|This Chinese man is offering to sell his organs to pay the bills, which is typical as poverty drives the shadowy trade worth an estimated $50m globally [GALLO/GETTY]
The stories are grim and often impossible to confirm: illicit clinics, corrupt doctors and global networks dealing in human flesh.
International organ trafficking is a big business, with an estimated value of $50m in 2008, according to Michael Bos from the European Platform on Ethical Legal and Psychosocial Aspects of Organ Transplantation.
The World Health Organisation (WHO) estimated in 2007 that organ trafficking accounts for between five and 10 per cent of kidney transplants performed annually across the globe.
Antonio Medina, 23, a paperless Central American migrant moving through Mexico to the US, says he knows a fellow traveller who witnessed organ trafficking, after he and his wife were captured by a criminal gang.
"He was travelling with his wife and they [gangsters] took both of them," Medina told Al Jazeera during an interview in Mexico. "They [gangsters] put them in separate rooms. He heard his wife screaming. After he went in and saw her on a table with her chest wide open and without her heart or kidney."
Medina's friend said he was saved from the grisly house-turned-clinic by Mexican soldiers. The claims, like many aspects of the organ trafficking business, are impossible to independently verify.
The profit motive
"I have no doubt organs are being removed from bodies," says David Shirk, a professor of political science and director of the Trans-Border Institute at the University of San Diego who has investigated trafficking. "But for the most part, organ trafficking occurs in hospitals, where there are corrupt medical practitioners."
"Maybe people are cutting organs out as a form of torture - a great way to torture someone would be to tie them to a chair and pull their guts out in front of their eyes - but it is not credible to me that bodies are being used for transplants, as the procedure requires very sanitary conditions and careful donor matching," he told Al Jazeera.
The World Health Organisation (WHO) defines organ trafficking as commercial transplantation, where there is profit, or transplantations occurring outside of national medical systems. Direct organ theft, including the case Medina described, represents only a small portion of global trafficking.
"There are criminal underground organisations providing kidney transplantations," says Luc Noel, coordinator of essential health technologies at the WHO. "But most cases involve the poor, the destitute and the vulnerable that are willing to part with an organ for money."
"The common denominator [with theft and "consensual" sales] is profiteering," he told Al Jazeera.
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Poor people can reportedly earn between $3,000 to $15,000 for selling their organs, specifically kidneys, to middlemen who re-sell them to wealthy buyers for as much as $200,000
In a 2009 report on organ trafficking, the Council of Europe and the United Nations concluded that there was possibly "a high number of unreported cases", attributing this to the "huge profits and rather low risks for the perpetrators".
Mexico is not considered one of the worst countries for organ trafficking; the grisly practice is thought to be most prevalent in Israel, India, China, Pakistan, Turkey, Brazil, Nepal, the Philippines, Kosovo, Iran, and former Soviet states in eastern Europe.
"Transplant tourisms flourishes in areas with weak authorities," says Noel from the WHO. "We do not want to see a society where the destitute become a store of organs for the wealthy and powerful."
Customers normally come from the US, Western Europe, the Arab Gulf states, Israel and wealthy enclaves in the developing world. "The patients are also vulnerable and often extremely sick," Noel says. "The solution is that each community should address its needs in organs. Public authorities need to increase awareness on the benefits of [volunteering] for transplants."
Most people are coerced into selling their organs through a combination of misinformation and poverty, says Debra Budiani, a visiting scholar at the University of Pennsylvania's Centre for Bioethics.
So, how does one go about buying an illicit organ? It's a bit more complicated than walking to a shady part of town and haggling with a guy carrying wads of kidneys in his trench coat.
"The procedure for American patients is to go online and look for these services," Budiani told Al Jazeera. "This has been the framework for transplant tourism."
China has been particularly sophisticated in using the internet to attract transplant tourists, she says. The nominally communist country has one of the world's highest execution rates, and dead convicts provide a ready supply of healthy young organs.
Once patients arrive in China and the deal is set up, organisers will often force them to compete for the organs in intense bidding wars, Budiani says. "They will get into a situation in the hospital where they are waiting to see who will get the first organ from an executed prisoner," and the highest bidder gets first pick, even though prices are normally negotiated before foreigners arrive in China.
"There is a lot of dirty business around these operations," she says. "And it started with a lot of coordination on the internet."
In a posting on a free announcements website in Tuxla Gutierrez, the capital of economically marginalised Chiapas state in southern Mexico, a user offers to pay $25,000 for an organ and promises to be "absolutely discrete and serious" with whoever responds to the add. The user leaves an e-mail address and says that the operation will be done in Houston, Texas. The proposed transaction is illegal, Budiani says.
New organising tools
In addition to her academic work at the University of Pennsylvania, Budiani directs the Coalition for Organ-Failure Solutions, a grassroots advocacy group.
The coalition is planning a trafficking hotline, to take calls from victims, so they can be linked to doctors and the appropriate authorities."We are establishing a virtual social network, with mobile phones as the common denominator," Budiani says. "Even if they are illiterate, they still have access to mobile phones."
A prototype of the plan will be tested in Egypt and India in the coming months. The hotline could also act as a resource for understanding the sources of this kind of crime, she says, adding that Egypt's recent revolution, and the political instability it has caused, creates a "vulnerable period where human trafficking could thrive".
Back in Mexico, Antonio Medina says his friend whose wife had her organs stolen just wants to forget the whole experience. "We keep in touch by email, he is back in Honduras."
As seems standard with trafficking victims, they fall back into the shadows, often irreparably physically and emotionally scarred, isolated and alone.
"Migrants are highly vulnerable to various forms of exploitation," says David Shirk. And that reality extends across the globe, from refugees of Sudan's internal conflicts facing organ trafficking in Egypt to Moldovans and Kazakhs who have had their kidneys illicitly removed in Kosovo.
Debra Budiani hopes the proposed anti-trafficking hotline will help prevent abuses, while providing solace to those who are missing organs, facing shame and sickness.
"We want to allow people to mobilise and share resources on how they have been abused," she says, "to put them in touch with other victims so they aren't so isolated."
Follow Chris Arsenault On Twitter: @AJEchris