Have you ever thought about selling your kidney? A piece of your liver? For many people in Asia, these difficult questions are part of everyday life.
Global demand for organs is growing rapidly. In 2023, there are over 100,000 people on the US organ waiting list, over 13,000 on the European waiting list, and thousands more in other countries. The limited supply of legal organs cannot meet this high demand. Although over 150,000 transplants took place worldwide in 2022, noticeable shortages still result in people waiting for years. Since the sale of organs is illegal almost everywhere in the world, a growing black market has emerged to meet the global demand for organs.
Organ trafficking is a huge industry. Including illegal organ transplants, the trade generates an estimated $840 billion to $1.7 billion annually. About 10 percent of all transplants – a total of 12,000 annually – are considered illegal.
Compared to labor or sex trafficking, organ and human trafficking for organ harvesting is particularly difficult to prosecute because it involves professional medical professionals. Organ transplants require a high level of technical knowledge, so traffickers use legitimate medical providers such as certified physicians and hospitals. These medical professionals – including nephrologists (kidney specialists), anesthesiologists and transplant surgeons – are rarely convicted for their involvement in the illegal organ trade.
Nowhere is this elusive black market for organs as prolific as in Asia. The world’s largest active organ market currently includes India, Nepal, Bangladesh, Pakistan, Sri Lanka and Iran. In addition, China, India, the Philippines and Pakistan have been the leading destinations for transplant tourism, where people travel abroad to obtain organs. This problem is exacerbated by poor economic conditions and inadequate law enforcement.
The “Kidney Valley” of Nepal and other illegal operations in Vietnam and Indonesia
Organ donors predominantly come from countries where a large proportion of the population lives below the poverty line. Coming from poor economic backgrounds and with poor education, these donors often see the sale of their organs as an important source of income. One Nepalese organ seller described selling his kidney as a “job”. The perceived need for illegal organ donations is exacerbated by inadequate law enforcement and monitoring in the destination countries of transplant tourism to prevent and prosecute the illegal organ trade.
In Nepal, poverty has for decades driven people to sell their kidneys to traffickers who then profit on the black market. The Kavre district in central Nepal in particular is known as the “kidney bank of Nepal” or the “Kidney Valley”. For the past 20 years, the villagers of Kavre have been the main source of kidneys for the entire country, and dozens of men from these villages have travelled to India to sell their kidneys both voluntarily and involuntarily – they have been trafficked, coerced and tricked into undergoing organ harvesting. Suppliers often receive far less than they were initially promised; other lies include promises that there will be no medical complications and that the removed kidney will grow back.
The volume of transactions in this area is extremely high. In Jamdi village in Kavre district alone, financial hardship has forced at least one person from every two households to sell a kidney. These cases are also underreported. According to Nepal’s National Human Rights Commission, at least 150 people from an unnamed village in Kavre district sold their kidneys, although only three cases were reported in total. Although 300 people from Kavre district are listed as victims of kidney trafficking in the last five years, the actual number of victims could be much higher.
Nepal is not the only country where this phenomenon occurs; Vietnam is facing a similar situation. In April 2023, Vietnam’s Ministry of Public Security discovered and busted a human organ trafficking ring in Hanoi, Vietnam. Organ recipients who purchased livers through this ring paid around $50,000. However, sellers received just under $20,000. This latest case highlights another tragedy of the illegal organ market: even when individuals voluntarily sell their organs illegally, they rarely receive full payment, as a large portion of the money goes to the recruiters.
A similar case was reported in July 2023 in another Southeast Asian country: Indonesia. Police and immigration officials worked with traffickers to bring 122 Indonesian citizens to Cambodia, where their kidneys were harvested for sale. After an investigation into the scheme, 12 people were arrested, nine of whom were former victims of organ trafficking themselves and became recruiters. The group had been active since 2019 and generated around $1.6 billion over the years. Each victim was promised only $9,000 for a kidney.
