Allegations of organ trade and illegal harvesting are rife as GCC and African states fail to conduct autopsies

Sharp-witted and quick to act, Jebrice (24) escaped a similar fate by the skin of her teeth, though she is still traumatised. In a one-room apartment on the fifth floor of a narrow building in Kilifi town on the Kenyan coast, Jebrice is helping her son with his homework as she recounts the narrow escape she had from a hospital in Madina, Saudi. She was just 20 when she went to the Kingdom in August 2020, “There was a couple and their 20-year-old son. I had to work there and also work in the madam’s mother’s house. The old lady was unwell. She had a kidney issue.” When the son sexually harassed her, Jebrice told the madam, who in turn accused her of wanting to sleep with her husband too. “She was very angry with me. Then she became very sweet to me and said she wanted to take me to the hospital to make sure I was not pregnant. I had not had sex with them, but she insisted. She said she didn’t care if I slept with them.”

Since Jebrice could not understand Arabic, every time she had an inkling they were speaking about her, she would record the conversation and translate it covertly. She first suspected there was something awry when she figured out the conversation between the madam and her sibling in the old lady’s house. “They were speaking about kidney donation,” she says.

When Jebrice was forced to go to the hospital and undergo a battery of tests, she knew she had to run away. “They made me sign a paper in Arabic, and I could not translate that. But I did record the conversation between the doctor and the family. They were saying I had agreed. They made me change into a hospital gown and said I would have to stay overnight in the hospital for the tests. I was also put on IV drips. I did not understand why all this was done for a pregnancy test.”

A younger family member was staying the night to keep watch, but as he dozed off, Jebrice ripped out the IV line and escaped from the hospital. A passerby helped take her to the police, and he warned that she may be arrested. “I was willing to be arrested. But I didn’t want to go back. The police kept asking me who my employer was. I pretended to know nothing, pretended to be blank, not remembering the employer. When they told me the employer had come searching for me, I showed them the marks on my hand left by the IV and begged them not to send me back. The police kept me in a detention centre for a month, after which I returned in October.” 

It’s a struggle to make ends meet now, but going abroad again is not on the cards for her, she says. Her friends have gone abroad to work, and some ask her to join them, but it holds no appeal. “I have heard of mistreatment, but this, to take my kidney, I had never heard of these things.”

The testimonies are fractured, and neither Eunice nor Feith believe even Pauline knew the entire truth. “Pauline told me that she had to donate an organ in order to fund her return to Kenya. Once she came back, she fell gravely ill and had to be taken to KU hospital. We were told there that her kidney was missing,” says Sophia, who has recently registered an organisation, Domestic Workers Returnees of Kenya (DWRoK), to advocate for the rights of survivors, though her activism precedes her organisation. 

The chain of custody, both in the GCC and in Kenya, is opaque at best. In the vacuum left by the government apathy, evidence-gathering is done informally by citizen journalists, activists, and families. In Kenya, calls from workers in distress first land on influencer social media channels and soon after are mired in controversy, with various parties trying to profit from the stories [see sidebar Survivors and predators - Scroll to section]. Almost weekly, there are cases of those who are severely abused or dead. One such is Emma,* who passed away in early February, and is yet to be returned. No one knows how she died, and the document issued by the Kenyan Embassy in Saudi gives authorisation for repatriation to someone named Ethan,* a name the family has never heard before. A reporter covering the news for a local channel in the sub-county says Ethan had asked the family if they were agreeable to donating her organs, as that might help cover the costs of repatriating the body. The family itself was unwilling to speak of the case.

Beatrice did speak to Margaret before she left. “She left Kenya on 20 February 2021. She was already having second thoughts and did not want to leave. She realised everything was forged, from her birth certificate to medical tests, and was scared. A man from the NADESCO agency pretended to be her father to get the paperwork done. But her choice was taken away, she was forced to leave.” As soon as she landed, the abuse began, and the first severe attack was her employer burning her arms with a clothes iron, at which point Beatrice called her boyfriend, pleading for help. Within a few days, all communication stopped, and the family began putting out calls for help. Confirmation of her death happened only two years later, with her remains returning home in 2023.

