Human traffic - the terrible organ trade
Human traffic: the terrible organ trade
The terrible traffickers control the kidney trade and they earn their money from desperate poor and the sick people. Nancy Scheper-Hughes writes about the problems.
Men from Manila, the Philippines. They show their scars from selling their kidneys in a photograph from 1999. (© Pat Roque/AP/Press Association Images)
The photo showed several thin, dark Filipino men in a line, showing their kidney scar. This was the Istanbul Summit in 2008, where more than 150 scientific and medical representatives from 78 countries met. They learnt about human trafficking for ‘fresh’ kidneys. ‘Is this why we started to be transplant surgeons?’ one of the US surgeons, Francis Delmonico, asked. ‘Are we comfortable with this? Is this fair? Do we want to be part of this?’
The man next to me, a Hindu surgeon in white robes, who looked like Hippocrates, was emotional. I asked what he was thinking and he said: ‘This is too late. Kidney selling is not unusual or exotic any more. It is normal and everyday. We in the South can agree that it is tragic, but the demand is from rich countries.’
In the early 1980s a new form of human trafficking, selling kidneys from living people to ‘transplant tourists’, started in the Middle East, Latin America and Asia. The first scientific report was in The Lancet in 1990. This told the stories of 131 kidney patients from three hospitals in the United Arab Emirates and Oman. They travelled with their private doctors to Bombay (now Mumbai), India. There, they had transplants – new kidneys from living people from slums and shantytowns. The sellers were paid $2,000 to $3,000 for a kidney. When they returned to their country, these transplant tourists had a lot of problems from badly matched organs, and infections eg. HIV and Hepatitis C. There was no information about the possible bad effects on the people who sold their kidneys. They were invisible, bodies with no names, like transplants from people who had died.
In 1997, I started Organs Watch, to make people see the invisible population of kidney ‘suppliers’. Today human trafficking for organs is a small, but very good business that earns some people a lot of money and involves about 50 countries.
We don’t want dead bodies
In summer 2009 someone phoned me.
‘Are you the Organs Lady?’ Jim Deal (not his real name) asked me, a little nervous.
‘Maybe,’ I replied. ‘How can I help you?’
‘My kidneys are really bad and my doctor wants me to start dialysis immediately.’
‘Well, I can’t stay next to a machine three days a week. I’ve just started a new company and I have no time. I need a kidney now. Where can I get one? I have money.’
I suggested that he ask his relatives (he had many brothers and sisters), but he said no. They were all busy with their careers and families. I asked if he wanted to do what Steve Jobs did and register at many transplant centres in different regions of the US. This made it more possible that he would get a transplant. He agreed.
But he didn’t want a kidney from someone who had died. He wanted to buy a kidney from a living person. He asked if I could recommend a surgeon or someone who could help. Jim had a grandparent from Iran, so I told him about the system in Iran. They had the only legalized kidney selling programme, but only for Iranian citizens and their families.
‘I’m not going to go to Iran,’ Jim said. ‘I want First World medicine.’
I told Jim that Iran had ‘First World’ surgeons, but he did not believe me. Some weeks later he called to tell me that his family had found several local people who would sell a kidney online through Craigslist. He chose the cheapest one: a kidney from 19-year-old college student Ji-Hun (not his real name). He was an immigrant from South Korea and he did not have enough money for his college course and living costs. He was afraid he would be sent back to South Korea if he stopped studying.
Jim paid $20,000. The night before the transplant, two very nervous Korean brothers met Jim’s relatives near Los Angeles to get the money. An armed guard was watching. The seller wanted half the money before the operation. The family said no, but they agreed to pay the money to the seller’s older brother when both Jim and Ji-Hun were under anaesthesia but before the operation was finished.
When I arrived at the famous ‘hospital for the Hollywood stars’ in Beverly Hills, the surgery was finished. Jim was in a private room with family and friends, flowers, presents, smiles and prayers. Nurses kept going in his room to see if everything was going well.
I had to look very hard to find Ji-Hun. He was in a corner room very far from the recovery rooms after operations. He was a thin young man, no more than 55 kilos. He was in great pain, and he was ashamed when I told him I fight for the rights of ‘kidney donors’. The nurses were worried when I gave them my card with its Organs Watch logo. They told me that Ji-Hun could leave hospital that same day. But he had not yet seen a doctor after his kidney removal. He was worried about returning to his one-room bedsitter apartment in a bad area of Los Angeles. Before he left the hospital Ji-Hun gave me his cell-phone number.
