Organ Trafficking Research Articles

Harvesting vulnerability: The challenges of organ trafficking in armed conflict

AbstractArmed conflicts leave populations vulnerable to organ trafficking, a criminal enterprise with little international regulation when viewed separately from human trafficking. The Council of Europe's Convention against Trafficking in Human Organs is the only instrument to contemplate the responsibility of actors involved in organ trafficking, but traffickers may go unpunished due to its limited scope. Yet in armed conflict, international humanitarian law offers additional protection. The rules protecting the living and the dead against ill-treatment provide the basic level of protection necessary to consider the international responsibility of organ trafficking networks and the individual criminal responsibility of their members.

233.3: Organ Trafficking: The Portuguese Experience in Developing A Legal Framework and a Protocol of Conduct for Health Professionals for the Management of Patients Who Receive an Organ Transplant Abroad and Return Home for Follow-up Care and for Reporting Suspected Cases to Law Enforcement Authorities for Criminal Investigation

The existence of a world-wide illicit trade in human organs for the purposes of transplantation is a well-established fact, and various means have been adopted to combat this criminal activity, in particular the Council of Europe Convention against Trafficking in Human Organs. This Convention is the first international legal instrument that criminalizes all illicit transplant practices. Healthcare professionals who treat patients in pre transplant and post-transplant play a crucial role in prevention, detection and reporting organ trafficking. However, healthcare professionals face with medical, legal, and ethical challenges when confronted with suspected or confirmed cases of organ trafficking due to their duty to preserve medical confidentiality. We present the recently developed Portuguese Model for the implementation of the Convention against Trafficking in Human Organs. Firstly, we present the changes introduced in Portuguese criminal law for the criminalisation of organ trafficking, including the options made with respect to donors and recipients regarding their criminalisation or not, and the solutions adopted to ensure that acts committed outside the country by nationals or residents can also be punished. Secondly, we present a protocol/code of conduct to provide an appropriate framework to prevent and address transplant-related crimes for healthcare professionals. Such protocol provide guidelines for the management of patients, including on how to ensure traceability and biovigilance for patients who travel for transplantation, and indicators for the identification of signs of organ trafficking and/or human trafficking for the purpose of organ removal. Third, we introduce the Portuguese reporting mechanism for the communication of information about such cases to law enforcement authorities for the purposes of criminal investigation. Finally, we present the amendments made to the Medical Code of Ethics to address doctors’ concerns regarding medical confidentiality. The new regulation provide an exception to the duty of medical secrecy in relation organ trafficking and human trafficking for the purpose of organ removal.

400.1: The “Global Kidney Exchange” Proposal Is Impractical And Not Financially Neutral

This paper argues that, notwithstanding some recent claims by moral philosophers, the proposed Global Kidney Exchange (GKE) should be rejected as impractical and not ethical, as it does not accord with the principles of intergovernmental bodies (such as the World Health Organization) and professional societies (such as The Transplantation Society and the Declaration of Istanbul), and would violate national laws that forbid organ trafficking and that require financial neutrality in organ donation. Under the proposal, a kidney patient in a high-income country (HIC) who is biologically incompatible with his or her donor would be matched with a prospective donor from a low/medium-income country (LMIC) who is willing to donate to a patient there who cannot get a transplant for lack of the necessary funding or facilities. The GKE would bring the LMIC pair to the HIC, coordinate the two transplant operations (LMIC donor to HIC recipient and vice versa), and fund a US$50,000 escrow account for follow-up care of the LMIC pair, including the recipient’s post-transplant immunosuppression. A normal “kidney swap” meets ethical and legal requirements because only organs are exchanged, whereas in the GKE an LMIC patient who can supply a donor who meets the GKE’s requirements will receive not only a kidney but substantial financial benefits. Since the exchange is not financially neutral, the Council of Europe has rejected the GKE as a form of “organ trafficking” and an exploitation of financial inequality.In response, recent defenders of the GKE have made several arguments. First among these is the claim that saving recipients’ lives outweighs all the objections raised to the program. This proves too much, as it would justify all organ sales (including from poorer to richer countries) if lives are saved. Nor can the GKE be defended on grounds of autonomy, when the terms are entirely set by the GKE; the preferences of the LMIC donor, who might prefer something else in exchange—perhaps something that might make the commercial nature of the transaction more apparent—are ignored. Besides being unethical, the proposal is impractical. Some patients from LMICs will respond to the possibility of an organ transplant by recruiting paid donors and disguising them as an altruistic friend or relative, a ruse that experience shows transplant programs in HIC often fail to detect. Moreover, the assumption that financial inducements will yield a net increase in organs is contradicted by experience: donation rates are much higher in countries such as Spain and the US than in countries where payments occur such as Iran and Saudi Arabia.Finally, the GKE does not provide, as the philosophers claim, “an eminently fair solution” to the inequities that face LMIC patients, who would be better served if HIC organizations helped LMICs develop appropriate programs to prevent and treat kidney failure, including deceased donor programs.