Mercy had tried appealing to the female employer, having acquired her number somehow, pleading with them to return her daughter’s body at least. “She said she had already forgotten about that story because she had already sent back the body. She threatened me, saying she can even buy the Kenyan president.”

Cultural taboos prevented Margaret from seeing her twin, but the charred, decomposed and badly mutilated body of her daughter is seared in Mercy’s memory. “How is this my daughter? Her body was empty. No stomach inside. Her breasts were cut, and her neck was almost severed. You get someone’s daughter and you do this to her? What has she done big that you do this to her? This man that killed my daughter, I wish I get that man… ” she cries. “Me, I asked, is this my daughter’s body! I want my heart to die.”

The family and Sophia, the activist who supported them, all confirm that Beatrice’s eyes and her organs were missing. 

NADESCO, the agency, was putting pressure on the family to stop their campaign for justice and demand a postmortem. Sophia had battled with the government and agencies to bring back Beatrice. “Mr G (name withheld) from Kisumu had reached out to me after my own return and saw my fight for justice. When Beatrice was not getting the government action she deserved, he then guided me on how to file a petition and take a case to the Kenyan parliament. So that’s what I did. He was with us throughout. Because of the petition, they were able to bring back Beatrice. Meanwhile, the agent was threatening me and the girl’s family. ASMAK was defending him, and they are powerful.” [See sidebar Briefcase companies and rogue brokers - Scroll to section]

With Beatrice’s family too distraught to understand the process, Sophia and a few others led the fight. “We went to the Nyayo house (a highrise in Nairobi which houses government departments) where the immigration offices are, and a guy there helped us reach the labour minister and other agencies.” It took seven months for the Kenyan embassy in Riyadh to be notified of her death, and another year and a half for her body to be returned. Sophia says the last voice notes from Beatrice to her boyfriend, which she was privy to, were of the young woman begging for help and expressing her fear that she was in great danger and would not survive.

Sophia was one of the handful allowed to see the body in the mortuary. “Her body had been opened. No eyes, her inside was empty. Her private parts were sewed up. Her body had decomposed beyond recognition, and only the tattoo on her hand helped identify her. I was frozen by the side of the gurney. I could not move. They had to push me out. That night I could not sleep alone, I was terrified by what I saw. A friend stayed with me. I've never been traumatised by a case like this one. I would get off the bed and feel like the floor was opening up and swallowing me.”

There was also further confusion around the paperwork. MR reviewed two separate documents the family received, both signed by the same sanitary inspector on the same day. One stated that her ashes were being permitted for international transport, while the other reported that her body was sent back after embalming. 

So many questions and so few answers, just like the case of Esther, whose sister, Mona,* is still angry about the lies and half-truths peddled to the family.

Mona works as a prison officer in one of the sub-counties on the Kenyan coast. After Esther left for Saudi in early 2022, Mona was the guardian for her nieces and nephews. “I would speak to her at least every two weeks, and she expressed her frustrations all the time. Her male boss was sexually assaulting her, and when she reported it to the madam, the quarrels began, and she was being attacked. I spoke to her last on 7 December, after which there was complete silence. Only on 26 January 2023 we heard she had died.”

Someone from the Ministry of Foreign Affairs in Nairobi called Esther’s mother, who was registered as the next of kin, but it was her young daughter who was in eighth grade who spoke to them. “She called me, ‘my aunty, there is a call from Nairobi foreign affairs telling us Esther is dead,’ and it is when I took the phone number and called them. They told me it was reported to the embassy there that she was found dead in Jeddah. I asked them why was she found there when she was working in Riyadh.”

They said she had escaped from the house, and the officials there claimed it was a suicide. In February 2023, Mona went in person to the Foreign Affairs office for help, and they asked her to go to the Labour office. “They asked me to go to the agent to get money to bring her back. The agent and we contributed some money and brought her back. The government office said they can’t help. Her body was finally received on 20 March.

“But when the body came, her hand was broken, and injuries on the forehead. How is that possible? And there were long incisions on her body, and we thought maybe they did post-mortem. There was a long cut from neck to the stomach. There were no intestines inside, and other organs were missing too. The stomach was fully sunken.” [Saudi does not routinely conduct autopsies even when the cause of death seems unclear or suspicious, and tends only to do so if ordered by the court — a point most cases never reach. Esther’s death was labelled as ‘natural’.]

