For all the attention by legal scholars, doctors, and politicians to the global organ shortage—and particularly the crisis in the United States, relatively little is said about tissue demand and that supply industry. Well known are the horrific stories involving black markets specializing in organs like kidneys and livers. The troubling stories of Indian women, Pakistani men, and Brazilian boys pillaged for parts and left suffering with grotesque scars, owing debts, and in medical need are chronicled by a growing chorus of scholars (see here, here, and here). Even those of us who support incentives to encourage organ donation strongly oppose human rights abuses paraded as free markets. What scholars continually overlook, however, are the surreptitious, global tissue trades that effect more people and have the potential to cause greater harm, such as diseased tissues, bones, and other body parts entering the stream of US commerce and transplantation.
Several years ago, I presaged some of these problems and wrote about these issues; one of the articles can be found here. More recently, an international consortium of journalist have come on board with an eye-opening special report, revealing black markets in Europe for human tissues and bones. Their story begins in the Ukraine, where earlier this year security guards discovered body parts and skin stuffed into coolers, and envelopes filled with cash–transported on a “grimy white minibus.” Authorities stumbled onto this body part heist thinking that a mass-murder had been uncovered. To their surprise, the bus and its contents were headed off to Germany before shipment of the parcels to Korea, the US and other countries.
On its own, tissue transplantation makes as much sense as organ transplantation, because they help to improve patients’ quality of life and in some instances may be vital to saving lives, such as heart valve transplants. The problem is that the dark-side of this industry operates nefariously. Sometimes this includes pillaging parts from cadavers dead from communicable diseases such as HIV and hepatitis or acquiring tissues through illegal means, or mislabeling parts—claiming that body parts are from Germany, when in fact they are from developing countries. Often companies that trade on stock exchanges are linked to the darker side. For example, investigators discovered that a US business, RTI, located in Florida is linked to the Ukraine discovery. As Dr. Martin Zizi remarked to reporters, “once a [body part] is in the European Union, it can be shipped to the U.S. with few questions asked…They assume you’ve done the quality check, [but] we are more careful with fruit and vegetables than with body parts.”
As I have noted in prior work, the challenge in parsing out the trade in body parts is that it is wedged between two legal processes, altruistic organ donation and legalized tissue implantation. In between is the black market industry that practically receives bodies and parts for the tiniest fraction of their profit and exploits that advantage through huge mark-ups to doctors and hospitals. Estimates range, but prosecutors speculate that thousands of Americans receive tissues generated through corrupt processes. I propose three measures to turn around this system. First, compensate relatives for providing human tissue and bone for transplant and medical research. Second, launch an ex-ante tissue sharing program. Allow people to sign up—with more explicit references to what is requested and required. Third, allow states to test out novel tissue donation programs to evaluate their strengths, weaknesses, and levels of support and buy-in by local communities.