Wednesday, October 30, 2013
Tuesday, October 29, 2013
Wednesday, October 17, 2012
Trafficking in Human Organs: Examining the Shadows of an Illicit Market
Executive Summary
This
paper will examine the transnational nature of trafficking in human organs. Up
until very recently organ trafficking was considered nonsense, even now this
seedy yet profitable industry retains the luxury of lingering in the shadows
because by most, it continues to be brushed off as a fictitious fabrication of
modern life. Evidence suggests that due to the scarcity that has arisen from a
basic supply and demand model of transplantable organs, a criminal market has
arisen – one that is comprised of a complex network of brokers, buyers, sellers
and surgeons. By focusing on the intersections of where the formal and illicit
markets overlap, the intended result is to shed light upon how aspects such as,
consent versus coercion, institutional corruption, and the emergence of
‘transplant tourism’, all act as contributors towards the facilitation of a
lucrative transnational criminal industry that is centered around the
trafficking of human organs.
Introduction/Background
Regardless of the nature that is intrinsic to
goods or services (be they legal or illegal) provided by a market, where there
is a shortage in supply or in other words, an existence of scarcity, it is
almost guaranteed that players involved in illicit markets will intervene and
capitalize upon the growing demand that remains. This same rationale is
applicable to the emergence of the illicit markets that revolve around the
trafficking of human beings for the purpose of organ removal and trafficking of
human organs or what has come to be known as trafficking in organs, tissues,
and cells (OTC)[1]. Until very
recently the trafficking of human organs has been largely considered a mythical
urban legend. During the mid part of the 1980’s, rumors surfaced and were
quickly picked-up by the media alleging that Americans and other foreigners
were trolling the Central American region, kidnapping children, and harvesting
their body parts. A combination of skepticism and widespread panic ensued
throughout the area. By April 1994 in Guatemala, these rumors had morphed into
violence when tourists were severely attacked, in separate incidences, by angry
mobs fueled by the belief that children were being taken for their body parts.
In response to these rumors of child organ trafficking and in an attempt to
diffuse the panic and escalating violence, the United States Information Agency
(USIA) released a report in December of 1994.[2]
The report claimed that no ‘credible’ evidence had been found to substantiate
that the rumors of trafficking in children’s organs were anything other than just
mere folklore. According to his investigations, USIA misinformation officer
Todd Leventhal contended that, “it
would be impossible to successfully conceal any clandestine murder-for-organ-trafficking ring. Because of the
large number of people who must be involved in an organ transplant, the sophisticated medical
technology needed to conduct such operations, the extremely short amount of time that organs remain
viable for transplant, and the abhorrent nature of the alleged activities, such operations could
neither be organized clandestinely nor be kept secret”.[3]
Indeed, during its time this declaration, as it was issued from a branch of the
U.S. government, severely discredited the existence of organ trafficking as
even a remote possibility. It should be mentioned that similar incidences have
continued to transpire in Guatemala. Specifically, with two separate
occurrences in 2007 and another in 2009 where in which locals were incited to
perpetuate violence due to their suspicions of foreigners that were thought to
be participating in baby kidnapping and organ harvesting.[4]
Perhaps this mentality, constructed in part by documents similar to the one
distributed in 1994 by USIA, have served as a mechanism that has continued to
compartmentalize trafficking in human organs to the realm of the absurd and
impossible. More importantly, however, perhaps this dismissal of organ
trafficking has facilitated the emergence of a lucrative industry in which the
provision of body parts has become a marketplace for those whom have the means
to purchase these illicit and potentially lifesaving spare parts, while others
turn a blind eye.
The Modern World: A Perpetuation of the
Colonization Process
Indisputably, both
industrialization and technological advances have played major parts in the
significant strides that have been taken in the modern world. Of the many
cascading changes, I would primarily like to focus on what I see as a sort of
creative tension that underlies both globalization and medical transplant
techniques. Through technological progress, specifically in the medical field,
incredible life-saving feats have been achieved through the performance of
organ transplants. These techniques are not only limited to the developing
world but are also being performed in developing countries, thanks to a
globalized world that is now more interconnected than ever before.
