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Beneath the organ trade: a critical analysis of the organ trafficking discourse

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Abstract

This paper critically examines how the organ trade fits into the human trafficking discourse. The organ trade involves diverse actors and consists of various practices, i.e. organ trafficking, transplant tourism, organ sales and organ harvesting. Nevertheless the organ trade is predominantly defined in terms of organ trafficking. Although organ trafficking is a major concern it is not representative of the phenomenon as a whole. Evidence based research indicates that the organ trade is better characterised by organ sales and transplant tourism. This paper argues that co-opting the organ trade into the ‘meta- narrative’ of human trafficking resists a wider critique of the phenomenon linking the emergence of a global market in organs to broader socio-economic conditions. Further it is argued that the organ trade is not a direct consequence of the global shortage of organ supplies, but is rather linked to the transfer of transplant capabilities to the global South. The rhetorical positioning of the organ trade as an object of crime control diverts critical attention away from the transplant industry and frames the phenomenon within a narrow criminal paradigm. Formulaic criminal responses follow which overlook important intersections of agency, identity, culture and politics.

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Notes

  1. This rumour has recently resurfaced. See ([21], August 6). Guatemala Children Stolen for Illegal Adoption, Organ Trafficking. Retrieved from Insight Crime, Organised Crime in the America’s: http://www.insightcrime.org/news-briefs/guatemala-reports-22-cases-of-stolen-children-in-2013 Accessed 10 August 2013.

  2. In this case St Augustine’s hospital in Durban, South Africa, was found guilty of 102 counts related to numerous offences, owing to the fact that it had allowed its ‘employees and facilities to be used to conduct … illegal kidney transplant operations’.

  3. In the Medicus Clinic Case, five individuals were found guilty of organising and conducting illegal kidney transplants at the Medicus clinic in Pristina, Kosovo. See, Ruling Confirming the Indictment.

  4. Trafficking in persons for the removal of organs is defined under Article 3 (a) of the Protocol to Prevent, Supress and Punish Trafficking in Persons, Especially Women and Children (2000).

  5. According to the Declaration of Istanbul (2008: 1228) “travel for transplantation becomes transplant tourism if it involves organ trafficking and/or transplant commercialism or if the resources (organs, professionals, and transplant centers) devoted to providing transplants to patients from outside a country undermine the country’s ability to provide transplant services for its own population.”

  6. Although this paper is critical of enforcement strategies it should not be mistaken as advocating a regulated market in organs. The key point is that Law enforcement needs to form part of a wider strategy, addressing the social determinants that sustain demand for illegal organ transplants. Any arguments for or against a regulated market would need to be context specific, taking into consideration the availability of resources necessary to implement a high level of regulatory oversight.

  7. It is unsurprising then that the TIP report 2012 ‘estimates’ that there are currently around 27 million people trafficked around the world. A seemingly static figure alluded to by several authors and advocates since Kevin Bale’s account of modern slavery in 2000.

  8. This is evident in the legislative bias of domestic human trafficking laws targeting trafficking for sexual exploitation ([8, 22]).

  9. While originally spearheaded by a moral campaign to abolish sex-trafficking the final draft of the Trafficking Protocol includes human trafficking in various forms, i.e. organ removal. The TVPA does not directly recognise organ trafficking or the removal of organ(s) as a form of exploitation.

    See, Pugliese, E. (2007). Organ Trafficking and the TVPA: Why One Word Makes a Difference in International Enforcement Efforts. J. Contemp. Health L. & Poly, 24, 181.

  10. This is not an indictment of the transplant profession or a dismissal of the therapeutic benefits successful transplantation can provide. In referring to the ‘transplant industry’ the author is referring to the various parties, i.e. pharmaceutical companies, insurance companies, private transplant clinics, organ sharing organisations, medical professionals etc. that have a commercial stake in transplantation. Accordingly, it is argued that the transplant industry has a vested economic interest in the international promotion of transplant medicine.