A few days later Ji-Hun said that he was still in bed, with a lot of pain. He could not eat, urinate or defecate. His older brother, who worked as a dish washer in a fast-food restaurant, was angry with him. He had no medical insurance, and the $20,000, which was paid to his brother in a public toilet in the hospital, was nearly finished. He had paid his college bills and sent money to their parents in Korea. I phoned Ji-Hun a few times. Then his phone went dead.
Jim was worried that people would find out, so he emigrated to another country. The last time I heard about him, he was married and able to work. The hospital where they did the operation refused to talk about the story because of patient confidentiality. The nephrologist (kidney specialist) who worked at the private hospital told me that he had seen many other kidney operations like this, but he did not want to talk about it publicly, to be a ‘whistleblower’.
Nicolae, a father of three children, has chronic hypertension. He is afraid he will not see them grow up. (Nancy Scheper-Hughes)
Vladiumir, sold a kidney when he was18. He died from an infection after the operation and kidney failure when he got home from the bad surgery in Turkey. (Nancy Scheper-Hughes)
Most illegal kidney transplants are in developing countries – India, Pakistan, Bangladesh, Egypt, the Philippines, and now Central Asia and Central America. But more in the future will be like Jim’s story. With the help of the internet, people will be able to buy organs locally from the large number of new immigrants, refugees and workers with no documents. The transplants will be done in private hospitals – the hospitals say the people are giving their organs for free to a friend or family member.
That is the future. Now, transplant tours are more usual. They can bring together people from four or five different countries: the buyer is from one place, the organisers are from two other countries, the surgeons travel from one country to another to do the kidney operations. The case of a private clinic in Kosovo is maybe the best example of this. The people involved appear and disappear quickly. The guilty people, including the surgeons, take all the information away with them so no-one can find any proof. When the police arrive, they find a black-market clinic, with very little forensic evidence, but the people have gone.
Viorel is very angry because his kidney was removed by force. A Turkish surgeon Yusuf Sonmez took out their kidneys. (Nancy Scheper-Hughes)
My colleagues from Organs Watch and I have done more than 17 years of research. We knew it was not a question of medical ethics. It was international organized crime. After research in Turkey, Moldova, the US, Israel, Brazil, Argentina, the Philippines and South Africa, we found out that the organisers were human traffickers. They used violence, if they needed to. Many of the people looking for new kidneys in poor areas are people who have sold their kidneys and then got jobs with the crime bosses.
The transplant and organ business brings in a lot of money. Selling human organs is illegal in nearly every country, but the laws are different, so it can be almost impossible to prosecute people across three or more countries. In some countries it is illegal to sell a kidney but not to buy one. In other countries it is illegal to buy and sell inside the country but not to buy and/or sell outside the country. They discussed organ trafficking for the first time at the 2000 United Nations Palermo Protocol on Human Trafficking. They agree even people who want to sell their kidneys in these illegal deals can be victims. Most of them do it because they need to, not because of physical threats or force. Some people even pay a lot of money to be trafficked. As it is illegal, it is difficult to know for sure how many people are actually trafficked for their kidneys, but at least 10,000 kidneys are sold each year. Human trafficking for organs is quite a small problem. If politicians wanted to, they could stop it. Difficult organisation A lot of other trafficking brings together people from lower levels of society. The organ trade brings together people from the highest levels: surgeons, doctors, laboratory technicians, travel agents, as well as criminals and people in need from the lowest levels. Transplant professionals do not want to talk about their colleagues who work in the organ trade. So this protects the human traffickers who get the organs. And because trafficking kidneys could be good and save lives (compared to trafficking bad drugs and guns that can take lives), the law does not want to see all the problems with it. The organisers, or ‘organ brokers’ are the centre of these criminal networks. They bring together three groups: (1) kidney patients who are happy to travel great distances and face a lot of risk and insecurity; (2) kidney sellers from the urban slums and villages of the poor world; (3) surgeons happy to break the law and professional codes of ethics. These organisers contact the hospitals, transplant centres and medical insurance companies, the local kidney hunters, and people who force the sellers to get on the operating table after the risks and dangers. They know the goverments are not interested and the police protect them. The medical professionals work together as teams – technicians in the blood and tissue laboratories, two surgical teams working at the same time, kidney specialists and nurses to help after the operation. There are ‘transplant tour agencies’ that can organize travel, passports and visas. In the Middle East and in the US, these international networks often hide behind religious organizations and charities. How they persuade people Some organisers in Moldova used the same ways they had used to get Moldovan women into sex work. They told unemployed young people they could get work for them in other countries; they promised money to parents who needed money to pay their debts or help sick children. When they arrived, the young men were kept in safe houses, they took their passports away, and they were totally dependent on the brokers. A few days later, the brokers told them the work was not painting or ironing but giving their kidneys. They beat them if they said no. One young man, Vladimir (not his real name), talked about the ‘choice’ he had to make in Istanbul: ‘If I hadn’t given my kidney to that surgeon, they would have killed me and thrown my body into the river.’
