ORGAN RACKETS Eboni Bledsoe November 15, 2010
ORGAN RACKETSEboni Bledsoe
November 15, 2010
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
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
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
Organ # transplants in 2008
# of patients on waiting list (as of Nov 2009)
Kidney 16,520 82,364
Kidney/Pancreas
837 2,220
Pancreas 436 1,488
Liver 6,319 15,915
Heart 2,163 2,884
Heart/Lung 27 83
Lung 1,478 1,863
Intestine 185 229
Totals 27,965 107,046
Source: TransplantLiving.org
Buyer’s Perspective
Source: TransplantLiving.org
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
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
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
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
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
Organized Crime Network (Colombian Model)
Corredores
Exploradores (Scouts)
Local Residents
Vendors
Corrupt Politicians
Doctors, Transporters
, Facilities
Intermediaries
Recipient
Case Study 1: Israel/Ukraine August 2007 Muhammed Taha Jeeth 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”
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
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
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
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
BibliographyHDNet. "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 Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, 2004.
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.