International Organ Trafficking: In Brief

International Organ Trafficking: In Brief

International Organ Trafficking: In Brief
December 22, 2021
Congressional Research Service
https://crsreports.congress.gov
R46996

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International Organ Trafficking: In Brief

Contents
Introduction ..................................................................................................................................... 1
Characteristics ................................................................................................................................. 1
International Frameworks ................................................................................................................ 4
U.N. Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially
Women and Children.............................................................................................................. 4
World Health Organization (WHO) Guiding Principles on Human Cell, Tissue, and
Organ Transplantation ............................................................................................................ 5
The Declaration of Istanbul on Organ Trafficking and Transplant Tourism ............................. 6
Regional Approaches ................................................................................................................ 6
Selected U.S. Government Responses ............................................................................................. 6
Combating International Organ Trafficking .............................................................................. 6
Reporting ............................................................................................................................ 6
Sanctions ............................................................................................................................. 7
Investigations and Prosecutions .......................................................................................... 7
Foreign Assistance .............................................................................................................. 7
Congressional Oversight and Selected Relevant Legislation.............................................. 8
Addressing U.S. Citizen Participation in International Organ Trafficking ............................... 9
Issues for Congress .......................................................................................................................... 9
Definitions ................................................................................................................................. 9
Information Gaps .................................................................................................................... 10
Reducing U.S. Demand for Trafficked Organs ........................................................................ 11
Restrictions on U.S.-Funded Medical Training and Sales of Medical Equipment ................... 11
Role of Professional Organizations ......................................................................................... 12

Contacts
Author Information ........................................................................................................................ 12

International Organ Trafficking: In Brief

Introduction
The term organ trafficking is commonly used to refer to a range of criminal activities, including
illegal organ harvesting from a living or dead individual and the illegal sale and transplantation of
human organs. While some experts include forms of enslavement or coercion to obtain an organ
donation in the definition, U.S. government sources typically describe such crimes as trafficking
in persons for the purpose of organ removal. Reflecting concerns over organ trafficking as a
human rights abuse, a profitable transnational crime, and an activity in which U.S. citizens or
businesses may be directly or indirectly complicit, many in Congress have sought to better
understand and address the practice. Through proposed legislation, funding decisions, and
oversight hearings, Congress has identified potential policy tools to address organ trafficking and
has endeavored to identify and change the behavior of actors that may play a role in facilitating
the illegal trade. Congress has also sought to understand organ trafficking’s relationship with
political repression in countries with poor human rights records (see the “Congressional Interest
in Organ Harvesting in China” textbox) and other crimes such as human trafficking.
Organ trafficking may be considered part of a broader market that includes tissues, cells, or other
human body parts or products, referred to by some as the “red market.” Prominent international
legal frameworks, and many national frameworks, including in the United States, prohibit any
sale of human organs (with exceptions for compensation for expenses incurred by organ donors).1
The wide-scale prohibition of organ sales makes organ trafficking unique among other
transnational crimes, because with rare exceptions, there is not a parallel, legal trade in the
commodity.2 Demand for organ transplants that is not met by legal organ donations contributes to
organ trafficking, which may be facilitated by criminal organizations or actors.
Characteristics
As with many clandestine activities, estimating the financial scale of international organ
trafficking is complicated by a lack of information.3 The nongovernmental organization (NGO)
Global Financial Integrity (GFI) estimates that the annual value of organ trafficking globally
ranges from $840 million to upwards of $1.7 billion.4 Transplants may cost a purchaser tens to
hundreds of thousands of dollars, depending on the organ involved, and associated medical care

1 The National Organ and Transplant Act of 1984 (P.L. 98-507) defines human organ as “the human (including fetal)
kidney, liver, heart, lung, pancreas, bone marrow, cornea, eye, bone, and skin or any subpart thereof and any other
human organ (or any subpart thereof, including that derived from a fetus) specified by the Secretary of Health and
Human Services by regulation,” 42 U.S.C. §274e.
2 Iran is reportedly unique in its legal organ sale program, though sales are subject to certain restrictions, and there is
state oversight of the nongovernmental organizations (NGOs) that coordinate sales. Some stakeholders contend that
this program has led to drastic reductions in waitlists for organ transplants in the country, while others argue that the
system preys on the poor, who make up the majority of vendors. See, for example, Saeed Kamali Dehghan, “Kidneys
for Sale: Poor Iranians Compete to Sell Their Organs,” The Guardian, May 27, 2012, and Samuel Howard, “How Iran
Solved Its Kidney Shortage, And We Can Too,” Niskanen Center, September 12, 2018.
3 According to INTERPOL, “The clandestine nature of the crime, combined with a lack of awareness on [trafficking in
human beings for the purpose of organ removal, (THBOR)] by law enforcement agencies and the deficiency of
information sharing channels between the medical and police sectors, have led THBOR to be among the least reported
forms of trafficking worldwide.” INTERPOL, ENACT, Trafficking of Human Beings for the Purpose of Organ
Removal in North and West Africa, July 2021, p. 5.
4 Channing May, Transnational Crime and the Developing World, GFI, March 2017, p. xi.
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and travel.5 Estimates of the number of illegal transplants performed and prices offered for organs
vary. GFI estimates that approximately 12,000 illegal transplants occur each year, around 8,000 of
which are for kidneys, followed by liver, heart, lung, and pancreas.6 GFI estimates that prices paid
to individuals for their organs vary significantly: for kidneys, payments reportedly range from
hundreds of dollars to individuals from less developed countries, to up to $20,000-$30,000 in
more developed countries. Some individuals may not receive any payment for an organ or may
receive less than originally agreed. Reports also describe individuals who provide organs and
subsequently incur significant medical costs or experience a loss of livelihood due to botched
surgeries or unanticipated residual effects.7 According to GFI analysis, markups for the recipients
are often 500%-1,900%, with organs costing the recipient between $100,000 and $237,000.8
Individuals who sell or otherwise provide organs for the illegal trade may be
 deceased persons who did not consent to the use of their organs, or individuals
who are killed for their organs;
 living persons who do not consent to the use or harvesting of their organs or are
coerced, including by threat of force or offers for payment that take advantage of
economic duress; or
 living persons who consent to sell an organ (in some cases, such individuals may
be misled about the nature of the medical procedure and recovery).9
Considerations of victimhood and culpability are complex, in part because even when individuals
consent to selling an organ, the sale is typically considered illegal pursuant to national laws.10
Some observers have acknowledged that although sellers frequently make the decision to sell an
organ under duress, they contribute to the existence of the black market, and are usually involved
in criminal activity.11 Organ trafficking may be facilitated by corrupt officials or criminal groups
and may include brokers or other middlemen who connect individuals providing the organ with
prospective recipients, negotiate the price, and identify medical facilities where the transplant can
occur. Organ recipients, along with the medical professionals involved in their procedure and
aftercare, may or may not be aware of the circumstances surrounding an organ transplant.

