By Andrew Rock

The World Health Organization estimates that current organ supply meets only a tenth of its need. This persistent shortage has led many people to search for organs elsewhere, resulting in a thriving black market. Desperate individuals who turn to the global marketplace usually enlist the services of a broker; brokers often charge $100,000 or more, a sum that is significantly more than what organ donors can expect to receive.
Many brokers claim that they are not engaging in illegal activity because they are not directly involved in the exchanges. Rather, they see themselves as assisting in a transaction that is, on the whole, good, because even if some individuals are negatively affected, the brokers’ actions are saving lives.

The supply side of this black market consists mainly of countries that have lax legislation regarding transplants for foreigners. Costa Rican national policy is especially permissive, making this nation particularly attractive to underground activity. Due to such policy, and its incredible beaches, Costa Rica has long been a destination location for wealthy foreigners looking for medical procedures at a bargain price.

Additionally, Costa Rica has a dual public-private healthcare system; such a system incentivizes doctors to take on foreign clients. In Costa Rica, physicians are required to work at state-run hospitals where they make a fixed salary. However, if they choose to take on private cases following regular work hours, they have the potential to supplement their incomes significantly, because for these patients, doctors are paid on a case-by-case basis. San Jose nephrologist Dr. Jose Fernando Mangel Morales told The New York Times that he could sometimes double his monthly salary by performing just one transplant in a private hospital.

These and other factors have led to many Costa Rican doctors becoming complicit with the underground organ market. While brokers and physicians have found several ways to conceal their illegal activities, Costa Rican officials have been combating these practices by tightening legal barriers and making arrests.

While a legal market for organs has often been criticized, it has become apparent that the need will not be met by relying only on altruistic donations and cadaveric donations. Attempting to regulate a market of this kind would introduce standards of practice that would make it cheaper and safer for all those involved.
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