Organ Trafficking: The Global Crisis Hiding in Plain Sight

Organ transplantation is one of the greatest achievements in modern medicine. For patients with end-stage kidney, liver, or heart disease, a transplant can mean decades of extended life. But for too many people around the world, the promise of transplantation is tied to a shadow system built on exploitation, coercion, and human suffering.

Organ trafficking is an illicit trade that removes, transports, or sells human organs through coercion or commercial pressure. This remains a significant and underappreciated global public health issue. Despite international laws, professional guidelines, and years of advocacy, the practice continues to exploit impoverished communities and destabilize the ethics of transplantation.

This article synthesizes major findings from global experts and recent research to explain the current state of organ trafficking, why the problem persists, and what the public health community can do to support ethical systems of donation.

A Global Health Problem Rooted in Inequality

Organ trafficking flourishes where poverty, inequality, and weak health systems collide. The World Health Organization (WHO) estimates that roughly 5% of the world’s annual 100,000 organ transplants may involve trafficked organs. Even though reforms in countries like China and Colombia have reduced the practice, trafficking is far from eliminated. The economic logic is disturbingly simple:

• Wealthy patients in high-income countries facing long waitlists for organ transplants seek faster access.
• Impoverished individuals, often with limited health literacy, are recruited by brokers with promises of financial compensation, employment opportunities, or family support.
• International networks of hospitals, surgeons, and intermediaries facilitate the extraction and transplantation process.

The result is an asymmetric system where desperation meets opportunity and where the poor become suppliers for the rich.

In Southeast Europe, for example, young men from Moldova and Romania were lured abroad with the promise of jobs, only to have their kidneys removed for foreign patients. Similar patterns occurred in Brazil and South Africa, where trafficked kidneys were transplanted into international “transplant tourists” paying upwards of $70,000–$160,000 for a package that included the surgery and the organ itself.

Almost none of this money goes to the donor.

How Organ Trafficking Works

Organ trafficking takes multiple forms, and each presents unique challenges for law enforcement and health systems:

1. Trafficking in Persons for Organ Removal (TiPOR)

This form involves physically moving the donor, often under false pretenses, to a destination country where the organ is removed. Vulnerable individuals may be:

• promised jobs abroad,
• misled about the risks of surgery,
• coerced through social pressure or debt.

2. Organ Trafficking Without Moving the Donor

Hospitals or clinics in low-income countries may directly recruit “donors” from local slums or rural areas. These procedures often bypass medical and ethical safeguards. Research has documented hotspots in Egypt, India, Pakistan, the Philippines, and Sri Lanka, where brokers use online ads to attract transplant tourists seeking cheaper and faster procedures.

3. Transplant Tourism

This is the demand side of the trade: patients leaving their home country to purchase an organ abroad. High-income countries with an insufficient organ supply, such as Israel before its reforms, inadvertently pushed their citizens toward the international market.

Why Organ Trafficking Persists Despite Strong Laws

Most countries, including those in Europe, Asia, the Middle East, and the Americas, now have laws prohibiting human trafficking and the sale of organs. International agreements such as the UN Palermo Protocol, and the Council of Europe Convention against Trafficking in Human Organs, explicitly ban the removal or sale of organs through coercion, deception, or payment.

Yet laws alone are not enough to stop organ trafficking, largely because the forces that sustain the illicit market run deeper than legal prohibitions. The most significant driver is the chronic global shortage of organs: demand for transplants dramatically outpaces supply, leaving patients in high-income countries facing years-long waitlists that push some to seek alternatives abroad. At the same time, weak regulatory enforcement in many low- and middle-income countries makes it difficult to monitor private clinics, prosecute brokers, or track cross-border transplant activity, allowing trafficking networks to operate with relative impunity.

Adding to these challenges are recurring proposals, mostly in wealthier nations, to legalize or regulate organ payments in hopes of reducing shortages. However, evidence consistently shows that monetizing organs crowds out voluntary donation, exploits people living in poverty who often endure serious health complications for minimal compensation, and creates new incentives for abuse even under so-called “regulated” systems.

Both the Declaration of Istanbul Custodian Group (DICG) and the World Health Organization (WHO) firmly oppose such approaches, urging governments instead to strengthen ethical donation frameworks and remove financial burdens for legitimate donors rather than introducing profit motives into transplantation.

Health Consequences for Donors and Recipients

Organ trafficking also places both donors and recipients at significant medical risk. For donors, procedures often take place in poorly regulated clinics with limited oversight, leaving individuals vulnerable to serious complications. Many former donors experience chronic pain, reduced physical capacity that affects their ability to work, psychological distress, and ongoing health problems made worse by the near-total absence of follow-up care.

Recipients, meanwhile, face their own set of dangers. Organs obtained through trafficking are frequently transplanted without proper screening or medical documentation, leading to higher rates of infection, organ rejection, and other complications linked to incomplete medical histories. Commercial transplant centers involved in this trade often prioritize speed and profit over patient safety, skipping essential testing and quality controls. These shortcuts put lives at risk on both sides of the operating table and highlight the profound public health dangers inherent in illicit organ markets.

Global Efforts to End Organ Trafficking

The Declaration of Istanbul

Launched in 2008, the Declaration of Istanbul galvanized over 130 organizations to oppose organ sales, transplant tourism, and trafficking. The DICG monitors implementation, promotes professional standards, and supports countries in reforming their systems.

