Cracking down on organ trafficking

Some people are even taking to the streets to sell their organs, like this man in Sao Paulo, Brazil Keystone

With organ trafficking rife around the world, Swiss laws - while effective - must be monitored to avoid opening the door to the trade, experts say.

Among the things for sale on one classifieds website are a car, a plot of land, a Chihuahua – and a kidney.

And the offers for sale are cropping up from all corners of the globe, from young men and women willing to give up part of their body in exchange for thousands of euros, dollars or francs. In pole position, the kidney.

According to this particular website, there are offers from France and Belgium, where organ trading is illegal. Neither would usually be described as a poor country.

“People, often the poor, have been selling their organs on the internet for years,” says Ruth-Gaby Vermot-Mangold, a Swiss parliamentarian and author of a Council of Europe report several years back on trafficking in organs in Europe.

Organ trafficking is not isolated to Chinese prisons, where it has been reported that organs of dead prisoners have been harvested and sold. It is also a reality that exists in Europe.

“Organ trafficking is a problem that must be resolved at international level,” notes Thomas Gruberski, whose doctorate in law on the issue of organ sales is currently being published.

Effective laws

Shrouded in secrecy, the trade in organs is particularly difficult to uncover. Therefore the only way for countries to protect themselves is to introduce effective legislation.

“In Switzerland, organisations like [the foundation promoting organ donations] Swisstransplant, do not use organs without first checking and being sure of their origin. These institutions know that they must be very careful, because it can quickly become a grey area where there is trafficking,” says Vermot-Mangold.

While throughout Europe there are laws banning the trade in organs as a matter of human rights, the laws do differ on several points, including the definition of the relationship between the donor and recipient.

In Denmark or Italy, a relationship must exist between the donor and recipient. In Germany, the law allows transplants between individuals with particularly strong emotional ties. In France, the parents of the recipient’s spouse or a person who has lived for two years with the recipient can be a donor.

In contrast, in Norway, Spain, Austria and Switzerland the laws are broader, and no particular link is required between the donor and recipient – a situation which can be open to manipulation.

Regulation versus freedom

“Regulation is a major dilemma. On the one hand it’s good if friends can be donors. But on the other hand, it can also lead to a grey area involving trafficking or transplants. We’ve heard of cases where the recipient brought a fake ‘friend’ along with whom he could not even talk because of a language barrier,” says Vermot-Mangold.

In countries where no link is required between the donor and recipient, the law may help deal with avenues that are open to trafficking. According to Gruberski, such countries, including Switzerland, may already be on the right track by liberalising their laws.

“Restrictive laws, are, in my opinion, ill advised. Because they can lead to situations of great pressure, where the donor may not be making his decision of his own free will. There may also be trade-offs within a family, for example, with the promise of a greater share of inheritance for the donor. For these reasons, it is important to widen the circle of donors allowed,” he says.

Going abroad

To fight against organ trafficking, some people such as British philosopher and bioethicist Janet Radcliffe Richards are even calling for the complete freeing up of laws. Richards believes freedom in organ trading will allow for better control and provide better medical care for donors.

It’s a viewpoint that Vermot-Mangold considers dangerous. As often people who agree to donate their organs are in an extremely weak state and cannot afford to seek treatment.

Such vulnerability is exploited by some people in more developed countries to obtain an organ. If it’s hard to get hold of an organ in a person’s home country, it is less complicated to simply go abroad for a transplant.

“In Switzerland, we recently did extensive research, and found no cases of recipients who have travelled abroad, especially to China, for transplants. But this does not mean it’s not happening,” admits Franz Immer, director of Swisstransplant.

Laureline Duvillard, swissinfo.ch (Translated from French by Jessica Dacey)

Lack of donors

In Switzerland, 1,000 patients are on waiting lists for an organ. For kidneys, the waiting time is between 2.5 and 3 years. For the lung, heart and liver, it is 6-9 months.

In 2009, 67 people died on waiting lists. Most of them needed a heart, lung or liver.

Last year there were 103 deceased donors (up 20% compared with 2007) and 103 living donors.

Compared to Europe, Switzerland has very few donors. In 2009, with 13.3 donors per million inhabitants, it was on a par with Germany but well below France and Italy. Spain led the European rankings, with 35 donors per million inhabitants.

According to a questionnaire on organ trafficking conducted in 2004 by the Steering Committee on Bioethics and the European Committee for Health, in several European countries people were travelling abroad for transplants. From France for example, recipients would travel to Africa, China, India or Turkey. Belgium was even considered a trafficking hub.