ILLICIT ORGAN TRADING by Julian Wagner-Carena

ILLICIT ORGAN TRADING By Julian Wagner-Carena

INTRODUCTION

Organ trafficking is one of the most prevalent transnational issues of the 21st century. The World Health Organization (WHO) approximates that 10,000 kidneys are illicitly traded worldwide every year. Put simply, that means that at least once every hour there is a kidney being illegally transplanted. In 2007, the WHO also, “estimated that organ trafficking accounts for 5-10% of the kidney transplants performed annually throughout the world.” (Budiani- Saberi). The proliferation of illicit organ trading stems from a steadily increasing division between the supply of essential organs for transplantation in the developed world and the demand for those

organs. This criminal activity often relies on the exploitation of the The symbol of the WHO, weak, impoverished, and liable populations of emerging nations. an agency of the United In many organizations and nations, organ trafficking falls under Nations focused on the categories of human trafficking and usually is heavily correlated public health on an international level with sex trafficking. This genre of criminal activity cannot be purely (who.int) resolved through policies that only address the nation from which the receivers originate (typically first world countries such as the United States and Canada). To tackle this issue effectively, there has to be worldwide cooperation and collaboration between essential assets. In order to resolve this issue, global institutions will need to rise to the occasion. This will involve establishing concrete policy changes that will address the issue at its roots, as well as addressing the shadow organizations that lead the criminal act and understanding why previous attempts to resolve the issue failed and where that failure stemmed from.

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EXPLANATION OF THE ISSUE

Historical Development The history of organ transplantation is rather short and recent. The first-ever successful human organ transplantation was a kidney in 1954. The decades that followed extended the medical procedures In the US, the to replacing hearts, livers, lungs, pancreases, and even corneas. average wait time While there was a steady risk for organ rejection in the past, medical for a kidney is 3.6 advances have minimized the risk progressively in healthy donors. At the same time, those medical advancements have also increased years the demand for organ transplantation. The United Network for Organ Sharing, or UNOS, stated that in 2017 a person joins the national transplant waiting list at least once every ten minutes. However, this increase in demand has been met with a desperately low supply of healthy donors. An article published in ACAMS Today stated that, “in Canada, it is estimated that the average wait time for a kidney is 4 years with some waiting as long as 7 years. In the U.S., the average wait time for a kidney is 3.6 years according to the National Kidney Foundation. In the U.K., wait times average 2 to 3 years but could be longer” (Bain). This extraneous wait time is a Organ Trafficking signal towards the shortage of vital and healthy organs in the – the recruitment, developed world’s health care system. Hence, some of that left-over transport, transfer, demand is met through black market channels. This is where the harboring or receipt issue of illicit organ trading has its roots. of persons, by means Organ Trafficking, as defined by the United Nations of the threat or use of Trafficking in Persons, is the, “the recruitment, transport, transfer, force or other forms harboring or receipt of persons, by means of the threat or use of force of coercion, of or other forms of coercion, of abduction, of fraud, of deception, of the abduction, of fraud, abuse of power, of a position of vulnerability, of the giving or of deception, of the receiving of payments or benefits to achieve the consent of a person abuse of power, of a having control over another person, for the purpose of exploitation position of by the removal of organs, tissues or cells for transplantation” vulnerability, of the (Canestrelli). As stated before, these underground market channels giving or receiving of typically rely on the exploitation of impoverished people. Like most payments or benefits trans-continental issues, the donors in organ trafficking are typically to achieve the consent citizens from developing nations. Those citizens end up being taken of a person having advantage of in most cases. The Washington Post states that illicit control over another organ trading, “originated in India in the 1980s; in the following person, for the years, Pakistan, the Philippines, Egypt and China (where the organs purpose of were alleged to have come from executed prisoners) became hubs of exploitation by the commercial transplants. Such illegal transplants are also known to removal of organs, have been done in Turkey, Kosovo, South Africa and other sites” tissues or cells for (Efrat). While donors stem from developing nations, the recipients transplantation. of the transplantations typically stem from rich and well-developed . countries. Good examples can be found in the United States, UK, Saudi Arabia, Israel, Japan, Taiwan, and many more.