5 ACAMS Today, “Organ Trafficking: The Unseen Form of Human Trafficking” June 26, 2018; Yosuke Shimazono,
“The State of the International Organ Trade: A Provisional Picture Based on Integration of Available Information,”
Bulletin of the World Health Organization, vol. 85, no. 12 (December 2007), pp. 955-962; Steve Farrer, “Why Illegal
Trafficking in Organs is Growing Fast ... But Few are Talking About It,” Financial Crime News, June 16, 2020.
6 According to GFI, “It is estimated that up to 10 percent of all transplants rely on organs that have been illicitly
acquired. “The GFI report relied on organ donation and transplantation statistics for 2014 from the Global Observatory
on Donation and Transplantation. See explanation in Channing May, Transnational Crime and the Developing World,
Global Financial Integrity (GFI), March 2017, p. 29.
7 INTERPOL, ENACT, Trafficking of Human Beings for the purpose of Organ Removal in North and West Africa, July
2021, p. 14.
8 Channing May, Transnational Crime and the Developing World, Global Financial Integrity (GFI), March 2017, p. 30.
9 U.N. Office on Drugs and Crime (UNODC), Trafficking in Persons for the Purpose of Organ Removal, Assessment
Toolkit, 2015, p. 16.
10 See discussion of the term “victim-donor” in INTERPOL, ENACT, Trafficking of Human Beings for the purpose of
Organ Removal in North and West Africa, July 2021, p. 14.
11 In a statement about the U.S. vote on a U.N. General Assembly resolution on organ trafficking, the U.S. Mission to
the U.N. stated, “Although individuals who sell their organs can be desperate, they contribute to a black market
industry that jeopardizes the health of organ sellers and recipients. In most circumstances, people trafficking in organs
are engaged in a crime. As such, States do not have an international law obligation to protect them.” U.S. Mission to
the United Nations, “Explanation of Vote on a Resolution on Organ Trafficking,” November 17, 2020.
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Although media and public attention has at times focused on allegations of forced organ
harvesting of certain repressed minority groups, such as those in China (see the “Congressional
Interest in Organ Harvesting in China” textbox below) experts suggest that many cases stem from
economic motivations. Some research indicates that cases frequently involve young men from
developing countries who are financially motivated to sell an organ, while organ purchasers
appear to be primarily from more developed countries.12 Poverty and imperfect access to
information are commonly cited as key vulnerabilities for individuals who decide to sell an organ.
Some research suggests that migrants are particularly vulnerable, as they may have little money,
may not be familiar with regulations, and may be easily manipulated by smugglers or
traffickers.13 Transplant procedures appear to typically occur in the country of the vendor or in a
third country, to which the vendor and purchaser both travel, and appear to frequently be
performed at medical facilities that also perform legal transplants. Those involved in organ
trafficking may take advantage of weak rule of law in such locations.
Organ trafficking may also occur within conflict settings or among displaced populations. For
example, several investigatory bodies have found that ethnic minorities were killed for their
organs on a limited scale, as authorized by officials in the Kosovo Liberation Army, during the
1998-1999 Kosovo War.14 Also, in 2017, the U.S. government’s Joint Counterterrorism
Assessment Team referenced evidence that the Islamic State appeared to have sold the organs of
its captives through regional criminal networks.15 Some scholars have identified likely cases of
organ trafficking or trafficking in persons for organ removal among Syrian refugees in Lebanon
and Sub-Saharan African refugees in North Africa, among other contexts.16
Key Terms
Organ Trafficking: According to definitions adopted by the U.S. Organ Procurement and Transplantation
Network (OPTN) and the United Network for Organ Sharing (UNOS), organ trafficking is “the recruitment,
transport, transfer, harboring or receipt of living or deceased persons or their organs by means of the threat or
use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a
position of vulnerability, or of the giving to, or the receiving by, a third party of payments or benefits to achieve
the transfer of control over the potential donor, for the purpose of exploitation by the removal of organs for
transplantation.”17 These definitions are informed by those adopted at the 2018 Istanbul Conference (see “The
Declaration of Istanbul on Organ Trafficking and Transplant Tourism” section).

