Editing Organ transplantation (section)

== Reasons for donation and ethical issues ==

=== Living related donors ===
Living related donors donate to family members or friends in whom they have an emotional investment. The risk of surgery is offset by the psychological benefit of not losing someone related to them, or not seeing them suffer the ill effects of waiting on a list.

==== Paired exchange ====
[[File:Pairwise exchange.svg|thumb|right|250px|Diagram of an exchange between otherwise incompatible pairs]]
A "paired-exchange" is a technique of matching willing living donors to compatible recipients using [[serotype|serotyping]]. For example, a spouse may be willing to donate a kidney to their partner but cannot since there is not a biological match. The willing spouse's kidney is donated to a matching recipient who also has an incompatible but willing spouse. The second donor must match the first recipient to complete the pair exchange. Typically the surgeries are scheduled simultaneously in case one of the donors decides to back out and the couples are kept anonymous from each other until after the transplant. Paired-donor exchange, led by work in the [https://web.archive.org/web/20060425142144/http://www.nepke.org/ New England Program for Kidney Exchange] as well as at Johns Hopkins University and the Ohio organ procurement organizations, may more efficiently allocate organs and lead to more transplants.

Paired exchange programs were popularized in the ''[[New England Journal of Medicine]]'' article "Ethics of a paired-kidney-exchange program" in 1997 by L.F. Ross.<ref>{{cite journal |doi=10.1056/NEJM199706123362412 |vauthors=Ross LF, Rubin DT, Siegler M, Josephson MA, Thistlethwaite JR, Woodle ES |title=Ethics of a paired-kidney-exchange program |journal=New England Journal of Medicine |volume=336 |issue=24 |pages=1752–55 |date=June 1997 |pmid=9180096 }}</ref> It was also proposed by Felix T. Rapport<ref>{{cite book |title=Legal and Ethical Aspects of Organ Transplantation |via=Google Books |publisher=Cambridge University Press |author=David Price |year=2000 |isbn=978-0-521-65164-6 |page=[https://archive.org/details/legalethicalaspe0000pric/page/316 316] |url=https://archive.org/details/legalethicalaspe0000pric/page/316 }}</ref> in 1986 as part of his initial proposals for live-donor transplants "The case for a living emotionally related international kidney donor exchange registry" in ''Transplant Proceedings''.<ref>{{cite journal |author=Rapaport FT |title=The case for a living emotionally related international kidney donor exchange registry |journal=Transplant. Proc. |volume=18 |issue=3 Suppl 2 |pages=5–9 |date=June 1986 |pmid=3521001}}</ref> A paired exchange is the simplest case of a much larger exchange registry program where willing donors are matched with any number of compatible recipients.<ref>{{cite web |url=http://www.nepke.org/math.htm |archive-url=https://web.archive.org/web/20060614163646/http://www.nepke.org/math.htm |archive-date=14 June 2006 |title=New England Program for Kidney Exchange}}</ref> Transplant exchange programs have been suggested as early as 1970: "A cooperative kidney typing and exchange program."<ref>{{cite journal |vauthors=Horisberger B, Jeannet M, De Weck A, Frei PC, Grob P, Thiel G |title=A cooperative kidney typing and exchange program |journal=Helvetica Medica Acta |volume=35 |issue=4 |pages=239–47 |date=October 1970 |pmid=4918735}}</ref>