Scope of the Problem The issue of illicit organ trading is not one that has been left unaddressed. There have been multiple policies enacted and agreements made between nations to try to curb the criminal activity. However, they clearly have not been productive enough in addressing the roots of the issue. Ideally, organ trafficking should not be as difficult to subdue as other illicit activities like drug trading or the counterfeiting of goods. It is far easier to detect since the location of those transplantations needs to occur in hospitals. They cannot occur anywhere on the streets. It should not be difficult to track the recipients of those transplants when they return to their home countries. More often than not, the recipients are on one or more extensive waiting lists for organs and require medical care afterward to ensure they are stable and do not reject the procedure. This can require immunosuppressive drugs (Efrat) which are not easy to come by and are again easily traceable. Illicit organ trading also does not produce as much economic revenue for developing nations. Although it could potentially produce billions in dollars of revenue a year, it only ends up benefiting, “a small group of organ brokers and physicians” (Efrat). That begs the question: if the efforts required by national policing and the incentives for those nations are so low, why is this issue still so pervasive? Lack of Viable Organs The bottom line is that the most relevant contributing factor to this issue is the lack of viable organs. To provide some relevant and disheartening statistics in addition to the wait time stated before, the Washington Post observes that, “as of early 2016, 100,791 people were waiting for life saving kidney transplants in the United States. Yet in 2014, only 17,107 kidney transplants took place there” (Efrat). These data can be rather well supplemented by the statistic from UNOS that in 2016, an average of 20 patients passed away every day as a result of waiting for a transplant. This extreme shortage leads to a fair amount of those patients who seek to avoid that fate traveling Transplant to countries like Egypt and China. This is known as transplant Tourism– Refers to tourism, where patients will travel across borders to purchase an patients traveling organ for transplantation in that foreign country. In those foreign across the borders to countries, it is typical that black market organizations lure and solicit be transplanted unaware individuals into selling their organs in exchange for elsewhere guarantees of economic benefit. However, those organizations are driven by completely economic incentives; most of the guarantees promised to the donors end up being false, simply used as a form of coercion. There are various reasons for the shortage of organ transplants. First, it is important to understand how organs are donated. The Cadaveric donor could be either alive or deceased; in the latter case, the Donation – Donations given by deceased© H ARVARDpatients M ODEL CONGRESS 2021 – REDISTRIBUTION OR REPRODUCTION PROHIBITED 3

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donation is entitled cadaveric. In a cadaveric donation, for the organ to be approved for transplantation will be very dependent on the circumstance of the death, the health history of the deceased, and how long the organ can remain viable between the time of death and the transplantation itself. Living donors will also be able to donate certain organs, such as a kidney, lung, intestine, pancreas, or a portion of a liver, as long as they can live without it. Living donors must be in exceptional health and must remain in reasonable medical care after the transplantation. Consent is incredibly important for organ transplantation. In the United States, there is an “opt-in” policy where you must choose to register to become an organ donor. Other nations adopt an “opt-out” policy, but that is met with various levels of concern. That may create unneeded tension where the general public may consider it an infringement on their right to choose. While unintentional, it may result in the reduction of donation rates. People may refrain from registering for a variety of reasons, all the way from religious or ideological beliefs to merely forgetting to take the time to sign up. Living donors, while representing nearly half of all organ donations in the United States (Brazier), need to be in the non-abundant percentage of people with above-average health. Even then, there is evidence to show that afterward the donors are at a greater risk of disease. In truth, the increment in risk is relatively small, but living donors may develop end-stage renal disease (ESRD). However, the percentage of consent given throughout the US varies greatly by state. Medical News Today (MNT) establishes that, “Utah has an 85% consent rate, while in California and New York, 2 out of 3 eligible donors leave the Department of Motor Vehicles (DMV) without registering” (Brazier). There are many misconceptions about organ donations that ensure that people, which result in a large number of wasted organs that could be the difference between life and death for another waiting patient. Consent, even expressly given, can be disregarded later on: the families of the deceased may be able to disregard the wishes of the deceased and refuse to allow their organs to be donated. The time shortly after the loss of a loved one is difficult, and many are unable to decide in the effective period that the organ remains viable. Those decisions typically need to be made within a few hours from the time of death. MNT states that, “the law in the US decrees a person’s legal consent to donate ‘irrevocable’, but doctors still consult with families and respect their wishes. . . . In the UK, 547 would-be donors’ wishes were vetoed by their families between 2010-2015, which could have provided for 1,200 recipients” (Brazier). Lack of Clear International Cooperation and Coordination Apart from the shortage of viable organs, there is another systemic issue that plagues any hope of diminishing this criminal

