How Corrupt Governments Make a Killing on Human Organs

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In December, the Council of Europe released a report alleging that Hashim Thaçi, the prime minister of Kosovo, is the leader of a criminal ring that smuggles contraband -- including human organs -- throughout Eastern Europe. While organ-trafficking stories are hardly new, Thaçi's has a bizarre twist: According to the COE, the prime minister used money generated from human organ sales to cement his political power in Kosovo, and he continues to profit from the traffic, along with many members of his Cabinet.

Thaçi's ring traces its roots to the Kosovo war of 1998-1999. At that time, NATO forces shelled the region in an attempt to expel Yugoslavian President Slobodan Milosevic, whose Serbian forces were committing acts of genocide. At the same time, the Kosovo Liberation Army was fighting against the Serbians on the ground. Thaçi rose to power as leader of the "Drenica Group," a prominent part of the KLA.

Consolidation Through Coercion

According to the COE report, while Thaçi owed much of his power to his relationship with the U.S. and other Western powers, he also controlled illegal trade throughout the region. In addition to human trafficking and the sex trade, the Drenica Group sold weapons, narcotics, stolen motor vehicles, cigarettes and other contraband, according to the COE.

As it expanded its smuggling operations into Western Europe, the group consolidated power through assassinations, beatings and other forms of coercion. By mid-1999, the Drenica Group was in charge of Kosovo's construction and fuel industries, and Thaçi had appointed himself prime minister.

At the same time, the COE report asserts, Shaip Muja, a high-level Drenica official, set up a series of detention facilities that were designed to transport captives from the Serbian war front to Tirana, the capital of Albania. In addition to Serbian prisoners of war, the KLA also gathered alleged traitors, including "large numbers of ethnic Albanians, as well as Roma and other minorities."

A Wartime Atrocity, a Peacetime Business

While most of the detention facilities were repurposed farmhouses, at least one was built for the specific purpose of organ trafficking. Located near Tirana, it included what the report describes as "A state-of-the-art reception centre. . . . It was styled as a makeshift operating clinic, and it was the site at which some of the captives held by the KLA members and affiliates had their kidneys removed against their will." These kidneys were then sold "to private overseas clinics as part of the international 'black market' of organ trafficking for transplantation." Many of these allegedly went to Istanbul, where they were used by Yusuf Ercin Sonmez, a Turkish doctor.

After the war, the organ extraction program gained a level of respectability through the development of the Medicus clinic, a hospital located near Pristina, the capital of Kosovo. Dr. Sonmez, who had been barred from practicing medicine in Turkey's public health sector, went to work at the clinic, performing transplants for wealthy German, Polish, Canadian and Israeli patients. Donors came from Russia, Moldova, Kazakhstan and Turkey, where they were solicited with promises of huge payoffs.

In 2008, EULEX, the European Union's legal mission in Kosovo, began an investigation into the clinic for its role in the organ trade. Recently, five doctors were indicted for "trafficking in human organs, organized crime, unlawful exercise of medical activities and abusing official authority." In addition to claims that Medicus was illegally transplanting organs, it also was accused of cheating its donors: After removing their organs, the clinic allegedly refused to pay the donors, transporting them to the airport before they had fully recovered from their surgeries.

In China, Turning Political Prisoners into Profit

Kosovo isn't the only country with an extensive, state-sponsored transplantation program. In China, organs are routinely harvested from condemned political prisoners and are often sold to foreigners for prices far below the transplantation costs in other countries. While China's program doesn't have Kosovo's genocidal component, it is still used as a revenue generator and a means of disposing of enemies of the state.

China has been performing organ transplants since the 1960s, but the roots of its organ trade trace back to the early 1980s. As part of its move away from socialism, the country began slashing health care expenditures. In 1980, China covered 36% of health care costs for the country. By 2005, that number had dropped to 17%. Over the same period, the percentage of health care costs covered out-of-pocket by patients almost tripled, from 20% to 59%.

To make up the difference, hospitals began searching for high-profit operations that could shore up their bottom lines. The military, which is permitted to engage in commerce, also was searching for ways to improve its finances. What resulted was a military/medical collaboration: Many of China's leading transplantation centers were either owned or extensively staffed by the military.

A Prime Source of Healthy Organs

Having developed an extensive transplantation infrastructure, China needed a steady source of organs. It is illegal to transplant organs without a donor's consent in China, but a 1984 law allowed the state to harvest organs from condemned prisoners who agreed to the operation. In the following decades, China developed an extensive prisoner organ harvest industry, offering low-price transplants to both domestic and international patients. In the face of international condemnation, it has developed a more traditional postmortem organ donation program, but the bulk of China's transplanted organs still come from condemned prisoners.

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While Chinese authorities emphasize that prisoner organ donation is voluntary, there is evidence to suggest otherwise. Dr. Wang Guoqi, a Chinese physician who was closely involved with the organ trade, alleged that it was "rife with corruption" and that prisoners often didn't give consent for harvesting. Moreover, he also described brutal transplant conditions, including one incident in which he and several fellow doctors harvested organs from a prisoner who was still alive.

There have also been allegations that China's organ harvesting system is being used as a weapon in its war against Falun Gong, a political and religious group that opposes the Communist government. Falun Gong exhorts its members to refrain from smoking, drinking, premarital sex, homosexuality and drug use, policies that make them prime candidates to be organ donors.

Following mass arrests, many members of Falun Gong refused to identify themselves to captors, fearing that their families would face retribution. Many of these prisoners subsequently "disappeared." According to a report by David Matas, a human rights lawyer, and David Kilgour, a former member of the Canadian parliament, some transplant coordinators have openly admitted that their organs come from Falun Gong prisoners.

State Trade in Human Organs

Like any valuable commodity, the high price of organs has fueled a trade that is often shady and exploitative. Some pundits have argued that the problem could be solved through a program of voluntary organ donation and sale. The libertarian Cato Institute, for example, theorized that if 0.06% of healthy people aged 18 to 65 sold one of their kidneys, there would no longer be a waiting list for the organs.

Outside of China and Kosovo, where the definition of "voluntary donation" is highly questionable, other countries have experimented with organ sales. Some, like India and the Philippines, outlawed the market in legal organ sales after discovering that it was subject to rampant abuse and that many "voluntary donors" were being coerced into selling their organs. Other countries, including Iran, continue to operate legal organ-selling markets, not only allowing citizens to sell organs but flying in donors from other countries such as Jordan.

Unfortunately, the organ donation problem has no clear solution. China's program is morally repugnant, while those of Iran and India are subject to serious corruption. For that matter, even the U.S. system of organ procurement is susceptible to manipulation by extremely wealthy patients, as Steve Jobs's 2009 liver transplant demonstrated.

Ultimately, only one thing about this is certain: State-run organ-transplant programs are a prescription for human rights disasters.
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