The first pair exchange transplant in the US was in 2001 at [[Johns Hopkins Hospital]].<ref>{{cite web |url=http://www.hopkinshospital.org/health_info/Bladder/Reading/triple_transplant.html |title=The Johns Hopkins Hospital &#124; Johns Hopkins Medicine in Baltimore, MD |publisher=Johns Hopkins Medicine |work=Hopkinshospital.org |date=24 June 2011 |access-date=17 April 2013}}</ref> The first complex multihospital kidney exchange involving 12 people was performed in February 2009 by The Johns Hopkins Hospital, [[Barnes-Jewish Hospital]] in [[St. Louis]] and Integris Baptist Medical Center in [[Oklahoma City]].<ref>{{cite news |title=Johns Hopkins Leads First 12-Patient, Multicenter "Domino Donor" Kidney Transplant |url=http://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_leads_first_12_patient_multicenter_domino_donor_kidney_transplant |access-date=25 December 2013 |newspaper=Johns Hopkins Medicine |date=16 February 2009 |author=Eric Vohr |location=Baltimore, Maryland}}</ref> Another 12-person multihospital kidney exchange was performed four weeks later by [[Saint Barnabas Medical Center]] in [[Livingston, New Jersey]], [[Newark, New Jersey|Newark Beth Israel Medical Center]] and [[New York-Presbyterian Hospital]].<ref>{{cite news |url=http://www.nj.com/news/index.ssf/2009/06/kidney_donations_connect_stran.html |title=Kidney donations connect strangers in "Chain of Life" forged by transplants |newspaper=The Star-Ledger |date=5 June 2009 |access-date=11 July 2009 |author=Amy Ellis Nutt/The Star-Ledger}}</ref> Surgical teams led by Johns Hopkins continue to pioneer this field with more complex chains of exchange, such as an eight-way multihospital kidney exchange.<ref>{{cite web |url=https://www.sciencedaily.com/releases/2009/07/090707183138.htm |title=First 16-patient, Multicenter 'Domino Donor' Kidney Transplant |website=Science Daily |date=11 July 2009 |access-date=14 July 2009}}</ref> In December 2009, a 13 organ 13 recipient matched kidney exchange took place, coordinated through Georgetown University Hospital and Washington Hospital Center, Washington, DC.<ref>{{cite news |url=http://www.cnn.com/2009/HEALTH/12/14/kidney.transplant/index.html |title=Massive transplant effort pairs 13 kidneys to 13 patients |publisher=CNN |date=14 December 2009 |access-date=24 December 2013 |author=Val Willingham}}</ref>

=== Good Samaritan ===
Good Samaritan or "altruistic" donation is giving a donation to someone that has no prior affiliation with the donor. The idea of altruistic donation is to give with no interest of personal gain, it is out of pure selflessness. On the other hand, the current allocation system does not assess a donor's motive, so altruistic donation is not a requirement.<ref>{{Cite book|title=ethics and the acquisition of organs|last=[[Timothy Martin Wilkinson|Wilkinson]]|first=T.M.|publisher=Oxford University Press|year=2011|isbn=978-0-19-960786-0|pages=148}}</ref> Some people choose to do this out of a personal need to donate. Some donate to the next person on the list; others use some method of choosing a recipient based on criteria important to them. Websites are being developed that facilitate such donation. Over half of the members of the [[Jesus Christians]], an Australian religious group, have donated kidneys in such a fashion.<ref>{{cite news |url=http://www.cnn.com/2006/HEALTH/06/01/living.donors/index.html |title=Would you give your kidney to a stranger? |date=5 June 2006 |publisher=CNN |access-date=2 May 2008}}</ref>

=== Financial compensation ===
{{See also|Organ theft|Organ trade|Repugnancy costs}}

Monetary compensation for organ donors, in the form of reimbursement for out-of-pocket expenses, has been legalised in [[Australia]],<ref>{{Cite news|last=Plibersek|first=Tanya|date=7 April 2013|title=Supporting Paid Leave for Living Organ Donors|url=https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id:%22media/pressrel/2357133%22|access-date=16 October 2021}}</ref> and strictly only in the case of kidney transplant in the case of [[Singapore]] (minimal reimbursement is offered in the case of other forms of organ harvesting by Singapore). Kidney disease organizations in both countries have expressed their support.<ref name="aus">[https://archive.today/20140721101036/http://www.theaustralian.com.au/news/latest-news/living-donors-to-receive-financial-support/story-fn3dxiwe-1226614172117 Live donors to get financial support], Rashida Yosufzai, AAP, 7 April 2013</ref><ref name="bmj">{{cite journal | doi = 10.1136/bmj.a2456 | pmid=18996933 | volume=337 | title=Singapore legalises compensation payments to kidney donors | journal=BMJ | pages=a2456 | year=2008 | author=Bland B| s2cid=38062784 }}</ref>

In compensated donation, donors get money or other compensation in exchange for their organs. This practice is common in some parts of the world, whether legal or not, and is one of the many factors driving [[medical tourism]].<ref>{{cite journal |last1=Budiani-Saberi |first1=D.A. |last2=Delmonico |first2=F.L. |title=Organ Trafficking and Transplant Tourism: A Commentary on the Global Realities |journal=American Journal of Transplantation |date=May 2008 |volume=8 |issue=5 |pages=925–929 |doi=10.1111/j.1600-6143.2008.02200.x |doi-access=free |pmid=18416734 }}</ref>

