When I first got my driver’s license years ago, they asked if I wanted to be an organ donor. Having learned to be skeptical of institutions and having heard some concerning stories, I said no. But I felt conflicted about it—I believe in treating others as you’d want to be treated, and if I needed a transplant someday, I’d desperately want someone willing to help save my life.
Since then, I’ve discovered much more disturbing information about organ transplantation that completely shifted my perspective. Recently, RFK Jr. did something I never expected—he formally announced that there were widespread failures in our organ donation system’s ethical safeguards. This opened the floodgates for others to start discussing the grim reality that organs were being taken from people who were still alive.
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The Value of Organs
Over time, medicine transformed our cultural relationship with death—from an accepted, intimate companion to a feared, medicalized enemy to be defeated (e.g., one author traces this shift through six historical stages, arguing that medicalization stripped individuals of autonomy and commodified death itself).
Medicine fueled this transformation by performing modern “miracles,” such as reviving the dead through cardiac resuscitation and transplanting organs—crossing what was once an absolute boundary between life and death. In doing so, it gained immense public trust and the ability to justify exorbitant costs.
This cultivated the myth that medicine can conquer death. Over time, it became seen not just as a means of survival, but as something to be continuously consumed in the name of “health”—transforming it into a highly profitable industry that now accounts for over 17.6% of all U.S. spending.
Because viable donor organs (a central crux of medicine’s dominion over death) are so limited, transplants quickly became incredibly valuable—costs range from $446,800 to $1,918,700 depending on the organ. Given how desperate people are for organs and how much money is involved, it hence seemed reasonable to assume some illegal harvesting would occur.
Over the years, as demand for organs continues to increase, I’ve continually found disturbing evidence that this was happening. This includes:
•Individuals being tricked into selling a kidney (e.g., in 2011, a viral story discussed a Chinese teenager who did so for an iPhone 4—approximately 0.0125% of the black market rate for a kidney, after which he became septic and his other kidney failed leaving him permanently bedridden, and in 2023, a wealthy Nigerian politician being convicted for trying to trick someone into donating a kidney for a transplant at an English hospital).
•A 2009 and 2014 Newsweek investigation and a 2025 paper highlighted the extensive illegal organ trade, estimating that 5% of global organ transplants involve black market purchases (totaling $600 million to $1.7 billion annually), with kidneys comprising 75% of these due to high demand for kidney failure treatments and the possibility of surviving with one kidney (though this greatly reduces your vitality). Approximately 10-20% of kidney transplants from living donors are illegal, with British buyers paying $50,000–$60,000, while desperate impoverished donors (e.g., from refugee camps or countries like Pakistan, India, China, and Africa) receive minimal payment and are abandoned when medical complications arise, despite promises of care. To quote the 2009 article:
Diflo became an outspoken advocate for reform several years ago, when he discovered that, rather than risk dying on the U.S. wait list, many of his wealthier dialysis patients had their transplants done in China. There, they could purchase the kidneys of executed prisoners. In India, Lawrence Cohen, another UC Berkeley anthropologist, found that women were being forced by their husbands to sell organs to foreign buyers to contribute to the family’s income, or to provide for the dowry of a daughter. But while the WHO estimates that organ-trafficking networks are widespread and growing, it says that reliable data are almost impossible to come by.
Note: these reports also highlighted that these surgeries operate on the periphery of the medical system and involve complicit medical professionals who typically claim ignorance of its illegality (e.g., a good case was made that a few US hospitals, like Cedars Sinai were complicit in the trade).
• A 2004 court case where a South African hospital pleaded guilty to illegally transplanting kidneys from poorer recipients (who received $6,000–$20,000) to wealthy recipients (who paid up to $120,000).1 2
• Many reports of organ harvesting by the Chinese government against specific political prisoners.1,2,3,4,5 This evidence is quite compelling, particularly since until 2006, China admitted organs were sourced from death row prisoners (with data suggesting the practice has not stopped).
Note: harvesting organs from death row prisoners represents one of the most reliable ways to get healthy organs immediately at the time of death (which is one of the greatest challenges in transplant medicine).
• I’ve read reports of organ harvesting occurring in Middle East conflict zones, by ISIS and in the Kosovo conflict, and with drug cartels.