Globalization, however, is a double-edged sword. Extensive world-wide research
into the fringes of the organ trade by medical anthropologist Nancy Scheper-Hughes
suggests that, “late modern ‘millennial’ or ‘second-coming’ capitalism has
facilitated a rapid dissemination to virtually all corners of the world of
advanced medical procedures and bio technologies alongside strange markets and
‘occult economies’ and other forms of ‘rotten trade’. Together, these have
incited new tastes and desires for the skin, bone, blood, organs, tissue and
reproductive and genetic material of others. The spread of transplant
capabilities into new areas have created a global scarcity of organs at the
same time that the processes we call globalization have released an exodus of
displaced persons and a voracious appetite for foreign bodies to do the shadow
work of production and to provide ‘fresh’ organs for medical consumption”(2002).[5]
What this dichotomous nature that seems to be inherent in an interconnected,
globalized world shows is that, the division between those who have and those
who do not has become dramatically more pronounced. From 1990 to 2003, the altruistic and legal donation
of kidneys (in the United States) increased by 33%, however, during that same
time, the number of people waiting for a donation grew by 236%.[6]
These numbers simply demonstrate the fact that, with regards to the procurement
of human organs through ‘ethical’ means, the demand greatly outweighs the
supply. The commoditization
of human organs into a product is an extension of the colonization process that
has created a new market structure yielding a collision of the realms inhabited
by both the licit and illicit. Another complicating factor that stems from
globalization has to do with the increased access to virtually everything, in a
sense, and understanding that along with this perceived progression, criminal
entities have not only adapted to these new border-less environments but they
have also developed sophisticated methods through which to flourish. The
creative tension that is encapsulated between globalization, medical transplant
techniques, and criminal entities has given way to the erosion of formal
institutions and given birth to an industry that is driven by the trade in
human organs. The organ market,
according to a recent article in TIME magazine, is “largely made up of
impoverished and desperate sellers, wealthy, ailing customers and predatory middlemen”.[7]
The perception of a scarcity in transplantable organs has led, in part, to the
generation of a shadowy marketplace that provides human organs to fulfill a
growing demand.
Supply & Demand
In 2007 the World Health Organization
categorized the shortage of organs as a universal problem and further stated
that, “the shortage of an indigenous supply of organs has led to the
development of an international organ trade, where potential recipients travel
abroad to obtain organs through commercial transactions”.[8]
To juxtapose this view, medical anthropologist Nancy Scheper-Hughes has argued
that the idea of an organ ‘scarcity’ has arisen out of an ‘artificially created
need’. Recent research has indicated that an organ transplant from a live donor
(as opposed to a deceased donation) will yield a greater longevity for the
recipient. In other words, an organ that is harvested from a living donor will
significantly increase the life span of the person that is receiving that
organ. Perhaps this new information has, in part, contributed to the emergence
of the industry that is commonly known in the medical world as transplant
tourism. In her argument regarding the subject of organ scarcity,
Scheper-Hughes continues by saying that, “the discourse on scarcity conceals the actual
existence of excess and wasted organs that end up in hospital dumpsters on a
daily basis throughout those parts of the world where the necessary
infrastructure to use them is lacking. Indeed, the ill will and competitiveness
of some hospital workers and medical professionals also contributes to the
production of organ “wastage.” For example, transplant coordinators in public
hospitals in many developing countries are often told to dispose of usable organs
rather than allow the competition to “get their hands on them.”[9]
Regardless of an actual shortage in organs or simply an artificially created
need, out of this perceived scarcity, an international trade in human organs
has emerged which has partially given way to the wide-spread practice of
transplant tourism. In June 2007, the United Network for Organ Sharing (UNOS),
the primary organization that manages the American transplant system, issued a
statement addressing the practice of transplant tourism, defining it as “the purchase of a transplant organ
abroad that includes access to an organ while bypassing laws, rules, or
processes of any or all countries involved. Transplant tourism remains a refuge
for desperate recipients of means, and there is anecdotal evidence that the
practice is growing. It is the considered view of the UNOS Ethics Committee
that the current practice of transplant tourism is predicated on exploiting the
desperation of vendors, recipients and their families. Reports of outcomes from
transplant tourism are necessarily anecdotal, given the underground nature of
the exchange, but it is pertinent that with few exceptions, the literature on
the subject is nearly uniform in reporting adverse consequences for vendors and
recipients. Brokers of transplant tourism leverage the underground nature of
the practice, exploiting the parties involved by obscuring the risks.”[10]
While UNOS clearly highlights the inequality upon which the industry of
