After reading and watching all Module 12 lesson content about organ removal and transplant tourism, please discuss this issue with your small group, addressing : What you learned,What you think / feel

 or of the giving to, or the receiving by, a third party of payments or benefits to achieve the transfer of control over the potential donor, for the purpose of exploitation by the removal of organs for transplantation ”. Required Videos  The Istanbul Declaration has been endorsed by >100 governmental and professional organizations, working in organ transplantation, globally  What is trafficking for organ removal?

( IOMX video , 2018, 1:18)  Undercover video of human organ traders – ( BBC News , 2017, 4:08) Trafficking in Persons….  Issue of trafficking in persons challenges policy makers, legislators and law enforcement to respond to a complex problem  The Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children ( Palermo Protocol ) represents the most widely accepted international framework for combating contemporary slavery  Palermo Protocol requires, amongst other things, that States Parties:

 Criminalize trafficking in persons (Art.5(1))  Ensure its domestic legal system contains measures that allow victims the possibility of obtaining compensation for damage suffered (Article 6(6)) Trafficking in persons for the purpose of organ removal cont’d  Terms like ‘organ trafficking’, ‘illegal organ trade’, ‘transplant tourism’, ‘organ purchase’ and others are often used interchangeably with “trafficking in persons for the purpose of organ removal,” even where they would not refer to the same phenomenon  Not a new issue but it has received significant attention over past decade  First successful organ transplants were in the 1950s  Used to be a risky/experimental procedure until 1980s  Today it is a worldwide practice, conducted in hospitals in >100 countries all over the world Organ Transplantation facts  Kidney transplantation is the most frequently carried out transplant worldwide (followed by liver, heart, lung )  Human organs for transplants have 2 sources, deceased donors and living donors  Transplants used to have to come from genetically related donors  The donor pool has expanded over the last 30 years to spouses, friends, acquaintances & anonymous donors due to the advancements in transplant technology & good results in live kidney donation  By 2012, genetically unrelated donors accounted for 2838 out of 5617 ( 50% ) of live kidney donation in the United States  There are professional, ethical and legal regulations that govern the procurement of donor organs and that state the conditions under which such organs are allocated Scarcity of resources  2013 there were over 118,000 organs transplants globally  This was an 3% increase from 2012  The number of transplants in 2013 may have met only about 10% or less of the global needs  Under these circumstances of severe organ scarcity, desperate patients may seek strategies to obtain organs illegally (outside legal transplantation frameworks)  With an increased demand for organs comes their increased potential profitability  This fuels the desire of some people to trade & sell organs illegally Victims of Organ Trafficking  Victims may be recruited through deception, not being fully informed as to the nature of the procedure, the recovery and the impact of the organ removal on his/her health  Their consent may also be obtained through coercion or abuse of a position of power and vulnerability  U.S. and international policies provides that in cases of organ removal from a living donor , the necessary consent must have been given expressly & specifically in written form or before an official body (usually a medical ethics board) Transplant tourism  Definition : a potential organ recipients travel abroad to undergo organ transplantation  a patient can obtain an organ through the organ trade or other means that contravene the regulatory frameworks of their countries of origin  this is the most common way to trade organs across national borders  “Transplant tourism” involves not only the purchase & sales of organs, but also to other elements relating to the commercialization of organ transplantation  The international movement of potential recipients is often arranged or facilitated by intermediaries and health -care providers who arrange the travel and recruit donors Transplant tourism ( cont )  The Internet has often been used to attract foreign patients  Several web sites offer all -inclusive “transplant packages” – the price of a renal transplant package ranges from US $70,000 to $160,000 (WHO, 2016)  There’s also facilitators in the recipients’ countries of origin  In Taiwan, China 118 patients who underwent organ transplants in China were questioned by their Department of Health, and 69 reported that their transplants were facilitated by doctors.