In the illegal black market the donors may not get sufficient after-operation care,<ref name="wsj">[https://online.wsj.com/news/articles/SB10001424052748703481004574646233272990474?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052748703481004574646233272990474.html#mod=todays_us_weekend_journal The Meat Market] {{webarchive |url=https://web.archive.org/web/20140411041413/http://online.wsj.com/news/articles/SB10001424052748703481004574646233272990474?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052748703481004574646233272990474.html#mod=todays_us_weekend_journal |date=11 April 2014 }}, The Wall Street Journal, 8 January 2010.</ref> the price of a kidney may be above $160,000,<ref>{{cite web|url=https://www.cbsnews.com/news/black-market-kidneys-160000-a-pop/ |title=Black Market Kidneys, $160,000 a Pop |last=Martinez |first=Edecio |date=27 July 2009 |work=CBS News |access-date=12 June 2011 |url-status=live |archive-url=https://web.archive.org/web/20110423173424/http://www.cbsnews.com/8301-504083_162-5190413-504083.html |archive-date=23 April 2011 }}</ref> middlemen take most of the money, the operation is more dangerous to both the donor and receiver, and the receiver often gets [[hepatitis]] or [[HIV]].<ref name="Economist" /> In legal markets of Iran<ref>{{cite journal | author = Movassagh Hooman | year = 2016 | title = Human Organ Donations Under the 'Iranian Model': A Rewarding Scheme for U.S. Regulatory Reform? | journal = Indiana Health Law Review | volume = 13 | issue = 1| pages = 82–118 | doi = 10.18060/3911.0013 | doi-access = free }}</ref> the price of a kidney is $2,000 to $4,000.<ref name="Economist">{{cite magazine|url=http://www.economist.com/node/8173039?story_id=8173039|title=Psst, wanna buy a kidney?|date=16 November 2006|magazine=Organ transplants|publisher=The Economist Newspaper Limited 2011|access-date=12 June 2011}}</ref><ref name="Tober2007">{{cite journal |last1=Tober |first1=Diane M. |title=Kidneys and Controversies in the Islamic Republic of Iran: The Case of Organ Sale |journal=Body & Society |date=September 2007 |volume=13 |issue=3 |pages=151–170 |doi=10.1177/1357034x07082257 |s2cid=146238746 }}</ref><ref>{{cite web|url=http://www.aakp.org/aakp-library/Compensated-Donations/|title=A New Outlook on Compensated Kidney Donations|last=Schall|first=John A.|date=May 2008|work=RENALIFE|publisher=American Association of Kidney Patients|access-date=14 June 2011|url-status=dead|archive-url=https://web.archive.org/web/20110927221324/http://www.aakp.org/aakp-library/Compensated-Donations/|archive-date=27 September 2011}}</ref>

An article by [[Gary Becker]] and Julio Elias on "Introducing Incentives in the market for Live and Cadaveric Organ Donations"<ref>{{cite news |url=http://graphics8.nytimes.com/images/blogs/freakonomics/pdf/BeckerEliasOrgans(5-06).pdf |newspaper=The New York Times|title=Introducing Incentives in the Market for Live and Cadaveric Organ Donations |author1=Gary S. Becker |author2=Julio Jorge Elías |access-date=24 December 2013}}</ref> said that a [[free market]] could help solve the problem of a scarcity in organ transplants. Their economic modeling was able to estimate the price tag for human kidneys ($15,000) and human livers ($32,000).

In the United States, [[The National Organ Transplant Act of 1984]] made organ sales illegal. In the United Kingdom, the [[Human Organ Transplants Act 1989]] first made organ sales illegal, and has been superseded by the [[Human Tissue Act 2004]].  In 2007, two major European conferences recommended against the sale of organs.<ref>{{cite news |url=http://www.slate.com/id/2164177/nav/tap1/ |title=Shopped Liver: The worldwide market in human organs |author=William Saletan |author-link=William Saletan |work=Salon |date=14 April 2007 |access-date=24 December 2013 |archive-date=7 July 2010 |archive-url=https://web.archive.org/web/20100707210309/http://www.slate.com/id/2164177/nav/tap1/ |url-status=dead }}</ref> Recent development of websites and personal advertisements for organs among listed candidates has raised the stakes when it comes to the selling of organs, and have also sparked significant ethical debates over directed donation, "good-Samaritan" donation, and the current US organ allocation policy. Bioethicist Jacob M. Appel has argued that organ solicitation on billboards and the internet may actually increase the overall supply of organs.<ref>{{cite journal |doi=10.1353/hcr.2005.0052 |vauthors=Appel JM, Fox MD |title=Organ solicitation on the Internet: every man for himself? |journal=Hastings Cent Rep |volume=35 |issue=3 |pages=14; discussion 14–15 |year=2005 |pmid=16092393|s2cid=144121833 }}</ref>