transplant tourism is hinged, it does not touch on the institutional corruption
nor the elements of organized crime which are also key embedded factors that
facilitate the operation of such an industry. This predilection is further
explained by Michael Bos who maintains that the global trade in human organs is
a combination of: transplant tourism and human trafficking. And it is the
blurred combination of these, at times, licit and illicit marketplaces that
fuels this lucrative and almost invisible industry. The identification of a
global picture to illustrate the participant countries is a lofty and
practically infeasible feat at this point in time, due to the lack of reliable
information and in-depth research into the international trafficking in human
organs. However, Bos makes reference to some of the most popular players whom
can be separated into the following categories:
· Vendor Countries:
Argentina, Bangladesh, Brazil, China, Colombia, Egypt, India, Israel,
Iraq (pre-war), Mexico, Moldova,
Pakistan,
Palestine,
Peru, Russia, U.S.A., Turkey (and more)
· Recipient
Countries: Australia, Canada, Gulf States, Iran, Israel, Hong
Kong, Japan, South Korea, U.S.A., Taiwan, Europe
· Facilitating Countries (transplant sites): China, India,
Iran,
Iraq
(pre-war), Israel, Philippines,
Russia,
South
Africa, U.S.A., Turkey[11]
While this list is in no
way a collective formation or all the participating countries, it does provide
a frame of reference through which to sift through the major players that are
involved in a complex web of selling, receiving, and facilitating the trade of
human organs that flows across borders, oceans, and whatever other obstacles
that may present a challenge. In 2008, an article appearing in The Economist made reference to what
was, at the time, referred to as a major ‘organ-harvesting scandal’. This
episode had transpired in India, “one of several poor countries where the sale
of organs used to be legal but has now been banned, with the apparent effect of
driving the trade underground. Amit Kumar, a doctor, confessed to having
performed hundreds of illegal transplants for clients from America, Britain,
Canada, Saudi Arabia and Greece. He was also accused of luring laborers into
his clinics with job offers; victims were then offered up to $2,000 in exchange
for their kidneys. Those who refused were said to have had their kidneys removed
anyway after being drugged.”[12] This story describes the heinous nature of
human behavior, particularly in the event that monetary value becomes attached
to something that we had not conceived of before as a product.
When addressing the existence of a growing global market for
trafficked human organs procured from living donors, the World Health
Organization (WHO) points to two main factors that are responsible for this
development: technological advances and longer life spans. To date,
transplantable body parts consist of: kidneys, heart, liver, lungs, pancreas,
small bowel, corneas, skin, and blood. However, Moses Naim writes that the most
commonly traded parts in the illicit organ market are the: corneas, kidneys,
and livers.[13]
In a 2007 report, the World Health Organization (WHO) estimated that in the
United States there were over 95,000 people waiting for a kidney transplant and
only 25,000 kidneys would be available through the traditional legal means. It
is through figures like these that we begin to grasp how the demand for human
organs staggeringly outweighs the supply. Also illustrated, through these
figures, are the many potential places where the licit markets collide or
interact with the illicit markets, particularly when desperation becomes a
defining factor in the decision-making process.
An Overlap of Formal and Illicit Markets: Trafficking in
Human Organs
To date, there is little reliable information that exists to reveal
the fundamental nature of the market structure that is inherent to the illicit
trade in human organs. In part, this factor can be attributed to the widespread
belief that trafficking in human organs has been nothing more than an
infeasible, sensational myth. Recent history proves that the perceived ‘myth’
of organ trafficking has, in fact, been thought to exist more as a rumor than
as an actual practice. Recent evidence and academic analysis, however, suggests
otherwise. Apart from the ever-increasingly mentioned practice of trafficking
in human organs appearing in international news sources, many scholars in the
academic world have taken on this issue from a variety of angles.[14]
Through focusing on the market structure of organ trafficking, and by
specifically looking at the margins where the formal and illicit markets collide,
I hope to glean a deeper insight into the nature of this industry. In “Criminals and service providers:
cross-national dirty economies”, Vincenzo Ruggiero suggests that dirty
economies – where the licit and illicit overlap – emerge from (both short-term
and long-term) partnerships between the actors that inhabit the formal or
official economy and individuals that are involved primarily in criminal
enterprises. By isolating certain economic aspects which include: ‘exchange,
reciprocal entrepreneurial promotion and mutual provision of services’[15],
Ruggiero highlights a core mechanism that enables a market such as the one that
is comprised of the trafficking in human organs, to not only function but to
thrive. A mutually beneficial relationship has emerged, between actors who
operate within the formal sectors (for example, a mortician) and actors who
operate within the illicit sectors (for example, an organ broker / middleman),
and over time these relations have evolved, adapted, and become extremely efficient.
