- Dear Mr. Rense,
- A special TV news report last night here in Australia,
was about "Dr. Frankenstein" in Istanbul Turkey. This Doctor
is nicknamed so by his own peers. He buys kidneys from Moldovians (most
underdeveloped soviet state), for $2500......and transplant them to wealthy
Israelis for $200,000. It is very common to see that a whole moldovian
village has travelled to Turkey to sell their kidneys. The TV broadcast
from Sydney also gave a warning that many backpackers who travel to third
world countries end up waking one morning with just one kidney.
- Regards, Judy Goldman
- PS; I did a search on the internet and found this from
the New York Times http://www.mugu.com/pipermail/upstream-list/2001-May/002193.html
- This Little Kidney Went To Market
- By Michael Finkel New York Times Magazine
May 27, 2001
- After four years on dialysis, with no sign that he was
nearing the top of the transplant waiting list, Moshe Tati decided to buy
a kidney. This was easier than he had imagined. Several months previous,
the name and telephone number of an organ broker had been passed, furtively,
around his dialysis group. At the time, Moshe did not think he would use
the telephone number. He thought he would wait. Then his health began to
fail. This happens with kidney patients.
- Dialysis is a tricky thing, rough on the body -- it keeps
you alive while gradually killing you. It is not uncommon for a person
to lose 15 pounds during a single three-hour dialysis session. Shortly
before he made his decision to buy, Moshe suffered a heart attack. The
attack was minor, but it reduced his suitability for transplant surgery
and dropped his standing on the organ-waiting list. He was now placed below
some people whose kidney failure had just been diagnosed. Moshe was 43
years old, and he was dying, and not one of his family members was a suitable
match for a kidney donation.
- So he called the broker. Moshe lives in Israel, which
happens to be one of the more active nations in the international organ-trafficking
market. The market, which is completely illegal, is so complex and well
organized that a single transaction often crosses three continents: a broker
from Los Angeles, say, matches an Italian with kidney failure to a seller
in Jordan, for surgery in Istanbul.
- Though hearts and livers and lungs are occasionally sold,
the business deals almost exclusively in kidneys. There are two reasons
for this. First, kidneys are, by far, the organ in greatest demand -- there
are currently 48,963 patients on the United States kidney waiting list,
and less than a tenth that number on the heart list. Second, the kidney
is the only major organ that can be wholly harvested from a living person,
leaving the donor essentially unharmed. (Recently, liver segments have
also been transplanted from live donors.) In other words, with kidneys
there are people who want to buy and people who want to sell -- that is,
- The sale of human organs, whether from a living person
or a cadaver, is against the law in virtually every country (Iran is perhaps
the only exception) and has been condemned by all of the world's medical
associations. In the United States, the National Organ Transplant Act,
passed in 1984, calls for as much as a $50,000 fine and five years in prison
if a person is convicted of buying or selling human organs. Francis Delmonico,
a professor of surgery at Harvard Medical School and the chairman of the
ethics committee of the American Society of Transplant Surgeons, says that
paying for organs is "morally and ethically irresponsible." Bernard
Cohen, the director of the Eurotransplant International Foundation, based
in the Netherlands, calls the idea "inhumane and unacceptable."
Pope John Paul II, in a recent address, said that the commercialization
of organs violates "the dignity of the human person."
- Yet in Israel and a handful of other nations, including
India, Turkey, China, Russia and Iraq, organ sales are conducted with only
a scant nod toward secrecy. In Israel, there is even tacit government acceptance
of the practice -- the national health-insurance program covers part, and
sometimes all, of the cost of brokered transplants. Insurance companies
are happy to pay, since the cost of kidney surgery, even in the relatively
short run, is less than the cost of dialysis.
- According to the coordinator of kidney transplantation
at Hadassah University Hospital in Jerusalem, 60 of the 244 patients currently
receiving post-transplant care purchased their new kidney from a stranger
-- just short of 25 percent of the patients at one of Israel's largest
medical centers participating in the organ business. Relatively few transplant
operations, illegal or legal, take place in Israel. Every proposed kidney
transplant in the country between two unrelated people is carefully screened
for evidence of impropriety by a national committee. Therefore, almost
all of these illegal surgeries are performed elsewhere, in nations where
the laws are easier to duck, including the United States.
- Israel also does not contribute much to the supply side
of the equation. Organ donation is extremely low; an estimated 3 percent
of Israelis have signed donor cards. Though several rabbis have declared
that donation is permissible, there is a deeply ingrained belief in Judaism
that the body must be buried intact so that it will be whole when it comes
time for resurrection. Islam has a similar doctrine. (Christianity does
not.) Neither Islam nor Judaism, however, has an edict against accepting
transplanted organs. This situation makes the transplant waiting lists
in Israel distressingly long.
- Paying for an organ has become so routine in Israel that
there have been instances in which a patient has elected not to accept
the offer of a kidney donation from a well-matched relative. "Why
risk harm to a family member?" one patient told me. Instead, these
patients have decided that purchasing a kidney from someone they've never
met -- in almost all cases someone who is impoverished and living in a
foreign land -- is a far more palatable option.
