Jordan LinAuthor: Jordan Lin, VITA Blog Co-ordinator and final year medical student.
On the 18th of January 2024, my VITA colleague Ruth and I had the privilege of attending a conference organised by the Metropolitan Police on the topic of human trafficking for the purpose of organ harvesting. This conference was organised on the back of the first legal case in UK history where someone was criminally convicted of this crime. Speakers at the conference represented varied professions, including law enforcement, lawyers, doctors, the Human Tissue Authority, and charities. In this blog I hope to give an overview of the conference and highlight what I think are some of the key takeaways.
The conference started with the CEO of the Human Tissue Authority (HTA). The HTA deal with legitimate live organ donations and are responsible for deciding if living tissue organ donations can proceed. Most live organ donations are for kidneys but can also include parts of the liver, small bowel, pancreas, uterus and corneas (eye). The talk covered the organ donation assessment and approval process, where after the donor has met with the clinical team, they are referred to the HTA and assessed by an independent assessor. For a live organ donation to proceed the HTA must be satisfied that:
- No reward has been or will be given.
- No duress or coercion is taking place.
- Consent for removal for transplantation has been given.
- Removal for transplantation is otherwise lawful.
If the HTA has any concerns, then the donation cannot proceed. The HTA has only referred 2 cases to the police, due to concerns, in the last 15 years but this has risen to 11 cases in the last 12 months.
We then heard from the Metropolitan Police investigators who oversaw the recently convicted case of human trafficking for organ harvesting. This was the first conviction under the organ harvesting section of the Modern Slavery Act. We are currently writing up the case to release as another blog so keep an eye out for that. In the meantime, there is a podcast that covers the case and investigation here File on 4 – The Organ Harvesters – BBC Sounds.
Next, one of the lawyers involved in the case went through more details of the case, including how even after the hospital had rejected the transplant, as there is no mandatory reporting of organ transplantation refusals, no concerns were raised to the HTA or police. The case displayed how inequalities had contributed to the vulnerability of the donor, as the decision of organ trafficking by the rich removes the choice of those who are desperate due to poverty. Inequalities of power are recognised in the law, meaning that perpetrators of organ trafficking can be convicted of the crime even if the victim had apparently consented to the organ donation.
Justice and Care are a charity that works with law enforcement to support victims of exploitation. They were the next speakers and showed how a stronger victim is a stronger witness. In criminal cases where victims have a victim navigator to support them, engagement with the justice system raises from 44 to 95%. This highlights the importance of high quality victim support if perpetrators are to be prosecuted.
We then heard from the UN office for Drugs and Crime. The speaker highlighted that there are very few cases of organ trafficking convicted globally and so this case is important in proving that human trafficking for organ harvesting is not just an urban myth. Organ trafficking is a global practice, but its scale is unknown, and the exploitative act only happens once, making it harder to detect. They also brought up the idea of ‘transplant tourism’ where, for example, someone on dialysis might go on holiday and then return and say they no longer need dialysis due to having a transplant abroad. There may be an increased risk in this situation of unlawful donor organ retrieval.
A consultant Nephrologist that works with the charity Doctors Against Forced Organ Harvesting spoke next. He emphasised the difference between organ trafficking and organ trade, with Iran being the only country with a government regulated kidney market. He also shared the consequences of transplant related crimes. For the organ victims/sellers, due to substandard donor evaluation, poor perioperative care, and non-existent follow-up, this can lead to increased complications, deterioration in health, inability to return to baseline and social stigmatization. Whereas in the UK donors get annual surveillance, for any complications, this is likely to be absent. Illegal transplants can also be suboptimal for recipients due to substandard donor and recipient evaluation and selection, poor perioperative management, and gaps in continuity of care. This can lead to decreased graft and patient survival, increased incidence of complications, and posttransplant malignancies and infections.
The final speaker was a Senior Lecturer at the University of Liverpool Law School and author of ‘Trading Lives: Organ trafficking, Illicit Networks and Exploitation’. He has been travelling to Egypt for 7 years to study the organ market. He gave a picture of the global organ trade with stories of how this occurs, especially in war torn countries, where people are selling their organs for safe passage out of danger areas. His studies found networks of organ brokers that would approach people offering to buy one of their kidneys but then only pay the donor half of the money promised and not give the rest until they had recruited someone else, and so the network grows.
This conference brought together a range of professions and will hopefully lead to collaboration and understanding of how we can work together to tackle any similar future cases. The main takeaway points from the conference for me included that the organ trade operates in the shadows and so we have very little idea how prevalent it is, and that this crime exploits vulnerability and inequality. Those who feel the need to sell parts of themselves to provide for people who depend on them will be attracted by brokers. Even if the victims consent to sell their organs, is this true autonomy if these people feel their only option is to sell their organs? This also raises serious ongoing questions about the severe socio-economic challenges, social and political determinants of health that shape the lives of so many of our fellow humans.
Finally, unlike other forms of exploitation and modern slavery, those being trafficked for organ harvesting will have healthcare professionals either involved or implicit in this crime at some point given its nature. You cannot have an organ transplant without healthcare professionals being involved.