Should the State Department Do More to Curb Global Human Organ Trafficking? (H.R. 6413)

What is H.R. 6413?

(Updated January 14, 2019)

This bill — known as the STOP Organ Trafficking Act — would aim to combat human organ trafficking, raise international awareness of this issue, and promote the establishment of voluntary organ donation systems with effective enforcement. To raise international awareness of this issue, it’d require Human Rights officers at U.S. embassy posts overseas to publish information on international organ trafficking. Additionally, it’d allow the Secretary of State to deny a passport to an individual who has been convicted of trafficking in human organs.

On an annual basis through 2025, the Secretary of State would submit a report to the appropriate congressional committees outlining the following information:

• A description of the sources, practices, methods, facilitators, and recipients of persons trafficked for the removal of their organs during the period covered by each report;

• A description of the State Department’s efforts, either unilaterally or in cooperation with other countries, to address and prevent human trafficking for organs; and

• A description of activities undertaken by other countries to address and prevent human trafficking for organs.

Argument in favor

Illegal organ harvesting and sales for profit harm the world’s poor, and are sometimes used to fund international terror networks. Both the human rights violations and security implications of human organ trafficking should impel the U.S. to take an active role in eliminating this global flesh trade.

Argument opposed

While this bill is well-intentioned, raising awareness alone won’t eliminate the global demand for human organs, which is increasing along with human longevity. Rather than making the organ trade illegal, the U.S. should consider other avenues, including legal, regulated markets, to protect buyers and sellers.

Impact

Organ transplant patients; organ donors; commercial organ donors; commercial organ sellers; U.S. embassies; Human Rights offers at U.S. embassies; State Department; and the Secretary of State.

Cost of H.R. 6413

A CBO cost estimate for this bill is unavailable. However, a previous, similar version of this bill was estimated to cost $7 million over the 2017-2021 period.

Additional Info

In-Depth: Rep. David Trott (R-MI) introduced this bill to combat terrorist organizations’ international trafficking of human organs:

“The illegal trafficking of human organs is a tragic and heinous crime that has existed for far too long. Terror groups use this brutal practice to fund their activities and strike fear in the hearts of innocent people. That’s why it’s critical that America takes a leading role in combating these atrocities and preventing more people from falling victim to these heartbreaking crimes. I introduced this legislation initially in 2015 and I plan to continue fighting to get this critical bill through the House in order to ensure that the voices of these victims are heard.”

While there is currently no public opposition to this bill from members of Congress, there is a heated debate in the ethics and medical communities regarding the idea of for-profit organ markets. Some, including philosopher Gerald Dworkin, argue that there are good reasons for considering a market for organs:

“We currently accept the legitimacy of non-commercial solid-organ donations. We also accept the legitimacy of the sale of blood, semen, ova, hair, and tissue. By doing so we accept the idea that individuals have the right to dispose of their organs and other bodily parts if they so choose. By recognizing such a right we respect the bodily autonomy of individuals, that is, their capacity to make choices about how their body is to be treated by others. By recognizing such a right we also produce good consequences for others, that is, save lives, allow infertile couples to have children, further medical research, and so on… Allowing people to sell things is one way of recognizing their sphere of control.”

There are also practical reasons for considering organ sales, specifically the number of patients who die waiting on the organ transplant list every year. Ever since organ donation became clinically feasible, there have been insufficient numbers of organs to meet demand. Every year, the gap between supply and demand grows — and the numbers of deaths related to the global organ shortage continue to climb.

Today, according to the United Network for Organ Sharing (UNOS), which administers organ donations in the United States, 20 people die every day while waiting for new organs, while someone is added to the national transplant waiting list every 10 minutes. In 2016, over 7,000 candidates died on the waitlist for an organ transplant.

There is one cosponsor of this bill, Rep. Theodore Deutch (D-FL).

Of Note: Currently, the World Health Organization estimates that 10% of transplant procedures worldwide involve organs that have been bought on the black market. The typical donor in these transactions has an average annual income of $480, while the typical recipient has an average annual income of $53,000 — reflecting that the flow of organs is “from poor to rich, from young to old.”

The World Health Organization (WHO) Guiding Principles on Human Organ Transplantation 1991 outlines a framework for living and deceased organ donation to increase organ supplies, and prohibits monetary transactions in exchange for an organ.

The human organ trade has been a source of growing concern for the international transplant community, members of whom have studied the detrimental consequences of organ trafficking and called for curbing commercially-driven transplantations and encouraging altruistic organ donations. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism, adopted by the Transplantation Society (TTS) and the International Society of Nephrology (ISN) in 2008, are the clearest expressions of these sentiments.

In recent years, the human rights and international terror funding aspects of human organ donation have come under scrutiny. Terrorist groups in Syria and Iraq have reportedly been harvesting and selling organs from their prisoners, using proceeds from the illegal organ trade to fund themselves.

Yet, despite the general consensus that it should be curbed, international human organ trafficking remains a significant, and growing, problem worldwide due to significant political obstacles and some governments’ choice to tolerate this practice.

However, there are documented methods to pressure governments into action. The examples of Israel and Pakistan — two countries whose governments previously showed apathy towards, or even support for, this trade, but whose national policies now strongly discourage and combat commercial organ transplantation — are salient examples.

Beginning in the early 1990s, Israel became a major country of origin for transplant tourists, as Israeli patients, facing a severe organ shortage at home, underwent commercial transplantations in various countries worldwide. Israeli HMOs — the country’s primary health insurance providers — reimbursed commercially transplanted patients, thereby facilitating transplant tourism and Israeli patients’ use of the commercialized organ market. On the other side of the equation, Pakistan has been a popular transplant tourism destination since the mid-1990s, such that by 2007, approximately 2,000 commercial transplantations were performed annually using organs obtained from impoverished locals. The majority of those surgeries (approximately 1,5000) were on foreigners, especially from the Middle East.

In both countries, a policy shift toward laws prohibiting organ trafficking and transplant tourism was effected by: 1) advocacy by local physicians, 2) national media coverage, and 3) the efforts of international medical bodies, namely the Transplantation Society and the WHO. While the actual effects of each country’s prohibition diverged, with Israel’s prohibition having much more observable impact than Pakistan’s due to lax — or even nonexistent — enforcement in the latter versus strict enforcement in the former, the path to policy reform in both countries is a salient case study in the context of this bill.

Iran is an interesting example of the potential impact of legalizing for-profit organ sales: in the 1980s, the country had a shortage of legally donated kidneys and subpar dialysis equipment to treat a growing number of patients with end-stage renal disease. However, the country had highly trained surgeons capable of performing organ transplants — so, in 1988, in a bid to eliminate the dangers associated with procuring or receiving an organ illegally, the country made it legal for a living person to sell their kidney. Today, Iran is one of the few nations without an organ shortage, and all kidney donations go through a national foundation that serves as an intermediary for payment.

Media:

• Sponsoring Rep. David Trott (R-MI) Press Release
  
• CBO Cost Estimate for H.R. 3694 (Previous Version)