These mutually beneficial relationships offer up a starting point for
institutional corruption. Ruggiero’s analysis concludes by stating that, “the
description, dirty economies, alludes
to the fact that the ‘informal’ tends to be absorbed into the ‘formal’ and the
alleged threats posed by the former tend to be turned into opportunities for
the later.” This interface that is proposed, between organized crime and the
official economy, is both thought provoking and deeply troubling. However, this
analysis provides an adequate, if not appropriate, lens through which to view
the market structure that composes trafficking in human organs. The mutual
exchange of services between the illegal provision of an organ, the matching of
a donor to a recipient, and the practice of the actual transplantation –
involves a complicated network of both legitimate and criminal players. This
same idea, or perhaps its origin, is captured best in Van Duyne’s “Organized Crime, Corruption and Power”,
which eloquently states that; “there is no organized crime corruption without
preceding upper-world decay of morals and a door ajar to corruption.”[16]
There are a multitude of actors that have been identified as having varied
levels of involvement in the organ trafficking process, they include but are by
no means limited to:
· The buyers of
transplantable organs
· The sellers of
transplantable organs
· Brokers /
middle-men
· Traffickers of
humans for the purpose of organ removal
· Traffickers of
human organs
· Surgeons
· Undertakers
· Hospital
directors
· Government
officials
· Morgue
officials
·
Intermediaries
As this list suggests,
the potential networks that must come together to facilitate the process that
is required for an organ to be both harvested and transplanted involves a
complex supply-chain. Oftentimes, this supply-chain is composed of an array of
actors from both formal and illicit domains. Thus, corruption is not only a key
component, more importantly, it is a driver that has carved out a shady realm
that is necessary for an industry based on the provision of transplantable
organs to quietly exist.
Understanding the Criminal Market of Organ Trafficking – A
Complex Network
In
“Nuclear Smuggling: Adaptability,
Organized Crime and Undercover Operations”, Williams and Woessner propose
the notion that in regards to black markets and the activities of organized
crime, “it is generally the unlucky or the incompetent criminals who get
caught”. While on the surface this statement might appear as fairly obvious, I
found it to be rather profound (particularly in regards to trafficking in human
organs) and a necessary precursor to further observation of the covert nature
of black market industriousness. The authors go on to suggest that if this is
indeed the case, then the status quo opinion of the ‘non-involvement’ of
organized crime (in nuclear material trafficking) requires both reexamination
and rethinking. I believe that this same logic can be utilized to better
understand the structures of the criminal markets that have arisen to
facilitate the cohesion of trade in the trafficking of human organs. Williams
and Woessner identify several types of criminal organizations in their analysis
(and although they are tailored specifically to describe the nature of Russian
organized crime and the trafficking of nuclear materials), I have chosen four
of these categories which I believe will assist in gaining a deeper
understanding in to the market structure of organ trafficking[17];
✦
Opportunistic
Amateur Groups: consists
of small groups and individuals motivated by greed or necessity, operate at low
levels of sophistication (unlikely to develop sophisticated smuggling
techniques), methods or concealment or deception are most likely to be poor or
nonexistent, and will oftentimes draw attention to themselves when searching for
a buyer (Williams & Woessner).
✦
Predatory
Criminal Organizations: generally
composed of criminal groups engaging in small-scale criminal activities, they
do not have links to corrupt officials and are more like street gangs than
organized crime groups, however, the more successful ones have the potential to
become more sophisticated and eventually develop links with the business,
political and administrative elites (Williams & Woessner).
✦
Ethnically-Based
Smuggling Organizations: ethnically-based
networks, an important aspect of smuggling is that the inefficient groups are
usually weeded out by law enforcement while the more efficient groups develop
more sophisticated forms of concealment and deception, groups enable themselves
to form infrastructure through which to move products quickly through routes,
methods, and bribery of officials (Williams & Woessner).
✦
Hybrid
Trafficking Networks: not
exhaustive nor rigid nor mutually exclusive, sometimes various groups will work
together, dynamic and fluid not static and fixed, participants form alliances
of convenience, if successful partnership could be repeated or it could
dissolve quickly, this type of network combines characteristics of other
criminal organizations (Williams and Woessner).
Although Williams and Woessner’s analysis
revolves around the nature of criminal organizations that are involved in the
trafficking of nuclear materials, at a fundamental level they directly address
the evolution of relationships that are necessary to move illicit products.
