The Dark Side of Transplant Tourism: Inside the Illegal Organ Black Market

Published Aug 09, 2024 at 5:00 AM EDTUpdated Aug 09, 2024 at 9:58 PM EDT

This is the second in a two-part series about the international organ black market and how bad actors are using different means to buy and sell body parts.

An organ black market thrives in certain regions based on skirted laws, bad actors and an unethical approach to broader organ transplantation—and law enforcement collaboration at the international level is the only way to curb it, experts have told Newsweek.

A Newsweek investigation previously uncovered a global marketplace trafficking organs through social media channels like Telegram and the Dark Web. Some of the traffickers operate openly in the public domain, facilitated by organ harvesting conducted through coercion or exploitation.

The United Nations Office on Drugs and Crime (UNODC) estimates there were around 700 victims trafficked for organ removal between 2008 and 2022. But numbers are difficult to parse based on in-person and online sales combined with “transplant tourism,” with the World Health Organization (WHO) estimating in 2018 that 10,000 kidneys—the most trafficked organ—are traded annually on the black market.

Transplant tourism refers to individuals who travel abroad to more easily obtain readily accessible organs for transplantation, either from poorer or desperate individuals who will sell body parts like kidneys, a lobe of the liver or a cornea in nations with fewer laws and regulations; or from wealthier, more developed nations with long waiting lists.

The role of governments

Francis Delmonico has been on the forefront of organ transplantation for more than 50 years, becoming an international figure in combating an illicit black market that exists in certain parts of the world.

He carries many titles: former surgeon at Harvard Medical School at Massachusetts General Hospital; past president of nongovernmental organization The Transplantation Society, which has a presence in over 100 nations; adviser on organ donation and transplantation to the WHO since 2006; and medical director of the New England Organ Bank since 1995.

He has traveled to more than 70 countries, including China, Iran, Nepal, Sudan and Canada, to discourage trafficking while touting the proven surgical procedure of transplantation.

By 2005, Delmonico and colleagues discovered that trafficking accounted for approximately 10 percent of all annual kidney, liver and heart transplants. Black market transactions are still common today in the Indian subcontinent, Africa and the Middle East, Delmonico noted, aided by physicians from other countries who may travel to Egypt or elsewhere if deals are negotiated.

He and other international transplant experts called organ shortages “the root cause of organ trafficking and transplant tourism—practices that pose a severe risk to individual and public health and to the notion of national self-sufficiency.”

“Organs ought to be voluntarily given,” Delmonico told Newsweek. “A living donor should not be compensated financially as a motivation for organ donation. And similarly, a deceased donation should be a volunteer situation because otherwise it becomes a market.”

Delmonico has visited cities like the Philippine capital Manila, where he said family donations are rare and organs are routinely purchased.

He and other medical experts have successfully corresponded with Pope Francis and the Vatican “to address [the] crime against humanity that is organ trafficking.” They warned in 2023 that India “is poised to be a major force in global organ transplantation as the burden of kidney failure exponentially increases in this region.”

National embassies are involved too, Delmonico added, like those in Nepal and surrounding nations that will send organ donors to India where organ “payoffs” lead to “big business” for sellers and physicians. Other aspects at play aside from legal tender include provided visas as part of predetermined agreements.

A September 2022 research paper published by Nepalese medical practitioners noted that while “stringent laws” are in place to regulate national human body organ transplantation, it warns of “a racket of human traffickers who lure rural people from this low-income country into the illegal organ trade” that is benefited from a lack of general public awareness.

The South Asian country is home to what is described as “Kidney Valley,” a region where nationals will sell organs due to financial desperation.

The U.S. embassy in Nepal did not respond to request for comment.

“If you were to ultimately see the people that have been victimized, I think you would have a sense of just human nature to say, abusing someone for their kidneys is not something that I wish to be involved with or foster,” Delmonico said. “And that’s just a common human person. You don’t want to see somebody exploited for their kidneys that could expose them to hazard, where you could die.”

“Transplantation is a very noble act,” Delmonico added. “My having been in this for 50 years has been demanding but a rewarding career saving lives, fixing people by giving them a new organ. That nobility is something that has been energy for me to be in all the places I’ve been.”

In China, doctors and officials were making large profits by selling organs from executed prisoners—with some hospitals even advertising heart transplants for prices in the six figures. In 2005, Delmonico made inroads with China when he received a call from Jiefu Huang, China’s former vice-minister of health.

In 2007, Chinese officials passed law-based regulations on organ transplantation that led to “arduous reform,” according to Huang, resulting in “remarkable achievements.” Delmonico said the Chinese have made positive strides to drastically reduce illicit sales.