When Mona kept pushing for answers, the people in the mortuary told her “to leave the story and take the body.”

Mona says the family could not afford a post-mortem independently, and that, “the process of bringing the body from Saudi itself wasn’t easy. Our family is too low, and to follow all those procedures was not easy for us. I was the only person following the procedures, and I also had my work.”

Feith understands this frustration all too well. “Because the family does not have the money to do further investigation. They have to let it go. They have to bury their loved one and just forget everything… What I know is that the bodies I have witnessed were tortured and were in a lot of pain. You can’t tell me this was a natural death or suicide. 

Sophia dedicates the bulk of her time to listening, advising, and helping those in distress, including helping families bring back their loved ones. “How do I manage, you ask? Faith… I am a born-again. I am protected.” A deep religiosity seems to be the crutch of many who have no faith in the government to do the right thing, or that even immediate family could step in. Mercy, even in her distress, sitting in the decrepit home she may lose any day, throws into a prayer every few minutes. Having seen Beatrice and listened to Pauline, Sophia is particularly attuned to the risks of organ harvesting when she receives distress calls, mainly from Saudi, Oman, and Iraq. “Especially from Saudi I have women calling me and telling me their employers are negotiating, saying they will give money if they will donate an organ. About half a million shillings.” That is roughly US$40,000 (SAR140,000). That’s a lot of temptation for those in abject poverty. 

“What’s the guarantee that they will get the money? Or that they will survive? It’s a trap, and I warn them repeatedly. Last year alone, three women reached out to me from Saudi as they were being pressured to donate.”

“They are hiding something from us. The reports from there always say three things, either heart attack, either suicide, either cardiac arrest…You ask yourself how someone dies of cardiac arrests and have scars on their head, on their body, there are bruises. It’s not making any sense. We need more investigations to be done. Families need to speak up too. I don’t believe in those reports,” says Feith, who is of the firm belief that many people have gone through this ordeal, but they fear coming out and speaking about it. 

”I think they are being threatened. I believe the authorities would rather have a case of someone who is dead than someone who is missing organs. Because that is a stronger case. So the victims are threatened. There is fear of talking, and there is no protection of victims.”

For those who are vocal about foul play, their pleas fall on deaf ears, so there is no incentive or hope for others to do so. They are wary of the police and lack faith in the government. For civil society organisations as well, there is a huge challenge in recording the cases. “They tell us, ‘You keep asking us for these stories. How do we benefit?’ And it is a very valid question.”

Post-mortems would answer a lot of questions, yet they are not carried out even in the most blatant instances of abuse.

DWRoK and the Centre for Domestic Training and Development (CDTD) which also runs a shelter for victims and helps with cases, shared details of 31 cases of suspicious deaths just in the last four years. Of these, five victims were under the age of 25; eight under the age of 30; five under the age of 40; and though the exact age is not on record for the rest, they all are mothers of very young children. On average, it took between two months to nearly a year for the deaths to be reported or communicated to the families and up to two years for the bodies to be repatriated. All of the bodies were returned with clear signs of physical injuries.

The most common causes attributed to these deaths are falls or cardiopulmonary arrest. Causes that the families don’t buy. In the case of one victim, Saudi health authorities attributed her demise to a "brain freeze" resulting from a fall. At least five of them were admitted to hospitals under the pretext of treatment for conditions they were not aware of and had passed away shortly after. Most of them were treated in the Al-Shumaisi hospital.

“The delay in reporting deaths—ranging from weeks to over a year—and the consistent citing of vague causes like cardiac arrest or accidental falls raises serious red flags. In nearly all cases we documented, families were left in the dark, struggling for answers and justice. Many expressed deep suspicions about the circumstances, especially given the prolonged timelines for repatriation and lack of transparent postmortems. These patterns suggest more than negligence—they point to the urgent need for deeper investigations into possible trafficking and organ harvesting networks,” says Chrispin Kimani, Lead Decent Work and Labour Migration at CDTD.

In fact, a 2018 study [Death certificate errors in one Saudi Arabian hospital - Opens in new tab] examined documents in one major Saudi hospital over a 20-year period and found “no errors of incompleteness or missed contributors to death. However, in all certificates (100%), the cause of death was either incorrect or absent; 75% provided no cause of death.” This places a huge question mark over the causes of migrant deaths as put forward by the Kingdom.