activity. The lack of international cooperation and coordination delays concrete action. As mentioned before, this is a transnational problem that cannot be resolved from policy changes that are enacted in the US. However, there are substantial roadblocks before global coordination is achieved. First, there are competing definitions of what constitutes illicit organ trading across national barriers. An article published by the Official Journal of The Transplantation Society & International Liver Transplantation Society argues that, “the lack of global definitions is exploited by traffickers and middlemen who take advantage of the differences between legal systems in their transnational crime.” These differing definitions are not purposeful. They stem from an overall confusion between “organ trafficking and trafficking in human beings for the purpose of organ removal” (Manzano). There is also a lack of accurate and reliable data that is produced by the countries where these illicit transplantations occur. This stems from a variety of factors, including underreporting. Underreporting in this There is a crime is largely based on the lack of traceability. The transplantations substantial lack of are transnational and different countries have very different rules for accurate and prosecution. Doctors that are involved in these crimes are also seen as high-class individuals and are typically underrepresented in the reliable data in figures of their developing country for committing white-collar relation to organ crime. trafficking There are also some promoters for these transplants. As is typical for issues stemming from underground channels, the countries from which the majority of these illicitly gathered organs stem refrain from providing exact statistics over essential data. An article published in the American Journal of Transplantation states that “countries that have facilitated organ trafficking such as Pakistan and the Philippines do not release public data (not surprisingly) regarding the numbers of foreign patients that travel to these countries for transplants” (Budiani-Saberi). Congressional Action The United States first addressed the topic of organ donation in 1968 with the Uniform Anatomical Gift Act. It stated, “The rights of individuals to designate their organs for donation after their death and also the conditions under which living donor transplant is permissible” (Jafar). Then, in 1984, Congress established one of the first pieces of legislation to address the lack of viable organs. The National Organ Transplant Act was meant to address the need for organs. It is currently overseen by the United States Department of Health and Human Services (DHHS), which has established that the donation and transplantation of organs and tissues must be monitored and organized. The act focused on providing a national method of handling organ management that will collaborate with both the public and private sectors.

The Organ Procurement and Transplantation Network (OPTN) is meant to handle the upkeep of the national registry in the US. The UNOS manages the OPTN in collaboration with the Health Resources and Services Administration (HRSA). The HRSA is part of the DHHS. There has also been legislation meant to provide incentives to potential donors and their families, such as the Stephanie Tubbs Jones Gift of Life National Medal Act signed by President Bush. As the name implies, the act is focused on allocation and distributing medals given to live organ donors or the family members of patients who had donated post-mortem. The medal is named after a deceased congresswoman who posthumously provided cadaveric donations that allowed many others to live. Stephanie Tubbs The Obama Administration had also spent considerable time Jones, a well- attempting to address the organ waiting list. The Affordable Care Act respected for a long while had “offered greater security to living donors by congresswoman prohibiting insurers from denying health coverage to someone with who provided a preexisting condition, including having donated an organ” (Kalil). various cadaveric More recently, in 2016, the House of Representatives passed the donations after her Strategy to Oppose Predatory Organ Trafficking Act, or the “STOP passing. Organ Trafficking Act” which dictates that the, “Secretary of State (Baldwin Wallace may refuse to issue a passport to any individual” (Trott) who has University) been convicted of the criminal activity of organ trafficking. It also allows the Secretary of State to revoke a passport in connection with organ trafficking. Another section of the act dictates that every year after it was passed and until 2024 the Secretary of State must “submit to the appropriate congressional committees a comprehensive report” that will provide necessary information towards “the trafficking of persons for the removal of their organs” (Trott). This act was passed and agreed in the House. There is another bill under the same name that is a slightly revised version of the previous bill introduced in 2019. That bill has only been introduced in the House and is waiting for passage towards the Senate. The most recent course of action from the Executive Branch was President Trump’s Executive Order on Advancing American Kidney Health, spearheaded by HHS Secretary Alex Axar, which had focused on “removing financial disincentives to living organ donations” and changing “Organ Procurement Organization (OPO) conditions for The American coverage” (U.S. Department). Journal of Kidney Diseases provides International Action excellent data and There have been more than a few international efforts towards analysis over the curbing this issue. The American Journal of Kidney Diseases organ trade, as it (AJKD) states that the World Health Assembly’s 2004 resolution had relates directly with “called for international cooperation in the formulation of organ kidney procurement guidelines on suitability, safety, and ethics and the transplantations. establishment of national oversight committees to ensure (AJKD.org)

