Illegal Organ Trafficking 

Charlie Zachariades 

 

Every day 18 people die waiting to receive an organ transplant in the United States (1). 

For patients lucky enough to receive a kidney transplant, the average cost for the first 90 days 

of care can be upwards of $100,000. In the long run however, this is still cheaper than the 

$80,000 a year it costs to be on dialysis (2). Since the beginning of transplant surgery the 

demand for kidneys worldwide has been rising at an alarming rate. At the same time the 

number of donors has remained stagnant in comparison (3). This discrepancy has created a 

huge demand for kidneys. With over 100,000 patients on the waiting list in the United States 

each year, 70% of which are looking for a kidney, many have to wait years to receive a 

transplant (4).  As a result, sidestepping the legal process and turning to the underground organ 

trade is often the only option to survive.

History of Organ Transplants 

The illegal organ trade has its roots in the world of legal transplants. The first successful 

kidney transplant on a human was performed in Boston between two identical twins at the 

Peter Bent Brigham Hospital in 1954 and subsequently led to the awarding of a Nobel Prize in 

medicine (4). Since then transplants have been performed with a steadily increasing success 

rate and with organs that previously would not have been suitable for transplantation. The 

largest advances have come with deceased donors. The most recent study in 2011 by the Organ 

Procurement and Transplantation Network indicates success rates in deceased-donor kidney 

recipients of 94% for one year survival and 82% for five year survival. This is drastically higher 

than the success rates of less than 50% that transplant surgeries had in their infancy. Among 

living-donor transplants the prognosis is even more promising with 98% of patients living at 

least one year and 90% living at least five years after their surgeries (5). 

Numerous pieces of legislation have been passed to allow for these transplants to occur. 

In 1968 the Uniform Anatomical Gift Act allowed for the donation of organs after one’s death. 

The law has since been revised numerous times, first to conform to other laws which outlawed 

the trade of organs, and most recently in 2007 to make it easier to become a donor by simply 

checking a box at the DMV when getting your driver’s license (6). Up until this time transplant 

surgeries were exceedingly rare due to the resources needed and risks involved. As these 

transplants became more commonplace and demand for organs increased, a system was 

needed to organize the organ transplant network and eliminate the organ trade that was 

starting to spring up. This set the stage for the National Organ Transplant Act of 1984 (NOTA). 

Spearheaded by Al Gore, this act established the Task Force on Organ Transplantation and the 

Organ Procurement and Transplantation Network in order to make more organs available from 

deceased individuals and coordinate the donation process on a nationwide level (7). It also 

specified how organ, bone marrow, and blood donors could and could not be compensated for 

their donations. At the time this act was passed a new drug called Cyclosporine A had come on 

the market which drastically deceased organ rejections by acting as a powerful 

immunosuppressant (4). This drug was one of the main reasons the number of organ 

transplants doubled between 1988 and 2006. This drastic growth coupled with little regulation 

proved to be an appealing investment opportunity, and the market for legal organ sales started 

to take shape. However the questionable ethics of this caused great concern among the 

medical community. Along with the issues of bribery and corruption, the main concern was that 

an unregulated market would result in the rich being the only ones who could afford organs (3). 

NOTA answered these issues by banning the sale of human organs and making it illegal to 

compensate donors in other ways. Transplants must instead rely on donated organs and 

recipients are selected from a waitlist, the order of which is determined by a number of factors 

including relative need, age, transplant prognosis, and how long they have been waiting (8). 

Desperate Times Call for Desperate Measures 

What this legislation failed to foresee however was that like many commodities that are 

made illegal, the market would be driven underground and abroad. A 2005 World Health 

Organization study estimated that 1 in 10 kidneys are sold illegally. These kidneys can cost up to 

$200,000 out of pocket, double what a legal transplant can cost. However for people without 

insurance years of expensive dialysis along with the costs of a legal transplant can make the 

proposition financially beneficial. This combined with an average time on the waitlist of 3-5 

years and in some cases upwards of 10,  makes bypassing the waitlist and circumventing years 

of grueling and costly dialysis an understandable (albeit unethical) choice. Many even see it as 

the only option to avoid being one of the roughly 5,000 Americans who die each year waiting 

for a suitable kidney (9). The unfortunate result of this is that around the world there is a 

growing need for transplant organs, and desperate people are enabling the illegal organ trade 

to thrive. 

The primary cause of this increased demand and consequential black market growth is 

twofold. Better anti-rejection medications have the unintended consequence of increasing 

illegal transplants. By decreasing the risk of rejection and recovery time, organ transplants are 

easier to perform, aren’t as risky, and allow for more doctors to take on the risks of an illegal 

transplant. Furthermore, these medications enable people to donate to recipients who in the 

past would have been incompatible. This not only allows more patients to be on the waitlist, 

driving up demand, but also makes it easier for black market brokers to find suitable donors. 

