Trafficking in persons for the purpose of organ removal: a poorly detected and underreported phenomenon of growing concern

The scarce availability of human organs for transplantation worldwide, vis-à-vis a growing demand from patients, has led in recent years to a worrying increase in cases of illegal organ trade and transplant.

"The World Health Organization estimates that more than 150.000 organ transplants are performed annualy, although this represents less than 10% of the global need,” said Mr. Efstratios Chatzixiros, Adviser on Transplantation of Human Organs, Tissues and Cells at the World Health Organization (WHO).

“The huge discrepancy in organ donation rates and the availability and access to transplantation services between Member States may lead desperate patients to an ilegal black market of organs," Mr. Chatzixiros continued.  

Seizing the opportunity to fill the gap between supply and demand for organs, organized criminal networks have increasingly engaged in the recruitment and exploitation of extremely vulnerable individuals for the removal of their organs, to then be sold to patients in need across the world, for very high profits.   

Between 2010 and 2018, approximately 300 victims of this form of trafficking were detected across multiple countries, according to global trafficking in persons reports by the United Nations Office on Drugs and crime (UNODC).

“In 2017, about 25 victims were reported, and in 2018, this number had risen to more than 40” notes the latest UNODC Global Trafficking in Persons Report.

While these figures may appear low at first glance compared to cases of trafficking in persons for other purposes, such as sexual exploitation and forced labour, the real magnitude of the phenomenon is likely underestimated and underreported. This is because detecting and adjudicating trafficking in persons for the purpose of organ removal can be extremely difficult for investigators and prosecutors.

Several reasons account for this complexity in detecting and prosecuting trafficking in persons for the purpose of organ removal.

Firstly, this particular form of trafficking can be highly disguised. As performing illegal transplants require high medical skills, such transplants normally take place in legitimate healthcare facilities, with the involvement of several medical professionals that might be acting in collusion with the traffickers.

The fact that trafficking in persons for the purpose of organ removal constitutes one of the most lucrative forms of trafficking makes it a very attractive business for a wide range of actors. In that context, a lack of clear frameworks for healthcare professionals to report on suspected incidents, coupled with lack of oversight to ensure transparency in transplantations, make it difficult for authorities to detect cases.

Investigators are often not familiar with the medical context in which trafficking in persons for the purpose of organ removal occurs. As Ms. Aimée Comrie, Coordinator of the Global Action against Trafficking in Persons and the Smuggling of Migrants (GLO.ACT) at UNODC notes, “law enforcement investigators repeatedly tell us that it is difficult to identify what exactly constitutes evidence of trafficking for organ removal in the clinical setting; there are complex ethical and evidential questions. There can also be a cultural obstacle to seeing high profile medical professionals as potential offenders, that impedes the criminal justice response”.

Secondly, the crime is often transnational in nature, meaning that illegal transplants usually performed on organ recipients located in different countries than the victims’ countries of origin. In that sense, the lack, for instance, of systems to track transplantations and limited information-sharing within and across States can make it challenging for investigators to detect all the actors involved and gather the needed evidence.

"Cross-border cooperation is central to deal with the crime’s transnational characteristics. Situations involving patients travelling abroad to get a transplant or coming from abroad without an organ should be given extra scrutiny” according to Mr. Valiant Richey, Special Representative and Co-ordinator for Combating Trafficking in Human Beings at the Organization for Security and Co-operation in Europe.

Mr Richey continued saying, “Robust laws, well-maintained and audited transplantation registries—including of donors and recipients—and cooperation among law enforcement and the judiciary are crucial to help victims and hold criminals accountable".

In addition, a widespread confusion in public debate between trafficking in persons for the purpose of organ removal and the crime of organ trafficking is likely leading prosecutors to mis-characterize the former with the latter.

Although the media uses the two terms interchangeably, the crimes are in fact distinct from a legal perspective. In simple terms, organ trafficking is the illicit trade of organs for financial gains and does not include the trafficking of the person whose organ is being removed.

Despite these differences, in reality, the so-called ‘organ donors’ of both cases of organ trafficking and trafficking in persons for the purpose of organ removal typically come from extremely vulnerable situations and might be, to some extent, ‘recruited’ by traffickers who take advantage of their desperate conditions, further blurring the line between the two crimes.

Regarding trafficking in persons for the purpose of organ removal, “Victims most often ‘agree’ to sell their organ for a small sum of money” adds Ms. Comrie.

Ms. Comrie further said that victims “are deceived about the surgery, psychologically coerced or their vulnerability is abused in the process. The trafficking in persons legal framework is very clear about this kind of situation – the consent of the victim is irrelevant, and victims must be seen as rights holders”.

A failure to fully understand the elements of the crime can have devastating impacts on States’ capacity to prosecute and respond to both crimes, as well as having numerous repercussions on the victims, who are in extreme need of protection and urgent care.

For example, while certain jurisdictions might hold organ donors liable for organ trafficking, the non-punishment principle, calling for the non-punishment of victims for illegal actions they would have been compelled to commit as a consequence of their trafficking, should apply for victims of trafficking in persons for the purpose of organ removal as well [to learn more about the “Non-punishment principle”, see the ICAT Issue Brief on Non-Punishment of Trafficking Victims].

According to Ms. Youla Haddadin, Senior Advisor on Trafficking in Persons at the United Nations Office of the High Commissioner for Human Rights, “the international legal position on non-criminalization of victims of trafficking for status-related offences is well-established. The criminalization of victims of trafficking for the purpose of organ removal is a contradiction of the human rights-based, victim-centred approaches, and may result in denying their right to be protected and assisted”.

To draw attention to trafficking in persons for the purpose of organ removal and to deepen its understanding, the Inter-Agency Coordination Group against Trafficking in Persons (ICAT) developed, in cooperation with WHO, an Issue Brief providing an analysis of its scope and impact.

United under one common voice, the 30 members of ICAT, working with WHO, offer a set of targeted recommendations to States and other stakeholders to help them better tackle this heinous crime.

The Issue Brief particularly stresses that ensuring that victims are treated in their best interest requires comprehensive anti-trafficking laws, more consistent data collection, specialized trainings, strengthened cross-border cooperation and the adoption of human rights-based approaches.

As trafficking in persons for the purpose of organ removal is a crime essentially based on the principle of supply and demand, access to legal and ethical forms of organ donation will remain key to tackle this crime in the coming years.

The Issue Brief is one of several efforts of ICAT in creating an evidence base and providing policy guidance to counter trafficking in persons.

About ICAT:

ICAT was established in 2007, pursuant to UN General Assembly resolution 61/180, as a policy forum to enhance cooperation and coordination among UN agencies and other relevant international organizations to facilitate a holistic and comprehensive approach to the scourge of trafficking in persons. Its members include 30 UN entities and other international and regional organizations.

UNODC and the UN High Commissioner for Refugees (UNHCR) are the current co-Chairs of ICAT for 2021.

ICAT has published extensively on trafficking in persons. Its wealth of information can be accessed on the website here.

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