In an experimental survey, Elias, Lacetera and Macis (2019) find that preferences for compensation for kidney donors have strong moral foundations; participants in the experiment especially reject direct payments by patients, which they find would violate principles of fairness.<ref>{{cite journal |last1=Elías |first1=Julio J. |last2=Lacetera |first2=Nicola |last3=Macis |first3=Mario |title=Paying for Kidneys? A Randomized Survey and Choice Experiment |journal=American Economic Review |date=August 2019 |volume=109 |issue=8 |pages=2855–2888 |doi=10.1257/aer.20180568 }}</ref>

Many countries have different approaches to organ donation such as the opt-out approach and many advertisements of organ donors, encouraging people to donate. Although these laws have been implemented in a certain country they are not forced upon everyone as it is an individual decision.

Two books, ''Kidney for Sale By Owner'' by Mark Cherry (Georgetown University Press, 2005) and ''Stakes and Kidneys: Why Markets in Human Body Parts are Morally Imperative'' by James Stacey Taylor:
(Ashgate Press, 2005), advocate using markets to increase the supply of organs available for transplantation.
In a 2004 journal article economist Alex Tabarrok argues that allowing organ sales, and elimination of organ donor lists will increase supply, lower costs and diminish social anxiety towards organ markets.<ref name="econjournalwatch.org">{{cite journal |url=http://www.econjournalwatch.org/pdf/Tabarrok%20Comment%20April%202004.pdf |journal=Econ Journal Watch|title=How to Get Real About Organs |author=Alexander Tabarrok |publisher=Fraser Institute |date=April 2004 |volume=1 |issue=1 |pages=11–18 |access-date=24 December 2013 }}</ref>

Iran has had a legal market for kidneys since 1988.<ref>{{cite journal |vauthors=Ghods AJ, Savaj S |title=Iranian model of paid and regulated living-unrelated kidney donation |journal=Clinical Journal of the American Society of Nephrology |volume=1 |issue=6 |pages=1136–45 |date=November 2006 |pmid=17699338 |doi=10.2215/CJN.00700206|doi-access=free }}</ref> The donor is paid approximately US$1200 by the government and also usually receives additional funds from either the recipient or local charities.<ref name="Tober2007" /><ref>{{cite journal |author=Griffin A |title=Kidneys on demand |journal=British Medical Journal |volume=334 |issue=7592 |pages=502–05 |date=March 2007 |pmid=17347232 |pmc=1819484 |doi=10.1136/bmj.39141.493148.94}}</ref> ''[[The Economist]]''<ref>{{cite news |url=http://www.economist.com/opinion/displaystory.cfm?story_id=8173039 |title=Organ transplants: Psst, wanna buy a kidney? |newspaper=The Economist |date=16 November 2006 |access-date=17 April 2013}}</ref> and the [[Ayn Rand Institute]]<ref>{{cite web |url=http://www.aynrand.org/site/News2?JServSessionIdr012=e38noczlb2.app7a&page=NewsArticle&id=11517&news_iv_ctrl=1085 |title=To Save Lives, Legalize Trade in Organs |publisher=The Ayn Rand Center for Individual Rights |work=Aynrand.org |author=David Holcberg |year=2005 |access-date=1 December 2013 |archive-url=https://web.archive.org/web/20131019212327/http://www.aynrand.org/site/News2?JServSessionIdr012=e38noczlb2.app7a&page=NewsArticle&id=11517&news_iv_ctrl=1085 |archive-date=19 October 2013 |url-status=dead }}</ref> approve and advocate a legal market elsewhere. They argued that if 0.06% of Americans between 19 and 65 were to sell one kidney, the national waiting list would disappear (which, the Economist wrote, happened in Iran). The Economist argued that donating kidneys is no more risky than [[Surrogacy|surrogate motherhood]], which can be done legally for pay in most countries.

