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Kidney Trafficking
- 1. ORGAN RACKETS Eboni Bledsoe November 15, 2010
- 2. Overview Why the proliferation of Organ Rackets? Organ Transplantation Buyer’s Perspective Seller’s Perspective Broker’s and Facility’s Perspective Case Studies Implications/Policy Considerations
- 3. Organ Transplantation Organ Shortage Increase in incidence of diseases requiring organ transplantation Diabetes, high blood pressure, etc Poor disease outcomes Cost of dialysis is high Medical and nonmedical The current annual cost of the ESKF program is estimated at $32.5 billion, > 6.5% of the total cost of Medicare. Better technology since the 1950s Better outcomes with live donors (immunosuppressants) Don’t need to be related 5-10% of all transplants are performed illegally
- 4. Buyer’s Perspective Kidneys are most in demand Kidneys can be removed from deceased or living donors, since most people are born with two and can live healthily with only one kidney 9 year wait in NY >3 year wait is US average Source: TransplantLiving.org
- 5. Buyer’s Perspective Source: TransplantLiving.org
- 6. Illegal Organ Transplantation (Buyer’s Perspective) Cheap Globalization Easy communication Easy travel Shorter Wait Time Vacation (transplant tourism) 10% of recipients in 2004 traveled from developed countries to poor countries for transplants Package deals
- 7. Seller’s Perspective Coercion, exploitation, physical harm Organ traders prey on the most desperate, impoverished, and uneducated most donors are 20-40 years old and either illiterate or with very low educational attainment Vendors with children 7 times more common Need to pay off accumulated debts 87-95% need immediate cash Brokers quote high payments, but pay out little
- 8. Organ Rackets - Results Pay as little as $1,000 to donors, but receive as much as $50,000 in payments from recipients Paid donations are often associated with depression, regret, and discrimination Risks Poor post-operative care for recipients and “donors” Complications Less employable and therefore worse off economically Sellers exiled from communities
- 9. Broker’s and Facilitator’s Perspectives Broker Insulated from punishment Sellers reluctant to go to authorities Weak penalties Fines and short prison sentences Corrupt officials Low transaction costs Hospitals & Doctors Highly Profitable procedures Hippocratic Oath – an oath to treat the sick
- 10. Major Players in the Organ Trade Organ trafficking is a global phenomenon Major Organ Exporters Pakistan, China, India, the Philippines, Bolivia, Brazil, Iraq, Israel, the Republic of Moldova, Peru, Turkey, Egypt, and South Africa Major Organ Importers Australia, Canada, Israel, Japan, Oman, Saudi Arabia and the USA
- 11. Organized Crime Network (Colombian Model)
- 12. Case Study 1: Israel/Ukraine August 2007 MuhammedTahaJeeth and Hassan Zahalka Sellers procured in Israel and transported to Ukraine Dr. Michael Zis (an Israeli surgeon) operated for $125,000 Paid $1800 to “donors” First time sellers came forward to prosecute 4 years in prison for 2 brokers Dr. Zis was released last year after a 2 year detention in Ukraine “Wanted-kidney donor of any blood type- blood type unimportant- a monetary prize during the convalescence- Dr. Muhammed 054-4423827”
- 13. Case Study 2: India About 2000 Indians per year sell a kidney “Dr. Kidney” Amit Kumar Lured poor laborers to Gurgaon Paid 30,000 rupees (about 660 USD) More than 500 transplants $50,000 for each operation Pts from UK, US, Turkey, Nepal, Dubai, Syria, and Saudi Arabia
- 14. Case Study 3: USA July 2009- 1st documented U.S. case Originated in Israel Operates in 12 countries Most extensive network Levy Izhak Rosenbaum Hunters in Israel Doctors in Israel Donor Bought organs from Israel for $10,000 and sold them to patients for as much as $160,000
