh peasant labourers to entice with the promise of riches.

The trade has sparked passionate debate in Pakistan and abroad. Two years ago, a London-based property developer, Thor Andersen, admitted to buying a kidney from a 22-year-old Pakistani woman for £3 000.

Andersen said he could not bear to queue with the NHS for a cadaver donation that might never come. A spokesperson for UK Transplant, the government health authority specialising in organ donations, said more than 5 200 Britons were currently on the list, waiting an average of 506 days. However, it can be as long as nine years, and about 400 patients die every year. In these conditions, it is reasonable to buy a kidney, say some British academics. The rich get a kidney, the poor get money, and the medical procedure that satisfies both is relatively safe.

Opponents counter that the practice is exploitative, fails to alleviate poverty and leaves impoverished donors medically vulnerable and even exposed to death.

Professor Adibul Hasan Rizvi, a surgeon at the state-run Sindh institute of urology and transplantation, is Pakistan's leading critic.

"We have no law governing transplants, so everyone just makes their own. That suits the rich, but the poor are coerced -- by the feudal-type societies they live in, or their own poverty -- into selling their kidney. It's just wrong. Where will it stop? With eye, lung or heart transplants?"

Andersen had his transplant at Masood hospital in Lahore, a smart private facility which advertises its services on the internet and has Visa and MasterCard stickers on the front door. Business is brisk. Surgeons perform an average of 10 kidney transplants at $13 959 each every month, according to the management. Out front, builders are at work on a new nine-storey extension.

The kidney business is not a trade but a form of cooperation, said the hospital's chief executive, Amir Masood Nasir. "It is not buying or selling. One family is dying of hunger. The other family is on dialysis three or four times a week. If they decide to cooperate, they can help save each other." Donors come from villages such as Mandia Wala, a settlement clustered around 25 brick kilns near the Indian border. The tall red chimneys bring to mind Victorian England, as do the working conditions. Labourers earn $3,35 for every 1 000 bricks they make, and many are heavily in debt to their employers. This makes them ideal kidney donors.

One kiln owner, Mian Maqsood, said he had asked the Masood hospital to stop recruiting his workers.

"We don't want our labour involved in that business," he said. "The people who give their kidneys spend all the money at once. Then afterwards they cannot work properly."

His observation is supported by a study published in the Journal of the American Medical Association in 2002. Researchers found that, of 305 Indians who had sold their kidneys an average of six years earlier, 96% had done so to pay off debts, but three-quarters remained in debt. Also, 86% said their health had declined since the operation.

Despite such qualms, relentless demand keeps the trade alive. One source in the medical industry said he was expecting a South African "transplant tourist" later this month; another said three Bulgarians recently passed through.

Most of Pakistan's clients come from the Middle East, many with the blessing of their own governments. Although paid-for transplants are illegal in Saudi Arabia, the Islamabad embassy actively assists citizens who seek one in Pakistan.

The embassy doctor, Eissa al-Harthi, said he visited patients in hospital and helped to iron out any difficulties, and sometimes his government footed part of the bill.

Pakistan's government has spoken for years of legislating to regulate kidney transplants, but the idea remains little more than a vague proposal.

In the meantime, a handful of doctors are getting very wealthy. Dr Riaz Tasneem, a public-health kidney specialist in Lahore, estimates there are 30 cash-for-kidney transplants in the city every month, earning surgeons about $4 839 for each operation.

Retired army surgeons run two busy transplant centres in Rawalpindi. "Another six people were being operated on at the same time as me," said the donor, Muhammad Iqbal. He is ambivalent about his experience. The $1 340 was invaluable for getting the debt collectors off his back, he said. But he had no money left over. Now his children still have no shoes, his health has deteriorated and he has taken out a new £45 loan.

"The scar didn't heal well, and I feel tired easily so I can't do hard work now. But I was tired of all those people coming looking for money," he said. "What else was I going to do?" - Guardian Unlimited © Guardian Newspapers Limited 2005

Illegal Organ Market: Who are the Players?

The next question you might ask is what or who makes up the illegal organ market? Who are the players? In the next series of posts, I will try to break down who makes up this market.

The Recipient

First, and foremost, the market is driven by the recipient. The recipient is the patient in desperate need of an organ transplant. The patient is put on a donor list. As you saw from the previous post, organ availability is low. As low as the availability of kidneys, which can be donated from a living donor, the availability of lungs, livers and hearts are significantly lower.

In the most likely scenario, the patient typically will die before receiving an organ, and/or spend a significant part of their remaining days with a poor quality of life. As an example, a patient in renal, or kidney, failure will spend most of their life receiving kidney dialysis three times a week, every week, until they receive a kidney transplant or die!

Facing this scenario, the patient begins to experience hopelessness, and begins to explore the black market looking for an organ, after losing faith in the ability of their physicians and healthcare system to find an organ in an expeditious time frame.

Next post...the Donor

Illegal organ trafficking

The concept of my book is based on the growing illegal organ trafficking "industry". Statistics show that this has become a multibillion dollar a year operation, infiltrating just about every country. Organ trafficking can take many forms, from individuals advertising to sell organs, primarily kidneys, to people advertising for kidneys, to "agents" soliciting organ donors, primarily in the poorest countries for minimal renumeration, to abduction and murder of individuals for harvesting of their organs. Why has this industry become so pervasive? Well...just look at some of these statistics:

US Transplant statistics (2001):
-79,523 people on waiting lists for all organs
-Only 22,593 organs transplanted

European statistics:
-40,000 patients awaiting for kidney
-Only 10,000 kidneys available

Worldwide:
-700,000 people on dialysis, needing a new kidney

So, you can understand why the organ trafficking industry has become so overwhelming!

....more information to follow....