- I can get you a kidney immediately," said the broker
whom Moshe Tati called. "All I need is the money." Then he quoted
a price: $145,000, cash, paid in advance. This would cover everything,
the broker said -- all hospital fees, the payment to the seller, accommodations
for accompanying family members and a chartered, round-trip flight to the
country where the surgery would take place. The trip would last about five
days, he said, and the destination would be kept secret until the time
- The broker promised that one of the top transplant surgeons
in Israel would be flying with them to perform the operation. The broker
instructed Moshe to undergo blood and tissue exams so that a match with
a kidney seller could be arranged. "I can guarantee you a living donor,"
the broker said, "a young, strong man. This won't be a cadaver organ."
- Desire for a living donor is another reason why dialysis
patients often prefer to purchase a kidney and circumvent national programs,
where legally transplanted organs are almost always from cadavers. An Israeli
kidney buyer named Avriham, who used the same broker as Moshe Tati and
traveled to Eastern Europe, described this notion in his own terms: "Why
should I wait years just to have a kidney from someone who was in a car
accident, pinned in his car for hours, then in miserable condition in the
I.C.U. for days, and only then, after all that trauma, have part of him
put inside me? That organ is not going to be any good! Or, worse, I could
get the organ of an elderly person, a person who died of a stroke or an
aneurysm -- that kidney is all used up! It's better to take a kidney from
a healthy young man who can also benefit from the money. Where I went,
families were so poor they didn't even have bread to eat. The money I gave
was a gift equal to the gift I received. I insisted on seeing my donor.
He was young and very healthy, very strong. It was perfect, just what I
was hoping for. A dream kidney."
- Occasionally, cadaver kidneys are purchased on the black
market, most notably in China, where the organs of executed prisoners are
sold, but it is living sellers who are usually demanded. With good reason.
"A person who receives a living-donor kidney has a reasonable hope
of a lifetime of kidney function," says Richard Rohrer, the chief
of transplant surgery at New England Medical Center in Boston. "A
person with a cadaveric kidney has a reasonable hope of a decade of kidney
function." The median survival length of a kidney transplanted from
a cadaver is about 11 years; from a living donor, it's more than 20 years.
- There are rampant rumors, buzzing about the Internet,
that to satisfy this desire for living donors, people are sometimes robbed
of their kidneys. A victim is drugged, one story goes, and then wakes up,
sans kidney, in a bathtub filled with ice. This crime has never been documented
anywhere in the world, not even once. Other stories, also false, involve
children being snatched off the streets in Brazil or South Africa or Guatemala
by "medical agents" in black vans. In truth, there is actually
a global surplus of kidneys -- sellers in India and Iraq literally line
up at hospitals, often willing to part with a kidney for less than $1,000
-- and therefore no need to steal any.
- Moshe told his broker he'd get the money. At the time,
he was working for the City of Jerusalem as a municipal sanitation inspector.
He'd managed to keep his job while on dialysis. He told his coworkers about
his desire to purchase a kidney, and a fund was established. More than
700 city employees donated, raising nearly $100,000. Moshe took out a bank
loan to cover the rest. Then, a month after the original phone call, he
informed his broker that the money was ready. The broker said they'd meet
a week later at the Tel Aviv Hilton, and everything would be arranged.
- At the Hilton, the broker told Moshe, "We've found
a perfect donor for you; he fits you like a brother." Moshe was traveling
with four companions -- his wife, his wife's sister, a friend from work
and his friend's wife. They handed over the money, a bank check for $145,000,
and were driven to Ben-Gurion Airport, where a chartered plane was waiting.
There were no papers to sign. "Everything was done by handshake,"
Moshe says. It was August 1997. On the flight there were three other kidney
patients, one from Italy and two other Israelis, as well as an Israeli
surgeon, two nurses, a psychologist, the broker and the patients' traveling
companions. It was only then, once he was aboard, that Moshe learned he'd
be going to Turkey.
- American dialysis patients have been significantly less
eager than Israelis to enter the kidney market. Most Americans, it seems,
harbor a deep-seated reluctance to engage in medical procedures done overseas.
But the United States does often serve as a host country for the surgery.
Foreign kidney patients occasionally arrive at U.S. hospitals with both
a donor, also a foreigner, and a ready supply of cash. In the United States,
there is no national transplant screening board; instead, every hospital
has its own committee. Some facilities, especially those struggling financially,
appear to employ a type of "don't ask, don't tell" policy when
it comes to transplant surgeries on foreigners. Brokers are familiar with
these hospitals and sometimes fly in pairs of buyers and sellers, who sign
documents attesting that no money is changing hands.
- A few Americans do go abroad for paid transplants. A
man named Jim Cohan, who lives in Los Angeles, helps organize such trips.
Cohan insists that "organ broker" is the wrong term for his profession.
"I call myself an international transplant coordinator," he explains.
He has been in the business a dozen years, he says, and has helped about
- "I got into transplant coordination when I discovered
how long the waiting lists were and how many people were dying," he
says. According to the United Network for Organ Sharing, 2,583 Americans
died last year waiting for a kidney. Worldwide, the number of annual deaths
is estimated to be at least 50,000. "There are plenty of spare organs
to be had in other parts of the world," Cohan says. "There's
no need for a single person to die waiting for a kidney."
- No person of at least some means, that is. Cohan's current
price for a kidney, he says, is $125,000, all inclusive. "First, send
me $500, and I'll send you an application," Cohan says. "You
and your doctor fill it out. Once you're accepted into the program, you
have to send me a check for $10,000. The balance is due before you leave.