In Pakistan, 40 percent to 50 percent of the residents of some villages have only one kidney because they have sold the other for a transplant into a wealthy person, probably from another country, said Dr. Farhat Moazam of Pakistan, at a [[World Health Organization]] conference. Pakistani donors are offered $2,500 for a kidney but receive only about half of that because middlemen take so much.<!--ORIGINAL DEAD REFERENCE; COULD NOT FIND; USING ALTERNATE RE-PUBLISHER INSTEAD: [https://web.archive.org/web/20071008202945/http://www.wtopnews.com/?nid=106&sid=110286] WHO Says Organ Demand Outstrips Supply, Alexander G. Higgins, Associated Press, March 30, 2007{{dead-link|date=December 2013}}--><ref>{{cite news |title=WHO says organ demand outstrips supply |url=http://usatoday30.usatoday.com/news/health/2007-03-30-1689076706_x.htm |access-date=25 December 2013 |newspaper=USA Today |date=30 March 2007 |author=Alexander G. Higgins |archive-url=https://web.archive.org/web/20131225031445/http://usatoday30.usatoday.com/news/health/2007-03-30-1689076706_x.htm |archive-date=25 December 2013 |url-status=live}}</ref> In Chennai, southern India, poor fishermen and their families sold kidneys after their livelihoods were destroyed by the Indian Ocean tsunami on 26 December 2004. About 100 people, mostly women, sold their kidneys for 40,000–60,000 rupees ($900–1,350).<ref>{{cite news |url=https://www.reuters.com/article/healthNews/idUSDEL21432720070116 |title=Indian police probe kidney sales by tsunami victims |author=R. Bhagwan Singh |work=Reuters |date=16 January 2007 |access-date=9 August 2008}}</ref> Thilakavathy Agatheesh, 30, who sold a kidney in May 2005 for 40,000 rupees said, "I used to earn some money selling fish but now the post-surgery stomach cramps prevent me from going to work." Most kidney sellers say that selling their kidney was a mistake.<ref>{{cite journal |doi=10.1001/jama.288.13.1640 |author=Rothman DJ |title=Ethical and social consequences of selling a kidney |journal=[[JAMA (journal)|JAMA]] |volume=288 |issue=13 |pages=1640–41 |date=October 2002 |pmid=12350195 }}</ref>

In Cyprus in 2010, police closed a fertility clinic under charges of trafficking in human eggs. The Petra Clinic, as it was known locally, brought in women from Ukraine and Russia for egg harvesting and sold the genetic material to foreign fertility tourists.<ref>{{cite web |url=http://pulitzercenter.org/blog/untold-stories/importing-egg-donors-ukraine-cyprus |title=Cyprus Clinic Accused of Human Egg Harvesting |publisher=Pulitzer Center |date=2010-08-17 |access-date=25 December 2013 |archive-date=26 December 2013 |archive-url=https://web.archive.org/web/20131226022756/http://pulitzercenter.org/blog/untold-stories/importing-egg-donors-ukraine-cyprus |url-status=dead }}</ref> This sort of reproductive trafficking violates laws in the European Union. In 2010, [[Scott Carney]] reported for the [[Pulitzer Center on Crisis Reporting]] and the magazine [[Fast Company (magazine)|Fast Company]] explored illicit fertility networks in Spain, the United States and Israel.<ref>{{cite news |title=Untold Stories: The Cyprus Scramble |url=http://pulitzercenter.org/blog/untold-stories/cyprus-scramble-investigation-human-egg-markets |date=17 August 2010 |author=Scott Carney |access-date=2 September 2010 |archive-date=18 August 2010 |archive-url=https://web.archive.org/web/20100818234708/http://pulitzercenter.org/blog/untold-stories/cyprus-scramble-investigation-human-egg-markets |url-status=dead }}</ref><ref>{{cite magazine |url=http://www.fastcompany.com/magazine/148/eggs-for-sale.html |title=Unpacking the Global Human Egg Trade &#124; Human Eggs for Sale |author=Carney, Scott |magazine=Fast Company |date=1 September 2010 |access-date=25 December 2013}}</ref>

=== Forced donation ===
{{See also|Persecution of Falun Gong#Organ harvesting}}
There have been concerns that certain authorities are harvesting organs from people deemed undesirable, such as prison populations. The World Medical Association stated that prisoners and other individuals in custody are not in a position to give consent freely, and therefore their organs must not be used for transplantation.<ref>{{cite web |url=http://www.wma.net/en/30publications/10policies/30council/cr_5/index.html |publisher=World Medical Association |title=WMA Council Resolution on Organ Donation in China |date=May 2006 |url-status=dead |archive-url=https://web.archive.org/web/20101204232011/http://www.wma.net/en/30publications/10policies/30council/cr_5/index.html |archive-date=4 December 2010}}</ref>