implementation” (Jafar). This was well-received but was not easily enforced. In many countries, such as Pakistan, the government had passed legislation to ban organ trade, but enforcement of the ban is not well received. The AJKD also states that, “kidney commerce is not legal in India, the Philippines, or Eastern European countries, yet the law enforcement agencies turn a blind eye to the flourishing underground organ trade” (Jafar). As mentioned before, the inability to abate the criminal act stems largely from a lack of incentive. The passage of those legislations is most likely meant to just avoid international pressure. For instance, China is possibly one of the greatest offenders in this issue. Gathered from an article from The Lancet based on a report by Amnesty International, “Chinese transplantation specialists estimated that 99% of organs come from executed prisoners. The Chinese government hides the number of prisoners it kills each year, but it accounts for at least 75% of the world's executions” (Watts). Due to international pressure, the Chinese government has dictated that “a signed agreement from prisoners before execution and organ harvesting” (Jafar) takes place. However, there is still a clear lack of transparency that has done less than nothing to help the issue. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism, established in April of 2008, was another strong international policy that provided some sort of collective effort to deter this criminal activity. It established a decree to prohibit all forms of illicit organ trading due to the effect it has on the disadvantaged population of the world. It specifically included transplant tourism and illicit organ trading. The declaration also calls for better safety and medical measures for legal organ donation. The article from the AJKD states that the Declaration “also calls upon At one point, 99% countries to increase programs for the prevention of kidney disease of organs from and enhance regional programs for availability of organs to meet the China came from transplant needs of its residents from donors within their own executed prisoners populations” (Jafar).

IDEOLOGICAL VIEWPOINTS

Liberal and Conservative View The legislation for organ donation usually receives bipartisan support. There is potential for a bill to be considered sometime in the near future that will provide non-financial incentives to organ donors to try to curb the shortage of organs and attempt to diminish the shocking wait time that thousands of Americans encounter every year. As of now, those plans seem to have the support of Democrats and Republicans alike.

However, there is a noticeable difference in how likely it is for constituents who advocate for more conservative political parties to register for organ donation in the United States. This largely plays into the ideological issues with organ donations that were stated before in the briefing. An article published in Pacific Standard states that a study found “supporters of conservative political parties were Most countries less likely to report that they intended to become organ donors. They also reported higher levels of disgust, and more concern about with ‘opt-in’ ‘bodily integrity,’ than their left-leaning counterparts” (Jacobs). policies have Typically, those who lean towards the right on the political spectrum around 15% of are more religious and are more concerned about the sanctity of the possible donors body, especially after death. registered AREAS OF DEBATE

After reading all previous sections in the briefing, you should be able to decide how to propose policy changes domestically and internationally to curb illicit organ trading. As members of the National Security Council, you will have the opportunity to exact systematic change at a rate that is unique to this committee and this committee only. You will need to make sure that the solutions you propose align with your ideological and political values. Consider carefully the consequences of your decisions and work effectively to protect the exploitation of the poor and disenfranchised populations of the world with respect to organ trafficking in all its forms. Increase Cadaveric Donation through Opt-Out Donations As of now, what seems to be the most likely to be effective and frequently proposed solutions to illicit organ trafficking is to increase donations. A common theme in these discussions is the shortage of viable donors. Once you diminish that shortage as much as possible, the demand for organs will decrease and illicit organ trading will be effectively curbed. The most effective way of doing so is by increasing cadaveric donation. The solution may be framed in quite a few ways. One of them that is most commonly implemented in foreign countries, such as Austria, is to adopt an “opt-out" option for cadaveric organ donation. This would change the current status-quo of “opt-in” donation. The arguments in favor are several. Stanford University published that in Austria the number of registered donors was more than 90% while in countries with an “opt-in” policy, such as the United States, the numbers were fewer than 15% (Scheiber). People tend to follow the status quo. Granted, there is no clear support in this. Some members of the conservative party will possibly view this as a policy that will force them to donate when not wanting to. This

may result in some pushback against organ donation. However, others would argue that once you provide an “opt-out” policy, then you change the viewpoint of organ donation in the country. We will start to view organ donation as inconsequential and typical, which should be the case if we want to decrease the shortage.

