This document summarizes information from the HOTT project, an international research project on human trafficking for organ removal. It describes the objectives of the project which are to increase knowledge through research, raise awareness, and improve the non-legislative response. It then briefly outlines some of the project's publications and upcoming reports. Finally, it discusses indicators of human trafficking for organ removal by outlining examples of the complex relationships between recipients, donors, brokers and other actors involved.

1. Human trafficking for
the purpose of organ removal
Jessica de Jong
jessica.de.jong@politie.nl

2. HOTT project
An international scientific research project into human trafficking for the
purpose of organ removal, funded by the European Commission
and led by the Erasmus Medical Center in the Netherlands.
Many international
associated partners,
such as Europol and
the National Police
of the Netherlands

3. Objectives
Increasing knowledge, raising awareness and improving
the non-legislative response by:
• writing a literature research;
• conducting a study on transplant tourism;
• analyzing prosecuted cases (in South Africa, Kosovo, USA and Israel);
• writing indicators and recommendations.

4. Publications
• Literature review – December 2013
• Report on transplant tourism – November 2014
• Case study report – November 2014
• Indicators and recommendations – August 2015
(Soon) available at www.hottproject.com
Report of the National Police of the Netherlands – December 2014
Trade in human organs and human trafficking for the purpose of organ removal:
An exploratory study into the involvement of the Netherlands and Europe.
Soon available at www.hottproject.com

6. Article 3 Palermo Protocol
(a) ‘Trafficking in persons’ shall mean the recruitment, transportation, transfer,
harbouring or receipt of persons, by means of the threat or use of force or
other forms of coercion, of abduction, of fraud, of deception, of the abuse
of power or of a position of vulnerability or of the giving or receiving of
payments or benefits to achieve the consent of a person having control
over another person, for the purpose of exploitation. Exploitation shall
include, at a minimum, the exploitation of the prostitution of others or
other forms of sexual exploitation, forced labour or services, slavery or
practices similar to slavery, servitude or the removal of organs.
(b) The consent of a victim of trafficking in persons to the intended exploitation
set forth in subparagraph (a) of this article shall be irrelevant where any of
the means set forth in subparagraph (a) have been used.

7. Actors
 Recipients
 Donors
 Brokers
 Transplant professionals
 Other facilitators:
hospitals, service providers,
translators, law enforcement
The relations among the different actors are complex and varying,
with some individuals occasionally acting in multiple roles,
e.g. former donors and hospitals may operate as brokers.

8. Trailer: Tales from the Organ Trade

9. Recipients
“Knowledge about the incidence, nature and scope of patients’ involvement
in human trafficking for organ removal is limited.”
 Main destination countries: China, Pakistan and India
 Motivations: dialysis/waiting list
 Contact through other patients, family, friends, brokers, Internet
 Amounts paid: $40,000- $200,000
Source: Shimazono, Second Global Consultation on Human Transplantation, WHO Genève, 2007

10. Donors
“Commercial donors are almost without exception subject to exploitation.”
 They originate predominantly from poor developing countries:
India, China, the Philippines, Pakistan, Bangladesh, Ukraine, Russia, Egypt,
Romania, Moldova, Kosovo, Turkey, Israel, Brazil, Colombia, Peru, Bolivia, etc.
 Poor, low level of education, relatively young age (30), usually men
 (Promised) amounts: $ 1,000-$20,000

11. Brokers
“The presence of a broker is likely to enhance the exploitation of donors.”
 Brokers may also include doctors, hospitals and matching agencies
“Licensed transplant professionals (many of them top-notch) are reported to
have the role of brokers, facilitators - key players in transplant schemes.”
 Easy to find persons willing to sell, donors approach brokers as well
 Other activities: locate transplant centre and accomodation, arrange
transport, medical examination and travel documents, when needed
 Donors are often misled about the procedure and impact of donation
and do often not receive after care or the agreed amount of money
“Brokers are claimed to financially benefit the most from the transactions.”

12. Financial profitability
1. Drugs $320 billion
2. Counterfeiting $250 billion
3. Humans $31.6 billion
4. Oil $10.8 billion
5. Wildlife $7.8 to $10 billion
6. Timber $7 billion
7. Fish $4.2 to $9.5 billion
8. Art and Cultural Property $3.4 to $6.3 billion
9. Gold $2.3 billion
10. Human Organs $614 million to $1.2 billion
11. Small Arms & Light Weapons $300 million to $1 billion
12. Diamonds & Colored Gemstones $860 million
According to the WHO, 5 to 10 percent of the kidney transplants
performed worldwide is illegal (roughly estimated for the year 2005).

13. Pakistan
Afghanistan
Schiphol

14. - surgeon
- specialized in kidney transplants
- own private clinic in Pakistan
- operates on Afghan refugees
- permission to operate abroad
- > 100.000 dollar bank account
Indicators trafficking for organ removal
- recruited in refugee camp
- medical tests before the journey
- return ticket, valid for three weeks