This attention to the evolution of relationships acknowledges a dynamic nature
and an ability to adapt to ever-changing environments. The recognition of these
traits has the capacity to provide a valuable insight into the underworld of
trafficking in human organs. The market structure of trafficking in human
organs is highly profit driven. When broken down into the four categories that
present the typologies of criminal organizations: opportunistic amateur groups,
predatory criminal organizations, ethnically-based smuggling organizations, and
hybrid trafficking networks – what becomes clear is that there are various
degrees of sophistication that enable this type of market (trafficking in human
organs) to function and continuously fluctuate between the formal and informal,
the consensual and the coercive, and so on. The market structure of trafficking
in human organs seems to be made up of these four categories distinctly that
also, at times, form linkages with one or a few of the others, creating, in a sense,
a bastardized prototype of the criminal organizations that Williams and
Woessner presented in their analysis. For example, consider a ‘predatory’
criminal organization that is involved primarily in petty crimes. Eventually,
through an already established relationship with a trusted family member who
works at a hospital, this organization recognizes an opportunity to prey upon
vulnerable peoples by coercing them to sell their organs (for a promised price
that may or may not ever be given). This predatory organization simultaneously
develops relations with an opportunistic amateur group or individual (that has
already been dabbling in the buying and selling of human organs) and an
ethnically based smuggling organization. A supply-chain is established, sophistication
of techniques are developed and a hybrid trafficking network emerges that will
continue to deal in the trade of human organs (alongside of other illicit
endeavors) until it is either too risky or deemed unprofitable. In viewing
these categories as separate entities of criminal organizations, we gain a more
substantial understanding of the networks that are involved in the trafficking
of human organs. It is also important, however, to consider that these entities
have the capacity to act as catalysts to one another, eventually morphing into
an impenetrable web of efficiency.
Through examining recent scenarios of organ
trafficking in the news, both the transnational nature and the complex networks
of this industry are revealed. In July 2009 an FBI sting operation broke up an
organ trafficking scheme that had allegedly been operating for over a decade,
the case had been referred to by many news sources as “the first case of organ
trafficking in the United States”. Levy Izhak Rosenbaum, a New York resident
and self-proclaimed ‘matchmaker’, was arrested after authorities connected him
to brokering the sale of black-market kidneys through buying the organs from
“vulnerable people in Israel for $10,000 and selling them to desperate patients
in the U.S. for as much as $160,000.”[18]
Apparently, Rosenbaum would match the donor and recipient, the donor would be
brought to the United States, passed off as a ‘relative’ to the patient needing
a kidney, and the transplant would be performed. Rosenbaum was recorded as
saying that ‘the money had to be spread around liberally, to Israeli doctors,
visa preparers and those who cared for the organ donors in this country which
is why is it such an expensive transaction because you have to pay everybody.’
This case shatters the preconceived notion that the illegal trade in and
trafficking of human organs is some how limited to occurring only in less
fortunate, developing countries. It clearly demonstrates the connection that
the United States has to the trade in human organs, as being one of the major
players that has an unfulfilled demand and thus will continue to capitalize
upon those markets that are able to and willing to supply. Another interesting
case has been the subject of much attention, highlighted by the media in November
2010. An article that appeared in the New York Times on November 15 discussed
the international nature of an organ trafficking network that was based in
Kosovo. According to the indictment, people from slums (in Kazakhstan, Moldova,
Istanbul, and Moscow) were lured to Kosovo with promises of up to $20,000 for
their organs. Officials within local law enforcement, however, reported that
many of these people never received any payment. The New York Times reported that those charged with involvement in this
criminal network ranged from the ringleader, a highly regarded surgeon and
professor at Pristina University Hospital, his son (who oversaw the day-to-day
functioning of the clinic), a senior official in Kosovo’s Health Ministry, and
two others.[19]
All have been ‘accused of crimes including trafficking in humans and body
parts, unlawful medical activity, participating in organized crime, and abuse
of office.’[20]
On a superficial level, what these two cases indicate is that the industry of
trafficking in human organs is made up of multifaceted levels and networks that
extend into the criminal typologies that were originally presented by Williams
and Woessner:
·
Opportunistic
amateur groups
· Predatory criminal organizations
· Ethnically-based smuggling organizations,
·
Hybrid
trafficking networks
These recent cases, showcased by the media, also
depict the transnational nature of both the market and the players that are
involved in the trafficking of human organs. Scheper-Hughes puts it well when
saying that “the emergence of strange markets, excess capital, renegade
surgeons, local kidney hunters with links to international mafia – and to a
parallel traffic in slave workers, sold babies, drug and small arms – has
produced a small but spectacularly lucrative practice of transplant tourism,
much of it illegal and clandestine. For these reasons, hard data and reliable
statistics on the extent of organs and transplant traffic are hard to come by.”[21]
What is evident about the industry of trafficking in human organs is that, in
order to efficiently function, it requires an interaction between actors from
both formal and informal markets. These markets, and the actors housed in each,
come together to form networks that fluctuate along the boundaries between the
legal and the illegal.
