Organ, tissue, and cell (OTC) trafficking and the trafficking of human beings for the purpose of OTC transplantation has gone global in the past 20 years with the proliferation of cheap travel. In the absence of an internationally recognized distinction between the two practices, as well as an encompassing legal framework to police the market, the trade has flourished underground.
A joint report [PDF] from the Council of Europe and the United Nations argues that a binding international treaty could define and distinguish OTC trafficking and hold member states accountable for its commercialization. The Council of Europe is now consulting with nations to gauge the level of support for such a resolution, said Rafael Matesanz, director of the Organización Nacional de Trasplantes (ONT) in Spain.
The United Nations is presently undertaking similar measures, but it is unclear when the treaty will reach the General Assembly floor. "There is an international convention that stands in opposition to trafficking of humans, of course, but there is not one devoted to combating the trafficking of the organ itself, like when they are taken from deceased people," said Luc Noël, coordinator of the World Health Organization's clinical procedures team, in a phone interview with Policy Innovations. "Without this, the issue fails to stand on its own, encapsulated in a larger discussion about trafficking of individuals."
The shady nature of the business leads to diverse estimates of the rates of organ trafficking—most often kidneys, followed by livers—and trafficking of humans for the purpose of transplantation.
Approximately 5 to 10 percent of kidney transplantations each year come from forced trafficking [PDF]. The Global Observatory on Donation and Transplantation estimates that around 68,000 kidney transplantations occur every year. This equates to approximately 3,400–6,800 kidney transplants per year from human trafficking.
The actual numbers are likely much higher, experts say, but remain unconfirmed. Data about the market's geographic base, as well as details about targeted donors, such as their gender, race, and medical history, are also unknown. The majority of donors "aren't healthy, middle class people," according to Thomas Diflo, a transplant surgeon at the NYU School of Medicine. "These are people who live in the slums and haven't had access to good health care," he said.
An international framework for ethical organ transplantation could enable countries to coordinate shared information and interdiction strategies for curbing the illegal transplant tourism market. Currently, countries police within their own borders what has become a transnational market. Some argue that these separate jurisdictions are unlikely to give way to any kind of international body or policy—especially one created or enacted by the United Nations General Assembly.
"The U.N. doesn't have a lot of power," Diflo said in a phone interview. "No matter how many pronouncements they come out with this is going to remain an issue. There is no solution at the moment."
An international agreement would principally benefit developing nations with financially and socially vulnerable populations. "These vulnerable countries are the ones who welcome people in search of organs, with no concern for where the organs come from," said Noël. "A binding document like this would create internationally recognized barriers, enforce a law that nations on a case-by-case basis might not want, or be able, to enforce."
In the absence of an international decree on organ trafficking, countries are operating in a "legal vacuum" according to Noël. Pakistan, for example, once a market hub, signed a Human Organ and Tissue Transplantation Bill into law recently, banning commercial exchange for human organs (though a deceased organ donor program will be implemented).
Egypt adopted comparable national legislation, while India and the Philippines have also tried to crack down harder on trafficking offenders. China [PDF] undertook similar legal action when it issued provisions on human organ transplantation in 2007, banning foreign tourists from obtaining an organ within the country.
An international treaty yet has to gain public momentum. Meanwhile, the WHO is drafting an updated document on guiding principles for organ transplantation, last revised in 1991. To boost the supply of donors, European countries like Austria, Belgium, Spain, and Italy now automatically list their citizens as organ donors. Matesanz helped pioneer this "presumed consent" system in the late 1980s after witnessing a worrying decline in available organs. It has increased the number of available donors significantly.
In the United States, one must opt in to a donor registry, usually when applying for a motor vehicle license. At least 70,000 Americans are presently on a waiting list for kidneys, and up to 15,000 Americans remain in need of a new liver. "More than anything, it's just a matter of numbers," explained Diflo.
Yet even with an updated set of guiding medical principles for transplantation, people will continue to experience complex dilemmas. Lacking luck or familial matches, Americans can turn to donor-recipient connection networks, like the United Network for Organ Sharing or MatchingDonors.com, or opt for transplant tourism and its ambiguities.