The rise of 'transplant tourism'

By Eimear Vize

How much is your kidney worth?

In Turkey the prized organ fetches around €2,300, an Indian or Iraqi kidney enriches its former owner by a mere €800, and the World Health Organisation (WHO) estimates the going price on the black market to be about €4,000.

But when you consider that wealthy clients will later pay well over €100,000 for the kidney, this massive profit margin would appear to guarantee a lucrative future for the international trade in human organs if it continues unchecked.

Laudable developments in biotechnology and organ transplantation are increasingly becoming tarnished by shades of questionable conduct ranging from buying and selling organs to trafficking in humans for their valuable body parts. Our organs, cells, tissues, and bones are now the raw material for new commercial products, and the simple laws of supply and demand have given rise to a thriving black market.

While primarily the circulation of organs flows from south to north, east to west, from third to first world, and from poor to affluent, increasingly ordinary people are finding themselves caught up in the macabre body-shopping business. And the Irish are no exception.

Mark Murphy, CEO of the Irish Kidney Association (IKA), knows of at least one Irish person who has travelled to Pakistan for a kidney transplant. The organ was sourced in Pakistan and the transplantation carried out by a local surgeon.

"I'm only aware of this one individual, but that's not to say there haven't been others," he told

"Up to now we wouldn't have considered this a potential problem in Ireland. Irish patients have had a reasonable chance of getting kidney transplants. But if someone did show up at their doctor's office looking for immunosuppressive drugs or follow-up care after an unapproved organ transplantation, they would be treated, and it may not necessarily be reported."

Fortunately, 2009 was a record year for organ donations and kidney transplants in Ireland. There were 261 transplanted organs obtained from 90 individuals, an increase of 21% on the previous year. Kidney transplants were at their highest level yet with 176 transplants last year.

However, there are still more than 600 people on Irish transplant waiting lists, and Mr Murphy warns that all indications point towards 2010 being a bad year for both organ donation levels and transplant surgeries across the board.

"For the first half of this year there has been only one heart and two double lung transplants. That compares to 11 heart transplants and five lung transplants for the 12 months of 2009.

"I don't have all the figures yet but I know we're down significantly in livers and kidneys as well. It's not a good donating year. Hopefully it will pick up in the second half of the year. But as for the heart and lung transplant situation this year, that's a disaster," he said.

A spokesperson for the National Heart and Lung Transplant Progamme, based in the Mater Hospital, clarified that the significant reduction in transplantations so far this year was due to low availability and suitability of organs donated.

So, could transplant tourism become an Irish problem in the future if our organ donor levels do not keep up with demand? Mr Murphy conceded that this could be a possibility.

"It may drive us in that direction because patients who need a new lung or heart don't have the ‘luxury' of dialysis to keep them alive. If I were put on a heart transplant list here I'd be sorting out my affairs and not expecting it."

Over the past decade, the demand for organ transplants around the world has increased dramatically, far exceeding the supply of organ donors. With more than 56,000 patients on transplant waiting lists across Europe and 12 people dying each day waiting for transplants, a growing number of desperate people are turning to the purveyors of black-market organs as their last life-saving option.

In a concerted effort to shorten transplant waiting lists and stamp out the illegal organ trade, new EU laws were passed in May this year governing organ donations and transplants across the European Union.

Although primarily addressing quality and safety standards needed to facilitate the donation, transplantation and exchange of organs in the EU, this new Directive also stipulates that organ donations must be ‘altruistic, voluntary, and unpaid', and that ‘member States should intensify their co-operation under the auspices of Interpol and Europol in order to address the problem of trafficking in organs more effectively'.

"This new plan allows for the creation of an EU database of information about organs intended for donation. It also provides for the sharing of information on living or deceased donors as well as a pan-European certification system to combat the sinister transplants tourism trade," explained Irish Labour MEP, Nessa Childers.

Fine Gael MEP Mairéad McGuinness agreed that increasing the availability of organs in the EU would reduce the risk of transplant tourism.

"We do not want people buying organs. We do not want, in the European Union, any sense that this would become a trade. It is about altruism that people donate and they give to somebody on the basis of wanting them to benefit."

The true scale of the grisly market in body parts has only surfaced in recent years with the WHO, Human Rights Watch, Interpol and many transplant surgeons speaking out publicly against the ongoing scandal of organ sales, transplant tourism and trafficking in organ donors.

The WHO estimates that 10% of transplants involve patients from developed countries travelling to poor countries to buy organs. Approximately 15,000 kidneys (the bulk of the black market in human organs) are being trafficked in this way each year.

These criminal organ trafficking networks involve a host of middlemen including local agents, who ‘source' the organs, surgeons and lawyers. In April this year, six men suspected of being involved in an international organ trafficking ring in northern Israel were arrested. Among the suspects are a retired army general and two lawyers.

In the US, a Jewish rabbi, Levy Izhak Rosenbaum, was charged with conspiring to broker the sale of a human kidney for transplant last year. In this alleged decade-long scheme, exposed in July 2009 by an FBI sting, Rosenbaum brokered the sale of black-market kidneys, buying organs from vulnerable people from Israel for $10,000 and selling them to desperate patients in the US for as much as $160,000.

The trial of Dr Amit Kumar, who spearheaded India's biggest kidney transplant racket, is expected to last another four to five years because of the large number of witnesses coming forward to testify. Dubbed Dr Horror, he allegedly performed 400 to 500 kidney transplants over a nine-year period, selling the organs to international clients through agents in countries as far apart as North America and Europe. He was arrested in February 2008.

Irish journalist and author Mary Kenny, whose sister Ursula was among the unwitting donors in an illicit trade in body parts in the US, found some consolation in June that year when the man behind this body-snatching scandal was sentenced to 18 to 54 years in prison.

Disgraced dental surgeon Michael Mastromarino's multimillion-dollar enterprise, Bio-Medical Tissue Services, illegally harvested tissue and bone - much of it deemed by regulations too old or diseased to use - from more than 1,000 cadavers between 2001 and 2005, using funeral homes in Brooklyn, Manhattan, Newark, Rochester and Philadelphia.

Print and electronic news services are peppered with similar accounts of formal investigations into organ trading in several countries, some resulting in legal proceedings and even fewer securing convictions. Ireland is noticeably absent from these efforts and for good reason - no legal provision exists in this country prohibiting the sale or the purchase of an organ here or abroad.

At a push, Irish legal eagles could dust off the 1832 Human Anatomy Act, which was introduced to stop people robbing bodies from graveyards for medical school dissection tables.

But this legal oversight is set to change when the Department of Health and Children presents the first draft of a new Human Tissue Bill to Government this autumn. When passed, the legislation will regulate the removal, storage, use and disposal of human tissue from cadavers, including the issue of consent for donation of organs after death for transplantation.

Organ trafficking and transplant tourism is a serious 21st century problem for health service providers and governments. There is no doubt that a worldwide shortage of organs is being exploited by unscrupulous operators, and is putting donors and recipients at risk. Commercialised organ transplantation ensures the middlemen become rich, the sick get bad treatment and the poor suffer the consequences.

"Organ theft and trafficking is not a myth or urban legend. It happens at an alarming rate in some countries. If we want to ensure that it doesn't become a problem in this country we need to get active now, get our donor rates up and our transplantation programmes busy," Mr Murphy insisted.


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