12 A 2007 WHO Bulletin article cited reports that Australia, Canada, Israel, Japan, Oman, Saudi Arabia, and the United
States were major “organ-importing countries” (defined as countries of origin of the patients going overseas to
purchase organs for transplantation). The article cited reports that China, India, Pakistan, Bolivia, Brazil, Iraq, Israel,
the Republic of Moldova, Peru, and Turkey were major “organ-exporting countries” (defined as countries where organs
from local donors are regularly transplanted to foreigners through sale and purchase). Yosuke Shimazono, “The State
of the International Organ Trade: a Provisional Picture Based on Integration of Available Information,” Bulletin of the
World Health Organization, vol. 85, no. 12 (December 2007), pp. 955-962.
13 Juan Gonzalez, Ignacio Garijo, and Alfonso Sanchez, “Organ Trafficking and Migration: A Bibliometric Analysis of
an Untold Story,” International Journal of Environmental Research and Public Health, vol. 17, no. 9, May 5 2020.
14 Julia Fioretti, “Inquiry Finds ‘Indications’ of Organ Harvesting in Kosovo Conflict,” Reuters, July 29, 2014; Dick
Marty, Inhuman Treatment of People and Illicit Trafficking in Human Organs in Kosovo, E.U. Parliamentary
Assembly, Committee on Legal Affairs and Human Rights, Doc. 12462, January 7, 2011.
15 Joint Counterterrorism Assessment Team, International Partnerships Among Public Health, Private Sector, and Law
Enforcement Necessary To Mitigate ISIS’s Organ Harvesting for Terrorist Funding, May 11, 2017.
16 UNODC, Global Report on Trafficking in Persons 2020, February 2, 2021, p. 36; INTERPOL, ENACT, Trafficking
of Human Beings for the purpose of Organ Removal in North and West Africa, July 2021, p. 26.
17 OPTN is a public-private partnership that links various actors involved in the U.S. organ donation and transplantation
system. UNOS, a nongovernmental organization (NGO), was first awarded the OPTN contract under the U.S.
Department of Health and Human Services (HHS) in 1986 and continues to administer the OPTN. OPTN, “Board
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International Organ Trafficking: In Brief

Organ Harvesting: Organ harvesting, or organ procurement, refers to the surgical procedure that removes an
organ from an individual, typically for transplantation. In some cases, the procedure may be forced or coerced.
Trafficking in Persons for the Purpose of Organ Removal: According to U.N. and U.S. government
sources, trafficking in persons for the purpose of organ removal is distinct from the broader crime of organ
trafficking in its focus on crimes perpetrated against the trafficking victim, rather than the il egal sale and
transplantation. In comments made in a hearing before the House Foreign Affairs Committee in 2010, Luis C. de
Baca, then-Ambassador-at-Large to Monitor and Combat Trafficking in Persons, stated that situations in which
“somebody was being held in servitude to have parts harvested … would be a trafficking case…. The freedom
being denied them for the harvesting, that is at the heart of the distinction that we make. It is the difference
between slavery and il icit transport of a piece of contraband.”18 U.N. sources have articulated similar findings.19
Organ removal is not explicitly included in the Trafficking Victims Protection Act (TVPA, P.L. 106-386) definition
of severe forms of trafficking in persons, which includes forced labor and forced sexual exploitation. Annual State
Department Trafficking in Persons Reports (TIP reports) have cited instances of “trafficking [in persons] for the
purposes of organ removal,” while stating that organ trafficking is not a form of trafficking in persons. The 2017
TIP Report stated that strong anti-trafficking laws include “a clear definition of human trafficking that describes the
acts, means, and ends, as distinct from related crimes—such as migrant smuggling, prostitution, kidnapping, organ
trafficking, or il egal adoption.”20
Transplant Commercialism, Travel for Transplantation, and Transplant Tourism: According to the
OPTN/UNOS Board of Directors, transplant commercialism “is a policy or practice in which an organ is treated
as a commodity, including by being bought or sold or used for material gain. Travel for transplantation is the
movement of organs, donors, recipients or transplant professionals across jurisdictional borders for
transplantation purposes. Travel for transplantation becomes transplant tourism if it involves organ trafficking
and/or transplant commercialism or if the resources (organs, professionals and transplant centers) devoted to
providing transplants to patients from outside a country undermine the country’s ability to provide transplant
services for its own population.”21
International Frameworks
Several international frameworks provide definitions and descriptions of organ trafficking or
related activities, guidelines for ethical and legal organ transplants, and law enforcement priorities
for combating the illegal trade.
U.N. Protocol to Prevent, Suppress and Punish Trafficking
in Persons, Especially Women and Children
The U.N. Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women
and Children, supplementing the U.N. Convention against Transnational Organized Crime (U.N.