However, since these drugs inhibit the entire immune system, they also leave patients much 

more vulnerable to complications and infections after surgery. This is especially a problem in 

the third-world countries where many of these donors are recruited from. The limited access to 

expensive antibiotics there results in many donors developing health complications (9). The 

second reason for the increase in demand is the dramatically increased rates of obesity and 

diabetes, both of which are closely tied to renal failure. Between 1980 and 2011 the number of 

Americans diagnosed with diabetes has more than tripled (from 5.6 million to 20.9 million) (10). 

In addition, life expectancy has increased over the years. This has led not only to more elderly 

people with failing kidneys, but also to more young recipients needing another kidney later in 

life. This is because transplant kidneys usually only last for around 25 years if they come from 

living donors and 15 years from deceased donors (4, 11). All of these factors have caused the 

waitlist for kidneys to increase 6 fold between 1988 and 2006, to over 100,000 people today, 

while the number of donors has seen only a relatively marginal increase (4).

The Illegal Trade Worldwide 

While the United States is often regarded as the most advanced and organized country 

with regards to the legal transplant market, countries around the world face their own 

problems with rising organ demand. Aside from the few developed countries with active organ 

transplant systems, the majority of the world faces major challenges when people develop 

renal failure. Although waitlist for organs in the U.S is overflowing with applicants, it is still one 

of the most progressive in the world. Many poor countries do not have a waitlist, so people 

searching for transplants resort to a largely unpoliced black market since travelling abroad is 

costly and difficult.  Increased international pressure from the human rights community has led 

to most countries banning the organ trade. However while most governments condemn this 

market on paper, most do little to actively combat it. Currently Iran is the only country where it 

is legal to sell organs, but even there it is restricted to Iranian citizens and highly corrupt (12). In 

the past one of the main providers of illegal kidneys to foreigners looking for organs was China, 

where even though selling organs for profit is illegal, laws allowed government officials to 

harvest and resell the organs of executed prisoners. With the vast majority of organs coming 

from these prisoners, often before they died, and little effort to get healthy people to donate, 

this practice was heavily opposed by the international community. Critics also pointed to the 

fact that this system gave an incentive to officials to execute prisoners in order to harvest their 

organs. This was reinforced by the numerous families of executed prisoners who claim they 

were coerced into signing donor agreement forms or that there was never consent given at all.  

In 2007, amidst external pressure from the human rights community, China passed the Human 

Transplantation Act, banning this practice and standardizing the organ collection process. 

Health officials in China still fail to acknowledge the ethical problems this practice had however, 

saying that the reason that it was discontinued was because the organs of prisoners were often 

diseased or infected. In addition, it was only in 2011 that China changed its laws to specifically 

ban the forced removal of organs. While these laws show that China is improving its practices, it 

also indicates that the black market is still thriving in a country that is often very secretive about 

these transplants (13, 14). 

With the increased regulations in China, brokers for illegal organs moved to other 

developing countries with little to no enforcement of transplant laws. Brazil, Pakistan, India, 

Israel, and Turkey are all countries which have seen increases in organ trafficking. The mecca of 

this practice in Europe is thought to be Moldova, a small eastern European country which 

became notorious as a hub for the illegal kidney trade. Here the black market is a thriving 

enterprise run by organized crime which takes advantage of the Moldovan citizens’ willingness 

to sell one of their kidneys. Living in a poor country with a high unemployment rate, many of 

these people are struggling to survive. The organ brokers entice these impoverished people by 

offering them between a few hundred and a few thousand dollars to donate their kidney (9).  

This combined with their assurance that it is a safe procedure that will save someone’s life is 

often enough to get many of these desperate people to agree in order to feed their families.  In 

reality most of these people are not aware of the actual risks involved. There are numerous 

consequences and complications to kidney donation that often lead to health problems later in 

life, especially in countries that do not have the medical resources to deal with any 

complications that may arise. In fact people who have donated a kidney on the black market 

are at a much higher risk for kidney failure later in life. This leads to an even higher demand for 

kidneys compounding the problem further. In addition to voluntary donation, men are often 

tricked into donating by brokers who offer them work in Istanbul. With the high unemployment 

rate, many people accept this offer, only to be told once there that that they must donate a 

kidney or be stuck with no money in a foreign country (15). For those that decline the offer for 

work and do not want to voluntarily donate, walking away may still not be an option. Brokers 

will come back numerous times trying to recruit people and will often turn to intimidation and 

threats to get people to donate. Although little is known about the statistics of this, it is thought 

that large portions of the people who donate are coerced into doing so (9).

