Interview with Dr. Rafael Matesanz in La Gran Epoca

Admitting the sale of organs is going back to the law of the jungle


By Lluís Badia

(English translation of an interview with Dr. R. Matesanz in La Gran Epoca from October 2, 2013. Rafael Matesanz, Director of the National Transplant Organization (ONT), describes in unvarnished detail the difficult fight against organ trafficking and transplant tourism in the world.)


MADRID, Spain—It was two decades ago when the media began to report a gruesome reality that surpassed any horror story. The bogeyman would now also remove a kidney and left you abandoned in a dumpster. Although some cases were known in Europe, the phenomenon began to grow in countries where state control was much more lax, or where the State was itself directly involved in the lucrative business generated by this atrocity.

But as the director of the ONT said, there is no seller without buyer. And most buyers come precisely from countries where there is more control over organ trafficking, leading to what is known as transplant tourism. This term began to be widely used little more than a decade ago. At that time, many hospitals in China were offering in their English websites the possibility to obtain a vital organ in less than a week for prices ranging between US$ 50,000 and US$ 150,000, and the flow of tourists in search of an organ grew exponentially in China.

However, it has been only in recent years that this crime against humanity has begun to gain prominence in international human rights forums. At the United Nations Human Rights Council held recently in Geneva, different NGOs drew attention upon the organ harvesting of Falun Gong practitioners in China. Falun Gong is an ancient meditation practice that is brutally persecuted by Beijing’s regime since 1999. Precisely, Chinese delegates tried to quell these NGOs statements during different sessions of the Council, achieving finally the opposite effect they were looking for by making this issue the most discussed among delegations of different countries.

No Spaniard seems to be surprised when Spain is considered every year the worldwide leader in organ donation. Many already know that the key to success is based on a well organized donation system established by the ONT, which more and more countries around the world try to learn from. However, there might not be many who know that Spain is also a world leader in combating transplant tourism and organ trafficking.

Since 2010, Spain is the only country in the world that punishes those who obtain an organ with knowledge of its illicit origin and those who promote or advertise in any way the procuration of this type of organs with sentences of 3 to 12 years in prison. The ONT, through its director, Rafael Matesanz, actively promoted this reform in the Spanish Criminal Code, which is an unprecedented breakthrough in the prevention of transplant tourism.

La Gran Epoca (GE): Dr. Matesanz, could you explain how did the Criminal Code reform of 2010 about organ trafficking came into being?

Rafael Matesanz (RM): Regarding this issue I have to say it’s an idea that I kept for 20 years. The issue of organ trafficking worldwide is something all international organizations and all developed countries are concerned about. But the United States, Israel, Japan or the EU, who are really the buyers of these organs, have not really done anything about it.

I had proposed this in Spain back in the 90s, and I even mentioned it at the European Council but it did not produce a really important impact. And the real trigger for this reform was precisely the appearance in media of a report about the purchase of a liver in China. It had a great impact, among other things, because I think it’s been the best report showing how a citizen was traveling to China to buy an organ. At that time, I spoke to the Health Minister, who was Trinidad Jiménez, and we took the opportunity to introduce something that is unique in the world, so that a Spaniard going abroad to buy an organ would then face responsibilities. This situation does not occur in any other country in the world and has raised much interest lately in international forums because there are many professionals who think that it is the right way to go. This is not really about punishing anyone, it is about preventing.


GE: You actively participated in the drafting of a European Directive about organ Transplantation in 2010, what were the chances of implementing the Spanish reform across the EU?

RM: It was not possible because the competency of the EU in that sense was not such . So it really would not have been possible even if we had tried. This must be done by each country within its competency. There is a number of international instruments that would be very positive for this idea of Spain to be developed. For example, there is a European Council Convention on organ trafficking, which is in its final stages and we hope it will be signed this year or next. Depending on how the final text remains and depending on the countries that subscribe it, yes, it would be a very important tool.


GE: So you think the WHO or the EU would promote these changes as in the Spanish Criminal Code?

RM: When you explain this matter and the position of Spain, people understand. But when it comes down to it, surgeons, transplantation teams. the people who are responsible about it … It sometimes surprises me that they are ok with people going in search of an organ. The fact of understanding the poor patient who will buy an organ out there is one thing I can not understand. But the fact is that in international forums I had to discuss this issue, and I found out that what ultimately slows down the countries to make changes in this sense is that their professionals, the ones who really advise them on transplantation issues, seem to be all right with the actual situation.