Addresses International Definitions of Transplant Tourism,” March 3, 2009, at https://optn.transplant.hrsa.gov/news/
board-addresses-international-definitions-of-transplant-tourism/; UNOS, “United Network for Organ Sharing FAQs,”
at https://unos.org/about/faqs/.
18 U.S. Congress, House Foreign Affairs Committee, Out of the Shadows: The Global Fight Against Human
Trafficking, 111th Cong., 2nd sess., September 30, 2010.
19 “In the case of trafficking in organs, the object of the crime is the organ, whereas in the case of human trafficking for
organ removal, the object of the crime is the person. Trafficking in organs may have its origin in cases of human
trafficking for organ removal, but organ trafficking will also frequently occur with no link to a case of human
trafficking.” UNODC, Trafficking in Persons for the Purpose of Organ Removal, Assessment Toolkit, 2015, p. 17;
Council of Europe and U.N., Trafficking in Organs, Tissues, and Cells and Trafficking in Human Beings for the
Purpose of the Removal of Organs, 2009, pp. 11, 93.
20 Department of State, Office to Monitor and Combat Trafficking in Persons, 2017 TIP Report, June 2017, p. 2.
21 OPTN, “Board Addresses International Definitions of Transplant Tourism,” March 3, 2009, at
https://optn.transplant.hrsa.gov/news/board-addresses-international-definitions-of-transplant-tourism/.
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TIP Protocol, also known as the Palermo Protocol), entered into force on September 29, 2003.
The protocol includes “the removal of organs” as a type of exploitation in its definition of
trafficking in persons.22
In providing advice and consent to the U.N. TIP Protocol in 2005, the U.S. Senate included a
reservation stating that U.S. federal criminal law was “broadly effective” for addressing activities
listed in the protocol and a declaration that U.S. law satisfied the obligations of the protocol and
that the United States did not intend to enact new legislation to fulfill protocol obligations.23 In
2010, then-TIP Ambassador C. de Baca explained the U.S. interpretation of the organ-related
provisions: “The United States has interpreted the organ trafficking portion of the Palermo
Protocol to criminalize those who would traffic a person in order to harvest their organ. Some
countries are looking at it more expansively and looking at the trafficking in the organ itself.”24
World Health Organization (WHO) Guiding Principles on Human
Cell, Tissue, and Organ Transplantation
First endorsed by the WHO’s decision-making body, the World Health Assembly (WHA), in
1991, and updated in 2010, the WHO Guiding Principles on Human Cell, Tissue, and Organ
Transplantation (WHO Guiding Principles) “are intended to provide an orderly, ethical and
acceptable framework for the acquisition and transplantation of human cells, tissues and organs
for therapeutic purposes.”25 The preamble references the growth of “commercial traffic in human
organs” and “the related traffic in human beings.” Several guiding principles relate to organ
trafficking, including provisions stating that
 live donations should occur with the donor’s informed and voluntary consent and
that donors should be provided professional medical care (Guiding Principle 3),
 cells, tissues, and organs should be donated, not sold, and that sales should be
prohibited, though compensation for donations is permitted (Guiding Principle
5), and
 health professionals should not engage in, or provide insurance coverage for,
transplantations that involved “exploitation or coercion of, or payment to, the
donor or the next of kin of a deceased donor” (Guiding Principle 7).
Furthermore, a 2004 WHA resolution urges member states to “take measures to protect the
poorest and vulnerable groups from ‘transplant tourism’ and the sale of tissues and organs.”26

22 “The recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or
other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or
of the giving or receiving of payments or benefits to achieve the consent of a person having control over another
person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of
others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude
or the removal of organs.” U.N. Office of the High Commissioner for Human Rights, Protocol to Prevent, Suppress
and Punish Trafficking in Persons Especially Women and Children, supplementing the United Nations Convention
against Transnational Organized Crime, Article 3 Use of Terms.
23 Ex. Rept. 109-4 U.N. Convention Against Transnational Organized Crime (Treaty Doc. 108-16).
24 According to Ambassador C. de Baca, “It is the difference between slavery and illicit transport of a piece of
contraband.” U.S. Congress, House Foreign Affairs Committee, Out of the Shadows: The Global Fight Against Human
Trafficking, hearings, 111th Congress, 2nd sess., September 30, 2010.
25 WHO, WHO Guiding Principles on Human Cell, Tissue, and Organ Transplantation, 2010.
26 WHA, Human Organ and Tissue Transplantation, WHA57.18, May, 22, 2004.
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The Declaration of Istanbul on Organ Trafficking and
Transplant Tourism
The Declaration of Istanbul on Organ Trafficking and Transplant Tourism (Istanbul Declaration)
arose from the International Summit on Transplant Tourism and Organ Trafficking convened by
the Transplantation Society and International Society of Nephrology from April 30 to May 2,
2008. The summit sought to address “the urgent and growing problems of organ sales, transplant
tourism and trafficking in organ donors,” and the resulting Istanbul Declaration included
principles and proposals relating to strengthening legal and ethical organ transplants and
preventing organ trafficking, transplant commercialism, and transplant tourism.27 Provisions
included calls for countries to maximize the number of organs available for transplantation and
prohibit advertising for organ trafficking. The declaration was updated in 2018.28
Regional Approaches
Some regional organizations have established frameworks relating to organ trafficking. For
example, the Council of Europe’s Convention against Trafficking in Human Organs, which
entered into force in March 2018, sought to “prevent and combat the trafficking in human
organs,” protect victims, and facilitate national and international cooperation.29 The convention is
open to non-European Union (EU) member states. The Pan American Health Organization
(PAHO) and WHO Regional Office for the Americas’ Strategy and Plan of Action on Donation
and Equitable Access to Organ, Tissue, and Cell Transplants 2019-2030 includes indicators
relating to national standards to address organ trafficking and transplant tourism. The strategy
asserts that “a high poverty index, and low educational levels predispose the Region to the risk of
organ trafficking.”30
Selected U.S. Government Responses
Combating International Organ Trafficking
The U.S. government employs various tools to counter the illegal, international trade in organs
and associated crimes.
Reporting
The State Department’s annual Trafficking in Persons reports (TIP Reports) and Country Reports
on Human Rights (Human Rights Reports) have discussed organ trafficking in specific
countries.31 The 2019 TIP Report, for instance, stated that in Mozambique, persons with albinism