Both voluntary and coerced donors are then taken to Turkey.  Here doctors and 

hospitals are paid off to either assist with the transplantation or turn a blind eye to it. The 

doctors themselves justify these surgeries not just by the large paycheck they receive, but by 

claiming that that they are doing it for patients who would die otherwise and ignoring the 

corruption and extortion that occurs. Recipients of these kidneys are usually wealthy Europeans 

or Americans who find the brokers online or through middle men. The surgery itself is 

performed in an unsanitary environment and rushed to avoid detection. There is usually very 

little testing that takes place to ensure that the kidney and donor are healthy and the recipient 

runs the risk of getting HIV or hepatitis from a diseased kidney or unsterilized medical 

equipment. In addition, paying off nurses and assistants is costly and corners are often cut to 

maximize profit. This inevitably leads to increased risks of complications, especially when the 

donor is often transported back home just hours after the surgery. While the recipient may pay 

up to $200,000, the donor gets pennies in comparison as most of the money goes into the 

pockets of the broker, doctor, and middle men. Popular culture and movies like Touristas has 

portrayed these organ harvesting rings as stealing organs from kidnaped foreigners. In reality 

this is exceedingly rare as most of the time it is easier to find poor people to donate or extort. 

However, these groups have been known to participate in human trafficking of poor 

populations for the sole purpose of harvesting organs (4, 9).

Finding a Solution

While coercing the poor to sell their organs is illegal in most of these developing 

countries, it usually goes unpunished since crime rings often have a strong hand in local 

governments. In addition, due to the global nature of the market, investigating these groups is 

exceedingly difficult without international cooperation. Unfortunately there has been very little 

regulation of these practices on an international level, and crime syndicates can simply move 

from country to country to avoid detection. In the past decade however there have been 

encouraging calls for action on the international level. In 2008 the Transplantation Society and 

the International Society for Nephrology held the first International Summit on Transplant 

Tourism and Organ Trafficking in Turkey. The landmark conference involved organizations from 

over 70 countries to specifically address the commercialism of the organ trade and the 

exploitation of poor populations for the purpose of harvesting organs for sale. From this 

conference the Declaration of Istanbul was produced which condemned “victimizing the 

world’s poor as the source of organs for the rich” and sought to “preserve the nobility of organ 

donation” by combatting the threat to “the legacy of transplantation… by the organ trafficking 

and transplant tourism” (16). Calling on countries to act, it suggested a ban on advertising for 

illegal organ donors and called for legal repercussions for the brokers and solicitors of the organ 

trade worldwide. It also addressed the fact that the organ marketplace naturally exploits the 

world’s poor for the benefit of the rich and suggested measures that governments should take 

to protect these people. Regarding the legal transplant market, it acknowledged the growing 

demand for organs and called for countries to encourage organ donation in order to become 

nationally self-sufficient with regards to transplantation. Developing countries were 

encouraged to establish organ donor registries and countries with long waitlists for organs were 

advised to create incentives for organ donation before and after death.  Based on these 

recommendations over 100 countries have reformed their legislation on organ trafficking. 

However the empty rhetoric of the document was often little more than suggestion. There is 

much room for more progress to be made as international organizations start to take up and 

enforce laws regarding the black market (17). 

One of these bodies was a 2009 joint UN and Council of Europe task force created to 

develop a comprehensive examination of organ trafficking since its origins. As a result of this 

study they called for the creation of new laws to combat the black market. In particular they 

suggested numerous changes to the organization of government bodies in order to resolve 

discrepancies between pieces of legislature. This would increase the efficiency of the 

international community by standardizing practices.  It also points out that tackling the organ 

trade head on may not be the best approach. Instead, addressing the demand for more donors 

through efforts to incentivize living deceased donation would collaterally strike a blow to the 

illegal organ trade. A special emphasis was put on the value of deceased donation due to the 

lack of complication risk that living donors hold. This study lead to numerous resolutions, 

notably the introduction of criminal penalties against complicit doctors, the effects of which are 

still seen in how the EU and UN fight organ trafficking (4).