Usually I can get an organ in less than a month. I send people to South
America, to the Philippines, to China, Singapore and South Africa. Where
you go depends on what's going on in the world and what's available."
- In a living-donor transaction, according to Cohan, only
a small portion of the money actually goes to the person selling the organ
-- as little as $800 and rarely more than $10,000. The broker, he insists,
takes a modest cut, around 10 percent. The majority of the cash is paid
to the surgeons. It has to be big money, or they won't be willing to risk
- Cohan used to accompany some of his patients on trips.
Then, in March 1999, he was arrested. He had been communicating with an
Italian transplant surgeon who had expressed interest in working with him.
It was a setup; when Cohan landed in Rome for a meeting, he was arrested
by Italian authorities. He spent five months in prison. "They claimed
I was part of an international ring," Cohan says, "but it's not
true. I'm just in business for myself. So the courts let me go. There were
no victims; there was no proof." The Italian courts concluded that
Cohan had not broken any laws.
- Since then, he no longer travels. "I do everything
on the phone and on the Internet," he says. "I talk with doctors.
I tell doctors about me, and doctors tell their kidney patients. I don't
buy organs; I don't sell organs -- I'm really just the producer. I produce
operations. I just bring all the parties together. And I've never had any
of my clients die."
- When Moshe's plane landed in Istanbul, there was no need
to clear customs, no one asking for passports. "Everything was already
taken care of," Moshe says. "The organization was like clockwork."
Moshe and the other three patients were driven to a hospital -- An old
hospital," Moshe says, "not modern, but very clean" -- and
their family and friends were taken to a hotel. Apparently, even the specific
taxi that transported Moshe and his family was prearranged. "The driver
of the taxi that took me to the hospital had sold a kidney," Moshe
says. "He showed me his scar. He told me he'd bought the cab with
the money. He was very proud."
- The transplant surgeries were performed late at night,
when the hospital was on skeleton staff and fewer people could question
what was going on. An entire floor of the hospital, Moshe says, was requisitioned
by the transplant teams. Two transplants were completed each night, the
first starting at about midnight, the second at about 4 a.m. Two surgeries
were done the night after they landed; two more the following night. Moshe
was the last of the four to go. The surgery to remove the seller's kidney,
Moshe says, was performed by a Turkish team; the transplant surgery was
completed by the Israeli physician and nurses who had flown with them.
- "As I was being prepared for surgery," Moshe
says, "I saw the man who was giving me his kidney. I just glimpsed
him briefly. He was in an operating room across from me. We never spoke;
when I saw him, he was already asleep, at the beginning of his surgery.
I wasn't nervous at all. I was about to start a new life."
- As Moshe awoke from his transplant surgery, the Israeli
doctor was at his bedside, grinning. "He told me, 'Congratulations,
everything's great,' " Moshe says. "He said I had already urinated.
The first time in four years! He said it was a complete success. But I
did not feel good. I felt pain from my neck to my stomach. Then I blacked
- Five hours later, when Moshe regained consciousness,
the doctor was again at his bedside, with an entirely different expression
on his face. "I said, 'Why are you looking at me like that?' And then
he told me." Moshe had suffered a second heart attack, this time a
major one. The other three patients were fine, but Moshe's condition was
grim. His entire body was swollen.
- Everyone was flown back to Israel, and Moshe was rushed
to the hospital. Toxins were detected in his blood stream. Five days after
receiving his new kidney, Moshe was operated on again, by a different surgeon,
and the kidney was removed. "The doctor told me the kidney was poisoned
and dirty and black," Moshe says. Most likely, this was the result
of a vascular thrombosis, in which an artery or vein linking the kidney
to Moshe's body was inadvertently pinched shut. Moshe was in the hospital,
recovering, for two and a half months. Never once was he contacted by the
Israeli physician who performed the surgery in Turkey.
- It has now been four years since Moshe's transplant trip.
The other three patients who traveled with him are healthy and free of
dialysis. Last year they held a reunion, a festive transplant-day party.
Moshe did not attend. He is on dialysis four times a week, three and a
half hours a session. "I feel tired all the time," he says. Since
the trip he has been unable to work, and he still owes money on the loan
he took out to pay the broker. He is 47 years old. "I thought about
suing," Moshe says. "I wanted my money back. But there was no
contract, nothing." Even the discharge papers from the Turkish hospital
were carefully prepared -- they are on a plain sheet of paper with no address
or telephone number. "There is no way for me to prove where I've been
and who performed the surgery," he says.
- Still, Moshe contacted a lawyer, who began the proceedings
for a medical malpractice suit. Almost immediately, Moshe was contacted
by the broker. The broker made him an offer: Drop the suit and whenever
you want, we'll take you abroad again, no charge. Next time, promised the
broker, there will be no mistakes. Moshe accepted the deal. "I'm still
not ready to go," he says, "but dialysis is killing me."
Because of his heart attacks, he's no longer eligible for the official
Israeli waiting list. The broker's offer is his only chance for a transplant.
"One day," he says, "when I'm prepared, I think I'll want
to try again."