Paul Adhoch of Trace Kenya, an NGO that works on counter-trafficking, says there have been enough allegations that it’s past time the governments took them seriously and started conducting autopsies.

He says they’ve received over a hundred bodies, mainly women, from Saudi and other Gulf states the past year alone. “The previous year it was 83. Saudi does not provide proper documents and only says cardiac arrests. Families do not take further review and just bury the body. As civil society organisations, we ask questions and don’t get answers. We ask what is ‘cardiac arrest’ as it could apply to any deaths.”

Adhoch says the bodies do not come in a good state, as in Saudi there seems to be an absence of appropriate preservation and embalming practices within morgue facilities, since local burials are generally done immediately and do not require storage facilities. “Many of the deceased are barely 30 years of age. How do so many young turn up dead? Their cause of death needs to be determined,” he says, stressing that merely attributing it to cardiac arrest does not cut it.

“We also have cases of people – previously of good health – falling sick suddenly and taken to hospital. And they would have gone through some procedure they are not aware of. Then there are those who just disappear. The Kenyan government has opened up labour export space and is planning to send tens of thousands to the region. Illegal organ harvesting is a legitimate concern that must be raised at this juncture,” he says. 

According to data published by the Saudi Center for Organ Transplantation (SCOT), half of all donations are from non-Saudis, but the data is not disaggregated by organ. Neither does it mention the nationality of the recipients. But those interviewed from the medical fraternity say organ donations are done only for Saudi nationals.

“Liver donation is not so much of an issue as that can be done safely with a live donor, but the challenges are with heart and kidneys.” 

Donor information was not forthcoming, nor was it needed for transplants, the nurse says. “I am not sure who and at what point consent was given, but the majority of the donors were from India, Pakistan, and the Philippines.  

Most deaths were of construction workers who died in motor vehicle accidents or on the road, the nurse adds, which the SCOT data corroborates – motor vehicle accidents and falling from heights are in the top three leading causes of brain deaths.

“On donations from deceased, the next of kin have to give consent. And this is where opportunity for coercion presents itself. If the family are not registered, it’s usually the sponsor whose name is on the records of the individual, and they are in a place to give consent. We have also heard that the average compensation promised to the family was SAR50,000.”

The nurse says that people do donate organs for compensation, and there is a black market. She says these practices are not carried out in the larger hospitals in Saudi’s major cities but in the smaller ones. “Horrors happen, but the systems are good at covering it up.”

A medical professional who practised in Saudi for several years says there’s a severe shortage of organs and believes it’s not unlikely that there’s coercion. “Many migrants’ consent is not informed, hence coerced, because there is a promise of some kind of compensation. Compensation for care is acceptable, but not for buying an organ.”

The doctor also says the terminology of ‘natural cause’ can be abused. “Cardiac arrest may be the root cause for some. But why do young people have cardiovascular disease? It’s likely the result of some kind of abuse. After stringent pre-departure medical tests, how can this happen if not due to abuse?” They attribute the low number of autopsies to both cultural and religious beliefs of not wanting to be examined medically after death. And even if one wishes to do so, it is not affordable.

Examining the high mortality rates and deterioration of health of migrant workers in the GCC, the Vital Signs Project - Opens in new tab found that, “Whereas a heart attack is something that physicians can diagnose as an underlying cause of death and can appear on a properly formulated death certificate, ‘cardiac arrest’ provides no information on the underlying cause of death and should not appear on a death certificate.”

Shortage of donors and the ethics of organ harvesting in Saudi

As per the 2022 statistics shared by SOTC - Opens in new tab, more than half of the Donation after Brain Death (DBD) donors were non-Saudis, though the historical data from 1986-2022 places it at little less than half [pg 7]. Analysis of the causes of death among possible Donation after Brain Death (DBD) donors in 2022 showed that the majority of traumatic causes of death were due to Motor Vehicle Accidents (MVA): 143 and Fall From Height (FFH): 31. The historical data (1986-2022) for both causes are MVA: 6263 and FFH: 900.