Note: many other disturbing cases of illicit organ harvesting are discussed in more detail here. Likewise, many other valuable tissues (e.g., tendons and corneas) can be harvested from dead bodies. Significant controversy also exists with the ethics of how these are collected (e.g., this investigation highlights that the industry is highly profit focused and gives minimal respect to the bodies).
When Consciousness Gets Trapped
Different parts of the brain control various aspects of our being, so people who are still conscious can sometimes completely lose control of their bodies or their ability to communicate—known as Locked-in syndrome.
The most famous case involves Martin, a 12-year-old who fell ill with meningitis and entered a vegetative state. He was sent home to die, but stayed alive. At 16, he began regaining consciousness, became fully aware by 19, and at 26, a caregiver finally realized he was conscious and got him a communication computer. He eventually married.
Note: Two things from his memoir stuck with me: years of being haunted by his mother once saying, “I hope you die” in frustration, and him sharing, “I cannot even express to you how much I hated Barney” because the care center had him watch Barney reruns every day, assuming he was vegetative.
When someone is dying, certain functions are lost before others. It’s frequently observed in palliative care that touch and hearing are the last senses to disappear (e.g., studies show hearing persists at the end of life). This is why I sometimes tell grieving families their “brain-dead” loved one might still hear their voice or feel their touch.
Note: Many people who’ve been resuscitated report “near-death experiences” where they were aware of their surroundings when their brain was supposedly “dead,” suggesting other senses may persist during brain death.
The Problem with Brain Death
Since organs rapidly lose viability once someone dies, the only way to ethically obtain them is from someone who has “died” but whose body is still keeping organs alive—someone who is brain dead.
Brain death was defined by a 1968 Harvard Medical School Committee report called “A Definition of Irreversible Coma.” They stated their purpose was to “define irreversible coma as a new criterion for death” for two reasons: the burden of caring for brain-damaged patients and avoiding controversy in obtaining organs for transplantation.
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However, the committee was confident about diagnosing “irreversible coma” but tentative about calling this “death.” A Harvard ethicist noted: “That link, between being irreversibly unconscious and being dead, has never really been made in a convincing way.”
The criteria included no response to stimuli, no breathing, no reflexes, no brainwaves, and replication after 24 hours. Though rapidly adopted, it was immediately contested by doctors who felt harvesting organs from someone with a heartbeat was unethical, worried about diagnostic errors, and suspected the primary motivation was avoiding long-term care costs and obtaining organs.
Note: Recent studies show fMRIs demonstrate intentional brain activity in 20% of vegetative patients, and 25% of patients with no physical ability to respond can still activate brain regions when spoken to.
The New York Times recently published an essay advocating for broadening the definition of death, arguing: “We need to broaden the definition of death… So long as the patient had given informed consent for organ donation, removal would proceed without delay… We would have more organs available for transplantation.”
When “Brain Dead” Patients Are Actually Conscious
Compelling cases demonstrate these concerns are valid. Zack Dunlap, a 21-year-old pronounced brain dead after an ATV accident, was about to have his organs harvested when a nurse relative tested his reflexes and got responses. The transplant was cancelled, and Zack fully recovered. Crucially, Zack was fully conscious throughout:
“The next thing I remember was laying in the hospital bed, not being able to move, breathe, couldn’t do anything, on a ventilator, and I heard someone say, I’m sorry he’s brain-dead… I tried to scream tried to move, just got extremely angry.”
Jahi McMath, a thirteen-year-old declared brain dead after tonsillectomy complications, was kept on life support by her family despite court orders. Nine months later, she had regained brainwaves and blood flow to the brain, and moved in response to verbal commands.
Similar cases include Lewis Roberts (began breathing hours before organ harvesting), Ryan Marlow (diagnosis reversed after wife’s insistence), Colleen Burns (awoke on the operating table and was later found by HHS to have been repeatedly misdiagnosed), and Trenton McKinley (13-year-old who recovered before scheduled donation). There were also cases like Steven Thorpe (declared brain dead by four doctors, parents refused organ donation, and he awoke two weeks later), and Gloria Cruz (husband refused to allow withdrawal of care, and she recovered).
Note: A recent study found that over 30% of brain-injured patients deemed unrecoverable would have partially or fully recovered had life support not been withdrawn.