Nancy Scheper-Hughes with Alberty Alfonso da Silva. He was taken from a Brazilian slum to give an organ to an American woman from New York City. (Nancy Scheper-Hughes) Most brokers promise a better life to people who give and receive organs. Normally they get people who need money and agree to give an organ. The pressure and force are not open. In Baseco, a poor area of Manila, brokers get young men (and some women) who are distant family to sell organs. Ray Arcella, a famous broker from the area, puts his arm round the young men he gets. They call him “uncle” or “godfather”. He tells the young people that kidney selling is the best way to help your family – now there are no more jobs in the docks of Baseco. Brokers pay local kidney hunters – often people who have sold their kidneys before – to get their neighbours and family members. People seem to agree to this, but there is a lot of hidden pressure and control. The sellers Kidney sellers are poor and vulnerable: people who have nothing, people who have debt, ex-prisoners or mental patients, Eastern European peasants, the Turkish junk dealers, Palestinian refugees, runaway soldiers from Iraq and Afghanistan, Afro-Brazilians from the slums of northeast Brazil, and Andean Indians.
Most agree to the deal verbally, but later understand how they have been cheated. Most of them do not have enough information when they agree. They do not under¬stand how serious the surgery is, the conditions in the hospital before and after the operation, or how it will take a long time to recover, and they will not be able to work. Some in the slums of Manila, as in the slums of Brazil, were young teenagers. The organisers told them to make up new names and say they were older so the surgeons would accept them. Many say that they were paid too little to call it a “sale” – for something so valuable as a part of the body. Is it a gift? Is it trade? Is it theft? It is a mixture. Male kidney sellers often say it was not so difficult – they are proud. But if you ask them questions about how their lives have changed, they talk about it. Some male sellers in Moldova did not agree that they were ‘trafficked’ because this makes them sound like female ‘prostitutes’, a terrible idea. Others become obsessed with selling their kidney and say that all their problems are because of that one ‘stupidity’. We followed a group of 40 Moldovan kidney sellers from 2001 to 2009. Some died from suicide, or failure of their second kidney. Some were attacked by angry villagers who felt that the sellers had brought a bad name to their village. Some were forced to leave their homes and disappeared. The brokers The organisers (brokers) can be transplant surgeons, or organized crime figures. They bring together rich kidney patients from Japan, Italy, Israel, Canada, Taiwan, the United States and Saudi Arabia with the poor people who sell their healthy organs. The organ traffickers and brokers are very clever and often change the way they work. Israeli brokers, for example, recently said that they either have to pay to get information about dead people in Russia or Latin America (Colombia, Peru and Panama in particular). Or they have to set up new temporary locations (Cyprus, Azerbaijan and Costa Rica) to get illegal transplants quickly. They know the police and government and others will be looking. They are always prepared to move quickly to new locations where they have links to secret transplant units. Some of these are simply a medical clinic or a ward in a public hospital. The buyers Transplant tourists are a variety of different people, but all want to take the risk to travel anywhere to buy a stranger’s kidney. They pay for a package deal; they do not know – and they do not want to know – the price that will be paid to the person who will sell their kidney. They do want to know if the new kidney is from a healthy person, an educated person. And ethnicity is important to them because it might be a ‘closer’ or a ‘better’ match. They want a kidney that has not had to work hard for a living. And they want their surgeon to make sure they get the seller’s healthiest kidney. They prefer male donors between the ages of 20-30 years. Transplant tourists are asked to pay a lot of money – usually $100,000 to $180,000. The seller gets a very low percentage of this.
Some buyers will not accept kidneys from women. This could be because they are old-fashioned gentlemen, or sexist. Most buyers are men. In 2010, David (not his real name) visited me. He was in his sixties, from southern California who insisted on setting me straight on certain matters. He wanted me to know how he felt. ‘Kidney dialysis is terrible,’ he said. ‘You get cataracts, problems in your intestines, you can hardly eat. You cannot have sex or urinate. You lose your energy, you become anaemic, and you are cold all the time. You get very depressed.’ He met a surgeon and his broker in Tel Aviv. He had to pay $150,000 in advance for a transplant at an unknown place. David travelled to Israel, and after some medical exams, he flew with the Israeli surgeon and his broker to Istanbul where they got a second surgeon. ‘One takes the kidney out and the other one puts the kidney in.’ In Istanbul, they told David that his transplant would be in Kosovo, a country he knew nothing about. The day before they flew there, the broker told him that police had broken into the Medicus Clinic in Pristina, and that they could not do the transplant there. But he offered a cheaper operation in Baku, Azerbaijan. So David got his kidney there, from a seller from Central Asia. The new generation After the Istanbul Summit in 2008, they started the Declaration of Istanbul Custodian Group. For the last eight years, they have been working closely with The Transplantation Society, the World Health Organization (WHO), and many transplant professionals to negotiate with public health and other government officials to create new laws. These laws will encourage deceased donor programmes, help countries become self-sufficient in transplants and help stop transplant tourism. It has also put pressure on hospitals to stop protecting the surgeons who do transplants on foreign patients and trafficked kidney suppliers.