- I f you ask Michael Friedlaender to discuss Moshe's case,
he will tell you that the experience is a perfect example of why kidney
sales should finally be legalized. Friedlaender is a nephrologist at Hadassah
University Hospital in Jerusalem; he treated Moshe both before and after
his trip to Turkey. He is also one of the world's most outspoken physicians
on the issue of organ sales. In 1999, at a conference in Denmark, Friedlaender
made the first public recommendation by an Israeli doctor that the laws
governing organ sales ought to be changed.
- "What's happening now is absurd," Friedlaender
says. "Airplanes are leaving every week. In the last few years, I've
seen 300 of my patients go abroad and come back with new kidneys. Some
are fine, some are not -- it's a free-for-all. Instead of turning our backs
on this, instead of leaving our patients exposed to unscrupulous treatment
by uncontrolled free enterprise, we as physicians must see how this can
be legalized and regulated."
- A decade ago, Friedlaender says, he, like most physicians,
was "fairly violently opposed" to the notion of selling organs.
Then, in the mid-90's, his Arab dialysis patients suddenly began showing
up in his clinic with new transplants. They'd been going to Iraq. Next,
his Jewish patients began traveling, some to Turkey, some to former Soviet
republics, and returning a week later with fresh kidneys. While there have
been a few fatalities and a couple of disasters, like Moshe's,
- Friedlaender discovered that the illegal transplants
actually seemed better, in some ways, than the legal ones. When he compared
his illegally transplanted patients with those transplanted in his own
hospital, Friedlaender found that the percentage of illegal transplants
still functioning after one year was, in fact, slightly higher than his
own hospital's success rate -- and that of many U.S. hospitals. The difference,
he says, is attributable to the benefits of transplanting kidneys from
- "After I realized that," Friedlaender says,
"I softened my stance. Examining those 300 patients brought me down
from my high horse of ethics. Now I'm more practical. My patients don't
want my opinion on whether or not buying a kidney is moral -- they want
to know if it's safe. And I have to say that it is. It's as safe as having
a transplant at a U.S. hospital. I realized that I had no right to actively
stop my patients from going. I realized that it may be harming them not
to go. So when they ask, I tell them, 'Yes, you should go.' "
- The current system of organ donation without remuneration,
says Friedlaender, is a failure. Between 1990 and 1999, despite numerous
marketing efforts trying to persuade people to sign donor cards, the U.S.
organ waiting lists grew five times as fast as the number of organs donated.
By the end of this decade, it is estimated that the average wait for a
kidney will exceed 10 years. Even the more optimistic proponents of xenotransplantation
-- that is, transplanting from animals into humans, a procedure that could
end organ scarcities -- admit that such operations may be several decades
away. It could be even longer before genetically manufactured organs are
- As donated organs have remained difficult to procure,
transplant operations have become safer and easier. The development in
the early 1980's of the powerful antirejection drug cyclosporin changed
transplants from risky, experimental procedures into common, highly successful
ones. "We're now at the point," Friedlaender says, "where
it's really not very complex to match organs. It's no more elaborate than
getting a blood transfusion. If sales were legalized, it would not be difficult
to make sure people were buying clean, well-matched kidneys."
- Though Friedlaender is not directly involved with any
of Israel's so-called transplant tourism, he is familiar with a physician
who has repeatedly been accused by the Israeli media, including one of
the nation's leading daily papers, Ha'aretz, of participating in hundreds
of overseas transplants, many of them in Turkey. The surgeon's name is
Zaki Shapira. "Shapira is a mastermind," Friedlaender says. "He's
made a big business out of this. I'm revolted by the amount of money he's
making, but not by what he's doing. He's helped a lot of patients. A lot
of people owe their lives to him."
- Shapira, who is also the chief of transplantation at
Beilinson Medical Center, one of Israel's largest hospitals, refused to
speak with me. However, a lawyer who is very familiar with his activities
-- a lawyer who insisted on anonymity -- estimates that Shapira goes overseas
with patients "more than twice a month." Shapira, she says, "doesn't
feel as though he is bound by national laws if these laws do not suit him.
He arrived at the conclusion that if he didn't do something to stop people
from dying on dialysis, then nobody would." It's unclear, she adds,
which laws Shapira has broken, what the potential punishment might be and
where he might be subject to jurisdiction.
- Shapira's activities have been investigated by the Israeli
Ministry of Health, but he has never been charged with wrongdoing. "Everybody
knows what Dr. Shapira is doing, though we haven't been able to prove it,"
says Simon Glick, a Ministry of Health official who worked on the Shapira
investigation. "There's not enough evidence. The patients won't testify
because he's saved their lives. We had the police involved, but they threw
up their hands at the whole thing. I think Dr. Shapira should be brought
to trial, but I'll bet he never will. Sometimes it seems to me that transplantation
is as much a moral failure as it is a medical success."
- W hen asked to examine the issue from the other side
-- from the point of view of people selling their kidneys -- Friedlaender
admits that he worries about the exploitation of the world's poor populations
but that he doesn't feel right telling people what they can or cannot do
with their bodies. "Medically," he says, "there is no evidence
to show that donating a kidney endangers a person's health in any significant
- Of the half-dozen studies performed on donors, including
a 20-year follow-up, none have revealed any increased mortality. Health-insurance
companies do not raise their rates for kidney donors. "We allow people
to give up a kidney for no payment at all," Friedlaender says. "Why
won't we allow it for pay?" After all, Friedlaender points out, everyone
else in the transaction profits -- the doctors, the hospital, the nurses
and of course the recipient. "Why," he wonders, "does the
person losing the most have to do it for free?"