I think in terms of transplant tourism internationally there is a double or a triple language and I find it very depressing. Hopefully the West will really get round to it and ban it.


GE: Maybe there should be at least some coordination at European level, to prevent a Spanish citizen from avoiding the Spanish system and be treated in another country.

RM: I think regarding this there is no measure to be taken overnight. The problem of organ trafficking or transplant tourism, whatever you want to call it, is that it is a phenomenon that was basically born out of a disproportion. According to the latest data we have from The Transplantation Society (TTS) in 2011 there were 112,000 organ transplants worldwide. Extrapolating the waiting list in Spain, which is very tiny, to the entire world, it could be estimated that each year more than one million people need an organ. Probably this would just be a rough estimate; there are some who assign one million people only to China. Then we find that, at best, only one out of ten of these people receive an organ. Well if that is so, and there is a part of the world who is rich and another part of the world who is poor, this is a perfect breeding ground for organ trafficking. And it is uncontrollable, unless countries commit themselves seriously. Why? Because admitting the sale of organs is going back to the law of the jungle. Even though there are people, or even a movement in the U.S., which is heavily aimed at defending the regulated sale of organs, I’ve always said, in my opinion, “zero tolerance with organ trafficking”. I think it’s a form of depravity of the human being at absolutely unbearable levels.


GE: Speaking of China, what is your impression of the situation of organ trafficking there?

RM: I think the right word is just that, impression. It is really difficult to know what happens there. Among other things, the latest data we have from China is for 2010. In 2011 China no longer provided it and neither in 2012. And the truth is that I’m not sure why. Because we just ask them about the activity they have, we are not asking for the source of the organs. But it’s like very opaque; I think this does not make any good to the Chinese government.

In recent years, China has made two things: One is committing itself to reduce the flow of organ transplanted from executed prisoners; and two, put many constraints for foreigners who want to go there for a transplantation. And also made two more things: one, establish a donor registry for people who want to donate their organs, which I think is a more for show than anything else, but at least it’s something. And has established a system of organ distribution, since it did not exist a state system before.

So the impression internationally, the impression the WHO has is that the issue progresses, but it progresses more slowly than it should. And the impression I have is that the Chinese central government can walk and actually seem to walk towards a reduction of this problem, but what is actually happening at a hospital in a lost region of China is not well controlled.


GE: What actions is the ONT taking against transplant tourism?

RM: We have carried all kinds of cooperation with international institutions on this issue for many years. In fact, in 2010 we filed a report by the Council of Europe to the United Nations, which was actually drafted by us in 90%, and we have led all the work at the Council of Europe.

Other initiatives, more legal oriented, in which we have participated at the technical level have been with WHO, the Council of Europe, in Latin America with OPS, and then with The Transplantation Society. In fact, the Prince of Asturias prize we got was for that, for our international cooperation in the fight against organ trafficking. We have invested much time and effort there.

In the fight against organ trafficking, I think there are two aspects. One, try to compensate for this disproportion. If it turns out that this occurs because the supply-demand relationship is 1-10, then we will try to increase the supply so that disparity is less. And the second is to make countries develop actions; this always occurs in the “weak” States.

Sometimes I would like that everything would move much faster, but I think we have done things in the past ten to fifteen years. At least there is a global awareness that this must be stopped somehow. The Chinese government itself feels a little enclosed in terms of world public opinion on how it cannot continue doing these things.


GE: Precisely in China, according to the report on the allegations of organ harvesting of Falun Gong practitioners in China, written by David Kilgour and David Matas in 2006, between 2000 and 2006 there were more than 44,000 organ transplants from unknown source.

RM: The issue is controlled by knowing the origin and destination of all organs. This information of a pharmaceutical product, who manufactured it, where it has passed through and where it ends, is essential to organs. But if a country fails in this regard, it cannot be said it has controlled the issue. In China, we start by not even knowing how many organs are transplanted. There are countries where it is clear that the control has been done and countries where no control has been done. But I think the way towards normalization is transparency, without transparency it is impossible.