  11. According to the United Nations Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power (1985) “victims of crime” are defined in the broad sense as “persons who, individually or collectively, have suffered harm, including physical or mental injury, emotional suffering, economic loss or substantial impairment of their fundamental rights, through acts or omissions that are violations of national criminal laws or of internationally recognized norms relating to human rights”. However, used in this broad sense the term victim has no specific legal status. Not all individuals who sell an organ can be considered a ‘victim’ of trafficking. I use the term ‘organ seller’ to make this distinction. In regards to organ trafficking the term ‘victim’ assumes that an individual has been trafficked. For legal purposes this can only be established after a judicial process. Unless the three elements of human trafficking (action, means, purpose) are satisfied an individual who may indeed be a victim, at least in the broader sense of the word, cannot be considered a victim of trafficking. Moreover, as this paper indicates the term victim is routinely used to convey a particular perspective or meta-narrative of trafficking which does not reflect the diverse experiences of trafficked persons.

  12. To put this into perspective: the Swiss pharmaceutical firm Novartis, which produces essential immunosuppressant drugs for transplantation, posted an annual profit of $12,811 m in 2012. See, Novartis <http://www.novartis.com/downloads/investors/financial-results/quarterly-results/q4-2012-media-release_en.pdf > accessed 16 May 2013.

  13. While conducting fieldwork in Cairo, the author did discover photographic evidence that kidneys were in fact being removed in the Sinai. However it was impossible to determine if this was an isolated incident or

  14. This is not an exhaustive list.

  15. The removal of an organ is not always illegal. It is only illegal to remove an organ under commercial terms or when there is no medical reason to do so. Hence the Protocol would benefit from clarifying the term ‘removal of an organ’.

  16. In contrast to the Trafficking Protocol the European Trafficking Convention established a Group of Experts on Action against Trafficking in Human Beings (GRETA) charged with monitoring the implementation of the Convention through country reports. The implementation of the monitoring body is made possible by the integrated status of the EU. This would not be effective on a global scale. Another important provision to note in relation to the legality of organ sales is Article 19, which invites states to impose liability on persons who ‘use the services of a victim of trafficking’ with the knowledge that the person is a victim of trafficking. Accordingly, recipients of a trafficked organ could –potentially- be held liable by States Parties to this convention.

  17. All the domestic transplant laws referred to in this article require that voluntary and informed consent is given prior to an organ donation.

  18. This is an important point to consider. However, it is beyond the scope of this article to deliberate on this further.

  19. See, Arab Republic of Egypt, Law No. (64) Regarding Combating Human Trafficking (2010) <http://www.protectionproject.org/wp-content/uploads/2010/09/Egypt_TIP-Law_2010-Ar+En.pdf> accessed 12 June 2013; See also, Law of 19th July of Venezuela on Organ Transplantation

  20. It is noted in the Explanatory Report that drafters are intending Article 21 to be limited to persons who are vulnerable because of age (presumably children, already covered under the previous clause), mental development or familial or social dependence on the perpetrator(s)).

  21. See, Wang Chin Sing v Public Prosecutor <http://www.unodc.org/cld/case-law-doc/traffickingpersonscrimetype/sgp/2008/wang_chin_sing_v_public_prosecutor.html?tmpl=old. accessed 10 July 2013; In this case both the organ buyer and organ seller (S.D.) were prosecuted. S.D. [Public Prosecutor v S.D. and Another [2008] SGDC 175] was convicted of entering into an arrangement to supply a kidney for valuable consideration under the Human Organ Transplant Act (Cap 131A, 2005 Rev Ed) section 14(1) read with section 14(2). He was also charged with making false statutory declarations under the Oaths and Declarations Act (Cap 211, 2001 Rev Ed). Two charges under the Human Organ Transplant Regulations 2004 (S 213/2004) regulation 8 were also taken into account in sentencing. S.D. was sentenced to two weeks imprisonment and fined S$1000. He was unable to pay the fine and was consequently imprisoned for another week.

  22. See, J.A. v State of Israel <http://www.unodc.org/cld/case-law-doc/traffickingpersonscrimetype/isr/2007/j.a._vs._state_of_israel.html?tmpl=old> accessed 10 July 2013. In this case the organ sellers were warned that if they complained to the police they would be arrested, since they were complicit in an offence.

  23. For example, Article 27 of Law No. (64) Regarding Combating Human Trafficking (Egypt) outlines a commitment to establish a fund for victims of trafficking. This fund has never been established.

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    Seán Columb

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Columb, S. Beneath the organ trade: a critical analysis of the organ trafficking discourse. Crime Law Soc Change 63, 21–47 (2015). https://doi.org/10.1007/s10611-014-9548-0

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