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.