About trafficking
Trafficking in human organs and transplant tourism (travelling abroad for the purpose of illegal transplantation with an organ of unknown origin) are criminal acts that violate fundamental human rights and trample on human dignity. Slovenia is one of the most progressive countries in the Council of Europe in this area. As of 2022, Slovenia has a law ratifying the Council of Europe Convention against trafficking in human organs.
Slovenija-transplant strongly condemns any abuse in organ donation and transplantation. Below we explain the responsibility of medical staff and measures to prevent human trafficking.
Warning: Black market transplants outside ethical and regulated donation and transplantation systems pose a serious health risk to donors and recipients. Infections, unprofessional procedures and post-operative complications make black market transplants deadly.
Transplant tourism mostly takes place in developing countries, and individual cases have also been recorded in Council of Europe countries. The actual extent of such crimes remains unknown. It is assumed that 5 to 10 % of transplants worldwide are carried out as part of (organised) international illegal organ trafficking. Organ trafficking takes place in countries where the removal and transplantation of human body parts is not regulated by law, where sick people have no access to transplant treatment within the public healthcare system and where highly specialised private clinics operate for the wealthy. Where there is a deep social divide between the impoverished and the extremely wealthy, these circumstances are exploited by organised criminal organisations that engage in human trafficking for the purpose of organ harvesting and trafficking in human organs. The most common objects of trafficking are kidneys from living donors.
In Slovenia, there is no organ trafficking or abuse in the system, and the risk of abuse is also very low. The national donation and transplantation system is legally well regulated, controlled, safe, ethical and completely transparent. An organ of unclear origin cannot enter in the donation system. After organ transplantation, all organ recipients receive lifelong care at the Centre for Transplantation at UMC Ljubljana. Excellent transplant treatments are available within the framework of basic health insurance. Waiting times for treatment are relatively short (among the shortest in the Eurotransplant region and beyond). By exchanging organs between Eurotransplant members, a better match between donors and recipients is assured and, more importantly, transplants in emergency cases is provided. Replacement dialysis treatment in the event of kidney failure is available to all patients. Organ donation is based solely on altruism and is a voluntary decision. In Slovenia, organ donation after brain death is predominant programme, kidney donation from a living donor is rare (1-2 cases per year). Each case of living donation is carefully reviewed and approved by the Ethics Committee for Transplantation.
National contact point for anonymous reporting
According to the Council of Europe Convention against trafficking in human organs, all organ transplants outside the country without a referral from a treating specialist and without prior agreement with a transplant centre outside Slovenia are a criminal offence and are subject to criminal prosecution.
Since 2017, Slovenija-transplant has been the national focal point for the anonymous reporting of such cases in the network of focal points (affiliated with the Council of Europe). By now, we have not detected a single case of unauthorised practise. We also cooperate with the police, the Ministries of Health, Justice, Interior and Foreign Affairs and non-governmental organisations dealing with victims of human trafficking. Independent organisations and supervisory authorities also have not reported cases or suspected cases of organ trafficking in Slovenia.
Anyone who suspects organ abuse or trafficking can file an anonymous report to the police via the online portal at the link.
Responsibility of medical staff
Medical doctors and healthcare staff have a key role and responsibility in preventing and eradicating illegal and unethical behaviour.
By being well informed, reacting quickly and not tolerating unethical behaviour, we all contribute to preventing and stopping organ trafficking. As transplant patients require long-term post-operative follow-up and medical care, healthcare professionals can detect patients who have gone abroad for transplantation outside national, ethical and safe programmes during outpatient treatment. Reporting by medical staff at the slightest suspicion of illegal and unethical behaviour is more important than the obligation of medical silence. At the same time, this obligation is officially established by the Convention against Organ Trafficking, which was adopted in Slovenia in 2022.
The World Medical Assiciation’s recommendations are:
- Physicians should never perform a transplant using an organ that has been illicitly obtained or is of unclear origin. If there are reasonable concerns about the origin of an organ, the organ must not be used. If a physician or a surgeon is asked to perform a transplant with an organ that has been obtained through a financial transaction, without the valid consent of the donor or without the authorisation required in a given jurisdiction, they must refrain from performing the transplant and should explain the reasons to the potential recipient.
- Physicians who participate in the preoperative evaluation of potential living donors should not only assess the medical suitability of the individual, but also attempt to ensure that the person has not been subject to coercion of any kind or is participating in the procedure for financial gain or any other comparable advantage. The legitimacy of the donor-recipient relationship and the altruistic motivations for donation should be scrutinised. Physicians should be particularly vigilant of “red flags” suggestive of a transplant-related crime. Non-resident living donors may be particularly vulnerable and should be given special consideration. For linguistic, cultural and other reasons, assessing the validity of their consent to donation can be especially challenging, as can ensuring that appropriate follow-up is offered to them. A referring physician should be identified in the country of origin of the living donor – and in that of their intended recipient, where appropriate.
- Physicians should never promote or facilitate the engagement of patients in transplant-related crimes. Moreover, they should inform patients of the risks these activities pose for their own health, that of their loved ones and, more generally, for public health. Patients should also understand that these activities entail an exploitation of vulnerable individuals who may themselves suffer from severe medical and psychosocial complications. By counselling patients, professionals may dissuade them from engaging in illicit transplant activities.
- Physicians have a duty to care for transplant patients, even if their organ was illicitly obtained. Should a physician have ethical or moral objections about caring for a patient who has received an illicit organ, they should make the necessary arrangements to transfer the care of the patient to another physician.
- Physicians should contribute to guaranteeing transparency of practices and traceability of organs. When patients who have undergone a donation or a transplantation procedure abroad seek follow-up care in their country of residence, all information must be recorded in national transplant-registries and reported to competent health authorities (Slovenija-transplant).
For more, please see WHMA statement.
Conventions and recommendations
International organizations including the Council of Europe, the European Union, the United Nations, the World Health Organisation (WHO) and international medical associations have drawn up treaties, resolutions and recommendations. The aim is an internationally coordinated fight against trafficking and crimes in connection with the transplantation of human organs.
List of the most important international documents and resolutions