Picture this: at your last checkup, you tell your doctor that you’ve been having difficulties going to the bathroom, feel nauseous more often and are more exhausted than ever. The doctor runs some tests, and you learn that your kidneys have suddenly lost their ability to filter waste from your blood .
At this point, you are faced with two choices. You can either enter your name on a waiting list with an expected wait time of three to years for a new kidney or you can join a clinic and begin a personalized dialysis schedule . You decide to sign up on the waitlist and begin doing dialysis to keep your blood waste-free. You do hemodialysis (dialysis using drawn blood) four times a week for four hours and hope that your kidneys are strong enough to recover on their own over time .
For many, however, this is far from the case. For those that decide to undergo dialysis, many grow to resent the process of injecting themselves with a needle or having a catheter permanently affixed to their abdomen, in the case of peritoneal dialysis . This process is known for draining patients physically, and it should come as no surprise that 25% of patients with end-stage renal disease also suffer from a long-term depressive disorder .
The only way around dialysis is transplantation. Tens of thousands of people every year wait for the coveted email from the United Network for Organ Sharing celebrating their removal from the kidney waiting list. The demand for kidneys is so high that in February 2022, the share of people on the waiting list that received a kidney was only 21.4% . This staggering gap can be largely attributed to the fact that kidney transplants have a significantly higher success rate than dialysis. According to UCSF Pharmacy Center, “after one year of treatment, those on dialysis have a 15-20% mortality rate, with a 5-year survival rate of under 50%. Persons who receive transplants have a survival rate of about 80% after 5 years” /. Those desperate for a kidney might consider another avenue for obtaining a functioning kidney, an avenue outside the realm of the national organ transplantation network: the dark web.
So, where does one begin?
Unless you know a guy who knows a guy, the first place to look for illegal organs is the dark web, a part of the internet hidden to Google and most search engines not regulated by the government. It is run by a network of different organizations, the largest of which is Tor.
Having never used this side of the internet before, I downloaded the Tor browser and created a fake, untraceable email (firstname.lastname@example.org). I immediately went to The Hidden Wiki, a massive link directory providing access to forums discussing everything from government censorship of journalists to committing acts of financial fraud. I perused many popular forums closely but could not find discussion of organ trade. I also looked at popular darknet markets like Alphabay, but I still could not find a single kidney being advertised despite the numerous listings for LSD tabs, fake passports, $10,000 worth of counterfeit bills, and other illicit goods.
Initially, I was puzzled as to why such a high-value item like a kidney wouldn’t be listed front and center in an anonymous marketplace. Though the actual market price of a kidney is largely speculative, all estimates are at least six-figures, so all parties involved in facilitating the transplant should earn a comfortable margin . That said, these are the three key reasons why kidneys are likely not sold on the dark web at all.
First, organs of any kind have a very short shelf-life. Current cooling and perfusion technology enables organs to be stored only for a few hours to a day and a half depending on organ quality and type . This short window of time explains why in hospital dramas, surgeons are portrayed as frantically running around scalpel in hand during transplants. Even assuming that transplant surgeries could be done instantly, the shipping time alone for a kidney bought off the dark web would render it useless.
Second, given how valuable kidneys are, large transfers of hundreds of thousands of dollars are an immediate red flag to banks, which, by law, report deposits or withdrawals of over $10,000 . Typically, when such illicit transactions successfully take place, buyers either use multiple accounts below the limit, or they launder the money through investing in private equity. In recent years, cryptocurrency has entered the limelight as a way to transfer money for illegal purposes as it is significantly less regulated than fiat currencies. However, all major trading platforms have capped the maximum amount for transfer in some capacity. For example, Coinbase, the largest cryptocurrency platform, has a maximum transfer and deposit limit of $25,000 a day .
Finally, organ trade is heavily policed. In 1984, the National Organ Transplant Act was passed. The law “prohibits the purchase or sale of human organs if such transfer affects interstate commerce.”  The movement of the organ market to the depths of cyberspace has not deterred federal authorities from cracking down on illegal organ sales. In 2014, DARPA, a division of the Department of Defense created MEMEX, a program which “would store and automatically cross-reference all of the user’s books, records and other information. This cross-referencing would enable users to quickly and flexibly search huge amounts of information and more efficiently gain insights from it” . The program was designed to crawl the dark web with the purpose of fighting human trafficking and identifying data about terrorists and victims through facial recognition, geoinformatics, and court citation data . With MEMEX still active on the dark web scanning for suspicious activity, it is very difficult to sell a kidney without getting tracked by law enforcement.
There are other reasons why a black market for kidneys would never work. For example, sellers could easily mislead recipients into thinking that a kidney has a compatible blood/HLA type, which could seriously put them at risk .
There is currently little activity pertaining to the sale of kidneys through the dark web, which is, of course, a good thing, considering the stakes of the kidney transplant process and tight federal regulations. Instead of making people wait on a waitlist, we need systemic changes to the organ donation process to increase the supply of kidneys ready for transplantation. One suggestion I strongly support is for the government to incentivize donors to donate by compensating them for the time spent not working during the transplant procedure. Donors are not typically remunerated for the days spent preparing, traveling, enduring and recovering from the procedure, so by removing barriers for transplantation, we can effectively keep people from searching online for kidneys in the first place . Through a simple change that prioritizes donors, we can keep more people off our waiting lists, out of dialysis centers and off the dark web.
Edited by: Alicia Yang
Illustrated by: Sophie Laye