The
Upper-world and the Under-world: A Perfect Convergence
Based on the evidence that has been presented through the
evaluation, thus far, of the market structure that formulates the trafficking
in human organs, what is clear is that there are formal and informal sectors
working together to fulfill what seems to be an insatiable demand in ‘product’.
Within this convergence, there is an element of institutional corruption that
can be viewed as flowing from the bottom-up, as well as, from the top-down.
Without this mechanism of institutional corruption, it would be difficult to
fashion an efficient supply-chain between the illicit supply of human organs to
their recipients and to those whom have the expertise to perform the required
transplant surgery. Even against a backdrop of a fairly recent history of
infeasibility, the United Nations Office on Drugs and Crime (UNODC) describes
the trafficking in organs as an organized crime that involves a multitude of
offenders.[22]
The UNODC has identified three broad categories of the trafficking in human
organs:
1) Cases where traffickers use either force
or deception to coerce a victim into giving up an organ
2) Cases where the victim makes formal
or informal agreements to sell an organ (oftentimes the victim is cheated
by not being paid for the organ at all or they are paid significantly less than
the promised price)
3) Vulnerable persons (migrants, migrant
workers, homeless persons, illiterate persons, etc.) go into a medical venue to
be treated for an ailment and without their knowledge their organs are
removed.
Similarly,
Georgios Antonopoulos has written that, in terms of the recruitment of donors,
there is a plethora of methods that are utilized which include: “formal and
informal consensual contracts, coerced contracts, kidnapping or abduction, and
murder.”[23]
Perhaps the very fact that there is such an array of methods that are applied
in the procurement of organs has the resulting impact of creating a blurred
interpretation of coercion versus consent. Beyond this confusion, the
underlying and clarifying factor is the operational instrument of deception.
Victims whom agree to sell an organ, in exchange for financial compensation or
victims whom have had their organs taken from them without either their consent
nor knowledge – these victims are united in the fact that they are both being
preyed upon because they are financially vulnerable or simply viewed as another
one of the voiceless masses. These varied methods in the recruitment of donors,
for the purpose of supplying organs, slightly parallels the shadowy nature of
the market structure of trafficking in human organs because it also embodies a
dichotomous characteristic of traversing the boundaries between both formal and
informal market sectors and the participating players.
Conclusion
To date,
Iran is the only country in which the trade in human organs is legal. China,
Pakistan, and the Philippines, all major players in the transplant tourism
circuit have implemented laws that officially ban the sale of organs, and in a
sense, reversing their respective statuses as havens for transplant tourists
seeking access to difficult-to-find organs.[24]
Despite this apparent upsurge in what seems to be well-crafted regulations
intended to prevent this industry from operating, there is still exists a
demand for human organs and criminal organizations will most likely remain
impenetrable to above-ground regulations and continue to participate in the
illicit supply of organs. The advisor to the World Health Organization (WHO),
Frank Delmonico, has suggested that; “organ selling has become a global problem
and it is likely to get much worse unless we confront the challenges of
policing it.” One of the main challenges, perhaps, will be not only closing the
gap between the supply and demand of human organs but also, more importantly,
focusing upon the criminal entities and elements that are involved in the
illicit markets of organ trafficking. While regulations like the ones
implemented by China, Pakistan, and the Philippines, appear to be aimed
primarily at the reduction of the activities upon which transplant tourism
relies (both licit and illicit), they might
possess the capacity to reign in renegade surgeons and correct (for a limited
amount of time) the institutional corruption (from the top-down) but they lack,
however, the capacity to deter the remaining illicit criminal components of the
organ industry. Without addressing the depths of the corruption that has
ravaged formal institutions and thus, the failure to recognize the powerful
implications that informal actors or criminal entities have upon formal
sectors, any regulations banning the sale of organs will do nothing more than
assure onlookers that ‘something’ has been done to prevent the operation of
this perverse trade. While the adoption of regulations[25]
by countries to eliminate the trade in human organs and to limit the
proliferation of the transplant tourism industry is a good starting point, it
is simply not sufficient. The reliance upon regulations alone, to combat this
problem, is akin to applying a band-aid to a gaping wound that clearly requires
stitches. The trafficking of human organs is composed of a vast corridor of
intersecting realities starting with: a worldwide demand for organs that
greatly overpowers the natural supply which has yielded the creation of an
issue of scarcity, another piece of this equation is the advance in technology
and globalization, the rise of transplant tourism, the corruption of
‘righteous’ institutions, and the collaboration of illicit and licit actors /
markets to procure organs and distribute them to those whom have the ability to
pay. These are all ingredients that are involved in the formation of what has
become a lucrative transnational criminal industry, dealing in the trafficking
in human organs.