Reappraising Effective Regulation in Preventing Human Organs Trafficking in Africa: Kenya and Nigeria in Perspective

Over the years, the issue of illegal human organ harvesting and trafficking has been an international concern. There have been so many stories of victims being promised better opportunies overseas but ended up being untraceable all over the world. The news that most of these people seeking greener pastures abroad must have fallen victim to the illegal international human harvesting and trafficking syndicates is quite alarming. The government of the countries, their citizens to be wary of the "too sweet to be true" job opportunities abroad and a better life abroad. United Nations' concern on this issue brought about the resolution adopted by the General Assembly at its 73rd session held on 17 December2018 on strengthening and promoting effective measures and international cooperation on organ donation and transplantation to prevent and combat trafficking in person persons for organ removal and trafficking in human organs. This article examines the law relating to organ harvesting and trafficking in Nigeria and Kenya putting into consideration the United Nations resolution. The article observes that Nigeria with its Trafficking in Person (Prohibition) Law Enforcement and Administration Act 2015 and Kenya with the Counter-Trafficking In Persons Act No. 8 of 2010 are yet to adopt the United Nations General Assembly resolution on strengthening and promoting effective measures and international cooperation on organ donation and transplanation to prevent and combat trafficking in persons for organ removal and trafficking in human organs. The article recommends total conformity with theUN resolution.

How a compensated kidney donation program facilitates the sale of human organs in a regulated market: the implications of Islam on organ donation and sale

BackgroundAdvocates for a regulated system to facilitate kidney donation between unrelated donor-recipient pairs argue that monetary compensation encourages people to donate vital organs that save the lives of patients with end-stage organ failure. Scholars support compensating donors as a form of reciprocity. This study aims to assess the compensation system for the unrelated kidney donation program in the Islamic Republic of Iran, with a particular focus on the implications of Islam on organ donation and organ sales.MethodsThis study reviews secondary documents for philosophical argumentation and ethical analysis of human organ donation and sale for transplantation.Results and discussionAccording to Islamic law, organ donation is an act of sadaqatul jariyah, and individuals are permitted to donate organs with the intention of saving lives. The commercialization of humans as organ sellers and buyers is contrary to the Islamic legal maxim eethaar, undermining donors of ‘selfless’ or ‘altruistic’ motivations. Such an act should be considered immoral, and the practice should not be introduced into other countries for the sake of protecting human dignity, integrity, solidarity, and respect. I, therefore, argue that Iran’s unrelated kidney donation program not only disregards the position of the Islamic religion with respect to the provision or receipt of monetary benefits for human kidneys for transplantation but that it also misinterprets the Islamic legal proscription of the sale of human organs. I also argue that the implementation of Iran’s unrelated kidney donor transplantation program is unethical and immoral in that potential donors and recipients engage in a bargaining process akin to that which sellers and buyers regularly face in regulated commodity exchange markets. Conversely, I suggest that a modest fixed monetary remuneration as a gift be provided to a donor as a reward for their altruistic organ donation, which is permissible by Islamic scholars. This may remove the need to bargain for increased or decreased values of payment in exchange for the organ, as well as the transactional nature of ‘buyer and seller’, ensuring the philosophy of ‘donor and recipient’ is maintained.ConclusionsOffering a fixed modest monetary incentive to organ donors would serve to increase organ supply while protecting donors’ health and reducing human suffering without legalizing the human organ trade.

