Organ trade
Organ trade refers to the commercial exchange of human organs, primarily for transplantation purposes. This practice has emerged as a significant issue in bioethics due to a stark imbalance between the high demand for healthy organs and the limited supply from voluntary donors. Key organs involved in this trade include kidneys, hearts, and livers, with kidneys being the most commonly traded due to the possibility of living donations. The illegal organ trade often preys on vulnerable populations, particularly in developing countries, and can involve coercion or exploitation of donors.
Despite advancements in medical technology that have made transplantation safer and more common, the demand for organs continues to outpace supply, leading to complex ethical debates. Questions arise about the rights of individuals to sell organs and the implications of compensating donors. While some countries, like Iran, have attempted to regulate kidney sales to address this issue, illegal organ trafficking remains a global concern, particularly in regions like North and West Africa and parts of Asia, where organized crime networks are known to operate. Overall, the organ trade raises critical ethical, legal, and social questions about health rights, exploitation, and the integrity of medical practices.
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Organ trade
Organ trading involves the commercial exchange of organs (and their accompanying tissue structures) to provide sufficient numbers of healthy organs for transplantation procedures. Although essentially any organ in the body can be eligible for transplantation, the dominant organs are the kidneys, the heart, and the liver. In the age of cutting-edge medical technologies that, since the 1990s, have entirely revolutionized the surgical protocols for replacing damaged organs through transplantation to the point where such procedures, once considered highly risky and rare, have become among the most commonly performed surgeries in the world, the organ trade has emerged as one of the most hotly debated issues in bioethics. The problem is a question of free market dynamics and elemental economics: the demand is greater than the supply, as those who need healthy organs far outnumber those willing to donate organs.
Background
Because most organs are necessary to the healthy life and survival of the owners, these organ donations, mainly the heart and liver (though pieces can be donated from living individuals), involve only the recently deceased—based upon their registration consenting to donation of their organs while they were still alive. At the same time, there is a vast black market for pilfering such organs from hospitals and clinics and feeding them into the back channels of illegal organ trading. It has been reported that there are a number of doctors and personnel in hospitals who are either unaware of where an organ comes from, or they are indifferent; traffickers will often seek these institutions out for sale.
Since a person can function sufficiently with only one of their two kidneys, the market for selling and trading kidneys is far more robust than for hearts and livers. In every advanced country (with the exception of Iran), however, purchasing a spare kidney is illegal and widely considered immoral. Therefore, the market for kidneys must rely on two avenues of supply: the voluntary organ donations of the altruistic (in many cases family members of the patient) and a shadowy global network of contractors and brokers who provide healthy kidneys through an entirely illegal black market operation in which donors, for the most part in poorer developing nations, are either paid for their organ or are coerced or even forced into donating their organ. These problematic donations are often done in less-than-sterile environments, and the donors risk life-threatening infections such as hepatitis and acquired immune deficiency syndrome (AIDS). While trends in the early twenty-first century showed that more kidney transplants were using organs from people who were living than had died, some doctors have argued that cutting into a perfectly healthy person and putting that person unnecessarily at risk violates medical ethics, specifically the basic tenets of the Hippocratic oath, in which a doctor promises to "first do no harm."
The market for kidneys represents the template for the illegal trading of organs. Although knowledge of the actual machinations of the black market organ trade for kidneys remained imperfect (the network, after all, is global and most often involves countries where surveillance and police operations lag far behind criminal activity), the work is thought to be carried out as a cooperation among four entities: the recruiter, responsible for soliciting and arranging donors among healthy individuals (usually through the enticement of money); the donor, whether voluntary or involuntary; the contractor or broker, who acts as liaison with hospitals and clinics worldwide; and some members of staff of the hospitals and clinics themselves. Each party typically receives a certain share of the price agreed upon by the often wealthy and desperate purchaser; in some cases, however, the donor is unpaid or tricked into receiving less than was promised. The organ market targets those who are disadvantaged, those experiencing homelessness, and even those who with mental and emotional disorders. Sometimes, organ trading is a part of the larger criminal network of human trafficking.
Organ Trade Today
Even as large numbers of organ transplants have been documented each year across the world in the twenty-first century, the lists of people waiting to receive organs has remained high.
Transplant commercialism raises fundamental questions among bioethicists about who controls a healthy body. Does a person have the right to sell a healthy organ that is not vital to their own body’s operations? Should a person be compensated for agreeing to donate their heart, corneas, or liver after death? Furthermore, law-enforcement agencies point out that setting up an international organ market that is open and above board would cut down on the criminal activity associated with organ donation and would bring down the black market prices charged for healthy organs. In Iran, for instance, where paid, regulated kidney donations were legalized in 1988, the transactions were so brisk that the country’s organ donation transplant list was virtually eliminated within years. Although relying on voluntary donors has helped and some areas have experimented with "presumed consent" (unless a person specifically refuses to be an organ donor, their organs can be harvested upon their death), some medical researchers have argued that live donations in which donors are compensated appropriately may prove to be the best way to address the vast need for healthy organs.
The illegal organ trade grew throughout the early twenty-first century due to both increased demand and the development of technologies that made the transplant procedure safer. At the same time, a number of outlets reported that both migrants and refugees were being targeted as victims of illegal organ trafficking. In 2021, the International Criminal Police Organization (Interpol) reported that although illegal organ trafficking was a global issue, it was particularly pressing in North and West Africa, where a number of organized crime groups had developed the practice of illegally trafficking humans as subjects for organ removal. Other studies of illegal trading worldwide conducted in the early 2020s also cited countries in Asia as having particularly large black markets for organs.
Bibliography
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