Ethical Sourcing and Anti-Trafficking Policy

A human organ is not a product. It cannot be bought, sold, advertised for sale, or exchanged for anything of value, and that prohibition is in the law of essentially every country that performs transplantation. It is also in the World Health Organization's Guiding Principles, adopted by the World Health Assembly, and in the Council of Europe's Convention against Trafficking in Human Organs, which makes the removal of an organ for payment a criminal offence and requires states to prosecute it. It is set out most directly in the Declaration of Istanbul, the statement of principle that the world's transplant profession wrote against organ trafficking and transplant tourism, and which we hold ourselves to.

So when this platform says organ sale is illegal, it is not a moral position we are adopting for presentation. It is the law wherever you are reading this, and it applies to the person paying as much as to the person selling and the broker between them.

The reason the rule has no exceptions, rather than a carefully bounded one for desperate patients, is what happens when exceptions exist. Every market in organs that has been documented has run the same way: the sellers are poor, they are paid a fraction of what the broker takes, they are frequently deceived about the risks, they are abandoned without follow-up care, and many are worse off years later than before. The buyers do badly too. Trafficked transplants are performed outside regulated systems with unscreened tissue and no accountable aftercare, and the published outcomes are markedly worse than for patients treated properly.

That is why our answer to "could you make an exception in my case" is no. Not because your case does not matter, but because the exception is the mechanism by which people get hurt.

It helps to know what the lawful routes look like, because knowing them makes an illegitimate offer obvious rather than merely uncomfortable.

Deceased donation is the source of most transplanted organs. When someone dies in circumstances that allow donation and consent is in place, a national coordination system allocates the organs to patients registered on that country's waiting list, according to medical urgency, matching and time waited. No money is involved at any point, no family is paid, and no hospital controls who receives an organ. This is also why travelling abroad for a deceased-donor organ is generally not possible: most countries restrict registration to residents, because a visitor joining the list takes a place from a resident who has been waiting.

Living donation is possible for a kidney and for part of a liver, and it is genuinely a route that can be travelled for, because the donor travels with the patient. Every country sets its own rules about who may donate — usually close relatives, sometimes spouses, sometimes altruistic strangers under strict oversight — and most require an independent ethics committee to approve the donation after interviewing the donor separately. That interview exists precisely to catch payment and coercion, and it works.

Tissue, including corneas, is banked rather than allocated by waiting list. An eye bank recovers, screens, tests, stores and often prepares the tissue, and charges a processing fee for that work. That fee is payment for the work, never for the tissue, and no donor or donor family receives money.

In every one of these routes, the donor is protected, the process is documented, and someone accountable can be asked what happened. Those three things are exactly what a trafficking arrangement removes.

A policy that only states a principle can be believed or not. Here is what it actually changes in how we operate.

We screen enquiries. When somebody describes an available donor, we ask about the relationship, and we tell them plainly which relationships the country in question permits and that an ethics committee will assess it independently. Where an enquiry suggests payment to a donor, we stop and explain why we cannot continue with it. We do not treat that as a case to be reshaped into an acceptable form.

We do not coach anybody. There is a real temptation in this industry to help a patient present a case in the way most likely to be approved. We do not do it. An ethics committee interview that has been rehearsed is worthless, and its worthlessness falls on the donor.

We only work with authorised centres. Every hospital we introduce patients to holds the authorisation its national health authority requires for the transplantation it performs, and operates inside that country's coordination system. We do not work with intermediaries who will not name the hospital, and we do not work with hospitals that will not name the source of the tissue they use.

We publish what we cannot do. Several pages on this site exist to tell readers that a pathway they were hoping for is not open — that a country does not permit non-resident registration, that a heart or a lung cannot be travelled for. Those pages cost us enquiries, and they are the opposite of what transplant tourism is usually accused of being. They are also the clearest evidence that this policy is real, because a business willing to lose a case is a business not selling one.

And we report. Where an approach to us is a credible trafficking offer, we report it rather than simply declining. Declining protects one patient. Reporting is the only thing that reaches the next one.

Most discussion of transplant ethics is about recipients, because recipients are the ones reading. The person at greater risk in an unlawful arrangement is always the donor.

A living donor undergoes major surgery from which they get no medical benefit. That is only justifiable when the donation is genuinely voluntary, when the donor understands the risks, when they have been assessed independently, and when they will receive follow-up care afterwards. Remove any one of those and the operation stops being donation and becomes harm.

So when a country requires an ethics committee to interview a donor without the recipient's family present, that is not bureaucracy. It is the only moment in the process where somebody who is being pressured can say so to a person able to stop it. We support that step without reservation, including when it delays a case we are involved in, and including when it ends one.

We also think donor follow-up is the most neglected part of this whole subject. A donor who is flown home a week after surgery with no arrangements for their own aftercare has been used. Where a case we are involved in includes a living donor, we ask what follow-up the donor will receive and who is providing it, and we tell the patient the answer.

If you are yourself considering donating and you feel under pressure — from family, from debt, from anybody — please talk to the transplant team alone. They are obliged to listen and they can stop the process without explaining why to anyone. That is what they are there for.

If you have been approached, reporting it is worth doing even if you declined, and even if nothing was lost. Brokers work at volume. The approach that failed with you is being made to somebody else this week.

Start with the police in your own country. Organ trafficking is a criminal offence, and in most countries it falls under human trafficking legislation, which means there is usually a specialist unit rather than only a local station. If you are already abroad, contact your embassy or consulate, who can put you in touch with the right authority and help if your documents or money are involved.

If a hospital or a clinician is implicated, the health ministry or medical regulator of that country can also act, and in several countries has done so.

Tell us as well. We will help you find the right authority, we will give you whatever record we have of the approach if it came through us, and we will make our own report. We will not ask you to prove anything first, and we will not treat you as having done something wrong for having listened to an offer — people in organ failure are approached precisely because they are desperate, and that is the broker's fault rather than the patient's.

One practical thing: keep the messages. Screenshots of what was offered, the account details you were given, the names used and the numbers they came from are what makes a report actionable. Do not delete them in embarrassment. They are evidence.