Book Review: Trading life: organ trafficking, illicit networks, and exploitation by Seán Columb

Book Review: <i>Trading life: organ trafficking, illicit networks, and exploitation</i> by Seán Columb

ESTABLISHING A MARKET FOR HUMAN ORGANS* IN SOUTH AFRICA PART 1: A PROPOSAL**

In the current system of organ procurement in South Africa, demand for transplantable organs outstrips supply by far. A change in legislation governing donation of organs is desperately needed as too many patients die unnecessarily waiting for an organ. A possible solution is to reward the donor financially. Authors in other countries have also expressed the need for changes in their countries’legislation in order to legalise the sale of human organs for transplant in an effort to save more lives. The proposed way of regulating the trade in organs is through “futures contracts”. In order to propose a market for human organs in South Africa, it is necessary to take note of these proposals. A problem highlighted is the question whether property rights in human organs exist. Although not legislated in South Africa, it will be shown that there are property rights in human body parts. Finally, a contract of sale for selling kidneys from living donors and a futures contract for the sale of transplantable organs from a deceased donor will be proposed after analysing arguments against the commercialisation of human organs. In Part 2 the shortcomings in South African legislation, specifically regarding organ transplants will be discussed. Solutions will be suggested in accordance with the four pillars of bioethics.

Organ Trafficking: Why Do Healthcare Workers Engage in It?

Organ trafficking in all its various forms is an international crime which could be entirely eliminated if healthcare professionals refused to participate in or be complicit with it. Types of organ trafficking are defined and principal international declarations and resolutions concerning it are discussed. The evidence for the involvement of healthcare professionals is illustrated with examples from South Africa and China. The ways in which healthcare professionals directly or indirectly perpetuate illegal organ transplantation are then considered, including lack of awareness, the paucity of both undergraduate and postgraduate education on organ trafficking, turning a blind eye, advocacy of organ commercialism, and the lure of financial gain.

Localised medical moralities: organ trafficking and Israeli medical professionals

ABSTRACT Organ trafficking is widely recognised as a human rights concern. Medical professionals play a decisive role in bringing international norms regarding organ trafficking into the local context as translators and localisers. In Israel, this localisation reflects the tensions and gaps between global and local values, moralities and beliefs. Based on in-depth interviews with 92 stakeholders, this article examines the Israeli medical professionals’ approach toward organ trafficking, the moral conflicts, challenges and dilemmas they faced given these tensions and gaps, and their attempts to address them in practice. The findings reveal that many Israeli healthcare professionals subscribed to an ambivalent stance on organ trafficking and a non-judgmental approach towards patients who engage in organ trafficking, preferring to turn a blind eye to this phenomenon. They internalised key aspects of the deeply rooted local ethical perceptions regarding organ trafficking. This internalisation points to the limitations of translators' freedom of operation between transnational and domestic languages. Localisation is not merely a result of pragmatic compromises but stems from the localisers' identification with local moralities. This study contributes to understanding the role of professionals in processes of societal change and the complex ramifications of this role.

ESTABLISHING A MARKET FOR HUMAN ORGANS* IN SOUTH AFRICA PART 2: SHORTCOMINGS IN LEGISLATION AND THE CURRENT SYSTEM OF ORGAN PROCUREMENT**

The present shortage of transplantable organs in South Africa may be attributed to inadequate legislation and the current system of organ procurement. The Human Tissue Act 65 of 1983, in the interim phase, still prohibits the sale of organs for transplantation. Chapter 8 of the new National Health Act 61 of 2003 will take over this function once it is promulgated. Although the new Act allows the reimbursement of costs incurred in the donation of an organ, it may still not be sufficient to motivate more donors to donate organs in an effort to alleviate the organ shortage. The purpose of this article is to illustrate that the sale of organs and a change in thecurrent system of organ procurement may be a solution. It is also submitted that, should legislation be changed to legalise organ sales, it will be neither an encroachment on the basic principles of medical ethics nor a violation of fundamental rights.

Agave Syrup: Chemical Analysis and Nutritional Profile, Applications in the Food Industry and Health Impacts.

