By Basheer Luqman Olarewaju
(The concluding part)
According to United Nations, there is a difference between “trafficking organs” and “trafficking persons for the purpose of organ removal”, which makes it difficult to combat both forms of trafficking and also to identify victims: Trafficking organs is an instance where the crime is buying and selling of organs, as a product, illegally. Trafficking persons for the purpose of organ removal occurs when the person is the product and the purpose of trafficking them is for their organs. Victims who “willingly” sell organs are sometimes treated as criminals involved in an illegal transaction, which would be trafficking in organs. This criminalization is a deterrent for victims to pursue their compensation when they have been recruited and exploited by brokers.
The recipients of trafficked organs are generally wealthy, and participating in transplant tourism. One study estimates that 70% of organ recipients are not registered organ donors, which some advocates argue is an unfair distribution of an already limited resource (Kelly, 2019). Recipients may have reached a point of desperation, cannot wait any longer for a legal donation, be deemed unsuitable for transplant domestically, or may not want to ask relatives for a living donation. Some recipients may even be unaware of organ trafficking and are responding to ads that seem legitimate from hospitals and medical professionals abroad that promise the organ transplant for one flat fee.
China is especially well-known for organ trafficking, with reports of prisons executing prisoners to illegally harvest their organs against their consent when they are a potential match for a recipient. The United States, Canada, the Czech Republic, and Israel have begun to take action to prevent their citizens from engaging in transplant tourism involving China (Doctors Against Forced Organ Harvesting (DAFOH), 2019). Alternatively, organ procurement through purchase in Iran is sometimes legal, as Iran is the only country in the world where it is legal to sell organs. Iran has established a base price for organs at $4,600, but that is only when the organs are procured legally–which is often not the case, as poor people still go through brokers and are paid an unknown, under-the-table price.
One would hope that only a few isolated countries are major participants in organ trafficking, but unfortunately it is a global business where organs are bought from the poor and sold to the wealthy. Organ recipients participating in transplant tourism are mostly traveling from the United States, Canada, Saudi Arabia, the Gulf states, Japan, and Taiwan into Costa Rica, Panama, Ecuador, Colombia, Egypt, Kosovo, Cyprus, Israel, Oman, Azerbaijan, China, and the Philippines to receive organs. While arguably, countries like India, Pakistan, China, Bolivia, Brazil, Iraq, Israel, Moldova, Peru, Nigeria, Togo, Cameron, Turkey, and Colombia have all been identified as common organ sellers.
One of the difficulties with organ trafficking is the participation of the medical field and medical professionals in maintaining the industry. Doctors, nurses, ambulance staff, and entire hospitals participate in illegal organ harvesting and transplanting. The medical field is not the only industry upholding illegal organ trade, though. The United Nations (2011) cites that travel agents, insurance agents, and faith-based organizations that call on “organ hunters” also act as major players in maintaining the illegal buying and selling of harvested organs.
The Declaration of Istanbul (2008) was drafted by over 150 representatives from 78 countries around the world to become the legal and professional framework for ethical practices of organ procurement and transplantation. The Declaration of Istanbul (2008) defined organ trafficking, transplant commercialism, and transplant tourism as well as gave specific guidelines for care, reimbursement, and recruitment of living donors. The revised 2018 edition of The Declaration of Istanbul further defines organ trafficking, specifically trafficking in persons for the purpose of organ removal, self-sufficiency in organ donation, and financial aspects of organ donation.
Following the Declaration of Istanbul, the World Health Organization, the World Medical Association, and the European Convention on Human Rights and Biomedicine have released guidelines and principals for the ethical obtainment of organs from consenting living and deceased donors, and ethical boundaries for medical professionals performing organ transplants (European Union, 2015). Unfortunately, though, none of these documents, with the exception of the European Convention on Human Rights and Biomedicine, are legally binding, and the European Convention is only legally binding to those European member states that have signed and ratified it, leaving a very large portion of the world unaccountable. The Declaration of Istanbul (2018) calls on “designated authorities in each jurisdiction” to ensure accountability and ethical practice. The United Nations Office on Drugs and Crime (2015) states that a lack of specific and adequate legislation is a major inhibitor to preventing trafficking in person.
It is difficult to know exactly how much transplant tourism generates annually worldwide but it is estimated that the illegal organ trade conservatively generates approximately $940 million to $1.9billion annually, according to GFI. Unfortunately, even with estimated flow of funds crossing $1 billion annually, it is difficult for both law enforcement agents and anti-money laundering (AML) professionals to detect related financial activity. This is due to a myriad of factors such as a lack of domestic laws deterring citizens from travelling abroad, the transnational nature of the crime, and the savviness of the purveyors who know the laws related to organ trafficking well enough to circumvent them by way of shell companies and sanitized (legal) offerings via public websites.
While it may be difficult for banks to detect financial transactions related to organ trafficking, it is not impossible as there are some indicators available. These red flags could include the following indicators and may be innocuous on their own but when combined, could present potentially suspicious behavior:
Wire transfers to entities in high-risk jurisdictions with names that include a variation of medical. For example, “Medicus”. Methods of payment such as wires payment, email money transfer, and bulk cash withdrawal. Payments between charities and medical tourism sites. Credit card payments to travel agencies, airlines or hotels, prior to movement of money and travel. First-line banking staff indication of potentially ill customers moving large amounts of funds to numbered companies or charities prior to travel. Medical tourism websites that offer transplant services abroad that recommend utilizing their own trusted domestic doctors prior to traveling.
One thing to keep in mind is that while traveling abroad to obtain an organ may be legal in certain countries, associated financial transactions would still be considered reportable in many jurisdictions as the act of purchasing an organ may be illegal within their country of citizenship. This stance gives AML professionals an interesting perspective above and beyond that of law enforcement as they are in a position to offer up intelligence that law enforcement agencies may have no insight on, nor a requirement to. Intelligence gathered by financial intelligence units (FIUs) within financial institutions associated with organ trafficking or transplant tourism can be further disseminated to international partners by national FIUs.
Looking Forward: Countries like the U.S. and Canada did not include organ trafficking as a form of human trafficking when adopting their national laws on human trafficking. However, in the U.S. for example, some individual states like Massachusetts include organ trafficking within their state laws on human trafficking.
The DICG has been an effective group of international colleagues monitoring illegal practices by their awareness of patients who return to their home country for sophisticated medical care following an organ transplant. Notifying the responsible authorities has led to the arrest of organ traffickers in Israel, China, Pakistan, India, Nigeria, Costa Rica, Egypt, and the United States.
Also, taking measures to address the legally obtained organ shortage; speed up implementation of national and international law; hold recipients criminally liable; address health professionals’ role in organ trafficking; improve organ traceability systems; prohibit payment for illegally obtained organs and seize criminal profits; and prohibit organ solicitation.
As of today, the extent of organ trafficking is still unknown as to the number of such transplants performed annually. Furthermore, the full integration of the issue within the human trafficking field as a whole is still lacking. In order to effectively combat organ trafficking and also raise its visibility among other forms of transnational organized crimes, it is vital to engage in effective public-private partnerships. The private sector, including the financial industry, can be essential in this global fight.