 Taiwan authorities in since then have prohibited this activity  There have also been allegations that embassy officials of certain Middle Eastern countries have facilitated overseas commercial kidney transplants in Pakistan & the Philippines Ethical Travel for Transplantation  According to the Istanbul Declaration:  In the absence of • Organ Trafficking • Transplant Commercialism • Transplant Tourism  Not undermining the ability of the country of destination to provide transplant services for patients of its own community The organ shortage crisis…  The access of patients to organ transplants varies according to their national situations, & is partly determined by:

 the cost of health care  the level of technical capacity  & most importantly, the availability of organs  The shortage of organs is a universal problem  In some countries, the development of a deceased organ donation program is hampered by sociocultural, legal and other factors  There is still a scarcity of organs in developed countries, where rates of deceased organ donation tend to be higher The organ - exporting countries  India was a commonly known organ -exporting country, where organs from local donors are regularly transplanted to foreigners through sale & purchase  In Pakistan ~2,000 kidney transplants were performed in 2005, and 2/3 were performed on foreigners  Of the 468 kidney transplants in the Philippines in 2003, 110 were for patients from abroad  China ~12,000 kidney & liver transplants were performed (2005)  Most of the transplant organs were alleged to have been procured from executed prisoners, a practice which is criticized by the international community  Other countries where kidneys are sold include Bolivia, Brazil, Iraq, Iran, Israel, the Republic of Moldova, Peru, Columbia & Turkey The organ - importing countries  Th e term “ organ -importing countries ” is used here to refer to the countries of origin of the patients going overseas to purchase organs for transplantation  Australia, Canada, Israel, Japan, Oman, Saudi Arabia and the USA are major organ -importing countries (Organs Watch, Un. of California org)  Yet transplant tourism has become prevalent in many other countries of all continents and regions (it is extremely difficulty to get data on this from some countries/doctors)  Tales From The Organ Trade (CNN interview from director of documentary, 2014, 10:49) Link Consequences & Side Effects  There are reported deaths of patients who went abroad for overseas commercial transplants;  The abuse, fraud and coercion of paid kidney donors are also frequently reported  These reports have raised serious concerns about the consequences of the international organ trade, both for recipients and donors  Also reported is heightened frequency of medical complications, including the transmission of HIV and the hepatitis B and C viruses  1 study from the UK reports that patients who had been suspended from the local transplant list for medical reasons were operated on abroad Consequences & Side Effects contd  These factors seem to indicate the existence of substandard medical practices. Given the desperate desire of the patients to undergo organ transplantation, their risk of being exploited should not be underestimated  Underlying motivation of most paid kidney donors is poverty  The lasting economic benefit after donation is limited or even negative because of the limited employability of such patients and the deterioration of their health  Paid kidney donation is also associated with depression, regret and discrimination  Paid kidney donors do not receive follow -up care, due to financial and other reasons Next steps….  The international organ trade links the incapacity of national health care systems to meet the needs of patients  Also a lack of appropriate regulatory frameworks or implementation elsewhere  The organ trade exploits these discrepancies and is based on global inequities (poverty/vulnerability)  Many argue the growth and regularization of the international organ trade should be regarded as a global public health issue (CNN debate previously linked)  Health authorities have been urged to update their legal frameworks – in both organ -exporting and -importing countries Next steps…..  International cooperation may be considered to establish rules pertaining to overseas transplantation to curtail the international organ trade (transplant tourism)  Health and legal authorities must also address the underlying problem of organ shortage by using organs from ethically acceptable sources  While considerable disagreement exists over whether the legally regulated market and the use of financial rewards/incentives are ethically acceptable……  the international organ trade could be an issue on which international consensus and policy harmonization could be effectively pursued C OMPLEMENTARITY TO THE E XISTING L EGAL F RAMEWORK Threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person Recruitment solicitation Removal Preparation / preservation Transport Transplantation Human Trafficking Organ Trafficking Sexual exploitation Forced labour Slavery LIVING PERSON DECEASED PERSON Tissues Cells Organ Removal (HTOR +THO) Organs Action s Means Purpose Complementarity to HTOR framework , for instance: • when it is difficult to prove that the person whose organ was illicitly removed had been subjected to human trafficking (e.g. when sellers take the initiative, by contacting potential recipients or intermediaries) • when it is difficult to prove that the person concerned has engaged in actions within the scope of the definition of HTOR or has used any of the illegal means set forth in the definition of HTOR • commercial transactions involving organs from deceased persons • diversion of properly obtained organs for illicit use by physicians providing transplant services to patients who do not qualify to receive them within national programs or at facilities that serve “transplant tourists” Recruitment, transportation, transfer, harboring or receipt of persons Removal of organs Child soldiering Blood The End Next Steps:

 Read Columb (2019)  Read required news stories  Watch the required videos  Turn in Paper 2 Next module  14. Working with victims of human trafficking – social services role & law enforcement tactics of prevention and response