27 Participants in the International Summit on Transplant Tourism and Organ Trafficking, “The Declaration of Istanbul
on Organ Trafficking and Transplant Tourism,” Clinical Journal of the American Society of Nephrology, vol. 3, no. 5,
(2008), pp. 1227-1231.
28 The updated version added a definition of trafficking in persons for the purpose of organ removal, in addition to
other changes. The Transplantation Society and the International Society of Nephrology, The Declaration of Istanbul
on Organ Trafficking and Transplant Tourism 2018 Edition, 2018.
29 Council of Europe, Convention Against Trafficking in Human Organs, Treaty Series no. 216, March 25, 2015.
30 PAHO and WHO Regional Office for the Americas, Strategy and Plan of Action on Donation and Equitable Access
to Organ, Tissue, and Cell Transplants 2019-2030, CD57/11, August 19, 2019.
31 Both reports are statutory requirements. For more information on these reports, see CRS Report R44953, The State
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are vulnerable to trafficking for the purpose of organ removal, and the 2018 TIP Report stated that
in Vietnam, “Adults are also reportedly subjected to trafficking for the purpose of organ
removal.” The 2020 Human Rights Report on China cited accusations of involuntary organ
harvesting in China.32
Sanctions
In at least one case, the Department of the Treasury’s Office of Foreign Assets Control (OFAC)
has sanctioned an individual for organ trafficking activities. According to a December 2017 press
release, OFAC sanctioned Mukhtar Hamid Shah, “a Pakistani surgeon specializing in kidney
transplants who Pakistani police believe to be involved in kidnapping, wrongful confinement, and
the removal of and trafficking in human organs.”33 OFAC sanctioned Shah through the Global
Magnitsky sanctions program, which targets human rights abusers and corrupt actors.34
Investigations and Prosecutions
Law enforcement agencies and the U.S. Department of Justice (DOJ) may in some cases pursue
charges against individuals for crimes relating to international organ trafficking. On July 11,
2012, Isaac Rosenbaum, an Israeli citizen, was convicted on three counts for acquiring, receiving,
and otherwise transferring human organs for valuable consideration for use in human
transplantation, and on one count of conspiracy.35 According to DOJ press releases, Rosenbaum
typically facilitated sales of organs from Israeli nationals who would travel to the United States
for transplantation of their organs to American recipients. Rosenbaum reportedly admitted to
fabricating cover stories to mislead U.S. medical practitioners about the agreements, making them
believe the organs had been genuinely donated.36 The Rosenbaum case was the first federal
conviction for illegal kidney transplants under the National Organ Transplant Act.37
Foreign Assistance
Some U.S. foreign assistance efforts address organ trafficking and related crimes. In some cases,
such assistance has included activities within projects focused on human trafficking. For example,
according to the U.S. Agency for International Development (USAID), a Combating Trafficking

Department’s Trafficking in Persons Report: Scope, Aid Restrictions, and Methodology, by Michael A. Weber,
Katarina C. O'Regan, and Liana W. Rosen, and CRS In Focus IF10795, Global Human Rights: The Department of
State’s Country Reports on Human Rights Practices, by Michael A. Weber.
32 U.S. Department of State, Country Reports on Human Rights Practices: China (Includes Hong Kong, Macau, and
Tibet, March 30, 2021.
33 U.S. Department of the Treasury, “United States Sanctions Human Rights Abusers and Corrupt Actors Across the
Globe,” press release, December 21, 2017.
34 Congress authorized Global Magnitsky sanctions under the Global Magnitsky Human Rights Accountability Act
(Title XII, Subtitle F of P.L. 114-328). See CRS Report R46981, The Global Magnitsky Human Rights Accountability
Act: Scope, Implementation, and Considerations for Congress, by Michael A. Weber.
35 Per the U.S. District Court indictment, Rosenbaum was charged pursuant to 18 U.S.C. §371, conspiracy to defraud
the United States, and 42 U.S.C. §274e, prohibition of organ purchases and was subject to criminal forfeiture under 18
U.S.C. §982. United States of America v. Levy Lzhak Rosenbaum, Crim. No. 11, U.S. District Court, District of New
Jersey (2011).
36 DOJ, “First Federal Defendant Convicted For Profiting From Illegal Kidney Transplants Sentenced To Prison,” press
release, July 11, 2012; DOJ, “Brooklyn Man Pleads Guilty In First Ever Federal Conviction For Brokering Illegal
Kidney Transplants For Profit,” press release, October 27, 2011.
37 According to DOJ, there are no DOJ records of other cases being filed pursuant to the statute. CRS correspondence
with DOJ, October 18, 2021. Individuals have also been charged for other offenses relating to organ trafficking.
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in Persons project in Nepal “helped support 59 convictions made against TIP perpetrators,
including landmark convictions for organ trafficking.”38 Other foreign assistance efforts may
address contexts that facilitate organ trafficking indirectly, such as by supporting economic
growth and livelihoods, strengthening health systems, or improving law enforcement capabilities.
Congressional Oversight and Selected Relevant Legislation
Congress has held hearings on the topic of organ trafficking, often in relation to alleged abuses in
China, and has introduced legislation related to the crime.39 In the 117th Congress, the Stop
Predatory Organ Trafficking Act (H.R. 1434) and the Stop Forced Organ Trafficking Act (H.R.
1592 and S. 602) would, in different forms, authorize various visa and passport restrictions on
individuals identified as being involved in organ trafficking, and require reporting by the State
Department on organ trafficking, in addition to other provisions. A discussion draft before the
House Committee on Financial Services, the Organ Trafficking and SARs Form Act, would direct
Treasury’s Financial Crimes Enforcement Network to inform financial institutions that organ
trafficking is considered a type of human trafficking for the purpose of filing a Suspicious
Activity Report (SAR).40 Legislation introduced in previous Congresses has also sought to
address organ trafficking, such as the STOP Organ Trafficking Act (H.R. 2121) in the 116th
Congress, which included passport restrictions and would have amended the TVPA to include
“trafficking in persons for purposes of the removal of organs” to the definition of severe forms of
trafficking in persons, as well as other provisions.
Congressional Interest in Alleged Organ Harvesting in China
Considerable congressional interest in international organ trafficking has focused on allegations of state-sponsored
forced organ harvesting in the People’s Republic of China (PRC), including of incarcerated persons and members
of certain persecuted groups. Several hearings have specifically focused on China, as have certain resolutions, such
as H.Res. 343 in the 114th Congress and S.Res. 274 in the 116th, which referenced allegations of nonconsenting
organ harvesting from Falun Gong practitioners in China.
The extent of organ trafficking-related activities in China is unknown, and characterizations of official policy and
practices differ substantially. In 2015, the PRC government announced it would end the policy of harvesting organs
from executed prisoners in favor of a voluntary transplant program. China’s first Civil Code, which took effect on
January 1, 2021, contained provisions relating to the prohibition of human organ sales and donations spurred by
force or coercion.41 Many human rights advocates maintain that such activities continue, however, and that, in
some cases, individuals from marginalized groups have had organs harvested.42 PRC officials have typically denied