Organ-wise donation data is not disaggregated by nationality. The list of organs harvested and transplanted are Kidney, Liver, Heart, Lungs, Pancreas, Cornea, Intestines, and Bone banking.

As per data from the National Registry of Organ Failure Patients - Opens in new tab, more than 18,000 people [as of 2024] in the Kingdom of Saudi Arabia suffer from kidney failure, the most common type of organ failure in the Kingdom. “A living person can donate part of their liver, one of their kidneys, or bone marrow. A brain-dead donor can save and improve the lives of more than nine people by donating organs such as kidneys, liver, heart, lungs, pancreas, intestines, and tissues like heart valves, corneas, and bones.”

Official statistics from the centre are as follows:

• Total organs transplanted from living and deceased people in 2023: 2091+
• Total number of living and post-mortem transplant patients in 2023: 2,037+
• Organ Transplantation from Living Donors: 1,662+
• Organ Transplantation by Donation After Death: 425+

According to the latest statistics, there are 130 patients waiting for a heart transplant. SCOT states that donor shortage is the biggest challenge facing the Kingdom.

A paper titled ‘Dilemma of commercial organ transplant in the Middle East’ - Opens in new tabdiscussing bodily autonomy and ethics of organ donation, states: “In Islam, humans are considered stewards of their bodies, with a strong emphasis on preserving life and avoiding harm. Selling organs may be deemed harmful, particularly if it exploits or endangers the seller’s health. However, Islam encourages organ donation without financial gain as an act of charity. Regulations in Islamic countries often aim to prevent the commercialisation of organ transactions to protect vulnerable individuals from exploitation.”

Financial neutrality

An article in the Journal of Philosophy, Ethics, and Humanities in Medicine - Opens in new tab, on compensation and Islamic ethics on organ donation and sale, highlights that scholars do not condone “[L]imited and fixed financial benefits as the rewards for receiving organs are expressing an appreciation and honor to altruistic donors.”

In 2019, the permanent committee of a supreme Islamic Judicial Authority in Saudi Arabia issued a ruling that “there is nothing wrong with accepting it (an amount of money as a gift), without you (the recipient) longing for that, and you can respond in kind if you are able to with an appropriate gift, or you can supplicate for him, because the Prophet Muhammad (PBUH) is reported to have said that “Whoever does you a favour, respond in kind, and if you can’t find the means of doing so, then keep praying for him until you think that you have responded in kind.” 

Academic debates on ethics and Islamic jurisprudence apart, awareness around organ transplantation continues to be low. A study conducted in 2022, Awareness, Attitude, and Beliefs Regarding Organ Donation Among the General Public in Saudi Arabia - Opens in new tab, only 24% of the 3507 individuals surveyed knew of the legislative body for organ donation; 58.5% believed that organ donation should be promoted; and 66.1% had a positive attitude toward donating body organs. Yet, less than 11% of respondents had an organ donor card, and about 53% stated religious reasons for refusing to donate an organ. Only 2.4% were willing to donate unconditionally, over 40% said under special circumstances and nearly a third said they would not donate. Nearly 70% of the respondents were between 18 and 30 years old. A study conducted in 2023 - Opens in new tab similarly found that regard for organ transplant and awareness of islamic regulations regarding donations did not translate into registration rates. 

Conclusion

Despite the growing body of evidence that, at minimum, indicates foul play in migrant deaths, and, at worst, illegal organ harvesting, there remains a troubling lack of investigations by governments on both ends of the migration chain. Human trafficking for the purpose of organ donation is a globally acknowledged problem, and not exclusive to this region. What makes the situation unique is the interplay of the Kafala system and labour agreements that accentuates vulnerabilities of migrant workers.

Testimonies from victims and families, alongside the unmet need for human organs in Saudi and lack of transparency surrounding consent calls for immediate scrutiny. Some of the recommendations presented below require no major legislative changes, but rather better implementation and adjusting of existing processes. However, a critical and urgent need — one that will require an allocation of resources — is routine post-mortems in case of deaths of young migrants. Classifications such as ‘natural causes’ or ‘cardiac arrest’ are not a good enough explanation.

Taken together, the available evidence and the persistent lack of answers for victims and their families point to a disturbing pattern of coercion and unethical organ harvesting that demands immediate and sustained attention.