Here is a fact of life that will surprise no one: Those who are poor sell what they can and those who have wealth buy what they want.

Does it make a difference when what’s being bought or sold is a human organ or tissue?

Legally, morally and ethically, it should.

Nevertheless, every day, maybe dozens of times a day, in countries throughout the world, people are induced, bribed, cajoled, fooled or threatened into bartering away a vital piece of their flesh. Others are just abducted, and they’re given no choice.

Today, a report on the need for international measures to prevent trafficking in human organs, tissues and cells was issued by the United Nations and the Council of Europe, which represents 47 member in issues involving the European Convention on Human Rights. The report’s primary recommendation was to find a way to eliminate the profit from this trafficking.

It has been 55 years since the first human kidney was transplanted at Boston’s Peter Bent Brigham Hospital.

The report cited the Global Observatory on Donation and Transplantation’s statistics that almost 100,000 patients worldwide receive transplanted hearts, kidneys, livers, lungs, pancreases or intestines every year.

The need is great – and growing. In the U.S. alone, as of 5:41 p.m. Tuesday, the United Network for Organ Sharing said 104,240 people were on waiting lists for organs.

The study’s authors said the success rate of organ transplantation has led to a dramatic increase in the number of new transplant programs worldwide and a willingness among transplant teams to accept far sicker patients as candidates for organs.

As a result, even more organs are needed and there is an even greater gap between supply and demand, said the authors, who came from the U.S., Spain and Austria.

The U.N. report emphasized that a barter system for organs is rampant,  but so is human trafficking for the purpose of removal of organs.

Unfortunately, this is not new.

Almost 25 years ago, the Pittsburgh Press sent my gifted partner, Mary Pat Flaherty, and me tromping around the world interviewing physicians, nurses, organ brokers, sleazy entrepreneurs and their slum-dwelling victims. We documented, for the first time, that organ selling was a big and filthy business.

In Tokyo, we interviewed an egotistic loan shark for the yakuza, the Japanese mafia, who eagerly loaned out money with the understanding that if the debtor owed $15,000 they would give up a kidney. Most of the Japanese organs, he told us, were shipped to hospitals in L.A., San Francisco and Seattle.

In India, we found an elaborate operation run out of Jaipur  which bought kidneys from thousands of willing “donors” living in the impoverished slums surrounding Mumbai, then called Bombay. They sold their organs for a fan, a black-and-white TV or $50 worth of food.

A large, red, leather-bound journal proudly maintained by tissue-typers at Mumbai’s enormous government-run hospital showed the name, health and age of the donor and meticulous detail on the often-prominent Western transplant surgeon receiving the organ. The kidneys, sold for thousands of dollars, were shipped to London, Saudi Arabia and hospitals in Boston, Chicago, Dallas, Baltimore and other U.S. transplant centers.

More than two decades later, not much has changed.

“Organ transplantation exists in a world of extreme economic disparity,” the U.N. report said.

“Watching your child go hungry when you have no job and a wealthy person waves a wad of money in your face is

not exactly a scenario that inspires confidence in the ‘choice’ made by those with few options but to sell body parts,” the report emphasized.

“Criminal groups take advantage of this desperation which is added to that stemming from poverty and misery in many areas of the world.”

The organ brokering has increased with what the report calls “transplant tourism.” This practice, which started in India, involves the potential recipient traveling to receive organs in countries where laws do not exist to protect organ donors or prevent the illegal trafficking of human parts.

About three years ago, a transplant surgeon, trained in Pittsburgh but living in Latin America, called to tell me that the reports of hearts being sold from human traffickers in Central America was not a pulp fiction rumor.

He said he had reported evidence of two alleged episodes to the World Health Organization and they said they could do nothing.

Think about what he’s alleging here: hearts are being sold. You can donate a kidney or even part of a liver and survive. Without a heart, the donor dies.

A few months ago, I spoke to Arthur Caplan, a co-author of the U.N. report and a top medical ethicist. He said he receives reports of sinister doings from the dark side of the transplant world and says it’s like a “whack-a-mole” game:  organ selling pops up one place, is slammed down, but pops up again someplace else.

“When there is money involved bad things will happen and human organs are a very valuable commodity.  Without meaningful, international laws, rigorously enforced on both the supply and demand side, these illicit sales will never be stopped,” said Caplan, who is the chairman of the Department of Medical Ethics of the University of Pennsylvania.

Caplan and the other authors of the report recommended:

– The need to understand and clearly distinguish the legal and ethical differences between “trafficking in organs, tissue and cells’’ and “trafficking in human beings for the purpose of the removal of organs.”

– The prohibition of making financial gains with the human body or its parts should be the paramount consideration in relation to organ transplantation. International legislation concerning organ transplantation should conform to this principle.

– The need to promote organ donation and establish organizational measures to increase organ availability.

Here is a link to what the U.S. Justice Department says about organ selling.

And this is a link to the very long U.N. report.