Body parts

The trade in body parts is booming. Growing numbers of the poor are allowing themselves to be mutilated to supply international trafficking operated by a transplant mafia. Meanwhile, unscrupulous tour operators and surgeons are engaging in a new kind of tourism. Although we are now seeing a response in the form of investigative networks, ethical codes and international positions, it is very much at the early stages.

‘Man aged 29, in perfect health, is selling one of his kidneys for EUR 150 000.’ This message, published on the free website and condemned by the Spanish consumer association Facua, was reported by various European media. The services charged with looking into this case by the Spanish Health Ministry and police conducting the investigation identified around 30 similar proposals on 13 websites. In most cases it is kidneys, lungs and bone marrow that are advertised for sale, by Spanish nationals as well as immigrants from Latin America, with prices ranging from 15 000 to a million euros. Such practices are contrary to the legislation of an EU Member State in which organs are not regarded as merchandise and their prevalence is all the more surprising as Spain has a high level of donors. But what can the law do in the face of poverty?

A special kind of tourism

Although such adverts are the result of individual initiative, organised crime is quick to seize upon them. They know the ins and outs of the complex path, with its shady surgeons and illicit transporters, by which the life of the ‘rich man’ can be saved or improved by amputating that of the ‘poor man’. Thanks to this special kind of operator, transplant tourism is booming. In most cases the surgeons are known in medical circles. The circuits are indirect: a Brazilian may have an organ removed in South Africa for a transplant patient in Israel, for example. In Pakistan, two-thirds of kidney transplant patients in 2006 were foreigners. Kidneys are in fact the ‘star product’ (although we have two, only one is needed for the body to function) and the going rate varies according to the country (from EUR 470 in South Africa to EUR 20 200 in the United States, and EUR 1 800 in Moldavia and EUR 6 800 in Turkey)(1).

The WHO (World Health Organization) estimates that 10 % of organs transplanted worldwide are the result of unethical commercialisation or practices. In 2004, it called on its member states ‘to take measures to protect the poorest and vulnerable groups from transplant tourism and the sale of tissues and organs, including attention to the wider problem of international trafficking in human tissues and organs.’ Known since the 1990s, these practices have grown considerably with the increase in poverty but also due to progress in treatment that has reduced the likelihood of the body rejecting the transplanted organ or tissue.

The good resolutions of 2008…

Some major stances were adopted in 2008. On 22 April the European Parliament approved the Adamou report. The resolution stresses that the donation of organs must remain ‘strictly without commercial intent’. The Commission and Member States were invited to take measures to avoid trafficking in body organs – regarded as a form of trafficking in human beings that violates fundamental rights and abuses vulnerable persons – as well as ‘transplant tourism’. There was also the declared intention to increase the availability of organs though legal channels. A European donor card was also seen as a possibility.

A month later, the Declaration of Istanbul, drawn up on the initiative of The Transplantation Society (TTS) and the International Society of Nephrology, was signed by 150 representatives from 78 countries (see box) including doctors, scientists, government representatives, social scientists and ethicists. This text clarifies concepts connected to trade in organs and suggests to governments ways of combating such practices. The aims are to encourage the removal of organs from deceased persons, to protect living donors from commercial malpractices and to give them a quality of care equal to that of the recipients. ‘We are therefore beginning progressively to accept the idea at international level that human organs are not spare parts, that nobody can put a price on an organ destined to save a life,’ remarked Dr Luc Noël, coordinator of the WHO’s Clinical Procedures Department.

Such a position does not have unanimous support. At the Constant de Rebecque Institute, a decidedly liberal Swiss research centre, Jan Krepelka – a member of the scientific team – takes the view that ‘a monetary price set arbitrarily at zero (…) is not in any way more moral than any other value’ and asks whether or not free trade in organs should be authorised ‘so as to finally allow supply to come into line with demand, and avoid unnecessary deaths.’ He believes that ‘banning the sale of organs simply aggravates the problems that are sometimes used as an excuse, such as the unacceptable removal of organs from living persons without their consent: there is much greater risk of seeing a proliferation of trafficking in stolen organs when the legal and consenting supply is limited by laws.’ He adds that ‘the role of intermediaries, who are criticised particularly in the present black market, would decrease with the reduced risk and the increased competition brought with a legal market.’(2)

… and the individualism of the legislation

The legislation is currently as varied as the opinions. According to a report published by the French newspaper La Croix, Iran officially pays donors (EUR 3 000, equivalent to a year and a half of the minimum wage) for what is described as a ‘religious donation’, provided the recipient is not a foreigner. In the Philippines, transplant tourism is flourishing, with specialists proposing fixed sums (organ, operation) ranging from EUR 45 000 to EUR 100 000. In China, Deputy Health Minister Huang Jiefu admitted, in 2005, that most of the 12 000 organs transplanted in the country were taken from people sentenced to death. This situation is now controlled by a law, passed in 2007, which bans the commercialisation of organs and stipulates that donors must consent, as well as the promise to set up a national network of organ donations Israel has banned insurance companies from reimbursing the costs of ‘medical tourism’.

The countries that are coping best are those where a sufficient number of donors are available. In Cyprus, for example, the rate of donations between living persons is high, while Spain is almost self-sufficient in organs due to removing them from deceased persons. France has seen organ transplants double since 2000 and every year the list of those awaiting transplants grows by around 4 %. In 2007 more than 275 000 Europeans were living with a transplanted organ and thousands were awaiting a transplant.

Christine Rugemer

  1. Figures presented at a WHO meeting in 2006.

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The Europeans and organ donation

The results of a survey on organ donations and transplants, ordered by the European Commission’s Directorate- General for Health and Consumers (SANCO), were published in the Eurobarometer series in May 2007. It is certainly a controversial subject: 41 % of the Europeans interviewed had already discussed the subject with family members, usually resulting in a positive view. A majority of those interviewed (56 %) say they would be prepared to donate their organs after their death and 54 % would agree for organs to be taken from deceased family members. These positive opinions are more common among those with a high level of education and/or high socioprofessional level.

More generally, the idea of having a ‘donor card’ stating that the holder is ready to donate an organ is viewed positively by the vast majority of Europeans (81 %). Currently rare, except for in the Netherlands where 12 % of citizens carry one, such a document, preceded by an awareness campaign, could therefore have a major impact on the acceptance of organ donation.

Downloadable report: