Israel has become increasingly involved in the world transplantation industry in the last decade. This comes a few years after India, which until the 1990s was the global center of the organ trade, enacted legislation prohibiting transplants using organs acquired from living people.

According to a 2015 European Parliament report, Israeli physicians and patients played a major role in the international organ trade, initially reaching Eastern Europe and later to other locales. The report says Israel played a key role in the trade that developed in Azerbaijan, Cyprus, Kosovo, the United States, Costa Rica, Panama, Ecuador and Colombia.

2008 was a turning point in which a Knesset law banned the purchase and sale of human organs. The illegal transplantation industry has continued to flourish globally in recent years, the European Parliament notes, but the place of Israel – along with the Philippines and Pakistan – as hubs of the organ trade has been taken by new countries, among them Costa Rica, Colombia, Vietnam, Lebanon and Egypt.

>> Illegal organ harvesting is rampant in Egypt, and refugees are the main target

A number of organ trade networks were uncovered in Israel, but until the 2008 legislation, the subject was addressed officially only in circulars issued by directors general of government ministries. In a 2003 trial of members of an Israeli network that engaged in illegal organ trade, the court expressed disapproval at the prosecution’s attempt to convict the dealers on a variety of charges ranging from forgery of documents to offenses against the Anatomy and Pathology Law.

“Punishment is meted out solely according to the law,” the court stated, “and we found no law prohibiting trade in organs. The legislature needs to take action on this matter and close the existing breach, which is liable to give rise to unacceptable situations and the exploitation of the plight of unfortunate individuals in order to acquire organs from them.”

A circular issued in 2006 by the Health Ministry director general at the time, Avi Yisraeli, sought to curb the phenomenon. Anyone wishing to receive an organ donation from a person living abroad, the directive stated, must present information about the donor’s identity and about how the donation was obtained in addition to submitting declarations by the donor and the recipient attesting that no payment was involved.

Yisraeli warned that the Kupat Holim HMOs were not being meticulous about ascertaining the origin of the organs. He also assailed the existing situation, which imposed a ban on the procurement of organs in Israel, but at the same time allowed the HMOs to underwrite transplants making use of organs that were purchased abroad.

“This situation is irregular,” Yisraeli stated. “It sends a dual and highly problematic message about the state’s commitment to the ethical and moral principles that underlie the universal ban on the organ trade.”

The breach was closed in 2008. Part three of the Organ Transplantation Law states, “No person shall receive a quid pro quo for an organ that is removed from his body or from the body of another person, or is intended to be removed, whether this occurs during the person’s lifetime or after his death.”

Part four stipulates, “No person shall mediate between the donor and the recipient, directly or indirectly, for the removal of an organ or the transplantation of an organ, if the mediation is conducted in return for a quid pro quo.”

Following the law’s passage, the Health Ministry instructed the Kupat Holim to stop reimbursing individuals who have an organ transplant abroad. Subsequently, the Supervisor of Insurance issued a similar directive to insurance companies. At the same time, the new regulations were criticized on the grounds that they constitute a death sentence for those who can’t afford transplantation surgery abroad, whereas those with the financial means would be able to cope.

Be that as it may, the new law, together with a significant increase in the number of Israelis who are ready to donate organs and who sign a form declaring their willingness to donate organs after their death, have helped to regularize the situation.