Agave syrup (AS), a food product made from agave plant sap, is a vegan sweetener that has become popular for replacing conventional sweeteners such as sucrose. As the demand for naturally derived sweeteners has grown in the last decade, this review paper addresses and discusses, in detail, the most relevant aspects of the chemical AS analysis, applications in the food industry, sustainability issues, safety and quality control and, finally, nutritional profile and health impacts. According to our main research outcome, we can assume that the mid-infrared-principal components analysis, high-performance anion exchange chromatography equipped with a pulsed amperometric detector, and thin-layer chromatography can be used to identify and distinguish syrups from natural sources. The main agave–derived products are juice, leaves, bagasse, and fiber. In sustainability terms, it can be stated that certified organic and free trade agave products are the most sustainable options available on the market because they guarantee products being created without pesticides and according to specific labor standards. The Mexican government and AS producers have also established Mexican guidelines which prohibit using any ingredient, sugar or food additive that derives from sources, apart from agave plants, to produce any commercial AS. Due to its nutritional value, AS is a good source of minerals, vitamins and polyphenols compared to other traditional sweeteners. However, further research into the effects of AS on human metabolism is necessary to back its health claims as a natural sugar substitute.

Knowledge and attitudes towards organ donation among students at An-Najah National University: a cross-sectional study

BackgroundOrgan transplantation is the most effective therapy for end-stage organ failure, but there is an organ shortage due to increasing demand and decreasing availability for a multitude of reasons. We investigated awareness and attitudes toward organ donation among university students, who may be future donors. MethodsWe did a cross-sectional study involving students at An-Najah National University, Nablus, West Bank, occupied Palestinian territory, between December, 2018, and April, 2019. Sociodemographic data and information about knowledge and attitudes towards organ donation were collected with a self-administered validated questionnaire in Arabic. Students were recruited by proportionate stratified random sampling from all 11 university faculties. Convenience sampling was used to obtain the final study sample. All respondents provided written informed consent to participate. SPSS version 21 was used to perform the χ2 test and ANOVA and the significance level was set at p<0·05. The study was approved by the An-Najah National University Institutional Review Board. Findings472 students (207 men and 265 women) were included in the study. The mean age of respondents was 21 (SD 3·06) years. 433 (92%) were undergraduates and 39 (8%) were postgraduates. 467 (99%) participants had heard about organ donation. The most common source of information, reported by 261 (56%) students, was mass media (television, internet, newspapers, etc). 360 (76%) of respondents had a positive attitude toward organ donation while alive, with altruism being the most prevalent motivation 276 (77%). Willingness to help a family member was the most common reason for living donation (108 [30%] respondents). 61 (13%) replied that they would donate organs for money. 330 (70%) of 472 reported knowledge of possible risks related to living organ donation, including general weakness 56 (17%) and infection 36 (11%). Willingness to donate after death was reported by 302 (64%) of 472 respondents. We found significant associations between this choice and sex (p=0·023) and type of faculty (p=0·01). 257 (55%) of 472 did not know whether there is any national law regulating organ donation and 274 (58%) did not know the religious position. Of those positive about donation, 184 (61%) of 302 willing to donate after death said that consent to use organs could be provided by a family member, whereas 266 (74%) of 360 willing to be living donors would make the decision themselves. 148 (31%) would not promote organ donation mainly due to concerns about possible misuse (44 [30%]) and fear of organ trafficking (46 [31%]). Among the sample, one respondent had donated a kidney to a family member. InterpretationThe responses to our survey a good level of awareness and knowledge about organ donation among university students. Increased information and discussion on the risks and consequences of organ donation, the relevant legislation, and the position of religion are indicated, especially in the mass media. Finally, addressing the fears, mistrust, and misinformation among students, who are viewed as an educated segment of society and a force for change in their communities, may convert them into goodwill ambassadors for the organ donation cause. FundingNone.

Tinjauan Yuridis Tindak Pidana Perdagangan Organ Tubuh Manusia untuk Transplantasi

Technological advances are starting to make great progress in the world of health, especially for some diseases for which a cure has been found. For example, by seeking new treatments by transplanting several organs in the body. However, in practice the method of treatment with human organ transplantation is not easy to do, considering that the available organs are still very few compared to the needs of human organs. This causes the high price of human organs which should not be commercialized and many people take this opportunity to fulfill their financial needs by trading human organs. One of the laws that prohibits organ trafficking is Law Number 21 of 2007 concerning Eradication of the Crime of Trafficking in Persons. The provisions regarding the prohibition are contained in the formulation of Article 2, Article 3, Article 4, Article 5, Article 6, and Article 7 in the law.