Increase Live Donation by Providing Incentives

Just as with the last proposed policy, this solution is geared at increasing donations. President Trump’s aforementioned Executive Order on Advancing American Kidney Health focused on minimizing whatever disincentives that living donors could have to donate. This included the lost wages while donating and recovering from the donation and most of the medical expenses. While this is effective, there is still no existing direct financial incentive for living donors. As mentioned before in this briefing, living donations account for almost half of organ donations in the United States (Brazier). There is also given research that leads to the belief that recipients of organs given from living donors tend to produce better results than organs given from cadaveric donations. Despite the inherent altruism behind organ donation, which should ideally be the only needed incentive, the only incentive that exists for living donors are awards such as the medals instituted by the Bush Foundation. While removing most disincentives is a great start, incentives could convince the majority of voters who are not registered at the moment who don’t have clashing ideological or religious beliefs. However, to implement this there needs to be careful consideration of making sure that the living donor is in above-average health to make sure the process does not harm them. The Executive As is the theme of this briefing, there also needs to be an assurance Order on that the incentives do not lead to the same exploitation of poor Advancing individuals that tends to occur with illicit organ trading. American Kidney Health, passed in Carry Out on All Legislation Against Illicit Organ July 2019, Trading instituted removing financial As mentioned in this briefing, there are multiple countries that, while publicly stating that they do not agree with illicit organ trading, disincentives to do not follow through on their passed legislation. This is especially providing living crucial in prime areas of Asia where illicit organ trading is notably organ donations pervasive. Typically, these countries pass this legislation because they are responding to international pressure. However, they can put minimal effort towards consummating the public statement. As stated before, illicit organ trading is hard to track, and these countries have a poor track record with putting forward needed

efforts for the benefit of their poor populations. A way of providing necessary pressure could be through the method of sanctions. There are several things to take into account regarding the effectiveness of sanctions. Most importantly, they would have to be specific and well-versed. For a sanction to be effective, the wording needs to be exact as to what the sanctions will be, what they are given for, and what the recipient country needs to do to relieve the sanctions. While sanctions may work with dependent countries, it may be difficult to enforce them effectively in countries like China who provide necessary exports to the United States. This committee should avoid a sanction war, especially with the current economic state of the United States. Other than imposing sanctions, one could also consider taking away different forms of aid. It would also be effective to consider pushing this legislation to the UN Council. This would make sure that the consequences of the legislation do not fall on the United States as a whole, but rather make the statement to the recipient nation one of an international collective. Ensure the Physical Wellbeing of Organ Donors in Developing Countries At the moment, the reason illicit organ trafficking constitutes

such a strong dilemma is that it is largely founded on profiting off the exasperation of low-income and typically disenfranchised This chart pinpoints individuals of developing countries. One of the main goals of this approximate prices for committee when discussing this briefing must be emphasizing on various organs in 2007 how to minimize the exploitation of these peoples. It seems essential (ACAMS Today) to enforce a standardized and ethical system of laws that would make

the acquisition of organs in all countries legal and safe for both the donor and recipient. It seems like one of the faults in previous legislation and international policies is the lack of specificity in the code of ethics that physicians involved in organ transplantation should be taking into account. All surgeons, regardless of their country of origin, should ensure that their work will not cause harm or profit off the patients in any way. The United States could support and fund multiple projects to enforce international caretaking over organ donors before and post- transplantation. One of the many tools that are at the disposal of this committee is once again, sanctions or the taking away of aid— financial, military, medical. Some of the projects that could be started and primarily funded by the United States, or the UN under the express advice of the United States, would be development projects to upgrade medical facilities in developing countries. That would ensure a more ethical and standardized system of medicine and could be one of the first steps towards regulating illicit transplantations.

Legalization of the Criminal Activity To curb illicit organ trading, the first step would be to know as much about the criminal activity as possible. However, that’s expressly difficult to do because of the underground nature of the crime. One can make estimates, but the likelihood those estimates represent the real statistics is very low. Of course, another way to think about the issue is to focus on where the incentive for those spearheading illicit organ trading comes from. They are not interested in assisting with the shortage of viable organs for transplantations, but rather are focused on the incredible monetary value that can be gained. Typically, these organs can sell for tens of thousands of dollars each. One of the proposed solutions to this issue is to completely Previous legalize the organ trade. Arguments for stem from similar arguments international used in the discussion for legalizing recreational drugs. Legalizing the organ trade governments can have greater control over the price policies have and distribution of organs and provide restrictions on the private largely all been sector for this trade. This could potentially fix the ineffectiveness of ineffective in some legislations and international policies towards curbing the curbing illicit illegal trade. Legalization could also hopefully increase the supply as organ trading recipients will be more likely to sell and the price for the kidneys will start to decrease. This hopefully will be one of the many consequences that will help in curtailing the criminal activity.