38 USAID, Democracy and Governance Program Combating Trafficking in Persons, Fact Sheet, July 2015.
39 Hearings have included those before the Tom Lantos Human Rights Commission (January 2012), the Subcommittee
on Oversight and Investigations and the Subcommittee on Africa, Global Health, and Human Rights of the House
Committee on Foreign Affairs (September 2012), and the Subcommittee on Africa, Global Health, Global Human
Rights, and International Organizations and the Subcommittee on Europe, Eurasia, and Emerging Threats of the House
Committee on Foreign Affairs (June 2016).
40 For more information on SARs, see CRS In Focus IF11061, Targeting Illicit Finance: The Financial Crimes
Enforcement Network’s “Financial Institution Advisory Program,” by Liana W. Rosen and Rena S. Miller. See The
Organ Trafficking ad SARs Form Act, at https://financialservices.house.gov/uploadedfiles/3.25_-_bills-117pih-
organtraffickingandsarsformact.pdf.
41 Civil Code of the People’s Republic of China, adopted May 28, 2020, Articles 1006 and 1007, at
http://www.npc.gov.cn/englishnpc/c23934/202012/f627aa3a4651475db936899d69419d1e/files/
47c16489e186437eab3244495cb47d66.pdf.
42 See, for example, U.N. Office of the High Commissioner for Human Rights, “China: U.N. Human Rights Experts
Alarmed by ‘Organ Harvesting,’ allegations,” June 14, 2021, at https://www.ohchr.org/EN/NewsEvents/Pages/
DisplayNews.aspx?NewsID=27167, which referenced “reports of alleged ‘organ harvesting’ targeting minorities,
including Falun Gong practitioners, Uyghurs, Tibetans, Muslims and Christians, in detention in China,” and “The
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such claims, arguing that they are fabrications pushed by members of the Falun Gong, a spiritual exercise
movement subject to repression by Chinese authorities.43 The 2020 State Department Human Rights Report on
China stated that there was no direct evidence of state-sponsored forced organ harvesting, but referenced
accusations that the Chinese government was “forcibly harvesting organs from prisoners of conscience, including
religious and spiritual adherents such as Falun Gong practitioners and Muslim detainees in Xinjiang.”44
Addressing U.S. Citizen Participation in International
Organ Trafficking
The U.S. government seeks to improve domestic organ transplant donations and to make citizens
aware of organ trafficking risks. OPTN, operated under contract with the Department of Health
and Human Services, seeks to increase the number of legal organ transplants in the United States,
in part by improving the electronic matching system and increasing education about donor
safety.45 The OPTN/UNOS Board of Directors resolved in 2006 that it was “strongly opposed to
practices in which patients in need of transplantation travel abroad to purchase an organ in
exploitive situations.”46 The Centers for Disease Control and Prevention (CDC) 2020 Yellow
Book: Health Information for International Travel references the WHA Resolution 57.18, the
Istanbul Declaration, and the WHO Guiding Principles and cautions that transplant tourists may
receive fewer immunosuppressive drugs, among other medical issues.47
Issues for Congress
Definitions
Numerous U.S., intergovernmental, and civil society sources acknowledge that the terms and
definitions pertaining to organ trafficking and related crimes are frequently confused or
mischaracterized.48 Unlike the clarifications made between organ trafficking and trafficking in
persons in State Department TIP reports, some U.S. government documents do not consistently
differentiate between the two.49 Additionally, different international conceptions as to whether