- 15. What’s Being Done? Campaign to educate people about organ donation based on altruism Opt-out Policy in some countries, including Spain and Singapore Istanbul Declaration Transplantation Society & International Society of Nephrology emphasizes need to address the safety and health care needs of the donor before, during, and after donation calls upon countries to increase programs for the prevention of kidney disease and enhance regional programs for availability of organs to meet the transplant needs of its residents from donors within their own populations No legal standing; only an ethical agreement among surgeons Prohibited in China, Philippines, Pakistan
- 16. What Can Be Done? Regulate the organ trade through state sanctions Iran donors could be compensated in other ways lifetime access to medical care life insurance tax credit help with college a small direct payment Harmonization of laws Prohibit advertisements Poor enforcement Overwhelming anecdotal evidence, underwhelming quantitative data
- 17. Bibliography HDNet. "Kidney Pirates." Dan Rather Reports.HDNet, 26 January 2010. Interlandi, Jeneen. Not Just Urban Legend. 10 January 2009. 23 November 2010 <http://www.newsweek.com/2009/01/09/not-just-urban-legend.html>. Jafar, Tazeen H. "Organ Trafficking: Global Solutions for a Global Problem: Regulated Compensated Kidney Transplantation." American Journal of Kidney Disease (2009): 1145-1157. Johnson, David Porter and Carla. First case of organ trafficking in U.S.?: NYC man accused of buying kidneys abroad, selling at hefty profit. 24 July 2009. 9 November 2010 <http://www.msnbc.msn.com/id/32132371/>. Matas, AJ and M. Schnitzler. "Payment for living donor (vendor) kidneys: a cost-effectiveness analysis." The American Journal of Transplantation February 2004: 216-221. Mendoza, Roger Lee. "Colombia's organ trade: Evidence from Bogotá and Medellín." Journal of Public Health (2010): 375-384. —. "Price deflation and the underground organ economy in the Philippines." Journal of Public Health (2010). National Kidney Foundation. 25 Facts About Organ Donation and Transplantation. 13 November 2010 <http://www.kidney.org/news/newsroom/fs_new/25factsorgdon&trans.cfm>. National Public Radio. The International Organ Trafficking Market. Washington, 3 July 2009. Pearson, Elaine. Coercion in the Kidney Trade?: A background study on trafficking in human organs worldwide.Eschborn: Deutsche GesellschaftfürTechnischeZusammenarbeit (GTZ) GmbH, 2004.
- 18. Bibliography (cont.) Shimazono, Yosuke. "The State of the International Organ Trade: a provisional picture based on integration of available information." Bulletin of the World Health Organization (2007): 955-962. Srinivasan, Sandhya. " 'Dr Kidney' arrest exposes Indian organ traffic." Asia Times Online 22 February 2008. Transplant Living. Financing a Transplant. 2010 November 11 <http://www.transplantliving.org/beforethetransplant/finance/costs.aspx>. Yakupoglu, Yarkin, et al. "Transplantation tourism: high risk for the recipients." Clinical Transplantation (2009): 1-4.
Editor's Notes
- “The current shortage in both living and deceased organ donors is expected to worsen in the near future. This owes to the increasing global incidence of diabetes, hypertension (key risks of kidney disease), hepatitis B and C (key risks of liverdisease), and various chronic abdominal organ illnesses. In recent years, there has also been an epidemic rise in the number of patients with end-stage renal disease (ESRD) and end-stage liver disease (ESLD), where kidneys and livers fail to perform permanently (Hamer and El Nahas 2006; Lim and Kim 2008; Interlandi 2009).”
- Kidneys are the most needed organ.Also, most folks can survive on 1 kidney, and are as a result, the most traded organ. Can wait for up to 9 years in NY for a kidney (varies by state). The present median waiting time on the transplant list in the United States is > 3 years and is projected to increase substantially during the next few years.4,500 Americans die each year waiting for a kidney.
- Craigslist As discussed before, the internet is often used to lure foreign customers. Several web sites offer all-inclusive “transplant packages” – the price of a renal transplant package ranges from US$ 70 000 to 160 000.