- If kidney sales were legalized, he claims, brokers and
rogue physicians would be out of business, and more money could flow to
the sellers. Friedlaender's ideas for a specific legalization plan mirror
those proposed by other Israeli and American lawyers and medical ethicists.
To start with, all organ sales would be arranged through a national regulatory
body (in the United States, there would be several regional centers). A
potential seller would register with the regulatory body and would be contacted
when his or her kidney was needed. Criteria for the allotment of live-donor
kidneys would be no different than the current system of cadaveric-organ
distribution; that is, based on the length of time a patient has waited,
the quality of the organ match and the direness of the patient's need.
The patient and the seller would never meet. The reduction in the number
of dialysis patients would yield financial savings that the regulatory
body would divide, allowing the seller to be well remunerated and, of equal
importance, the recipient to not have to pay for either the organ or the
surgery. Payment to the seller would be made either in cash -- $25,000
has been discussed, paid through the regulatory body -- or via an indirect
method, like a reduced income tax rate or free health insurance. While
sellers would almost certainly come from poorer populations, at least the
recipients, under this plan, would include both the poor and the rich.
- Depriving the sellers of an opportunity to profit, says
Friedlaender, is an unjustifiable form of protectiveness: "It implies
that the sellers are ignorant and that they are endangering themselves.
I believe it is paternalistic for us to judge the motivations and values
of other people and other cultures." It's already legal, he notes,
to sell semen and plasma and ova. And surrogate motherhood, also legal,
carries far more risk, statistically, than kidney removal. In a recent
paper titled "The Case for Allowing Kidney Sales," published
in the British medical journal The Lancet, eight physicians from four nations
write, "If the rich are free to engage in dangerous sports for pleasure,
or dangerous jobs for high pay, it is difficult to see why the poor who
take the lesser risk of kidney selling for greater rewards -- perhaps saving
relatives' lives, or extricating themselves from poverty and debt -- should
be thought so misguided as to need saving from themselves."
- Paternalism," says Nancy Scheper-Hughes, "is
the backbone of the medical profession. Medicine is all about care, and
if you toss that out and reduce patients to a collection of free-market
consumers, then doctors will lose whatever vestiges of moral authority
they still have." Scheper-Hughes is a professor of medical anthropology
at the University of California at Berkeley, and a co-founder of a group
called Organs Watch. Under the auspices of Organs Watch, Scheper-Hughes
has spent three years traveling the world while investigating the organ
market, focusing on human rights implications and violations of national
laws. Her work in Israel was instrumental in exposing many of the nation's
- As Michael Friedlaender's views have gained acceptance
-- a survey in the United States by the National Kidney Foundation, cited
in a recent issue of The Journal of Medical Ethics, showed that nearly
half the respondents favored some form of compensation for organ donors
-- Scheper-Hughes has become increasingly alarmed. Kidney sellers, she
says, are treated not as humans but as commodities. "These people
have been reduced to bags of spare parts," she says. "For doctors
to justify this by saying, 'Well, the seller is getting something out of
it too,' is unethical. Turning one person's poverty into an opportunity
for someone else is a violation of the most basic standards of human ethics.
Doctors should not be involved in transactions that pit one social class
against another -- organ getters versus organ givers. Doctors should be
protectors of the body, and perhaps we should look for better ways of helping
the destitute than dismantling them."
- Scheper-Hughes remains unconvinced that selling a kidney
is actually a low-risk activity. She says she feels that the chief tenet
of the Hippocratic Oath -- do no harm -- is being violated. "In these
deals you are certainly harming someone else," she says. "You
are harming the sellers." The argument that the slight harm to the
sellers is more than offset by the lifesaving potential on the other end
of the transaction is also troubling to Scheper-Hughes. "I call this
'increasing the net good,' " she says. "Is this really the kind
of world we want to live in -- one based on utilitarian ethics in which
net gain to one relatively privileged population allows them to claim property
rights over the bodies of the disadvantaged?"
- Further, she points out, every study demonstrating that
kidney donation does not compromise health has been conducted in a wealthy
nation. "It is not exactly clear that poor people can really live
safely with one kidney," she says. People who sell their kidneys,
she adds, usually live in abject conditions and face greater-than-average
threats to their health, including poor diets, low-quality drinking water
and increased risk of infectious disease, all of which can easily compromise
the remaining kidney.
- The actual kidney-removal surgery may also not be as
gentle as advertised. Even Michael Friedlaender admits that removal surgery
is a more painful procedure than transplantation. After a surgeon has carved
through skin, fat and several layers of muscle, getting at a kidney sometimes
necessitates the partial extraction of the 12th rib. Short-term complications
have been documented in nearly one in five kidney-donation surgeries. Rather
than moving toward legalization, Scheper-Hughes says, perhaps what is needed
is stronger enforcement of existing laws. She points out that almost no
one, worldwide, has ever been convicted of organ trafficking.
- There is further concern about the notion that sellers
are making an autonomous choice. Lawrence Cohen, an associate professor
of medical anthropology at Berkeley and the other founder of Organs Watch,
has done much of his fieldwork in India. He recently studied 30 kidney
sellers in the city of Chennai. Twenty-seven of them were women. Some of
their husbands, Cohen learned, made it clear that if the men had to do
heavy labor, it was only fair that the women contribute to the family income
by selling a kidney. Cohen observed that in none of the cases did selling
an organ significantly improve the family's fortunes in the long run. "If
only I had three kidneys," one of the women told Cohen, "then
I could sell two and things might be better."