BUDGETARY CONSIDERATIONS

Unfortunately, as incredible this committee will be in producing fantastic solutions towards this difficult problem, you need to consider the constraints of your solutions. Nothing will ever get passed or done effectively if you are unable to make sure it makes fiscal sense. Without considering every implication of what you are proposing, you will encounter consequences. That’s not to say your resolution will necessarily require funding at all, but be sure to make sure you are stating exactly where the money is being taken from and how it is being used if you want to be effective members of the National Security Council.

CONCLUSION

Illegal organ trading has been one of the most prevalent transnational issues in the last few decades. It will be likely to continue to do so unless there is an effective strategy put in place by this committee. Policies have been put in place by this country, the UN, and the WHO but have all not succeeded in correctly curtailing

the criminal activity. You must provide creative solutions that will demonstrate the thought and due research you have put to prepare. You must be able to effectively coordinate with other members of this committee to provide one of many solutions that will attack this issue from as many fronts as possible while remaining efficient. You may need to consider your stance in terms of your ideology, your party allegiances, and your expertise. Remember that when collaborating with others in developing your solutions, you must consider the two greatest causes of organ trafficking. First and foremost, the shortage of viable organs across the board. Secondly, the lack of international cooperation and the fulfillment of promised legislation. Again, this issue must be tackled with an international standpoint taking into account. You can start to solve the issue at home, but the exploitation of the poor in developing countries will not change unless resolutions are focused on those countries. Remember that your proposals can combine multiple solutions, many of which are not found in this briefing. The solutions attached were only to provide a few ideas of what is typically proposed. To stand out, provide a unique solution based on further research you found. Think effectively. Think about what is best for the US and the world as a whole. Provide the best solution you can to this growing problem.

GUIDE TO FURTHER RESEARCH

As difficult as this topic, it is not difficult to find effective research. Most research has been developed and published in the last two decades, and it will prove helpful for you to look at further information regarding everything that is mentioned in this briefing. It is up to you to make sure you are well prepared to provide educated solutions towards combating this problem. Take a look at the bibliography attached and read through some of the articles and journals that were read to prepare this briefing. Take a look at some or all of the organizations that are mentioned or quoted. Try your best to look for articles that were published in the last decade that provide a lot of concrete information and statistics over this issue and see what analysis can be made from them. Google Scholar is a great way to find free articles. You can also perform an advanced search to make sure your results are exactly what you are looking for. Best of luck.

GLOSSARY

Organ Trafficking – the recruitment, transport, transfer, harboring 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, of a position of vulnerability, 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 by the removal of organs, tissues or cells for transplantation.

Transplant Tourism – Refers to patients traveling across the borders to be transplanted elsewhere

Cadaveric Donation – Donations given by deceased patients

BIBLIOGRAPHY

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Bain, Christina, et al. “Organ Trafficking: The Unseen Form of Human Trafficking.” ACAMS Today, 31 July 2018, www.acamstoday.org/organ-trafficking-the-unseen-form-of- human-trafficking/.

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Jacobs, Tom. “Liberals Are More Willing Than Conservatives to Donate Organs.” Pacific Standard, 22 Jan. 2019, psmag.com/social-justice/liberals-are-more-willing-than- conservatives-to-donate-organs.

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Scheiber, Francesca. “'Opt Out' Policies Increase Organ Donation.” SPARQ, Stanford University, 2012, sparq.stanford.edu/solutions/opt-out-policies-increase-organ- donation#:~:text=People%20tend%20to%20conform%20to,con sequently%2C%20saving%20thousands%20of%20lives.

Trott, and David A. “H.R.3694 - 114th Congress (2015-2016): Strategy To Oppose Predatory Organ Trafficking Act.” Congress.gov, 14 June 2016, www.congress.gov/bill/114th- congress/house-bill/3694.

U.S. Department of Health and Human Services, HHS Press Office. “Trump Administration Proposes New Rules to Increase Accountability and Availability of the Organ Supply.” HHS.gov, US Department of Health and Human Services, 17 Dec. 2019, www.hhs.gov/about/news/2019/12/17/trump-administration- proposes-new-rules-increase-accountability-availability-organ- supply.html.

Watts, Jonathan. “China Introduces New Rules to Deter Human Organ Trade.” The Lancet, vol. 369, no. 9577, 9 June 2007, pp. 1917–1918., doi:10.1016/s0140-6736(07)60897-6.