‘I’m not Sherlock Holmes’: Suspicions, secrecy and silence of transplant professionals in the human organ trade
| Author | Linde Van Balen,Frederike Ambagtsheer |
| DOI | 10.1177/1477370818825331 |
| Published date | 01 November 2020 |
| Date | 01 November 2020 |
| Subject Matter | Articles |
https://doi.org/10.1177/1477370818825331
European Journal of Criminology
2020, Vol. 17(6) 764 –783
© The Author(s) 2019
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/1477370818825331
journals.sagepub.com/home/euc
‘I’m not Sherlock Holmes’:
Suspicions, secrecy and silence
of transplant professionals
in the human organ trade
Frederike Ambagtsheer
and Linde Van Balen
Erasmus MC, The Netherlands
Abstract
This article presents the results of a qualitative interview study amongst 41 Dutch transplant
professionals. The overarching aim was to acquire in-depth understanding of transplant
professionals’ experiences with and attitudes towards patients who purchase kidneys. We found
that transplant professionals occasionally treat patients who are suspected of kidney purchases
abroad. However, they turn a blind eye to their patients’ suspected purchases. Secrecy and
silence function as a tacit agreement between patients and their caregivers that keeps the subject
of kidney purchase at a safe distance and allows transplant professionals to ignore its suspected
occurrence. They thus participate in the building of walls of secrecy and silence in the organ trade.
Keywords
Disclosure, ethics, kidney transplantation, medical tourism, organ trafficking, professional
Introduction
The human organ trade is receiving increasing attention from international (transplant)
organizations, the media, researchers and non-profit organizations. According to the
Council of Europe, this trade constitutes a ‘major threat to the public health’ (Council of
Europe, 2014). The World Health Organization (WHO) first condemned it in 1987,
declaring that ‘payment for organs is likely to take unfair advantage of the poorest and
most vulnerable groups, undermines altruistic donation, leads to profiteering and human
trafficking [and] conveys the idea that some persons lack dignity, that they are mere
objects to be used by others’ (World Health Organization, 1987, 2010). The trade is pro-
hibited worldwide, except in Iran (Budiani-Saberi and Delmonico, 2008).
Corresponding author:
Frederike Ambagtsheer, Internal Medicine Department, Section Transplantation & Nephrology, Erasmus
MC, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
Email: j.ambagtsheer@erasmusmc.nl
825331EUC0010.1177/1477370818825331European Journal of CriminologyAmbagtsheer and Van Balen
research-article2019
Article
Ambagtsheer and Van Balen 765
Nevertheless, a growing number of reports suggest that the organ trade is proliferating
around the globe. Although reliable data about the scope are lacking, the WHO has esti-
mated that 5–10 percent of all organ transplantations take place illegally each year
(Shimazono, 2007a). Owing to the lack of available organs, large numbers of patients are
travelling outside their home country to purchase an organ (Albugami et al., 2017;
Ratkovic et al., 2018). Some patients have been reported as paying up to US$300,000 for
a transplantation (Ambagtsheer et al., 2016; Greenberg, 2013; Khalaf et al., 2004). Organ
sellers, by contrast, receive next to nothing in return for their organs (Lundin, 2012;
Scheper-Hughes, 2014; Tong et al., 2012). Intermediaries such as brokers, doctors,
recruiters and corrupt police officers reportedly reap most of the profits (De Jong, 2017;
Pascalev et al., 2016). According to Global Financial Integrity, the trade features in scale
and profit alongside the illicit trade in drugs, wildlife and weapons, with an estimated
annual profit of US$1.7 billion (May, 2017). Defined as a form of human trafficking, the
prevailing discourse on the organ trade is that of an organized crime, driven by mafia-
like networks that exploit the poor for their organs (Franko Aas, 2013; Scheper-Hughes,
2003; United Nations, 2000).
Condemnation of the organ trade is not, however, as widely accepted as is assumed
(Evans, 2008; Greenberg, 2013). There has been widespread criticism of its prohibi-
tion since the WHO first denounced it (Matas, 2004; Radcliffe-Richards et al., 1998).
Numerous authors point out that the grounds for prohibition are questionable and that
prohibition has increased exploitation rather than prevented it (Cherry, 2015; Working
Group on Incentives for Living Donation, 2012). After studying the organ trade in
Cairo, Columb (2017) concluded that, ‘while the organ trade is publicly maligned, in
practice organ markets are considered a solution to the surplus demand for organs’.
The growing body of empirical research further suggests that the organ trade is not
necessarily exploitative and that not all cases take place through organized crime.
Rather, studies show that the organ trade involves a variety of practices that can be
placed along a spectrum ranging from exploitation to voluntary, mutually agreed ben-
efits (Fry-Revere, 2014; Heidary Rouchi et al., 2009; Van Buren et al., 2010). Such
benefits are particularly reported from Iran, which, as we will point out, is the only
country that has adopted a government-controlled programme that pays donors in
return for their kidneys (Mahdavi-Mazdeh, 2012). In other countries however prohibi-
tion has, amongst others, led to illegal transplants being disguised as ‘altruistic’ dona-
tions between relatives and to the increased risk of vulnerability of patients and donors
(De Jong, 2017). Codes of secrecy and ‘the impunity enjoyed by a professional medi-
cal elite’ are said to impede research into illegal transplants in medical facilities
(Scheper-Hughes, 2004).
Global trends and patterns in the organ trade
The organ trade is fuelled by a worldwide organ scarcity. With the ageing of populations
and the growth in diabetes and vascular diseases, the number of people with organ failure
is growing exponentially. Of all organs, kidneys are in highest demand (Shafran et al.,
2014). At the end of 2016, 191,874 patients were registered on kidney transplant waiting
lists worldwide (Newsletter Transplant, 2017). However, only 62,333 (32 percent)
To continue reading
Request your trial