IN every country of the world except Iran it is illegal to financially entice prospective donors to donating their organs.  Altruism on the part of the donor: namely, genuine concern for the afflicted recipient, is almost universally regarded as the only legitimate motive for live-organ donation. Nevertheless, the secretive world of organ “trafficking” is an indisputable reality, and has become a world-wide source of exploitation of the poor and disadvantaged.  Tragically, despite claims to the contrary, it has even taken place in the United States, as is described below.

ARGUING against any relaxation of the restrictions on organ trafficking in the United States Doctors Delmonico, Arnold, and Scheper-Hughes noted in 2002 that:

Cultural values embodied in the National Organ Transplant Act make it illegal for “any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation.”¹¹ Though the purchase of organs is explicitly unlawful in the United States (as it is in virtually all other countries), the shortage of cadaveric organs has led to a worldwide black market for organs from living donors, and patients with sufficient means can travel to distant locations in order to purchase kidneys for transplantation.^12,13 (Delmonico, Arnold, & Scheper-Hughes ,“Ethical Incentives — Not Payment — For Organ Donation,” New England Journal of Medicine, June 20, 2002, pp. 2002-2005).

¹¹ National Organ Transplant Act, 98-507 (1984) (title III prohibition of organ purchases).

¹² Scheper-Hughes N. The global traffic in organs. Curr Anthropol 2000;41:191-224

¹³ Cohen L. Where it hurts: Indian material for an ethics of organ transplantation. Daedalus 1999;128:135-165

Scheper-Hughes.

PROFESSOR Nancy Scheper-Hughes is one of the world's leading researchers into the practice of organ trafficking.

Her comments at a 2008 conference in Austria give some indication of the breadth of the problem:

Friday, February 15, 2008 15,000 kidneys trafficked each year: Organ Watch

Vienna, Austria: Top transplant surgeons are collaborating with criminal organ trafficking networks to target the desperate, an expert said Thursday.”It involves people from the highest level of their profession,” said Nancy Scheper-Hughes, founding director of Organs Watch, an academic research project at the University of California, Berkeley.

Some surgeons are ‘‘willing to collaborate with the lowest levels of society — with criminal networks, brokers and with kidney hunters, who are the absolutely necessary factor,” she said.

Scheper-Hughes, a professor who is also the director of the university’s medical anthropology program, made her remarks at the Vienna Forum to Fight Human Trafficking. Organs Watch has a presence in 10 countries with anthropologists, human rights activists and doctors who volunteer, some of them anonymously, she said.

Illegal organ transplants made headlines recently when a man in India was accused of being the leader of a syndicate that is alleged to have illegally removed hundreds of kidneys, sometimes from poor laborers held at gunpoint. Indian police have said he headed an illegal organ transplant ring based in the upscale New Delhi suburb of Gurgaon. Authorities believe his group sold up to 500 kidneys to clients who traveled to India from around the world in the past nine years.

“We don’t really know how many people are trafficked for organs,” Scheper-Hughes said, adding that a conservative estimate for the number of trafficked kidneys was 15,000 each year.

Scheper-Hughes said there were ‘‘strong cases’’ documenting coercion in Eastern Europe, Turkey, Israel, India and the United States. “Most victims of kidney trafficking are coerced by need, not by physical force,” she said, giving an example from Brazil where people were competing to be chosen, stuffing US$10 bills into the pocket of a so-called broker. “It’s driven by desperation,” she said.

Trafficking doesn’t have to be transnational and can also be found within countries, Scheper-Hughes said.

Rabbi Rosenbaum

IN October 2011, an Israeli-American, Levy-Izhak Rosenbaum, a revered member of his religious community and sometimes incorrectly reported to be a rabbi, pleaded guilty, to organ trafficking.  This was the first case of its kind in the United States. The transplants had been performed at reputable medical centers:, including the Albert Einstein Medical Center.  A physician from that hospital  testified that Rosenbaum brought as many as 15 pairs of donors and recipients to the hospital for transplants from 1999 to 2002.

The physician, Radi Zaki, and Beth Duffy, the vice president of health care services at Albert Einstein Healthcare Network, testified separately that Rosenbaum always presented himself as a legitimate facilitator of donor matches for Israeli patients and provided all the correct paperwork for the donor matches.

As it turned out, Rosembaum had induced impoverished Israelis to sell their kidneys for approximately $10,000 and charged wealthy American recipients $120,000 or more. Newspaper reports include the following:

A man portrayed by his lawyers as a good Samaritan pleaded guilty on Thursday to organ trafficking in the United States in what the prosecutor said was the first conviction under a federal statute banning sales of kidneys by paid donors.

The man, Levy-Izhak Rosenbaum, admitted in federal court here that he had brokered three illegal kidney transplants for people in New Jersey in exchange for payments of $120,000 or more. He also pleaded guilty to one count of conspiracy to broker an illegal kidney sale.

His lawyers, Ronald Kleinberg and Richard Finkel, said in a statement that their client had performed a lifesaving service for desperately ill people who had been languishing on official transplant-waiting lists.