Independent Tribunal into Forced Organ Harvesting from Prisoners of Conscience in China, Judgement, March 1,
2020. The Independent Tribunal was initiated by the Australia-based NGO International Coalition to End Transplant
Abuse in China.
43 See Matthew Pennington, “House Panel Calls on China to End Organ Harvesting,” Associated Press, July 30, 2014
and Willa Wi and Honey Tsang, “Organ Harvesting Rumors Slammed,” China Daily, August 19, 2016. For more
information on the Falun Gong and other human rights issues in China, see CRS Report R46750, Human Rights in
China and U.S. Policy: Issues for the 117th Congress, by Thomas Lum and Michael A. Weber.
44 U.S. Department of State, Country Reports on Human Rights Practices: China (Includes Hong Kong, Macau, and
Tibet, March 30, 2021.
45 OPTN, “Goal 1 Increase the Number of Transplants,” at https://optn.transplant.hrsa.gov/about/strategic-plan/goal-1/.
46 OPTN, “Board Opposes Transplant Tourism,” June 30, 2006, at https://optn.transplant.hrsa.gov/news/board-opposes-
transplant-tourism/.
47 Isaac Benowitz and Joanna Gaines, Yellow Book Health Information for International Travel, CDC, “Chapter 9
Travel for Work & Other Reasons: Medical Tourism,” 2020.
48 According to the UNODC, referencing the joint Council of Europe and U.N. study from 2009: “Trafficking in organs
and trafficking in persons for organ removal are different crimes, though frequently confused in public debate and
among the legal and scientific communities.” UNODC Trafficking in Persons for the Purpose of Organ Removal,
Assessment Toolkit, 2015, p. 17.
49 A USAID factsheet, for example, lists “organ trafficking” as an emerging trend of human trafficking in Nepal.
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organ trafficking is a form of human trafficking may complicate U.S. efforts to counter organ
trafficking-related crimes internationally. According to former TIP Ambassador C. de Baca,
definitional questions have arisen during State Department evaluations of countries’ efforts to
combat human trafficking.50
Some observers have suggested that unclear terms and definitions have impeded robust
international efforts to counter organ trafficking. The 2009 Council of Europe and U.N. study
found that consensus on definitions was important to effectively enforce relevant prohibitions,
and emphasized that “it is important to achieve international agreement on precisely why
particular types of conduct and practices are unacceptable.”51 Other researchers have called for a
more sophisticated understanding of how transplant commercialism relates to trafficking in
persons for organ removal, arguing that the nuances of vulnerability and coercion are lost when
individuals who provide organs are seen as victims only if they have been trafficked.52 Questions
also exist about the grouping of organs, tissues, and cells in frameworks to address the illegal
trade. For example, human tissues that do not require continuous blood circulation can be
preserved for longer periods, so the nature of illegal harvesting and transplantation and the
demand for illegal transplants may differ from that of vital organs.53 Some observers have called
for the development of a new intergovernmental agreement on organ trafficking, which could
clarify definitions and improve global coordination to address the practice. 54
As mentioned above, recently introduced legislation would amend the U.S. definition of
trafficking in persons to explicitly include organ trafficking-related crimes, or would clarify that
organ trafficking should be included as human trafficking for certain reporting purposes. Through
these provisions or others, Congress may seek to refine definitions related to organ trafficking or
advocate for increased international consensus on how to address it.
Information Gaps
The lack of information on global organ trafficking is a key challenge. Gathering information on
specific cases is difficult because of the covert nature of the crime and, in some cases, because of
doctor-patient confidentiality, which may prevent clinicians from reporting patients who disclose
their intentions to travel internationally for an organ transplant or who seek follow-up care upon
their return.55 Many activists and experts advocate for increased information gathering or

USAID, Democracy and Governance Program Combating Trafficking in Persons, Fact Sheet, July 2015.
50 “We have tried to explain to other countries, when they proffer their organ trafficking policy as something that meets
our minimum standards from the TVPA or the Palermo Protocol, the difference between that thing, the liver or the
kidney, what have you, and the person whose freedom is being denied them for the harvesting, that that is at the heart
of the distinction that we make.” U.S. Congress, House Foreign Affairs Committee, Out of the Shadows: The Global
Fight Against Human Trafficking, hearings, 111th Congress, 2nd sess., September 30, 2010.
51 Council of Europe and U.N., Trafficking in Organs, Tissues, and Cells and Trafficking in Human Beings for the
Purpose of the Removal of Organs, 2009, p. 96.
52 See Seán Columb et al., “Re-Conceptualizing the Organ Trade: Separating ‘Trafficking’ from ‘Trade’ and the
Implications for Law and Policy,” Transplant International, vol. 20, no. 2, February 2017, pp. 209-213.
53 See discussion of corneas in U.S. Congress, Organ Harvesting: an Examination of a Brutal Practice, June 23, 2016.
54 Vladimir Makei, “Trafficking for Human Organs,” Forced Migration Review, May 2015, pp. 91-92.
55 For discussions of doctor-patient confidentiality and its relevance to the illegal trade in organs, see Frederike
Ambagtsheer et al., “Personal Viewpoint: Reporting Organ Trafficking Networks: A Survey-Based Plea to Breach the
Secrecy Oath,” American Journal of Transplantation, vol. 15, 2015, pp. 1759-1767; Timothy Caulfield et al.,
“Trafficking in Human Beings for the Purpose of Organ Removal and the Ethical and Legal Obligations of Healthcare
Providers,” Transplantation Direct, vol. 2, no. 2, February 2016.
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reporting on organ trafficking and related crimes.56 Some proposed legislation, such as the Stop
Forced Organ Trafficking Act (H.R. 1592 and S. 602), would require reports on global trafficking
in organs. Congress may consider the value of such reporting requirements and the capacity of
State Department offices and other government entities to measure or monitor organ trafficking.
Reducing U.S. Demand for Trafficked Organs
Given policymakers’ concerns over Americans pursuing illegally sold organs abroad, Congress
may consider approaches to reducing U.S. demand. By many accounts, the United States ranks as
one of the top countries for organ donation; however, approximately 107,000 people are
reportedly on the waiting list for a lifesaving organ transplant.57 Certain efforts have sought to
strengthen the U.S. domestic organ transplant donation system. For example, in July 2019,
Executive Order (E.O.) 13879 called for “a regulation to remove financial barriers to living organ
donation.”58 A final rule was subsequently issued by the Health Resources and Services
Administration (HRSA) in September 2020, which added lost wages and child-care and elder-
care expenses as reimbursable expenses for living organ donors.59 Other proposals to increase
U.S. organ donation include improving technology used by hospitals, and adopting opt-out
frameworks rather than opt-in, where registration as an organ donor is automatic.60 Some
stakeholders have proposed addressing health conditions—such as tobacco use and obesity—that
may limit the number of viable donors, increase the need for donations, and complicate recovery
after a transplant.61 When considering ways to diminish U.S. participation in international organ
trafficking, Congress may seek to understand the potential costs and benefits of such proposals.
Congress may also seek to increase awareness of the risks of transplant tourism.
Restrictions on U.S.-Funded Medical Training and Sales of
Medical Equipment
Some proposals to address international organ trafficking have focused on restricting the
international sale of medical equipment that could be used for organ transplantation and U.S.
training of foreign medical personnel who might use such skills to engage in organ trafficking.
The Stop Forced Organ Trafficking Act (H.R. 1592 and S. 602) would require a report on U.S.
medical and educational institutions where organ transplant surgeons from Tier 3 countries (the
worst performing countries for organ trafficking as defined by the act) are trained. As proposed,
the bill would prohibit the export from the United States of “a device that is intended for use in
organ transplant surgery” to entities identified in the required report as being “responsible for