Organ commercialism, trafficking and transplant tourism.

The gap between demand and supply of organs continues to widen worldwide, encouraging transplant commercialism. While solid organ commerce is most prevalent in impoverished countries, commercialisation of body parts such as tissues is prevalent in economically developed countries. A number of international legal instruments and transplant societies define, condemn, and criminalise these practices and have issued statements related to organ commercialism. In contrast, limited attention has been paid to illicit and unethical activities associated with the procurement and clinical use of tissues. In India, The Transplantation of Human Organs (Amendment) Act, 2011, has taken multiple measures to combat organ and tissue commerce and as a result the number of such instances seems to be on the decline. However, the fight against unethical organ procurement through the internet and the social media is challenging and requires the cooperation of global bodies. Keywords: Organ trade, Declaration of Istanbul, tissue commerce, organ transplants, transplant tourism.

Cacao value chains and credence attributes: lessons from Ecuador

PurposeMotivated by transformations in global food systems and increasing demand for multidimensional credence attributes, the authors analyze cacao value chains in Ecuador – the main producer of fine and flavor cacao worldwide. The authors identify opportunities and discuss how private and public sector initiatives can help meet emerging challenges.Design/methodology/approachPrimary information was collected through interviews of actors in the Ecuadorian industry during spring/summer 2020, including cacao producer associations, exporter associations, chocolate processing firms, public institutions and local universities. Two focus groups were also conducted with producers from associations in the Ecuadorian Amazon.FindingsFindings suggest new opportunities for cacao producers and chocolate processors have emerged from the global market transformation. To exploit these, firms need to personalize and differentiate their products, for example, by using quality certifications such as organic and fair trade. Market developments, such as European cadmium regulations and the necessity of worldwide traceability systems, are driving exporters to enhance Ecuador’s cacao value chains. The sector still requires coordination to reap the benefits associated with demands for credence attributes.Originality/valueFindings are supported by two case studies. The first focuses on how associativity can help those producing high-quality beans to differentiate themselves in modern agri-food markets. The second describes the success of a local chocolate firm and its links with local farmers.

Polish attitudes towards unspecified kidney donation: a cross-sectional study

BackgroundChronic kidney disease effects about 4.2 million people in Poland, yet Polish organ donation research is rare. In addition, compared to other countries in the world, Poland has a relatively low living donation rate. Still, little is known about how Poles would react to the possibility of living kidney donation to strangers. A study was conducted to examine public opinion about living kidney donation, as well as their knowledge about it, willingness to donate to a stranger, and support for a possible expansion of existing Polish organ donation legislation to include living donation to strangers.MethodsA self-report questionnaire, which included a socio-demographic datasheet (9 questions), 16 questions about attitudes towards living donation, and 1 question about knowledge concerning transplantation law was sent to the respondents from December 2020 – February 2021. Logistic regression was used to assess factors affecting the support of the legalization of unspecified kidney donation amongst the participants.ResultsMore than sixty percent (62.1) of respondents supported legalization of unspecified living kidney donation. Such legalization would be accepted by people who accept a choice of a family member to donate a kidney to a stranger (OR = 3.50; Cl 95%: 1.49 to 4.85), who think bone-marrow transplant is safe (OR = 2.65; Cl 95%: 1.80 to 3.91), recognize the benefit of carrying out tests before donating a kidney (OR = 2.56; Cl 95%: 1.79 to 3.69), would agree to receive a kidney from another person (OR = 2.24; Cl 95%: 2.53 to 3.13), or would agree to donate organs after death (OR = 2.06; Cl 95%: 1.45 to 2.95). However, support for unspecified living kidney donation would not be given by respondents fearing the risk of organ trafficking (OR = 0.54; Cl 95%: 0.38 to 0.79).ConclusionsIn Poland there is strong support for legalization of unspecified living kidney donation. It is vital that future legislation define organ trafficking as a crime with serious punishment so that legal unspecified living kidney donation is not hindered.Trial registrationThe study was registered with ClinicalTrials.gov (ID: NCT04789122) on 08/03/2021.