In the U.S. the main problem regarding the organ trade involves “transplant tourism,” in 

which the wealthy travel abroad, typically to poor countries where trafficking is rampant, in 

order to receive a transplant. While this practice is acknowledged as a major problem, many 

people do not realize that it is possible to receive an illegal organ within the U.S. Although 

American hospitals are seen as highly reputable institutions that screen donors well for 

potential fraud, there have been numerous accusations of illegal operations taking place 

domestically. One of the main people to call attention to these crimes has been Nancy Scheper- 

Hughes, a UC Berkeley anthropologist who has been a vocal opponent of the illegal organ trade 

for decades. Hughes’s investigations led to the exposure of an international ring of organ sellers 

led by Isaac Rosenbaum. An Israeli citizen living in Brooklyn, N.Y, Rosenbaum’s case made 

headlines in 2011 when he became the first person convicted of brokering an organ transplant 

in the U.S under the aforementioned National Organ Transplant Act. For over a decade 

Rosenbaum’s network of traffickers in the U.S. and Israel, a growing nexus of the organ trade, 

recruited Israeli sellers and brought them to the U.S.  Here Rosenbaum used his connections in 

prestigious hospitals including Mount Sinai, John Hopkins, and Albert Einstein to bypass the 

screening process that organs usually go through and pay off doctors and administrators to 

perform the surgeries (9, 18).

With convictions like Rosenbaum’s becoming increasingly common, there have been 

numerous propositions to fix the problem. Many have pushed for greater support for social 

altruism. Volunteer Firefighters receive numerous benefits for helping their community, but 

organ donors take on the medical risks to save someone’s life without any help or reward. 

Some have argued for a regulated organ trade like that of Iran. Proponents of this idea believe 

that commercializing the organ market will not only instantly eliminate the black market for 

organs, but will also drive the price of organs down and nearly eliminate the waiting list. 

Without delving too far into the philosophy of natural rights, one of the primary arguments of 

this view is that as an autonomous being you own your organs, and it should therefore be your 

human right to do with them what your want as long as it does not harm others (19). While I 

acknowledge the logic behind this argument, I believe it is too simplistic and idealistic a view. I 

also take issue with the idea that people can be viewed as just a collection of parts to be sold.  

Furthermore, as seen in Iran, regulating the organ trade would lead to corruption and 

exploitation. The poor would inevitably end up being the sellers and the rich the buyers. There 

is precedent for this in the U.S in blood transfusions. In the early days of transfusions hospitals 

bought blood from people regularly. However with increased demand the government turned 

to a population eager to give blood in exchange for money, prisoners. Coercion and corruption 

was soon rampant as donors would often lie about diseases they had in order to donate while 

officials accepted tainted supplies to increase sales. While purchased blood is still technically 

legal today, hospitals almost exclusively use donated blood. Compensation for blood plasma is 

still a common practice, and there have been increasing reports of corruption in this area as 

well. Some investigations have reported that donation centers misrepresent the risks of plasma 

donation (20). Organ donation has many more complications than giving blood or plasma. A 

legal organ trade would incentivize the downplaying of these risks and cause people to donate 

when they are not healthy enough to live on one kidney, exchanging one person’s medical 

problems for another’s. 

Although a free market on organs has a number of drawbacks, it does not mean that 

organ donation should remain a purely altruistic endeavor. When Al Gore spearheaded the 

NOTA he intended to test out if voluntary donation would be viable. If it was not, “a voucher 

system or a tax credit to a donor’s estate” may need to be instituted if “efforts to improve 

voluntary donation are unsuccessful” (18). This could be instituted with deceased donors 

similar to how a life insurance policy works, providing a major incentive to donate with much 

less risk of corruption. 

Another policy that has recently been gaining ground due to its success in Europe is a 

change from the opt-in structure the U.S. has today to an opt-out one. In this system the health 

care providers relinquish the burden of recruiting donors and gives implied consent to harvest 

organs. If individuals do not consent they simply go through the process to opt-out of donating. 

A great examination of this systems effectiveness is in looking at Germany and Austria, two 

countries with very similar cultures and medical systems, but the former with an opt-out 

system and the later with an opt-in system. Studies have shown that in these countries and 

others, an opt-out system has led to an increase in organ donation by as much as 30% (3). 

In addition to policy changes, advances in medical technology seek to bypass the donor 

process altogether. Although still experimental, xenotransplantation is a promising practice that 

may eliminate the need for donors entirely. By transplanting organs obtained from another 

animal or grown ex vivo through the implantation of human genes into animal tissue via stem 

cells, petri dish organs can be grown for everyone in need of an organ (21).

However we address the problem of organ transplants, it is clear that something needs 

to be done. As the waitlist continues to grow and black market brokers both domestic and 

abroad thrive, experts agree that the best way to combat the illegal organ trade is to fix the 

legal system regulating it. Cooperation from the international community along with incentives 

for social altruism, tax breaks, opt-out systems, xenotransplantation, or a combination therein 

seem to provide the best hope to save the thousands of people who die each year waiting for 

an organ. 

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