Role of WHO

The WHO works with ministries of health to:

• promote ethical deceased-donor programs,
• support national self-sufficiency,
• strengthen regulatory oversight, and
• create transparent organ allocation systems.

Countries such as the Philippines, the Balkans, and Latin America have received technical support to shut down transplant centers linked to trafficking.

Case Study: Israel

In response to serious concerns about transplant tourism, organ trafficking, and an acute shortage of transplantable organs, Israel passed the Organ Transplantation Law, 5768-2008 (commonly referred to as the Organ Transplant Law) in 2008. It came into full effect in 2010.

• Prohibition of organ trafficking and transplant tourism: The law made the purchase or sale of human organs a criminal offence, and also banned reimbursement of transplants abroad when the donor or organ origin was illegal.
• Changes to donor priority and organ allocation: The law introduced a “priority” or points system for individuals who had registered as donors (or whose first-degree relatives were deceased donors), increasing their priority on transplant waiting lists.
• Incentives/support for living donors: Israel instituted measures to remove some of the financial burdens for living organ donors (e.g., expenses associated with donation).
• Stronger framework for defining brain death and procurement from deceased donors: Given religious and cultural concerns around brain death in certain Israeli communities, the law clarified criteria and strengthened oversight.

Several empirical evaluations have shown that the law contributed to measurable changes in organ donation and transplantation behavior in Israel. A study comparing five years before and five years after the law was implemented found that living-kidney donations increased from an average of 3.5 to 6.1 per month in the largest centre, largely due to a rise in donations from related donors. By 2018, commentary noted that both deceased-donor and living-donor rates had improved, and transplant tourism had been significantly reduced. The policy of reimbursing donor expenses and removing obstacles to donation has been highlighted by policy analysts (e.g., the Cato Institute) as an exemplar of how donor-support systems can function effectively.

Why This Matters for Trafficking and Exploitation

The Israeli reform offers several lessons relevant to reducing exploitation in the organ-trade ecosystem:

• By banning reimbursement for overseas transplants when organs were derived unethically, the law undercut the demand side of transplant tourism, demand is a major driver of exploitation.
• By improving domestic donation rates (both living and deceased), Israel worked toward “self-sufficiency” in transplant supply, thereby reducing the incentive for patients to seek organs abroad in potentially exploitative contexts.
• By providing donor support (expenses, lost wages, etc.), the policy recognized the donor’s interests and reduced one of the key vulnerabilities that traffickers exploit (i.e., financial desperation).
• By attaching priority benefits (in organ allocation) to donor registration/participation, Israel employed a behavioral economics approach to shift societal norms toward donation and away from illicit procurement.

Key Caveats & Ongoing Challenges

While the reform has been fruitful, several caveats and limitations are relevant if we attempt to generalize the lessons.

• Although donation rates improved, Israel still does not meet all of its transplant needs. The 2018 commentary emphasized there is “still room for improvement.”
• Ethical controversies persist about the “priority” system: some critics argue that granting higher allocation priority to those who registered (or whose relatives did) may raise fairness issues.
• Cultural and religious barriers remain, especially in communities that do not fully accept brain death diagnoses which limits the pool of deceased donors.
• Monitoring and enforcement of donor-expense reimbursement, professional standards, and hospital engagement continue to be key tasks. The law alone doesn’t guarantee full compliance or optimal operation without ongoing oversight.

Toward Ethical, Equitable Organ Donation Systems

Israel’s experience offers important lessons for countries seeking to reduce organ trafficking and build fairer, more ethical transplant systems. A key insight is that stopping trafficking requires addressing both demand and supply. Legal bans and enforcement are essential, but without a strong domestic donation infrastructure, patients will continue to seek transplants abroad through unsafe or illicit channels. Strengthening deceased-donor programs through public awareness, transparent allocation systems, and investment in hospital-based donation capacity is central to reducing this pressure.

At the same time, supporting living donors is critical. Removing the financial and logistical burdens associated with donation, such as notably lost wages, travel costs, and medical expenses, can encourage legitimate donation and help prevent the kind of economic desperation that traffickers exploit. Israel’s adoption of donor-expense reimbursement demonstrates how donor-support policies can shift behavior without introducing unethical financial incentives.

Countries must also consider how allocation incentives shape public participation. Systems that reward donor registration or participation with increased priority on transplant waitlists, when designed carefully, can help shift social norms toward donation while maintaining fairness and transparency. However, such incentive structures must be paired with ongoing evaluation to ensure they do not unintentionally disadvantage certain groups.

A successful approach must also align with local cultural and ethical contexts. Engaging religious leaders, community organizations, and the broader public, especially around sensitive issues like brain death criteria, is essential for building trust and increasing deceased-donor rates. Without this alignment, even well-designed policies may fail to gain traction.

Finally, a sustained commitment to equity and transparency is vital. Donation and allocation systems must be continually assessed to determine who is registering, who is receiving priority, and who may be left out. Clear, equitable policies foster public trust, increase donation rates, and mitigate the vulnerabilities that organ traffickers exploit.

The Public Health Bottom Line

Organ trafficking is a global crisis rooted in inequity and driven by unequal access to lifesaving care. While international conventions and strong laws provide a foundation, the solution lies in strengthening ethical donation systems, eliminating financial burdens for legitimate donors, and reducing global inequalities that make trafficking profitable.

For public health professionals, this means advocating for evidence-based reforms, supporting ethical transplant systems, and elevating the voices of vulnerable communities most impacted by this hidden trade.

A fair and transparent organ donation system is a medical necessity and moral imperative.