[1]
Trafficking
in “OTC”, term borrowed from; “Trafficking in Organs, Tissues, and Cells (OTC)
and Trafficking in Human Beings for the Purpose of the Removal of Organs”, a
2009 Council of Europe / United Nations study by the Directorate General of
Human Rights and Legal Affairs.
[2]
Leventhal, Todd. “The Child Organ Trafficking Rumor: A Modern ‘Urban Legend”, A
Report Submitted to the United Nations Special Rapporteur on the Sale of
Children, Child Prostitution, and Child Pornography. United States Information
Agency, December 1994. http://pascalfroissart.online.fr/3-cache/1994-leventhal.pdf
[3]
In
its concluding statements, this same USIA report suggests that unwarranted
attention was being given to this issue by saying: “the assertion of the Special Rapporteur in his 1994
report that ‘there is mounting evidence of a market for children's
organs’ is unfortunate. In the absence of clear evidence that clandestine child organ trafficking takes place at all, mere allegations, which have
been commonplace in the world press for years, should not be treated as
anything more than groundless rumors”. Leventhal,
Todd. “The Child Organ Trafficking Rumor: A Modern ‘Urban Legend”, A Report
Submitted to the United Nations Special Rapporteur on the Sale of Children,
Child Prostitution, and Child Pornography. United States Information Agency,
December 1994. http://pascalfroissart.online.fr/3-cache/1994-leventhal.pdf
[4]
U.S. Department of State, http://travel.state.gov/travel/cis_pa_tw/cis/cis_1129.html
Trafficking
Underworld”, in: Ethnography. Vol. 5(1): 29-73 (2002). Pg. 34.
[6]
Background Paper Workshop 011: Trafficking in Persons for the Purpose of Organ
Removal. The Vienna Forum to Fight Human Trafficking, 13-15 February 2008,
Vienna, Austria. Pg. 2. Also quotes Scheper-Hughes: “…the circulation of kidneys followed
established routes of capital from South to North, from East to West, from
poorer to more affluent bodies, from black and brown bodies to white ones and
from female to male or from poor, low status men to more affluent men. Women
are rarely the recipients of purchased organs anywhere in the world.”
[7] Suddath, Claire and Altman, Alex. “How Does
Kidney-Trafficking Work?” TIME. 27
Jul. 2009. Web. Oct. 2010.
[8]
Yosuke Shimazono. “The State of the International Organ Trade: A Provisional
Picture Based on Integration of Available Information”, Bulletin of the World Health Organization, December 2007: Vol. 85.
http://www.who.int/bulletin/volumes/85/12/06-039370/en/
[9]
Scheper-Hughes, Nancy. “The
Ends of the Body: Commodity Fetishism and the Global Traffic in Organs”, SAIS Review 22:1 (2002).
[10]
United Network for Organ Sharing (UNOS); Newsroom, June 26, 2007. http://www.unos.org/about/index.php?topic=newsroom&article_id=2194:613e14e00777b29645c8c7d3ce417dbd
[11]
Michael A. Bos. “Transplant Tourism and Organ Trafficking: An Overview of Practices
in Europe”, ELPAT Forum, ESOT, October 2, 2007. http://www.esot.org/Files/Elpat/Content_Files/KmULJPresentation_Bos.pdf
[12]
From Print Edition International, “The Gap Between Supply and Demand”, The Economist, 29 Oct. 2009. Web.
December 2010. http://www.economist.com/node/12380981?story_id=12380981
[13]
Moses Naim. “The Five Wars of Globalization”, Foreign Policy Magazine, January/February 2003. http://web.clas.ufl.edu/users/zselden/Course%20Readings/Naim.pdf
[14]
Medical anthropologist Nancy Scheper-Hughes has contributed
a substantial wealth of information on the intersecting dimensions of
trafficking in human organs. For over a decade, she has traveled across the
world tracing the origins of networks involved in organ trafficking.
in: Crime, Law and Social Change, Vol.
28: 27-38.
[16]
Van Duyne, P., “Organized Crime, Corruption and Power”, Crime, Law, and Social Change, 1997; 26: 201-238.