According to former Chinese Deputy Minister of Health, Huang Jiefu, the practice of transplanting organs from executed prisoners is still occurring {{As of|2017|February|lc=y}}.<ref>{{Cite news|last=Kirchgaessner|first=Stephanie|date=8 February 2017|title=China may still be using executed prisoners' organs, official admits|work=The Guardian|url=https://www.theguardian.com/world/2017/feb/07/china-still-using-executed-prisoners-organs-transplants-vatican|access-date=26 July 2021}}</ref><ref name=":0">{{cite web |script-title=zh:世界日報──大陸新聞 |trans-title=World Journal – mainland news |url=http://www.worldjournal.com/wj-ch-news.php?nt_seq_id=1275791 |archive-url=https://web.archive.org/web/20071009130822/http://www.worldjournal.com/wj-ch-news.php?nt_seq_id=1275791 |archive-date=9 October 2007 |language=zh}}</ref> World Journal reported Huang had admitted approximately 95% of all organs used for transplantation are from executed prisoners.<ref name=":0" /> The lack of a public organ donation program in China is used as a justification for this practice. In July 2006, the [[Kilgour-Matas report]]<ref name="orgharv">[[David Kilgour]], [[David Matas]] (6 July 2006, revised 31 January 2007) [http://organharvestinvestigation.net An Independent Investigation into Allegations of Organ Harvesting of Falun Gong Practitioners in China] {{webarchive|url=https://web.archive.org/web/20161004182359/http://organharvestinvestigation.net/ |date=4 October 2016 }} (free in 22 languages) organharvestinvestigation.net</ref> stated, "the source of 41,500 transplants for the six-year period 2000 to 2005 is unexplained" and "we believe that there has been and continues today to be large scale organ seizures from unwilling [[Falun Gong]] practitioners".<ref name="orgharv" /> Investigative journalist [[Ethan Gutmann]] estimates 65,000 Falun Gong practitioners were killed for their organs from 2000 to 2008.<ref name="Jay">[[Jay Nordlinger]] (25 August 2014) [http://www.nationalreview.com/sites/default/files/nordlinger_gutmann08-25-14.html "Face The Slaughter: The Slaughter: Mass Killings, Organ Harvesting, and China's Secret Solution to Its Dissident Problem, by Ethan Gutmann"] {{webarchive |url=https://web.archive.org/web/20160223172904/http://www.nationalreview.com/sites/default/files/nordlinger_gutmann08-25-14.html |date=23 February 2016 }}, National Review</ref><ref name="Slaughter">Ethan Gutmann (August 2014) [https://www.amazon.com/The-Slaughter-Killings-Harvesting-Dissident/dp/161614940X The Slaughter: Mass Killings, Organ Harvesting and China's Secret Solution to Its Dissident Problem] {{webarchive |url=https://web.archive.org/web/20160302164440/http://www.amazon.com/The-Slaughter-Killings-Harvesting-Dissident/dp/161614940X |date=2 March 2016 }} "Average number of Falun Gong in Laogai System at any given time" Low estimate 450,000, High estimate 1,000,000 p. 320. "Best estimate of Falun Gong harvested 2000 to 2008" 65,000 p. 322.</ref> However 2016 reports updated the death toll of the 15-year period since the persecution of Falun Gong began putting the death toll at 150,000<ref>{{cite journal|last1=Kilgour|first1=David|title=Blood Harvest: The Slaughter|journal=End Organ Pillaging|page=428|url=http://endorganpillaging.org/wp-content/uploads/2016/06/Bloody_Harvest-The_Slaughter-June-23-V2.pdf}}</ref> to 1.5 million.<ref>{{cite web|last1=Samuels|first1=Gabriel|title=China kills millions of innocent meditators for their organs, report finds|url=https://www.independent.co.uk/news/world/asia/china-kills-millions-of-innocent-meditators-for-their-organs-report-finds-a7107091.html |archive-url=https://ghostarchive.org/archive/20220524/https://www.independent.co.uk/news/world/asia/china-kills-millions-of-innocent-meditators-for-their-organs-report-finds-a7107091.html |archive-date=24 May 2022 |url-access=subscription |url-status=live|website=The Independent|date=2016-06-29}}</ref> In December 2006, after not getting assurances from the Chinese government about allegations relating to Chinese prisoners, the two major organ transplant hospitals in Queensland, Australia stopped transplantation training for Chinese surgeons and banned joint research programs into organ transplantation with China.<ref>[https://www.smh.com.au/news/National/Hospitals-ban-Chinese-surgeon-training/2006/12/05/1165080933418.html Hospitals ban Chinese surgeon training] {{webarchive |url=https://web.archive.org/web/20161025090747/http://www.smh.com.au/news/National/Hospitals-ban-Chinese-surgeon-training/2006/12/05/1165080933418.html |date=25 October 2016 }} The Sydney Morning Herald. 5 December 2006</ref>