But there are still many illegal transplant trafficking schemes. The new generation of organ traffickers is cleverer. During the Beijing Olympics, foreigners could no longer get organs from executed Chinese prisoners. So brokers started to get transplants from living donors, some from trafficked Vietnamese, others from villagers in parts of China where people were already selling blood, so they accepted the idea of selling kidneys too. There are more illegal transplants now in Asia, the Middle East, Central Asia, Eastern Europe, Central and Latin America, Europe and the United States. And kidney sellers can be found in almost any country. After several crises, there are many political and economic refugees. They easily agree to donate organs. It is difficult to prosecute anyone. Some less important brokers and kidney sellers are caught. But the surgeons, very necessary for the transplants - and the hospital administrators often escape. They say they did not know it was illegal.
In the famous Netcare case in Durban, South Africa, there were 109 illegal transplants at Saint Augustine’s Hospital (and the donors were underage in five of them). The police discovered this and made agreements with some brokers. Netcare, the largest medical corporation in South Africa, pleaded guilty because they allowed the transplants. The value of Netcare stocks went down. The four surgeons and two transplant co-ordinators arrested said they were not guilty. They said the company and its lawyers had told them these international surgeries were legal. In December 2012, they ended the case and the state had to pay the surgeons’ legal costs. So these surgeons are protected. This is bad, as they are a very important link in the transplant-trafficking business. A crime with no victim? Some judges have said this is a crime with no victim, because human trafficking for organs can help some very sick people (but be bad for other people who are not so important).
Police in New Jersey caught Levy Izhak Rosenbaum. He was a hyperactive inter¬national kidney trafficker and he sold transplant packages for more than $180,000. But the FBI had no idea what a ‘kidney salesman’ was. The prosecutors could not believe that important US hospitals and surgeons had worked with the scheme, or that the trafficked sellers had been deceived or forced. They agreed the end of the case in 2011: Rosenbaum admitted he had bought and sold only three kidneys, but he agreed he had been in the business for over a decade. At the end of the trial in July 2012, the judge was impressed by the support from the transplant patients. They came to praise the trafficker and ask for him not to be punished. There was only one kidney-selling victim, Elhan Quick, a surprise witness by the prosecution. He was a young black Israeli, who had traveled to a hospital in Minnesota to sell his kidney to a 70-year-old man from Brooklyn. Mr Cohen had 11 adult children, but not one wanted to donate a kidney to save the life of their father. But they were happy to pay $20,000 to a stranger. Quick said that he agreed to the donation because he was unemployed. He hoped he would find a place in society by helping in this way. But when he arrived at the transplant unit, he changed his mind and did not want to do it. This was just before he went under anaesthesia. His testimony had no effect. The judge said it was sad. She did not want to send Rosenbaum to a low-security prison in New Jersey for two-and-a-half years because she thought that he was really a ‘good man’. She said that Elhan Quick had not been cheated; he was paid what he was promised. ‘Everyone,’ she said, ‘got something out of this deal.’ Closing down the networks
If the brokers and kidney hunters go to prison, it is easy to find other criminals. But if they put transplant professionals in prison, this would break the networks. It could be very effective to take away their licence to practice. They must not continue to protect each other. International bodies like the UN and the EU need to take action to prosecute these international crimes. The people who buy kidneys are not punished because they are sick and want to save their lives. But buyers do not worry about taking a kidney from poor people with no medical insurance, no future, and sometimes no home. They have to have some responsibility. There needs to be a revolution in the practice of transplantation. But before that happens, we need a more modest medicine that realizes our lives have limits. This is a difficult to say when transplant patient groups and religious organizations demand transplants and organs from other people, like a moral crusade. The kidney is the modern ‘blood diamond’. The organ trade is one of the worst examples of capitalism: poor bodies are sold to help rich bodies. Nancy Scheper-Hughes is Professor of Medical Anthropology at the University of California, Berkeley, and an activist in many social movements. She wrote the 1993 study Death without Weeping: the Violence of Everyday Life in Brazil. NOW READ THE ORIGINAL: http://newint.org/features/2014/05/01/organ-trafficking-keynote/