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An overview of practices in Europe Michael A Bos ELPAT Forum ESOT 2007, Prague, October 2nd 1 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 ESOT 2007, Prague, October 2nd 2 Scope of the problem ESOT 2007, Prague, October 2nd 3 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 ESOT 2007, Prague, October 2nd 4 But….Where there is demand, there is supply ESOT 2007, Prague, October 2nd 5 Global trade in organs combines: Transplant tourism Human trafficking ESOT 2007, Prague, October 2nd 6 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 ESOT 2007, Prague, October 2nd 7 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 ESOT 2007, Prague, October 2nd 8 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 ESOT 2007, Prague, October 2nd 9 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) ESOT 2007, Prague, October 2nd 10 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. ESOT 2007, Prague, October 2nd 11 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 ESOT 2007, Prague, October 2nd 12 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 ESOT 2007, Prague, October 2nd 13 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 ESOT 2007, Prague, October 2nd 14 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) ESOT 2007, Prague, October 2nd 15 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 ESOT 2007, Prague, October 2nd 16 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 ESOT 2007, Prague, October 2nd 17 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 ESOT 2007, Prague, October 2nd 18 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 ESOT 2007, Prague, October 2nd 19 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 ESOT 2007, Prague, October 2nd 20 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 ESOT 2007, Prague, October 2nd 21 Legal action against traffickers? Few cases: Romania Ukraine Bosnia Turkey ESOT 2007, Prague, October 2nd 22 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 ESOT 2007, Prague, October 2nd 23 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 ESOT 2007, Prague, October 2nd 24 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) ESOT 2007, Prague, October 2nd 25
"Transplant tourism and organ trafficking"