- "Nobody seems concerned about the sellers,"
Scheper-Hughes says. "The buyers are supported by doctors, but no
one represents the sellers. Nobody solicits their opinions. In this market,
they have become an invisible population. Someone needs to listen to them.
What do they have to say?"
- At about the same time that Moshe Tati was busy raising
money to pay his broker, a 44-year-old man named Mehmet Piskin entered
a hospital in suburban Istanbul in order to have his blood and tissue tested
so that he might sell his kidney. Mehmet had a steady job, collecting garbage
for the Istanbul Department of Sanitation, but his salary was low. His
health insurance did not adequately cover his family. He was living in
a one-room apartment with his wife and three children, and his youngest
child, Ahmet, was suffering from a degenerative bone disease. Ahmet's knees
and elbows were gradually calcifying; already, at age 4, his growth had
nearly stopped. He had difficulty walking. A series of corrective surgeries
could alleviate the problem, but they would cost Mehmet nearly $20,000,
a sum he could never imagine saving. It was Mehmet's neighbor, in an apartment
down the hall, who first suggested the sale. "One day," Mehmet
recalls, "my neighbor knocked on my door. He said to me, 'Do you want
to save your boy's life?' I said, 'Of course I do.' He told me that if
I gave up a kidney I could save the boy."
- In recent months, Mehmet had noticed a distinct change
in his neighbor's fortunes. The neighbor had once been employed as a night
watchman. Then, rather suddenly, he'd purchased a new car and opened his
own business, selling men's clothing. Mehmet asked his neighbor if he had
sold a kidney. "He told me he had," Mehmet says. "He told
me he'd been in debt, and that selling his kidney had saved his life. He
said the operation was safe. He said maybe I'd be slowed a little for a
month, but then I'd be back to normal." He also admitted to Mehmet
that he was now earning money by finding other people willing to sell.
"I told him," Mehmet says, "that I needed time to think
things over." Mehmet thought for three months. "I realized I
had no other alternatives," he says. "So I said O.K. I said yes.
I never discussed anything with my wife. I just decided on my own."
- His neighbor took Mehmet to a private hospital on the
Asian side of Istanbul. When they walked in, everybody seemed to know the
neighbor. "It was like we were celebrities," Mehmet says. "There
were 100 other patients waiting, and we just went right in." At the
hospital, Mehmet met with a doctor and underwent blood and tissue tests.
"We talked about the price right there in the hospital," Mehmet
says. "We bargained a little, but I was firm. I said I wanted $30,000,
and I wasn't going to take anything less. They agreed. I was told I'd be
paid in the hospital, after the operation. There was no contract. Nothing
was written down. It was a handshake. I trusted them -- it was my neighbor,
and it was a doctor. Of course I trusted them."
- Three days later, Mehmet's neighbor knocked on his door.
The surgery, the neighbor said, would take place tomorrow; he said they'd
go to the hospital together. In the morning, Mehmet called into work sick.
He was given a private hospital room. Elsewhere on the floor he saw the
other sellers -- all Turks, all poor people" -- and the buyers --
at least a dozen Israelis, on dialysis machines, waiting for kidneys."
(Wealthy Turkish kidney patients are also involved in the market; they
tend to travel to India for surgery.) The nurses told Mehmet not to eat
- Shortly before he was taken into surgery, he wrote a
letter. "It was a just-in-case letter," he explains. "In
case something happened to me. I asked whoever found the letter to contact
my wife. I put down her name and our address. I wrote, 'Please give all
the money to my wife, but do not tell her that I've given a kidney.' I
wrote, 'Tell her that I've been in a traffic accident and have passed away,
and that this is the blood money from the driver that hit me.' I put the
letter under my pillow."
- Then he was rolled into surgery. He caught only a glimpse
of the person who was buying his kidney. They never exchanged a word. The
doctor told him that the Israeli receiving his kidney was very sick and
about to die. The doctor told him that he was saving a life. The last thing
Mehmet remembers before his surgery is music. "There was a stereo
in the operating room," he recalls. "Foreign music was playing.
Disco-dancing music. Loud. The doctors were dancing to it. One doctor was
dancing with a scalpel in his hand. I had to laugh. A doctor asked me,
'Why are you laughing?' I said: 'I'm happy. I'm happy because I will save
my boy.' "
- T he surgery lasted a little less than three hours. "When
I woke up I had severe pain in my right side," Mehmet recalls. "I
told the doctor about the pain and he gave me a shot. I felt better, and
then I called my wife. I told her I'd been in an accident. I told her I
was hit by a car while I was walking across the street."
- Mehmet's wife, Sebnem, rushed to the hospital and stayed
with her husband for two days while he recovered. "I came into the
hospital room," Sebnem says, "and I saw him lying there with
so many machines and I thought, that can't be a car accident. Mehmet insisted
it was. Then I saw the envelope, and I knew something was happening."
The morning of Mehmet's release, a doctor came into the room and handed
Mehmet an envelope. Inside, in U.S. currency, in crisp hundreds, was $10,000.
