Have you ever thought about selling your kidney? A piece of your liver? For many people in Asia, these difficult questions are an everyday reality.
The global demand for organs is growing rapidly, with over 100,000 people on the US national organ waiting list in 2023, over 13,000 on the European waiting list in 2023, and thousands more listed in other countries. The limited supply of legal organs does not meet this high demand. Even though over 150,000 transplants took place globally in 2022, noticeable shortages still keep people waiting for years. With organ sale being illegal almost everywhere in the world, a growing black market has emerged to meet the global demand for organs.
Organ trading is a huge industry. Including illegal organ transplants, the trade generates an estimated US$840 million to US$1.7 billion annually. About 10 percent of all transplants—totaling 12 thousand annually—are believed to be illegal.
Compared to labor or sex trafficking, the trafficking of both organs and human beings for organ removal is especially difficult to track due to the involvement of professional medical practitioners. Organ transplant procedures require a high level of technical knowledge, so traffickers use legitimate medical providers, such as certified doctors and hospitals. These medical professionals—including nephrologists (kidney specialists), anesthesiologists, and transplant surgeons—are rarely convicted for their involvement in illegal organ trafficking.
Nowhere is this elusive black market for organs more prolific than in Asia. The world’s largest currently active illegal organ market includes India, Nepal, Bangladesh, Pakistan, Sri Lanka, and Iran. Furthermore, China, India, the Philippines, and Pakistan were the leading destination countries for transplant tourism, in which people travel abroad to obtain organs. This problem is exacerbated by poor economic conditions and inadequate law enforcement.
The “Kidney Valley” of Nepal and Other Illegal Operations in Vietnam and Indonesia
Organ suppliers come predominantly from countries in which a large portion of the population lives below the poverty line. Coming from poor economic and educational backgrounds, these suppliers often see the sale of their organs as a critical way to make money. One Nepali organ seller called the sale of his kidney a “job.” The perceived necessity of illegal organ donations is exacerbated by insufficient law enforcement and surveillance in transplant tourism destination countries to prohibit and track the illegal transactions of organs.
In Nepal, poverty has pushed people for decades to sell their kidneys to traffickers who then profit on the black market. Central Nepal’s Kavre District is specifically known as the “kidney bank of Nepal” or as the “kidney valley.” For the past 20 years, Kavre villagers have been the main source of kidneys for the entire country, and dozens of men from these villages have traveled to India to sell their kidneys both voluntarily and involuntarily—trafficked, coerced, and tricked into undergoing an organ removal procedure. Suppliers are often paid far less than originally promised; other lies include promises of no medical complications and that the removed kidney will grow back.
The volume of transactions in this area is extremely high. In Jamdi village alone—located in the Kavre District—financial need has driven at least one person from every other home to sell a kidney. These cases are also under-reported. According to Nepal’s National Human Rights Commission, at least 150 people from an undisclosed village in the Kavre district sold their kidneys, even though only three total cases were reported. Although reports list 300 individuals from the Kavre district as victims of kidney trafficking in the past five years, the actual count of victims could be much higher.
Nepal is not the only country experiencing this phenomenon; Vietnam faces a similar situation. In April 2023, the Vietnamese Ministry of Public Security discovered and disbanded a human organ trafficking ring in Hanoi, Vietnam. Organ recipients who purchased livers through this ring paid around US$50,000. However, sellers were given just under US$20,000. This recent case highlights another tragedy of the illegal organ market: even when individuals illegally sell their organs voluntarily, they rarely receive full payments, with a large share of the money going to the recruiters.
A similar case was reported in July 2023 in another Southeast Asian country: Indonesia. Police and immigration officers collaborated with human traffickers to send 122 Indonesian nationals to Cambodia, where their kidneys were harvested for sale. Following an investigation into the scheme, 12 people were arrested, nine of whom were themselves former organ trafficking victims who became recruiters. The group had been operating since 2019 and generated around US$1.6 billion over the years. Each victim was promised just US$9,000 for a kidney.
