Bulletin of the World Health Organization

Organ trafficking and transplantation pose new challenges

The international trade in human organs is on the increase fuelled by growing demand as well as unscrupulous traffickers. The rising trend has prompted a serious reappraisal of current legislation, while WHO has called for more protection for the most vulnerable people who might be tempted to sell a kidney for as little as US$ 1000.

IN FOCUS:
1 September 2004

Increasing demand for donated organs, uncontrolled trafficking and the challenges of transplantation between closely-related species have prompted a serious re-evaluation of international guidelines and given new impetus to the role of WHO in gathering epidemiological data and setting basic normative standards.

There are no reliable data on organ trafficking — or indeed transplantation activity in general — but it is widely believed to be on the increase, with brokers reportedly charging between US$ 100 000 and US$ 200 000 to organize a transplant for wealthy patients. Donors — frequently impoverished and ill-educated — may receive as little as US$ 1000 for a kidney although the going price is more likely to be about US$ 5000.

A resolution adopted at this year’s World Health Assembly (WHA) voiced “concern at the growing insufficiency of available human material for transplantation to meet patient needs,” and urged Member States to “extend the use of living kidney donations when possible, in addition to donations from deceased donors.”

It also urged governments “to take measures to protect the poorest and most vulnerable groups from ‘transplant tourism’ and the sale of tissues and organs, including attention to the wider problem of international trafficking in human tissues and organs.”

Earlier this year, police broke up an international ring which arranged for Israelis to receive kidneys from poor Brazilians at a clinic in the South African port city of Durban. But such highprofile successes merely scratch at the surface.

Countries such as Brazil, India and Moldova — well-known sources of donors — have all banned buying and selling of organs. But this has come at the risk of driving the trade underground.

Behind the growth in trafficking lies the increasing demand for transplant organs.

In Europe alone, there are currently 120 000 patients on dialysis treatment and about 40 000 people waiting for a kidney, according to a report last year by the European Parliamentary Assembly.

It warned that the waiting list for a transplant, currently about three years, would increase to 10 years by 2010, and with it the death rate from the shortage of organs.

In Asia, South America and Africa, there is widespread resistance — for cultural and personal reasons as well as due to the high cost — to using cadaveric organs, or those from dead bodies.

The majority of transplanted organs come from live, often unrelated, donors. Even in the United States, the number of renal or kidney transplants from live donors exceeded those from deceased donors for the first time in 2001.

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