- "The doctor said to me, 'When you come back to have
your stitches removed, we'll pay you the rest.' I said, 'Why not now?'
He said: 'It's a Saturday. The banks are closed.' And so I left the hospital
with the $10,000."
- On the cab ride home, Mehmet told his wife the truth.
"I'm still angry at him," she says. "One evening, a few
weeks before the surgery, he told me that we'd be able to save the boy.
I asked him how, and all he said was, 'Don't worry, we will.' If he had
told me what he was doing, I'd never have let him give a kidney. Never.
He should have kept working. In the hospital, I heard the doctor tell Mehmet
that when he came back he'd get the rest of the money. After Mehmet explained
everything to me, I said to him right in the cab, 'You left that money
behind, and now you'll never see it.' "
- His wife was correct. When Mehmet returned to the hospital
to have his stitches removed, the doctor was not there. His neighbor said
not to worry. Mehmet phoned a dozen times, but the doctor did not return
any of his calls. Meanwhile, the recovery time forced Mehmet to quit his
job. He and his family left Istanbul and moved to the small farming village,
about 100 miles away, where Mehmet had grown up. He had wanted to return
home, and now he could. He spent most of the money fixing up a small house.
He never spoke to the doctor again. The last time he telephoned his former
neighbor, the neighbor told him that he'd pay Mehmet the rest of his money
only if Mehmet's younger brother, Mustafa, also agreed to donate a kidney.
When his neighbor said that, Mehmet hung up the phone.
- A few months later, a group of Turkish television journalists,
working with the police, set up a sting operation and captured on film
a Turkish surgeon named Yusuf Sonmez as he was about to begin what he thought
was an illegal transplantation. Sonmez has been linked by Organs Watch
with Zaki Shapira, the Israeli surgeon who has been implicated in the organs
market. After Sonmez was filmed, he was arrested by the police and held
for three days but was not charged with any crime -- money had not yet
changed hands, and there was no proof that it would. Punishment was left
up to the Turkish medical association. Sonmez was banned from practicing
medicine for six months. He has since been restored to full medical standing.
Sonmez dismisses the whole thing as a setup.
- Mehmet, meanwhile, has never regained his health. It
has been four years since the operation. "I'm not the same person,"
he says. "I swell up like a pregnant woman. I can't sleep. I have
not been able to work; my health has not allowed it. I go from place to
place looking for work, and everyone says no. The economy is very bad,
they tell me, and there are younger and healthier people to hire. The people
of this village, they look down on me because of what I've done. I feel
- An American surgeon, after being told of Mehmet's symptoms,
suggested that Mehmet might suffer either from nerve-entrapment syndrome
-- in which a nerve was mistakenly caught in one of his internal sutures
-- or a type of hernia that can result if one of the layers of abdominal
muscle the surgeon sliced through did not heal properly. Mehmet has not
gone to see a doctor about his pain. He can't. All of the money from the
operation is gone. Mehmet's wife is the family's sole wage earner. Sebnem
works six days a week in a refrigerator factory. She earns about $150 a
month. The family can't even afford electricity -- instead, they have illicitly
tapped into a power pole. Their son's bone disease is still attacking and
deforming his body. Ahmet's wrists and knees are both nearly fused. He
has a new growth on his chest. He rarely attends school.
- "Everything is worse now than before," Sebnem
says. "Mehmet was a healthy person, and now he is like this. Nothing
is right. The wages have not been paid at the refrigerator factory in three
months. Ahmet is crippled. We've basically been reduced to begging."
- The kidney market is an interesting business. It's a
business in which the satisfied customers keep quiet. Actually, not entirely
quiet. Certainly they do not like to advertise what they have done -- it
is, after all, illegal -- but they will talk with other kidney patients.
This is how information is passed; by word of mouth, transplantee to dialysis
patient. This is how Moshe Tati first learned about the broker. The business,
like a back-room poker game, seems continually on the move. The place to
go is always changing -- first India, then China, then Russia, then Turkey.
Lately, the kidney trade is said to be phasing out in Turkey and setting
up shop in Moldova. Romania, too, seems to be an emerging player.
- A ccording to Friedlaender, though, one market trumps
the rest. This market, he says, appears to offer kidney transplants performed
by excellent surgeons, with careful screening of sellers, extraordinary
postsurgical care and a success rate that evidently rivals even the finest
U.S. hospitals. The program seems absent of false promises and persistent
rip-offs. The price is a bargain. Some people have even idealized this
program as a model of how a legalized system might one day function. It's
located in Iraq.
- Michael Friedlaender credits the family of a young Palestinian
named Sami (who spoke on condition that his family name not be used) for
proving the effectiveness of the Iraqi system. Sami's story begins on the
afternoon of Jan. 30, 1999, when Sami, then a 22-year-old student at Golden
West College in Southern California was involved in a car accident. When
he was treated for his injuries, the doctor discovered that Sami had a
severe kidney problem. It had nothing to do with the accident -- it was,
Sami was told, a genetic condition. He was immediately placed on dialysis
and told that his siblings should be examined as soon as possible for signs
of the same illness.