Catfishing for Organs and the Surprising Presence of Social Media
To recruit potential organ sellers, recruiters use methods common to other forms of human trafficking. These include false promises of employment abroad, withholding of passports, threats, and physical abuse. Recruiters may also emphasize the desperation of the buyer as a manipulative mechanism and tell donors that they cannot revoke consent once the buyer commits to the transaction.
Organ brokers have also employed social media, thereby escalating the illicit organ trade. Recruiters create numerous Facebook pages under the guise of transplant support groups looking for potential organ donors. Their true identities concealed, buyers also pose as relatives urgently seeking an organ transplant or as foreigners to present themselves as more reliable, since victims often think that foreigners will pay more. Outreach over social media also allows brokers to change identities often to avoid tracking by law enforcement.
Transplant Tourism
Illegal organ trading also exacerbates international inequality. “Transplant tourism” is a term used to describe typically wealthier individuals traveling abroad to obtain organ transplants from poorer destination countries. Foreigners’ participation is motivated by organ shortages in their home countries or heavy domestic restrictions on organ transplantation. In addition to fueling illicit and unethical organ transplantation, transplant tourism negatively impacts areas of social justice, poverty reduction, and equity, enhancing and deepening the economic differences among countries.
Declarations and Failed Solutions
To address these unethical practices, the World Health Assembly held a summit meeting of more than 150 medical professionals, government officials, and social scientists in Istanbul, Türkiye from April 30 to May 2, 2008. The meeting concluded with the creation of the Istanbul Declaration on Organ Trafficking and Transplant Tourism. The Declaration—updated in 2018—seeks to establish international norms, guidelines, and support for organ transplants, in collaboration with other intergovernmental organizations such as the World Health Organization, the UN, and the Council of Europe.
While the Declaration still exists today, it has not deterred organ trafficking and transplant tourism. Dr. Sanjay Nagral, co-chair of the Declaration of Istanbul Custodian Group, said that there is “big money” in organ transplants and a supply of rich individuals who need organs and are willing to pay whatever is needed to get them.
Looking Ahead: Bolstering Legal Frameworks and Boosting Awareness
In addition to the Declaration of Istanbul, countries are attempting different measures to address the illegal organ trade. China, another affected country, has taken a series of legal steps in recent years. The government announced a monitoring system in 2014 to counter and prevent the “private” sale of donor organs. While new rules published in December 2023 are powerful, analysts worry that the involvement of institutions such as military hospitals to perform illegal operations could hinder the rules’ efficacy. Canadian human rights lawyer David Matas described the rules as "a big smokescreen” because there is lack of information regarding where the organs are being sourced and which part of the population is benefiting from them.
Indonesia has also taken measures to combat organ trafficking. In 2009, Indonesia signed into its national law the Palermo Convention—also known as the United Nations Convention Against Transnational Organized Crime—a 2000 multilateral treaty encompassing organized crime related to organ trafficking. In 2015, Indonesia also signed the Association of Southeast Asian Nations Convention Against Trafficking in Persons, Especially Women and Children, a regional and legally binding agreement that aims to provide action plans and international obligations to its member countries regarding victim protection and the prevention of trafficking. Even with all of these measures, many of which are decades old, Indonesia remains a key player in the illegal organ trade. Different officials are calling for more organized and concentrated task forces that would enforce anti-trafficking laws, rather than relying solely on non-binding international treaties with largely symbolic value.
Other critics have called for informational campaigns to increase awareness—both from governments and humanitarian NGOs—of this overlooked yet pervasive illegal market. Increased awareness would strengthen communication for detecting illegal operations, create mechanisms to increase transparency between organ donors and recipients, and combat the misconceptions that lead many victims to donate their organs (for instance, the fallacy that victims will be paid what they are promised).
There are different possible solutions for solving the crisis of the illegal organ market. A first step would be instituting a better organ distribution system for high-income countries, ensuring equity among organ recipients. Greater research into regulating donations and waiting lists in an equitable, efficient way can ease the lack of organs available. This step would help directly combat organ transplant tourism and shift some of the attention away from poorer countries and their ready supply.
At the same time, there cannot be a fast and hard solution for combating such a debated issue as long as the root causes of the supply of donors exist. The illegal trade will continue to thrive if the underlying economic and educational conditions that catalyze the market are not remedied.
