By Frederike Ambagtsheer

The human organ trade is proliferating globally. However, far fewer cases have been prosecuted than would be expected based on estimates of the crime. Research exploring the challenges to investigating and prosecuting organ trafficking cases is practically non-existent. Also no studies exist that explain these challenges utilizing a criminal justice framework. This article aims to explain the legal, institutional and environmental factors that affected the investigation and prosecution of two organ trafficking cases: the Netcare case, exposed in South Africa and the Medicus case, exposed in Kosovo. It analyzes these factors through a comparative, mixed-method design, utilizing a theoretical criminal justice framework. Both cases constituted globally operating criminal networks involving brokers and transplant professionals that colluded in organizing illegal transplants. Both cases contained human trafficking elements, however only the Medicus case was prosecuted as a human trafficking case. Legal uncertainty, a lack of institutional readiness and cross-border collaboration issues hampered investigation and prosecution of the Netcare case. The Medicus case also reported problems during cross-border collaboration, as well as a corrupt environment and institutional barriers, which impeded a successful case outcome. Recommendations to improve enforcement of organ trafficking include improving identification of suspicious transplant activity, streng

Trends in Organized Crime (2025) 28:51–78

By Flore Berger and Mouhamadou Kane 

West Africa has become a hotspot for the trafficking of medical products, with estimations that the illicit market makes up to 80% of medical products in Burkina Faso and Guinea, the two case studies of this brief. Despite its enormous scale, there are gaps in knowledge that this report seeks to address by providing a qualitative analysis of the market’s key characteristics and enablers (corruption and insecurity), and an assessment of national and regional responses. Recommendations l The complex supply chains feeding the illicit market for medical products dictate that responses must be international, and at the very least regional, to be effective. ECOWAS hence has a key role to play at the regional level to enhance cross-border intelligence gathering and cooperation. l National authorities are best placed to tackle the structural drivers (affordability and accessibility) behind the demand for illicit medical products, and should work simultaneously on awareness campaigns, as well as on wider distribution of and access to key high-demand products such as antimalarials. l Civil society has a key role to play. In addition to supporting the awareness-raising effort, civil society is also central in holding people accountable (including customs officials and politicians, for example) by denouncing cases of corruption and malfeasance.  

  OCWAR-T Policy Brief 5 | August 2023, Institute for Security Studies, 2023. 10p.