Transplant tourism and organ trafficking by dfgh4bnmu

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									              An overview of practices in Europe
                                 Michael A Bos
                                 ELPAT Forum




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         Overview

>Transplant tourism and
 trafficking in global perspective

 Buyers, sellers and brokers

  Some definitions

  Trafficking in Europe

 Fate of donors

 Donor complications

 Action against Trafficking




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Scope of the problem




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     On a European scale
Europe as a whole:
120.000 patients on dialysis
65.000 patients on waiting list for transplant
Average waiting time for kidney >3 years
65 patients get transplant daily
15 patients die every day without transplant
Post-mortem donation stagnates in most countries
NHBD and Living donor transplants do not resolve the
shortage
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But….Where there is demand,
      there is supply




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        Global trade in organs
             combines:
Transplant tourism                          Human trafficking




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Global organ trade links 3
players
 The organ buyer:
 Patients in countries with
 low CAD rate and long
 waiting times
 Usually males >50
 Patients seeking preemptive
 transplant
 Too old, too sick for regular
 transplant
 Well-to-do,Well insured
 Do not want to ask family

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 The organ seller (vendor)
The poor, unemployed,
hungry
Socially marginalized
People in debt or peonage
Illegal immigrants,
refugees
Ex-prisoners, ex-soldiers
The young and naïve


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              The organ broker
Types of brokers                               Mr. Tauber, Recife, Brazil
  Local:
  Small maffia (smuggling,
  prostitution)
  Former kidney sellers
  Corrupt officials (police,
  immigration, customs)
  International:
  Independent transplant
  coordinators
  Physicians, hospital directors
  Crime syndicates
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What is transplant tourism?
 Patients traveling abroad with the aim of obtaining
 transplantable organs from both living (Philippines,
 Pakistan, Brazil) and cadaveric (China) donors – for cash
 money
 Selling organs in these countries is legally allowed or
 tolerated, but sometimes illegal
 Buying organs abroad is not legally forbidden in most
 national transplant laws (Europe, US)
 In some countries health insurance will reimburse the cost
 of organs obtained and transplanted abroad (Israel, Gulf
 States)
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    What about trafficking?
Definition UN Trafficking Protocol (2000):
“Trafficking = exploitation of human beings for sexual
exploitation, forced labor, slavery, servitude or for the removal
of organs”
“The recruitment of people through criminal means or by threat
or use of force, coercion, abduction, fraud, deception, or by the
abuse of power in a situation of vulnerability”
“It includes the recruitment, transportation, transfer, harboring
or receipt and handling of persons”
Trafficking is not only transnational across border crime, but
can also happen domestically.

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Organ trafficking is Crime!
Recruitment and transport of paid living donors through
international crime networks
Trafficking means flagrant violations of national laws and
international conventions /regulations prohibiting the sale
of organs and tissues
It involves corruption of transplant clinics, surgeons,
insurance agencies via money laundering, fraud and false
affidavits (consent, non-payment)
Bad medicine: inadequate screening, minimal aftercare of
donors and risks for recipients
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              Global picture
Vendor countries: Argentina, Bangladesh, Brazil, China,
Colombia, Egypt, India, Israel, Iraq (pre-war), Mexico,
Moldova, Pakistan, Palestine, Peru, Philippines, Romania,
Russia, USA, Turkey (and more)
Recipient countries: Australia, Canada, Gulf States, Iran,
Israel, Hong Kong, Japan, S.Korea, USA, Taiwan, Europe
Facilitating countries (transplant sites): China, India, Iran,
Iraq (pre-war), Israel, Philippines, Russia, South Africa,
USA, Turkey


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            How many organs?
  WHO estimate: 50.000 kidney transplants yearly world wide; 20.000 from
  live donors
  Number of sold and trafficked organs: 5000 – 8000 per year
  Price of trafficked organs:
  Iraq (pre-war) - $1000
  Philippines - $1500
  India - $1500-$2000
  Moldova - $2700
  Brazil/Turkey - $6000
  Israel - $15.000 - $20.000
  USA - $30.000

Brokers’ fees (both from sellers and buyers) can be 2-5 times as much


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      Trafficking in Europe
Organ trafficking in Europe is closely linked with criminal
organizations that deal in human trafficking
Illegal immigration, prostitution, illegal adoption, also
drug and weapons and money laundering
Organ selling is Europe is not through ‘regulated’ market
(e.g. Iran) or from ‘transacted’ sales (with donor consent)
(e.g. Brazil, Pakistan, Philippines), but mostly from
coercively, fraudulent sales
Trafficking is illegal everywhere and remains invisible
Traffickers are almost never prosecuted and sentenced
(corruption)
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         Fact and Figures
Lack of precise data
What we do know is mostly from case reports by (local)
investigative journalists
2003: fact finding report by Council of Europe (ic the
Moldova case)
2004: background study commissioned by German
Ministry of Int. Cooperation and Development
NGO’s reports: Organs Watch


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           Some estimates
Donor countries: Albania, Belarus, Bosnia, Bulgaria,
Czech Rep.,Estonia, Georgia, Kosovo, Macedonia,
Moldova, Romania, Russia, Serbia, Turkey, Ukraine
Recipient countries: Israel, Gulf States, USA, France,
Germany, Italy, UK, Denmark (etc.)
Transplanting countries: Turkey, Russia, Ukraine, Israel,
USA, South Africa, Romania
Unofficial estimate: 150-250 per year



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          Case of Moldova
Poorest country in Europe
High corruption rate
>5000 people per month
leaving the country
Emigrees need money for
travel and documents
Evidence of >400 young
people having sold a kidney
Average reward $2500
Clandestine transplants in
Turkey, Russia, Ukraine


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              Fate of donors
Mostly young men, poor,
jobless (18-30 years)
Kidney hunters look for
desperate people
Some donors give consent
(signing false affidavits – no
payment)
Some recruited through
deception (promised a job)
Varying degrees of coercion
or force
Paid less than promised
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      Donor complications
Donors are reluctant to admit to their selling (socially
taboo and illlegal)
Avoiding contact with health carers: no post-donation
care, hiding health problems
Socially marginalized: stigma, no wedding-candidate
Not accepted as employees
Ill health, depression, suicide
Fear of repression by traffickers, no legal action against
them
Economic position almost never improved

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Factors that promote
trafficking
 Poverty and economic recession
 Corruption (police, civil servants)
 Corrupted hospitals and medical staff
 Governments usually deny trafficking
 Big financial benefits for brokers and cooperating doctors
 Almost no cases ever go to court




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Legal action against
traffickers?
 Few cases:
 Romania
 Ukraine
 Bosnia
 Turkey




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      What action is taken?
CoE flagged the issue since
1987
2003: fact-finding report on
Moldova, followed by CoE
Recommendation (1611) on
trafficking
2004: EU Parliament
proposes ban on organ
tourism, heavy sentences for
traffickers
2006: EC will start initiative
against organ shortage, and
also against trafficking

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  Some recommendations
All member states should ratify UN Protocol and CoE
Bioethics Convention
States/hospitals should adopt WMA Statement (2000)
Increase funding to Interpol/Europol
International close monitoring of human/organ trafficking
Improve traceability of donor organs
Better cooperation with NGO’s
Stricter maintaining of national legislation
Anti-corruption policy
Efforts to increase CAD and living donation in Europe
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                            Caveat
Focus now on trafficking of
organs from live donors
However, large problem
with trafficking of cadaveric
organs, tissues, bones, heart
valves, etc.
Illegal retrieval from
patients, accident victims,
unclaimed corpses (cases in
Russia, Latvia, Ukraine)


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