“The transplants were successful, and the donors and recipients are now leading full and healthy lives,” the statement said. “In fact, because of the transplants and for the first time in many years, the recipients are no longer burdened by the medical and substantial health dangers associated with dialysis and kidney failure.”

The lawyers added that Mr. Rosenbaum, 60, of Borough Park, Brooklyn, had never solicited clients, but that recipients had sought him out, and that the donors were fully aware of what they were doing.

The money involved, they argued, was for expenses associated with the procedures, which they said were performed in prestigious American hospitals by experienced surgeons and transplant experts.

The lawyers did not name the hospitals involved, nor did court documents.

Prosecutors argued that Mr. Rosenbaum was aware he was running an illicit operation, buying organs from people in Israel for $10,000 and selling them to wealthy Americans.

“A black market in human organs is not only a grave threat to public health, it reserves lifesaving treatment for those who can best afford it at the expense of those who cannot,” said Paul J. Fishman, the United States attorney for New Jersey. “Each of the four counts carries a maximum five-year prison sentence and a fine of up to $250,000. Mr. Rosenbaum also agreed to forfeit $420,000 in property.

Mr. Rosenbaum was arrested in July 2009 after he tried to set up a kidney sale to a government informant.

The arrest was part of a sweeping federal case that became the largest corruption sting in New Jersey history, involving charges of international money laundering and bribery of municipal officials.

New York Times, from Associated Press, October 27, 2011

[N.B. Following his trial and conviction, Mr. Rosenbaum was sentenced to two and a half years in prison, in what was America’s first federal conviction for illegal organ profiteering. He was released in 2014.]

International Organ-Trafficking

THE international community has at last resolved to begin formally investigating the scope of harm done by international organ trafficking.  In November 2012 a three-year probe spearheaded by the Erasmus Medical Center in Rotterdam was announced.  Its aims are "map out the trade and the involvement of criminals in the trafficking." "Our goal is not to get hard numbers," one of the principal researchers told The Associated Press in a telephone interview. "What we want to do is research the supply and demand and the involvement of organized crime — who is facilitating these transplants and how?"

In the meantime, the following reports give a hint of the breadth of this terrible evil:

ON June 28, 2012 The New York Times published an article describing a Serbian couple who had recently lost work, and who hope to gain financial security by selling their kidneys on the black market:

BELGRADE, Serbia — Pavle Mircov and his partner, Daniella, nervously scan their e-mail in-box every 15 minutes, desperate for economic salvation: a buyer willing to pay nearly $40,000 for one of their kidneys [...].

[N.B in India and Bangladesh poor donors are paid around $2,000-2,500  for a kidney: https://www.aetv.com/real-crime/organ-trafficking-facts]

IN January 2009 the journal Newsweek reported:

The exchange of human organs for cash or any other “valuable consideration” (such as a car or a vacation) is illegal in every country except Iran. Nonetheless, international organ trafficking—mostly of kidneys, but also of half-livers, eyes, skin and blood—is flourishing; the World Health Organization estimates that one fifth of the 70,000 kidneys transplanted worldwide every year come from the black market.

In Brazil, Africa and Moldova, newspapers advertised the sale and solicitation of human body parts while brokers trolled the streets with $100 bills, easily recruiting young sellers[...] ” In some of these countries, as the WHO later quantified, 60 to 70 percent of all transplant surgeries involved the transfer of organs from those countries’ citizens to “transplant tourists” who came from the developed world.

[...] Unlike some organ sellers, who told of dingy basement hospitals with less equipment than a spartan kitchen, Rosen found an organ broker through a local paper in Tel Aviv who arranged to have the transplant done at Mount Sinai Medical Center in New York. An amateur filmmaker, Rosen documented a portion of his odyssey on camera and sent the film to Scheper-Hughes, whose research he had read about online. The video excerpt that NEWSWEEK viewed shows Rosen meeting his broker and buyer in a New York coffee shop where they haggle over price, then entering Mount Sinai and talking with surgeons—one of whom asks him to put the camera away. Finally, after displaying his post-surgery scars for the camera, Rosen is seen rolling across a hotel bed covered in $20 bills; he says he was paid $15,000. (Brokers, on the other hand, typically net around $50,000 per transplant, after travel and other expenses. In America, some insurance plans will cover at least a portion of the donor’s medical expenses.)

Tom Diflo, a transplant surgeon at New York University’s Langone Medical Center [...] became an outspoken advocate for reform several years ago, when he discovered that, rather than risk dying on the U.S. wait list, many of his wealthier dialysis patients had their transplants done in China. There they could purchase the kidneys of executed prisoners. In India, Lawrence Cohen, another UC Berkeley anthropologist, found that women were being forced by their husbands to sell organs to foreign buyers in order to contribute to the family’s income, or to provide for the dowry of a daughter. But while the WHO estimates that organ-trafficking networks are widespread and growing, it says that reliable data are almost impossible to come by.

IN Iran the sale of organs by Iranians to Iranians is legal and (theoretically) regulated by The Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD), under control of the Ministry of Health.  Organ donors are paid, on average, $2000 to $4000 for a kidney.  As would be expected, the majority of the donors are poor.

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