#seán columb

[quotesfrommyreading]

Several countries, including Pakistan, Egypt, Bangladesh, India, Turkey, the Philippines and China, have been identified as centres of organ trafficking, but the trade in organs is a transnational operation. In its 2018 Global Report for Trafficking in Persons, the United Nations Office on Drugs and Crime identified more than 700 cases of organ trafficking, the majority in the Middle East and north Africa. A 2021 Interpol report claimed that organ trafficking was of particular concern in north and west Africa, “where impoverished communities and displaced populations are at greater risk of exploitation”.

According to the Global Observatory on Donation and Transplantation (GODT), only 10% of the global demand for transplants is met each year. Increased demand for kidney transplants, in particular, has been exacerbated by a shortage of altruistic donations and limited access to transplant services. This has led to an increased dependence on criminal networks that obtain organs from vulnerable individuals.

There is a black market for organs including kidneys, corneas and liver lobes. Rising demand for kidneys is partly a result of the spread of so-called diseases of affluence – diabetes, hypertension, obesity – and the subsequent rise in kidney failure. According to the charity Kidney Care, in the UK, the waiting list for a kidney transplant has increased dramatically since the pandemic. Consequently, more people are travelling overseas for transplant surgery. In many countries that attract transplant tourists, kidneys are sourced from the bodies of the poor and disenfranchised.

As a legal academic, I have been investigating the global trade in organs since 2014. Over the past 10 years, I have spoken to 43 people from Sudan, South Sudan and Eritrea who sold a kidney out of economic necessity. In most cases, people were targeted by criminal groups because of their precarious status as asylum seekers, refugees or undocumented migrants. Most were not paid what they were promised. Some were paid nothing. Doubly criminalised, as illegal migrants and organ sellers, they were in no position to negotiate a price, or to ensure they got paid the agreed amount. Because of their precarious legal status they were also less likely to report abuse to the authorities.

In the absence of legal pathways to migration, many had sold their kidneys after they had been arrested, detained and in some cases deported back to countries where their lives were under threat. Most had opted to avoid refugee camps, describing them as “prisons” and “death camps” where people go to die. They were disillusioned with the United Nations Refugee Agency (UNHCR). It was better to risk crossing the Sahara, Yonas told me, than to live under permanent surveillance, captive and dependent on a broken asylum system. Many, like Yonas, had expended all their resources trying to reach Europe and claim asylum. Categorised as illegal and pushed to the margins of society, they were exposed to exploitation of different kinds.

The illicit networks that supply organ markets depend on the close cooperation of medical doctors. Criminal intermediaries are involved in the negotiation of fees, and the preparation of official-looking paperwork presented as evidence of informed consent to an altruistic donation. These brokers, who connect sick patients with impoverished and vulnerable “donors”, also form long-term partnerships with medical professionals. Without the involvement of surgeons who perform illegal transplants for profit, the trade in organs would cease to exist.

In March 2023, the UK tried its first organ-trafficking case. A Nigerian politician, his wife and their broker were found guilty of conspiring to bring a man to the UK from Lagos to obtain his kidney for transplant. The judge said in sentencing: “The trafficking of people across international borders to harvest their organs is a form of slavery. It treats human beings, and their body parts, as commodities to be bought and sold. It is a trade that preys on human poverty, misery and desperation.” Unfortunately, as war and climate crisis displaces more people, there is no shortage of desperate people to prey on.

  —  ‘For me, there was no other choice’: inside the global illegal organ trade

[quotesfrommyreading]

Yonas had all but given up hope of reaching European shores when he was approached by a Sudanese man, who gave his name as Ali, at a street market in Cairo. Yonas told him his story. Ali said that he knew a way that Yonas could pay back all his debts and secure a place on a more reliable fishing vessel crossing from Egypt to Italy. He told Yonas he could sell his kidney, make a lot of money and save a life in the process.

Yonas had his doubts. But he had amassed significant debts trying to cross the Mediterranean and he was coming under pressure to pay back friends, family and moneylenders. “This is the last thing you want to do,” he explained. “But for me there was no other way.” Ali, the broker, was personable and seemed genuine. Yonas agreed to the deal. He was promised $10,000 for his kidney. The money, he hoped, would be enough to cover his debts and pay for his onward journey across the Mediterranean.

The surgery took place at a medical facility near Alexandria in November 2018. “I remember waking up and feeling confused,” said Yonas. The first thing Yonas he was aware of was a buzzing noise coming from a loose lightbulb, like the sound of a trapped insect. Next came pain, then fear, panic, anger. “I was shouting as loud as I could. I just wanted to get out of there.” Yonas rolled over and vomited on to the floor.

Hours passed. Finally the door opened and a man holding a clipboard came in. The man told that Ali would be coming soon, at which point he could leave. He handed Yonas two painkillers and a glass of water, and slid out the door before Yonas could ask any questions.

When Ali finally appeared, he told Yonas to get dressed. His voice was hard, all his old charm now gone. A nurse removed the drip attached to Yonas’s hand and two heavy-set men escorted him back to the car. Yonas spent the next two weeks in an apartment in Cairo convalescing. He was closely monitored, in case he should decide to leave the apartment. They did not want him to attract attention. If someone were to see him, they might report his presence to the police. Best to keep him hidden while he healed.

Yonas had been promised $10,000, but he was given just $6,000 in notes. This would just about pay off his existing debts, but it was not enough to cover the cost of smugglers’ fees ($3,500) for the next stage of his journey, across the Mediterranean. Yonas went to the police and reported Ali for trafficking. He was trying to explain that he had been deceived into selling a kidney when another officer entered the room. The second officer informed Yonas that it was a criminal offence to sell a kidney. He took out a notebook and asked Yonas for his identification papers. Yonas fumbled in his pockets, searching for documents he knew he didn’t have.

The officers joked that Yonas didn’t look like an Egyptian, remarking on his dark skin and curly hair. If he was a refugee, they suggested, he should go and complain to the UNHCR. But maybe he wasn’t a refugee. Maybe he was an illegal migrant. The second officer reminded Yonas he could be arrested or deported for failing to produce his identification papers.

Yonas was regretting going to the police. He looked around, nervously waiting for someone to speak. The second officer smiled scornfully and told him to leave.

  —  ‘For me, there was no other choice’: inside the global illegal organ trade