- Sami had been living with his extended family in the
United States and was in the process of applying for citizenship. He phoned
home, to the West Bank, and his five sisters and two brothers were checked
at Hadassah University Hospital. An older sister, Rana, and a younger sister,
Samia, were also found to have chronic renal failure. Rana, who is now
27 years old, was the sicker of the two. She vividly recalls her first
trip to Hadassah: "I went into the dialysis center and I saw the machines
and I started to cry. I wasn't prepared. I saw people with tubes going
into their neck and others with tubes going into their stomach. I saw the
scars that the needles leave. I wanted to try something else; anything
- A kidney patient mentioned to Rana that if she wanted
to avoid dialysis, the best place to go was Iraq. The family made a few
phone calls. Rana's father was given the name of a private hospital in
Baghdad and told to simply show up. No broker was needed. While Rana still
had limited function in her kidneys, she and her parents decided to travel.
- Sami, meanwhile, was on dialysis three times a week in
California, and on the U.S. transplant waiting list. He dropped out of
college. "I was told to be prepared for a three-year wait, minimum,"
he says. He heard about his sister and the trip to Iraq and promptly left
the United States and went home to the West Bank.
- Rana was gone for 40 days. She returned in excellent
condition, with a healthy, functioning kidney. The total price, for six
weeks in a private hospital room, a furnished apartment for her parents,
all medical fees and the payment to the seller was $20,000. She never had
to endure a minute of dialysis. Her sister, Samia, went next, last February.
She, too, was gone more than a month and returned with a perfect kidney.
Samia, as well, never once had to be punctured by a dialysis needle.
- Finally, last September, it was Sami's turn. He and his
parents took a taxi into Jordan. They spent a night in Amman then hired
a car for the 10-hour trip to Baghdad. Sami was placed in a hospital room
on a floor that was entirely reserved for illegal kidney transplants. On
his floor he met people from Lebanon, Syria, Turkey, Algeria, Libya and
Morocco. His parents stayed in a nice apartment on the hospital grounds,
with a full kitchen and maid service. When they arrived at the hospital
they stopped at a special foreign-transplant office and paid the whole
amount -- $20,000, cash, U.S. currency. Sami's father says that he was
told that about $2,000 of this fee went to the seller. For a manual laborer
in the Middle East, this represents as much as a decade's salary in one
- On Sami's second day in Iraq, he was introduced to his
donor. The donor's name was Essam. He was 24 years old, a Palestinian refugee
residing in a Jordanian village. Essam was living with his parents and
four brothers and one sister in a single room. The family had no money.
Essam's father was very sick and had gone blind. The Jordanian government
does not provide welfare for Palestinian refugees. Essam, as the oldest
son, felt that he had to help his family. So he took the bus to Baghdad.
"He was engaged to be married," Sami says, "and he said
the money would aid his family and allow him to start his married life.
He said he was happy to help me."
- Sami and Essam spent two weeks together, while both were
carefully screened and prepared for surgery. "The doctors are very
cautious," Sami says. "If they doubt the donor's medical condition
even 1 percent, they don't take him. The kidney has to be clean."
Essam was accepted as a seller, then had to sign a document attesting that
he was a volunteer.
- The sellers, Sami explains, live on a separate floor
of the hospital. They are all men, all young. Most come from poor parts
of Egypt or Jordan or Iraq. There is never a shortage of sellers. They
arrive at the hospital and are tested, then they live at the hospital until
a buyer with a good match appears. "The sellers' floor is like a dorm,"
Sami says. "Four guys to a room. The donors were always joking and
playing cards. It was fun to go down there and hang out. I felt like Essam
and I became brothers."
- Occasionally, Sami and Essam left the hospital and toured
Baghdad. Sami's parents took photos. There is a photo of Sami and Essam,
arms around each other, at the Baghdad Zoo. Essam is a thin young man with
a stubbly mustache and opaque eyes. There is another photo of them at a
cafeteria. In a third picture they are dressed in light blue hospital gowns,
emerging from an elevator just minutes before their surgeries.
- Both operations went smoothly. Afterward, Sami spent
15 days in isolation, allowed no visitors. "I had to talk on the phone
with my parents," he says. Paid transplantation is illegal in Iraq,
but the government is either unaware that this is going on, or, more likely,
the appropriate people are paid off. In any case, the patient care is exemplary.
All other illegal transplant programs discharge their patients almost immediately
after surgery, exposing them to infectious hazards and leaving the patients'
home countries to handle the resulting complications. Essam, too, according
to Sami, was provided with ample recovery time. Then Essam returned to
Jordan and Sami to the West Bank, where Michael Friedlaender is providing
- "After seeing the results," Friedlaender says,
"I have to say if you're going to do this, you should go to Iraq."
According to Sami, the hospital where he bought his kidney performs 100
illegal transplants a year, and there are at least six other hospitals
in Baghdad with similar programs. "They are all in communication with
one another," Sami says, "to swap sellers, to find the best matches."
It's not just for people from the Arab world, he insists. "They are
very nice there. Very welcoming. It's a humanitarian thing."
- Sami and his two sisters are doing well. "I'm feeling
strong -- strong and happy," Sami says. He and Essam have kept in
contact. They sometimes write letters. "In my last letter," Sami
says, "I invited him here for a visit, to come stay with me."
Essam, according to Sami, is fine. "He used some of the money to support
his family," Sami says, "and some to rent his own place."
Then, says Sami, he used the remainder of the money to pay for his wedding.
- Michael Finkel is a contributing writer for the magazine.
His last article was about the Israeli-Palestinian conflict.