A Scoping Review of Labor and Organ Trafficking Resources for U.S. Healthcare Professionals

ABSTRACT To summarize available curricula and identify gaps in publicly available or published educational resources for healthcare professionals on labor and organ trafficking. The following databases were searched to January 2022: Cochrane, Embase, Google Scholar, Pubmed, Scopus, and Web of Science. Additional educational resources were added through snowball method and gray literature search. Inclusion criteria were materials for healthcare professionals or trainees on labor or organ trafficking published in any year or language. Exclusion criteria were empirical or survey research. The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist was used. Of the 37 resources which met criteria, 32 (86.5%) defined labor trafficking, 24 (64.9%) described indicators or warning signs, 18 discussed prevention (48.6%), 16 (43.24%) included child labor, 9 (24.3%) were eligible for Continuing Medical Education credit, 8 (21.6%) included organ trafficking, 3 mentioned race or racism (8.12%), and 3 (8.12%) considered trainee education. Labor and organ trafficking directly inhibits progress toward UN Sustainable Development Goals 8, 10, 12, and 16. This scoping review reveals minimal comprehensive published resources for healthcare professionals, which challenges their ability to address human trafficking.

Risk Assessment and Management for Potential Living Kidney Donors: The Role of "Third-Party" Commission.

Living kidney donation is the most common type of living-donor transplant. Italian guidelines allow the living donations from emotionally related donors only after clear and voluntary consent expressed by both the donor and the recipient involved. Living donation raises ethical and legal issues because donors voluntarily undergo a surgical procedure to remove a healthy kidney in order to help another person. According to the Italian standards, the assessment of living donor-recipient pair has to be conducted by a medical “third party”, completely independent from both the patients involved and the medical team treating the recipient. Starting from the Hospital “Città della Salute e della Scienza” of Turin (Italy) experience, including 116 living kidney donations, the Authors divided the evaluation process performed by the “Third-Party” Commission into four stages, with a particular attention to the potential donor. Living donation procedures should reflect fiduciary duties that healthcare providers have toward their patients, originating from the relationship of trust between physician and patient. In addition to that, the social implications are enormous if one considers the worldwide campaigns to promote public awareness about organ donation and transplantation, and to encourage people to register their organ donation decisions. The systematic process proposed here can be a tool that proactively reduces and controls the risks of coercion, organ trafficking, vitiated consent, insufficient weighting of donative choice, that could arise especially in donors involved in living kidney donation.

Theoretical and Practical Characteristics of Human Trafficking for Labour Purpose

Studies and underlying research on the phenomenon of trafficking in human beings focus on sexual exploitation. It is an unfortunate fact that in our country (Hungary) little attention is paid to labour exploitation, let alone to other purposes (such as organ trafficking or forced marriage). The following study, after a brief theoretical introduction and statistical data, aims to typify employment-related crime.Aim: To synthesise theoretical and practical knowledge and experience, to present the difficulties, opportunities.Methodology: This study based on analysis of statistical data, review of international literature and detailed presentation of a case.Findings: The role of the community is crucial in the fight agains t labour exploitation: to recognise the characteristics of the phenomenon and, if detected, to report them to the police. A few things are crucial for successful detection: raising awareness among the public, making them aware of ways to help. In addition, the flow of information among different police forces, proper analysis, and evaluation of the information available must be emphasised to successfully investigate these cases.Value: a theoretical and practical approach to labour exploitation, which can help to increase proactivity to improve the success of detecting and investigating these cases.

Establishing a missing person DNA Biobank as a form of human rights protection.

Nowadays, organ transplantation is considered an established medical practice that, every year, improves the quality of life of thousands of patients. However, the increasing demands for kidney transplantation are in contrast with the global lack of organs. The imbalance between supply and demand for organs has created the basis for a highly profitable black market, placing illicit organ trafficking in the broader context of human trafficking. Currently, thanks to the advancements of the analytical techniques used in laboratories, forensic genetics is able to discriminate the geographical origin of genetically distinct populations. The recent availability of genetic data regarding many populations of the world and the concomitant development of technologies and methodologies that are appropriate for the study of panels of STRs and SNPs are fundamental resources in this direction. This type of analyses, together with the creation of missing person DNA databases, may be used in cases of dubious origin of organs or in transplantation cases in which clear and comprehensive medical records of patients and donors are not available. It can also establish a scientific tool useful to contrast the illegal traffic of human kidneys. In this article, we will discuss biological and ethical aspects of this interesting perspective.