Newsweek reached out to Chinese officials for comment.

Human trafficking and open advertising

Christina Bain, a human trafficking expert who formerly initiatives at Babson College and Harvard University, began associating organ transplantation with human trafficking about a decade ago.

“It’s all one to me because you can’t have the organ without the human, the organ. The organ can travel. But you still have to have the human, and the human is still in that moment exploited, which is the definition of human trafficking,” Bain told Newsweek.

Unlawful or unethical transplantation is aided by an inconsistently regulated online world, said Michael Falls, a data collection and technology manager at the Anti-Human Trafficking Intelligence Initiative.

He provided Newsweek with multiple examples of organ sales being advertised on both the Dark and Clear Web, the latter being what is accessible to the general public.

Sites on the Clear Web are blatantly publicizing organ sales for tens of thousands of dollars seemingly without any repercussions from online platforms, with names that sound fabricated—such as organ-city.com and realhumanbodypartsforsale.com.

Newsweek reached out to both websites for comment.

Another website called activescienceparts.com, based out of Mary Esther, Florida, currently lists human lungs, hearts, kidneys and livers on sale for $40,000, $85,000, $70,000 and $50,000, respectively.

On the website, Active Science Parts International, Inc. says it is “committed to providing legally and ethically obtained” natural and replica specimens for professional, medical and educational communities.

The kidney presently available is for sale “from the most reliable medical experts in the world,” according to a website description.

The company did not respond to Newsweek‘s repeated attempts for comment.

“You can almost trace it back to the beginning of Bitcoin,” Falls said. “It’s just like AI now; they started using AI for a bad purpose. It’s kind of the same way with any new technology: [illicit actors] jump right on it because they know there’s bound to be less regulation.”

Cutting out the middleman

More international partnership took hold in 2008 with the Declaration of Istanbul (DOI), created to further influence government compliance. The main sponsors are The Transplantation Society and the International Society of Nephrology.

Thomas Müller, a nephrologist—or kidney specialist—in Zurich, Switzerland, is co-chair of the Mission of the Declaration of Istanbul Custodian Group (DICG), which promotes traditional transplantation methods and ethics while combating organ trafficking, transplant tourism and transplant commercialism. Nearly 80 countries are involved.

“Just working with one country will not really work,” Müller told Newsweek. “It has to work in collaboration, [to] see where the donors coming from, where the recipient is coming from. You have these hotspots that we had in previous times, but they are now enlarged.

“So, it’s not one country or two countries, [it’s] neighboring countries. Now, you can have places where there’s quite a big group of cases where the donor comes from a different region, the recipient comes from a different region, the organization is located in another region. And then the surgeon as well as the nephrologist comes again from another region, and they do it in another country.”

He said one focus was in Eldoret, Kenya, where DOI saw donors come from former Soviet Union republics like Tajikistan or Azerbaijan or from wealthier Western countries. Surgeons and nephrologists, meanwhile, traveled to Eldoret from India and operated at a private hospital.

“[Kenyan officials] were not aware about the extent of it,” Müller said. “But there was really a building up of trust. We were invited to speak more directly about it. And they were really embarrassed, the Kenyan colleagues, and they asked us to help them so we wrote a letter to the health ministry…and then slowly they acted on this hospital in Eldoret.

“But it’s a very long process, and it did not stop the whole thing. We heard that it’s kind of starting again. It’s profitable for the hospitals. It’s not just the physician but it really brings the revenue in for the hospital.”

India’s Ministry of External Affairs referred Newsweek to the country’s Transplantation of Human Organs and Tissues Rules enacted in 2014, which includes rules and laws individuals and entities should follow. India’s National Organ & Tissue Transplant Organization also posts updates about its activities “for proper regulation of organ transplantation in India, including prevention of any associated illegal activities.”

They did not reply to Newsweek‘s question on whether national laws have been broken in the black market.

Research published in 2023 in Kidney International Reports by U.S. transplantation surgeon Ronald Parsons and Indian doctor Priyadarshini John warned that a global uptick in chronic illness has made people look for wider options.

“Not surprisingly, patients continue to explore any means necessary, often outside their country or continent, to achieve access to kidney transplantation which has led to a growth in ‘transplant tourism,'” the report reads.

Müller and colleagues are traveling back to Kenya in October after identifying physicians performing unethical transplants.

“I’m very optimistic that we can interfere there quite effectively, but I’m realistic enough to know that it’s then moving to another hospital,” Müller said, adding that the middleman in these scenarios is often the hardest to track.

Update 08/09/24, 12:04 p.m. ET: This story was updated to reflect Christina Bain’s title.

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