56 See request for organ-related crime coverage in annual State Department TIP reports in U.S. Congress, Organ
Harvesting: an Examination of a Brutal Practice, June 23, 2016.
57 U.S. Health Resources & Services Administration, “Organ Donation Statistics,” October 2021, at
https://www.organdonor.gov/learn/organ-donation-statistics.
58 E.O. 13879, “Advancing American Kidney Health,” 84 Federal Register 33817, July 15, 2019.
59 HRSA, Health and Human Services Department, “Removing Financial Disincentives to Living Organ Donation,” 85
Federal Register 59438, September 22, 2020.
60 See UNOS, 5 Ways to Improve the U.S. Organ Donation and Transplant System, December 5, 2020; Nicole Moore,
“How Opt-Out Donation Could Affect U.S. Waiting Lists,” University of Michigan Health Lab, October 25, 2019.
61 See, for example, National Kidney Foundation, “Obesity Reduces Organ Donor Pool,” May 10, 2012, at
https://www.kidney.org/news/newsroom/nr/Obesity-Reduces-Organ-Donor-Pool and Jonathan Heldt et al., “Donor
Smoking Negatively Affects Donor and Recipient Renal Function following Living Donor Nephrectomy,” Advances in
Urology, vol. 11, September 6, 2011.
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forced organ harvesting or trafficking in persons for purposes of the removal of organs.”62 Many
human rights advocates have heralded the proposals, though some observers have cautioned that
such restrictions will only be effective if other countries enact similar export prohibitions.63
Congress may consider the impact of such restrictions on U.S. educational institutions and
companies, the potential or likely effects on foreign medical institutions, and the likelihood of
other countries enacting similar restrictions (potentially as a result of U.S. advocacy).
Role of Professional Organizations
Given the role of medical professionals in international organ trafficking, some observers have
suggested that professional organizations can play a role in countering the illicit trade. Such
advocates say that rejecting clinicians from conferences or publications if they are involved in
organ transplant procedures or research in countries known to facilitate organ trafficking could
send a powerful signal that such activities are unacceptable.64 According to testimony by a human
rights lawyer for a 2016 hearing before the House Foreign Affairs Committee, the Transplantation
Society, a Canada-based NGO focused on transplant-related research and education, rejected 35
papers from China for its 2014 international conference and declined an invitation to attend a
conference in China, in protest of organ harvesting practices there.65 Others, however, contend
that participation in research and international conferences facilitate collaboration and may
provide opportunities to educate medical practitioners about organ trafficking risks. For example,
in 2017, Vatican officials reportedly defended inviting the head of China’s National Organ
Transplant Committee to participate in a conference on organ trafficking, saying they hoped that
the event would encourage change if organ trafficking was still occurring.66 Congress may
consider bringing public attention and oversight to the decisions of U.S.-based professional
organizations regarding work with entities associated with organ trafficking.

Author Information

Katarina C. O'Regan

Analyst in Foreign Policy

62 These prohibitions would be carried out in coordination with the Secretary of Commerce and notwithstanding any
other provision of the introduced legislation.
63 See, for example, statements by Ethan Gutmann in LiCAS News, “U.S. Lawmakers to ‘Hold Beijing Accountable’
Over Forced Organ Harvesting,” December 18, 2020.
64 See, for example, A.L. Caplan et al., “Time For a Boycott of Chinese Science and Medicine Pertaining to Organ
Transplantation,” The Lancet, vol. 378, no. 9798, October 1, 2011; Wesley Smith, “Fifteen Science Papers Retracted
Over China Illegal Organ Harvesting,” National Review, August 18, 2019.
65 The lawyer, David Matas, stated that these actions “had an impact in China” and that “peer pressure is useful as
leverage and it has worked in the past.” U.S. Congress, Organ Harvesting: an Examination of a Brutal Practice,
hearings, June 23, 2016.
66 B.B.C., “Vatican Defends China Invite to Organ Trafficking Summit,” February 7, 2017; Didi Kirsten Tatlow,
“Debate Flares Over China’s Inclusion at Vatican Organ Trafficking Meeting,” New York Times, February 7, 2017. The
2016 hearing included discussion of the individual, Dr. Huang Jiefu, including perspectives by a witness, Dr. Francis
Delmonico, that Jiefu was a genuine reformer and questions by some Members of Congress about his reliability and
complicity in human rights abuses as an official in the Chinse government. U.S. Congress, Organ Harvesting: an
Examination of a Brutal Practice, hearings, June 23, 2016.
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Disclaimer
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