Catfishing for organs and the surprising presence of social media
To recruit potential organ sellers, recruiters use methods common to other forms of trafficking, including false promises of jobs abroad, withholding passports, threats, and physical abuse. Recruiters may also emphasize the buyer’s desperation as a manipulative mechanism and tell donors that they cannot withdraw their consent once the buyer has committed to the transaction.
Organ traffickers have also used social media to fuel the illegal organ trade. Recruiters create numerous Facebook pages under the guise of transplant support groups to search for potential organ donors. Their true identities remain concealed, and buyers pose as relatives urgently seeking an organ transplant or as foreigners to appear more reliable, as victims often believe foreigners will pay more. Social media distribution also allows traffickers to frequently change their identities to avoid prosecution by law enforcement.
Transplant tourism
Illegal organ trafficking also exacerbates international inequality. The term “transplant tourism” typically describes wealthier individuals who travel abroad to receive organ transplants from poorer destination countries. The foreigners’ participation is motivated by organ shortages in their home countries or strong domestic restrictions on organ transplants. Transplant tourism not only promotes illegal and unethical organ transplants, but also negatively impacts areas such as social justice, poverty alleviation and equality, and reinforces and deepens economic disparities between countries.
Explanations and failed solutions
To address these unethical practices, the World Health Assembly held a summit in Istanbul, Turkey, from 30 April to 2 May 2008, attended by more than 150 medical, government and social scientists. The meeting culminated in the drafting of the Istanbul Declaration on Organ Trafficking and Transplant Tourism. The declaration – updated in 2018 – aims to establish international standards, guidelines and support for organ transplantation in collaboration with other intergovernmental organizations such as the World Health Organization, the United Nations and the Council of Europe.
Although the declaration still stands today, it has not prevented organ trafficking and transplant tourism. Dr. Sanjay Nagral, co-chair of the Istanbul Custodian Group, said there is “big money” to be made in organ transplants and there are many rich people who need organs and are willing to pay any price for them.
Outlook: Strengthening the legal framework and raising awareness
In addition to the Istanbul Declaration, countries are trying to combat illegal organ trafficking with various measures. China, another affected country, has taken a number of legal steps in recent years. The government announced a monitoring system in 2014 to combat and prevent the “private” sale of donor organs. Although the new rules, published in December 2023, are effective, analysts fear that the involvement of institutions such as military hospitals in illegal operations could undermine the effectiveness of the rules. Canadian human rights lawyer David Matas called the rules a “great smokescreen” due to a lack of information about where the organs come from and which part of the population benefits from them.
Indonesia has also taken measures to combat organ trafficking. In 2009, Indonesia signed the Palermo Convention – also known as the United Nations Convention against Transnational Organized Crime – into national law, a 2000 multilateral agreement that covers organized crime related to organ trafficking. In 2015, Indonesia also signed the Association of Southeast Asian Nations Convention against Trafficking in Persons, Particularly Women and Children, a regional and legally binding agreement that imposes action plans and international obligations on its member countries to protect victims and prevent trafficking. Despite all these measures, many of which are decades old, Indonesia remains a major player in the illegal organ trade. Various officials are calling for more organized and focused forces to enforce anti-trafficking laws, rather than relying solely on non-binding international treaties with largely symbolic value.
Other critics call for educational campaigns – by both governments and humanitarian non-governmental organizations – to raise awareness of this overlooked but widespread illicit market. Greater education would improve communication to expose illegal activities, create mechanisms to increase transparency between organ donors and recipients, and combat the misconceptions that lead many victims to donate their organs (for example, the false belief that victims will get what they are promised).
There are several approaches to solving the illegal organ market crisis. A first step would be to introduce a better organ distribution system for high-income countries that ensures equal treatment for all organ recipients. More research into fair and efficient regulation of donations and waiting lists can alleviate the shortage of available organs. This step would help to directly combat transplant tourism and divert attention from poorer countries and their large supply.
At the same time, there can be no quick and hard solution to such a contentious problem as long as the root causes of donor supply remain. The illegal trade will continue to flourish unless the underlying economic and educational conditions that catalyze the market are addressed.
