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Resolution 2327 (2020)
Organ transplant tourism
1. Organ transplant tourism is one
of the most lucrative illegal activities worldwide, which makes
it extremely difficult to eradicate. This is because organ transplantation
is the best – and frequently the only – lifesaving treatment for
end-stage organ failure. While the number of transplants performed
worldwide has been steadily increasing, the need for transplants
is also growing. Demand far outstrips supply.
2. The disparity between the need for and the supply of organs
prompts some patients to try to purchase an illicitly obtained organ,
often involving travelling to countries where laws prohibiting organ
sales are poorly enforced or marred by loopholes. This practice
has been consistently and uniformly condemned by the Council of
Europe, the World Health Organization (WHO) and by professional
organisations such as the World Medical Association and the Transplantation
Society.
3. The Declaration of Istanbul on Organ Trafficking and Transplant
Tourism defines organ “transplant tourism” as travel for transplantation
involving: “trafficking in persons for the purpose of organ removal, trafficking
in human organs, or if the resources (organs, professionals and
transplant centres) devoted to providing transplants to non-resident
patients undermine the country’s ability to provide transplant services
for its own population”. In this regard, it is necessary to clearly
define the conditions of transplantation for residents and non-residents
in a country’s national legislation.
4. Both at global and at European level, widely ratified conventions
with effective monitoring mechanisms that combat trafficking in
human beings, including for the purpose of organ removal, are in
force. The Council of Europe is also at the origin of the Convention
against Trafficking in Human Organs (CETS No. 216), which constitutes
the only international criminal law framework addressing organ trafficking.
It entered into force on 1 March 2018 but has, so far, only been
ratified by nine member States, and its Committee of the Parties
has yet to be established. The use of transplant resources that
undermines a country’s ability to provide transplant services for
its own population is not explicitly addressed by the above-mentioned
conventions. The Council of Europe Convention for the Protection
of Human Rights and Dignity of the Human Being with regard to the Application
of Biology and Medicine: Convention on Human Rights and Biomedicine
(ETS No. 164) and its Additional Protocol concerning Transplantation
of Organs and Tissues of Human Origin (ETS No. 186) establish the
principle that the human body and its parts shall not, as such,
give rise to financial gain.
5. Unfortunately, despite this solid legal framework, organ transplant
tourism continues, including in Europe and China, though its magnitude
is not well known. Organ transplant tourism may involve the use
of organs from deceased persons (who may not have given proper consent,
as in the case of executed prisoners in China, or whose organs were
properly donated but later diverted for illicit use by physicians
providing transplant services to patients who do not qualify to
receive them within national programmes or at facilities that serve “transplant
tourists”) or, in its most pervasive and hideous form, from living
persons. Organ sellers often come from the poorest strata of society
(including migrants and refugees). They usually only co‑operate
because of their desperate financial situation and because they
are misled about the nature of the surgery and the consequences
of giving up an organ. Medical reports of the health status of returning
transplant tourists demonstrate that transplant tourism frequently
also has negative effects on the interests of the recipients, their families
and communities. Combined with the financial sacrifices that they
have made to obtain an organ, transplant tourists thus run a real
risk of being exploited themselves and of suffering severe health consequences.
The only profits made are by corrupted health professionals, middlemen
and other criminals. However, these profits are huge and there is
often little risk of punishment.
6. A holistic approach is necessary to solve the problem of organ
transplant tourism. At its root, there is a need to close the gap
between the demand for and the supply of organs, in the face of
desperate people who need an organ and whose numbers will only increase
in the future.
7. The Parliamentary Assembly thus recommends that member States
of the Council of Europe:
7.1. sign,
ratify and implement all relevant global and Council of Europe conventions,
including the Protocol to Prevent, Suppress and Punish Trafficking
in Persons Especially Women and Children, supplementing the United
Nations Convention against Transnational Organized Crime; the Council
of Europe’s Convention on Human Rights and Biomedicine and its Additional
Protocol concerning Transplantation of Organs and Tissues of Human
Origin; the Council of Europe Convention on Action against Trafficking
in Human Beings (CETS No. 197) and the Council of Europe Convention
against Trafficking in Human Organs;
7.2. develop and improve existing transplant programmes in
accordance with good practice examples, through professional education
and training, and collaboration across countries, with the aim of
striving for national self-sufficiency in organ donation and transplantation:
this may involve establishing and providing financial and human
resources for national transplant organisations, training critical
care professionals in deceased donation to maximise the detection
of potential organ donors, appointing transplant “donor co-ordinators”
in every hospital with an intensive care unit and developing and
optimising ethically sound living donation programmes;
7.3. develop and implement population-based strategies to prevent
(and treat) organ failure in the first place by, for example, encouraging
a healthy lifestyle and providing universal health care;
7.4. improve transplant oversight through intergovernmental
efforts, in Europe and globally, by putting into place comprehensive
mechanisms of traceability for donors and recipients, including
at the transnational level; recording information about transnational
transplant activities, including by joining the International Network
of National Focal Points on Travel for Transplantation and providing information
to their International Database on Travel for Transplantation; enforcing
international referral systems before any travel for organ transplantation;
and informing and training health-care, judicial and other professionals
about their roles in recognising, preventing and combating organ
transplant tourism;
7.5. effectively combat trafficking in human beings for the
purpose of organ removal and trafficking in organs, including through
transnational and international co-operation, while ensuring adequate protection,
compensation and assistance of victims (as stipulated, inter alia, in the human trafficking
and organ trafficking conventions), including by closing legal loopholes
and establishing persuasive legal sanctions; increasing collaboration
between monitoring bodies, professional organisations and law-enforcement
agencies; and strengthening partnerships between global actors (for
example, the UN Office on Drugs and Crime (UNODC), the Office of
the UN High Commissioner for Refugees (HCR), WHO and Interpol),
regional actors (for example, the Council of Europe, the Organization
for Security and Co-operation in Europe (OSCE), Europol and Eurojust),
professional actors (for example, World Medical Association, the
Transplantation Society and the International Society of Nephrology),
non-governmental organisations and others (such as the Declaration
of Istanbul Custodian Group).
8. In the light of the above, the Assembly believes that there
is an urgent need to strengthen the role of national parliaments
in tackling organ transplant tourism. It invites them to promote
public awareness, adopt relevant legislation and ratify international
legal instruments, and monitor their effective implementation.
9. In view of the global nature of the phenomenon of organ transplant
tourism, the Assembly invites all States interested in joining the
fight, but particularly Council of Europe observer States and the
States whose parliaments hold observer or partner for democracy
status with the Assembly, to do so and, in particular, to accede
to the relevant Council of Europe conventions open to them.
10. Finally, the Assembly recommends that member States exercise
particular caution when co-operating with the China Organ Transplant
Response System and the Red Cross Society of China, in view of a
recent study casting doubt on the credibility of China’s organ transplant
reform.