- India, Egypt, Israel, Turkey, Italy,India was especially popular due to its large number of doctors and low cost, but it appears that Egypt has taken over as the hot spot in the past 5 yearsBrokers or middlemen frequently lie about the procedures and consequences of kidney removal. For example, they tell sellers that the operation is a minor one, that they can return to work immediately, that one kidney is 'useless' or dormant so this one will be removed etc.A study of organ sellers in Colombia showed that “Vendors with dependents, whether single or married,numbered seven times more than those who did not report any dependents.”In between 87 and 95% of the subjects, the primary reason that vendors sold their organs was for “immediate” cash.A study in Chennai, India interviewing 305 kidney sellers in the State of Tamil Nadu found that the amounts promised to kidney vendors (by both brokers and clinics) were an average of one third more than what they were actually paid.
- One study showed that recipients of the organs had more post-surgical complications that the acceptable international standard. Some of these complications include transmission of HIV and Hep C. The Indian study that I mentioned earlier reported that sellers’ family income was reduced on average by 36%. 86% reported a decline in health after removal. 79% of participants would not recommend others to sell a kidney.
- *surgical fees, hospitalization fees make human trafficking of donors more profitable for hospitals than simply shipping the organ on ice
- In Colombia, a typical kidney seller will receive about $1,700. By comparison, the black market price for a kidney (exclusive of gratuities and other valuable considerations) in the US is at least US$ 30,000, US$ 10,000.00–20,000,00 in Israel, US$ 7,500 in Turkey and US$ 6,000 in Brazil.
- This case set a precedent in that it was the first case where the organ sellers went to the courtsTwo of the accused were sentenced to 4 yrs in prisonDr. Zis (a Moldovan surgeon) was arrested in UkraineThose who answered the ad were offered the opportunity to sell one of their kidneys (some accepted while others were coerced with threats)They all underwent a series of medical tests and were transported to Ukraine, where Dr. Zis surgically removed the kidneys.the eventual decision to commute his sentence stemmed from the fact that his offenses were "relatively mild" and "because he has a minor daughter".
- “Kumar is accused of luring poor laborers to his "hospital" in the New Delhi suburb of Gurgaon with promises of job offers or large sums of money. Typically, they were promised 300,000 rupees (US$7,500) but paid only 30,000 ($750) after the surgery, police said. He is alleged to have conducted more than 500 transplants over an unspecified period, charging up to $50,000 dollars for each operation. Investigators say his patients came from Britain, the United States, Turkey, Nepal, Dubai, Syria and Saudi Arabia. The racket first came to light on January 24 when police raided Kumar's hospital following a complaint by a "donor" who had been paid less than the amount promised. At his hospital police found recipients recovering from surgery and arrested a number of doctors, nurses and support staff. The kidney trade requires the collusion of highly trained surgeons. Kumar was the organizer of the enterprise and seems to have either hired or partnered with surgeons and other medical personnel. He had contacts all over the world who directed patients needing transplants to him, and a network of brokers all over India who ensnared poor people into parting with a kidney with promises of large rewards”
- A federal corruption probe in NJ involving several government officials revealed an extensive black market organ trade.Israeli network in: Argentina, Brazil, India, Iran, Cuba, Israel/West Bank, Moldova/Romania, Philippines, Russia, Turkey, USA and South Africa). Rosenbaum lived in an Orthodox Jewish neighborhood in Brooklyn and claimed to be running a nonprofit organization.The scheme lasted for a decade until Rosenbaumwas arrested, 10 days after meeting in his basement with a government informant and an FBI agent posing as the informant's secretary. The agent claimed to be searching for a kidney for a sick uncle on dialysis who was on a transplant list at a Philadelphia hospital.the organ donors were brought from Israel to the United States, where they underwent surgery to remove the kidneys.The Israeli network is the most extensive in the world, and Rosenbaum was a part of this organization. This network’s brokerages in Brazil and South Africa had already been broken up, but the U.S. was late on this…Usually, US brokers set up independent businesses, and are not a part of a larger networkRosenbaum carried a gun, and when a potential organ seller would get cold feet, Rosenbaum would use his finger to simulate firing a gun at the person's head
- Concerns about ethics arise here A few transplant surgeons support changing the law to allow a system of regulated compensation to increase the pool of donor kidneys.Existing prosecutions have tended to focus on low-level brokers rather than including medical staff, and traffickers have received light sentences.