In May 2008, two United Nations Special Rapporteurs reiterated their requests for "the Chinese government to fully explain the allegation of taking vital organs from Falun Gong practitioners and the source of organs for the sudden increase in organ transplants that has been going on in China since the year 2000".<ref name="MW">Market Wired (8 May 2008) [http://www.marketwired.com/press-release/chinas-organ-harvesting-questioned-again-by-un-special-rapporteurs-falunhr-reports-853799.htm China's Organ Harvesting Questioned Again by UN Special Rapporteurs: FalunHR Reports] {{webarchive |url=https://web.archive.org/web/20161025084003/http://www.marketwired.com/press-release/chinas-organ-harvesting-questioned-again-by-un-special-rapporteurs-falunhr-reports-853799.htm |date=25 October 2016 }} Retrieved 26 October 2014</ref> People in other parts of the world are responding to this availability of organs, and a number of individuals (including US and Japanese citizens) have elected to travel to China or India as [[medical tourism|medical tourists]] to receive organ transplants which may have been sourced in what might be considered elsewhere to be unethical manner.<ref>{{cite news |author=Anuj Chopra, Chronicle Foreign Service |url=http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/02/09/MN23UPQ0K.DTL |title=Organ-transplant black market thrives in India |newspaper=SFGate |date=9 February 2008 |access-date=17 April 2013}}</ref><ref>{{cite news |url=http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/04/17/MNGHAIA5B51.DTL |title=Patients seeking transplants turn to China / Rights activists fear organs are taken from executed prisoners |newspaper=SFGate |author=Vanessa Hua |date=17 April 2006 |access-date=25 December 2013}}</ref><ref>{{cite news |last=Coonan |first=Clifford |url=https://www.independent.co.uk/news/world/asia/japans-rich-buy-organs-from-executed-chinese-prisoners-470719.html |archive-url=https://web.archive.org/web/20080719102429/http://www.independent.co.uk/news/world/asia/japans-rich-buy-organs-from-executed-chinese-prisoners-470719.html |url-status=dead |archive-date=19 July 2008 |title=Japan's rich buy organs from executed Chinese prisoners  |newspaper=The Independent |date=21 March 2006 |access-date=17 April 2013 |location=London}}</ref><ref name="n10">{{cite journal |last1=Cyranoski |first1=David |last2=Gaind |first2=Nisha |last3=Gibney |first3=Elizabeth |last4=Masood |first4=Ehsan |last5=Maxmen |first5=Amy |last6=Reardon |first6=Sara |last7=Schiermeier |first7=Quirin |last8=Tollefson |first8=Jeff |last9=Witze |first9=Alexandra |title=Nature's 10: Ten people who mattered in science in 2019 |journal=Nature |date=19 December 2019 |volume=576 |issue=7787 |pages=361–372 |doi=10.1038/d41586-019-03749-0 |pmid=31848484 }}</ref><ref name="RogersRobertson2019">{{cite journal |last1=Rogers |first1=Wendy |last2=Robertson |first2=Matthew P |last3=Ballantyne |first3=Angela |last4=Blakely |first4=Brette |last5=Catsanos |first5=Ruby |last6=Clay-Williams |first6=Robyn |last7=Fiatarone Singh |first7=Maria |title=Compliance with ethical standards in the reporting of donor sources and ethics review in peer-reviewed publications involving organ transplantation in China: a scoping review |journal=BMJ Open |date=February 2019 |volume=9 |issue=2 |pages=e024473 |doi=10.1136/bmjopen-2018-024473 |pmid=30723071 |pmc=6377532 }}</ref>