[17]
The following definitions: opportunistic amateur groups, predatory criminal
organizations, ethnically-based smuggling organizations, and hybrid-trafficking
networks, are borrowed from Williams and Woessner’s analysis of smuggling in
nuclear materials and adapted to describe the criminal market structures of
trafficking in human organs.
Phil Williams and Paul
N. Woessner. “Nuclear Smuggling: Adaptability, Organized Crime and Undercover
Operations”, Transnational Organized
Crime, Vol. 5, No. 2, summer 1999, pp. 85-89.
[18]
David Porter and Carla K. Johnson, “First Case of Organ Trafficking in U.S.?” MSNBC.com. 24 Jul. 2009. Web. October
2010. http://www.msnbc.msn.com/id/32132371/
The article
goes on to mention that, “Rosenbaum was arrested in a sweeping federal case
that began as an investigation into money laundering and trafficking in kidneys
and fake designer bags. It mushroomed into a political corruption probe, culminating
in the arrests of 44 people, including three New Jersey mayors, various other
officials, and five rabbis. The politicians and rabbis were not accused of
involvement in the organ trafficking ring.”
[19]
One of these suspects is thought to have links to the organized crime group of
the Kosovo Liberation Army (KLA), which allegedly had harvested organs of
captured Serbs during the conflict in the 90’s.
[20]
Bilefsky, Dan. “7 Charged in Kosovo-Based Organ-Trafficking Ring.” The New York Times. 15 Nov. 2010. Web. 16 Nov. 2010. http://www.nytimes.com/2010/11/16/world/europe/16kosovo.html?_r=1
This article continues with saying that, “Western law enforcement
officials said they suspected the ring might be part of a larger criminal
network whose nexus was in Israel. In September, five doctors from South Africa
were charged with participating in an international kidney-trading syndicate in
which dozens of poor Brazilians and Romanians were paid for kidneys for wealthy
Israelis. Analysts said the organ-trafficking case was part of a disturbing
global trend in which unscrupulous traffickers take advantage of the growing
waiting lists of desperate patients and the vulnerability of poor people
further buffeted by the international financial crisis.”
Trafficking
Underworld”, in: Ethnography. Vol. 5(1): 29-73 (2002). Scheper-Hughes goes on to write, “his
confluence in the flows of immigrant workers and itinerant kidney sellers who
fall into the hands of ruthless brokers and unscrupulous, notorious, but
simultaneously rewarded, protected and envied outlaw transplant surgeons is a
troubling subtext in the story of late 20th and early 21st
century globalization, one that combines elements of pre- and post-modernity.
These new transplant transactions are a blend of altruism, consent and
coercion, gifts and theft, science and sorcery, care and human sacrifice (34).”
[22]
“The recruiter who identifies the vulnerable person, the transporter, the staff
of the hospital, clinic and other medical centers, the medical professionals,
the middlemen and contractors, the buyers, the banks where the organs are
stores – are all involved in the racket. It is a fact that the entire racket is
rarely exposed and therefore, the dimensions are yet to be appropriately
fathomed.” UN.GIFT.HUB, Global Initiative to Fight Human Trafficking, http://www.ungift.org/knowledgehub/en/about/trafficking-for-organ-trade.html
[23]
Antonopoulos, G.A., and J.A. Winterdyk. “Techniques of Neutralizing the
Trafficking of Women: A Case Study of an Active Trafficker in Greece.” European Journal of Crime, Criminal Law and
Criminal Justice 13(2) (2005): 136-147. The article goes on to say that
other common methods include, “theft of organs from individuals receiving
routine operations, from executed or alive prisoners in China and from cadavers
elsewhere in the world (Brazil) and without consent from the relatives, is also
commonplace.”
[24]
China and Pakistan passed laws banning the sale of organs in 2007 and the
Philippines passed theirs in 2008. “The Gap between Supply and Demand”, The Economist, 9 Oct. 2008. Web.
December 2010.
[25]
Scheper-Hughes concludes a presentation on organ trafficking by saying that, “finally,
the argument for "regulation" of kidney sales is out of touch with
the social and medical realities operating in many parts of the world but
especially in second and third world nations. The medical institutions created
to "monitor" organs harvesting and distribution are often
dysfunctional, corrupt, or compromised by the power of organs markets and the
impunity of the organs brokers and of outlaw surgeons willing to violate the
first premise of classical medical bio-ethics: above all, do no harm.”
Nancy
Scheper-Hughes, “The Global Trafficking
in Human Organs: A report presented to the House Subcommittee on international
operations and human rights, United States Congress”, June 27, 2001.
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