Every day, 17 Americans die of organ failure. In Israel, the average wait for a kidney transplant is four years. In response, a global gray market has bloomed. In India, for example, poor sellers are quickly matched with sick buyers from Taiwan. Critics call it "transplant tourism." Proponents say the market is meeting a need.
The Monitor follows three men: an unemployed Brazilian and an ailing Israeli, as well as a South African investigator who helped bust an organ-trafficking ring.
The case raises anew hard legal and ethical questions, such as: Who owns our bodies? Should it be illegal to sell an organ if it could save someone's life? What is the government's role in protecting two vulnerable groups - the poor, who are willingly exploited, and the sick, who are desperate for healing?
On a warm afternoon in Recife, a city on Brazil's northeastern coast, Hernani Gomes da Silva sits alone in the Bar Egipcio, quietly nursing a drink, ruminating about his predicament. He is 32 years old and still lives in his mother's two-room house. Rain comes in through the roof, and cockroaches and rats scuttle across the cement floor. He has three kids, a wife who loathes him, and a mistress 20 years his senior. He is unemployed with no money, no skills, and a criminal record. The future is bleak.
Suddenly the words "we pay people $6,000" leap out at him from behind. His radar clicks on.
"I don't mean to eavesdrop," he says, turning to the bald man sitting at a nearby table. "Were you talking about earning money from transplants?" He has heard of others in Recife who have sold their organs and can't believe his good fortune.
"Yes," says the man.
"Which organ?" Hernani asks.
"The kidney. Why, are you interested?"
"Of course I'm interested."
"What blood type are you?" the man asks.
"O-positive," says Hernani.
The man nods - it's the most compatible blood type. It's 2002 and Hernani has passed the first test for selling a kidney to an organization that will stretch across three continents; make hundreds of thousands of dollars for the people behind it; and rouse the interest of police, politicians, ethicists, and doctors around the world.
Soon Hernani is walking home, dreaming of a motorbike and a roof that doesn't leak.
* * *
More than 5,000 miles away across an ocean, Arie Pach, a stout Israeli lawyer in failing health, sees his future flash before him. It makes him shudder.
As he heads to an appointment on the sixth floor of Jerusalem's Hadassah Ein Kerem Hospital, he walks past the dialysis ward. Below the glare of fluorescent lights, the thin, feeble-looking patients sit in special armchairs hooked up to oven-sized machines that click and whir and simulate the job of the human kidney: They clean the patient's blood. It's a life-preserving process for people whose kidneys have failed, but they have to be connected roughly three hours at a time, three days a week.
Michael Friedlaenderheads the kidney-transplant follow-up unit at Hadassah University Hospital in Jerusalem.
Nancy Scheper-Hughesis a professor of medical anthropology at the University of California, Berkeley, and director of Organs Watch.
In February 2002, Arie's doctors told him his kidneys were beginning to falter. By early 2003, he's had minor surgery to prepare for dialysis, but he is already formulating plans to avoid the ward. "I don't want to be one of those people with big needles in my arm, getting my blood changed in and out of the machine like a car going for an oil change," he thinks.
Then there's the expense of dialysis to the healthcare system - about $45,000 to $50,000 per year. And only some 10 percent of dialysis patients live more than 10 years, according to the US National Center for Health Statistics. Arie has too many things left to do in life. He loves to travel abroad with his wife. One of his two sons will marry this summer. To see any grandchildren, he's got to stick around. But the doctors warn him that his blood could soon start to become toxic. They give him two choices: dialysis or a kidney transplant.
* * *
In the seaside resort city of Durban, South Africa, private investigator Johan Wessels is working in his home office, plinking away at the computer keyboard. The phone rings. It's a woman from the health department. She wants to know if he'd be willing to work on a case under something called the Human Tissue Act.
In 24 years as a police detective and private investigator, Johan has tackled all kinds of cases - smuggling, embezzlement, bribery. He's achieved a 98 percent conviction rate. But he's never heard about this act and has little idea what he's getting into as he says yes.
Hanging up, he yells to his wife, Carol, in the kitchen. "That was the health department. They want me to investigate some case about human tissues."
His partner of 29 years is pleased. "I've been praying all morning about you getting more work," she says. Both are "reborn Christians." They read the Bible daily and sit up front at church on Sundays.
His curiosity piqued, Johan is faxed a copy of South Africa's Human Tissue Act and scans it.
Click on a country to see how its government has dealt with legal issues surrounding organ trade.
BRAZIL: A 1997 law makes it illegal to sell organs and tissue and forbids anyone from soliciting them. Punishment includes three to eight years in prison and a fine equal to as much as 360 days of minimum wage. In 1998, Brazil passed a law making every Brazilian adult an organ donor at death, except in case of special exemption. But "presumed consent" was decried by critics and was subsequently amended a year later to require the consent of relatives. In the 1990s, Brazilian newspapers reported that prisoners were granted furloughs to donate their organs.
SOUTH AFRICA: The Human Tissue Act of 1983 says that no one can receive payment for the transfer of any tissue, including flesh, bone, organ, or body fluid. Violators are subject to a maximum fine of $300 or imprisonment of no more than one year. But a loophole grants a hospital's medical director and pathologist the right to remove tissues and organs without consent, when the identity of the deceased person is initially unknown and relatives have not come forward to claim the body within the period when organ retrieval is medically feasible.
ISRAEL: While it is now against health ministry regulations to buy and sell organs, one bill pending in the Knesset would make it a felony. If it passes, brokers could be fined and receive up to three years in prison, though recipients and donors would not be prosecuted. Another proposal would make it legal to reimburse a kidney donor for healthcare costs.
UNITED STATES: President Bush signed the Organ Donation and Recovery Improvement Act on April 5. While it is still illegal to sell or pay for organs, the act authorizes the federal government to reimburse living donors for expenses and to offer project grants aimed at increasing donations and improving organ preservation and compatibility. And this year, Wisconsin became the first state to give living donors a tax deduction of up to $10,000 for medical costs, travel, and lost salary.
IRAN: Kidney sales are legal and regulated. The trade is organized and controlled by two nongovernmental organizations – the Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD) – both endorsed by the government. The CASKP connects potential recipients and donors, and organizes tests to ensure compatibility. Recipients often offer donors employment or extra money after the transplant.
CHINA: It's illegal to buy or sell organs in China. But a 1984 law allows organs to be transplanted from an executed prisoner if family members don't claim the body right away. Amnesty International says Chinese media reported 1,060 judicial executions in 2002. But it says the actual figure may be as high as 15,000. Most harvested prisoner organs are sold to medical "visitors" from Hong Kong, Taiwan, or Singapore.
INDIA: The Indian government tried to stop illegal organ transplants with a 1994 law that criminalizes organ sales but allows for "unrelated kidney sales," a loophole that has led to corruption. Nonprofit organizations in the area claim the trade is rising now that it has gone underground.
BRITAIN: A British woman may be the first citizen to face prosecution under the country's Human Organ Transplants Act of 1989, which prohibits the sale or solicitation of any organ within the country. Last month, to pay off her legal debts, the woman closed a deal over the Internet to sell her kidney for $50,000 to an American.
Sect. 1: "[T]issue means ... any flesh, bone, organ, gland, or body fluid...." Sect. 28: "No person ... may receive any payment in ... the ... acquisition ... of any tissue...." Section 33: Violators "shall be ... liable ... to a fine not exceeding 2,000 Rand or to imprisonment for a period not exceeding one year...."
One year in jail or a fine of about $300. This thing has "no teeth," Johan thinks. Maybe that's why they're buying and selling organs in South Africa.
It's June 2003, and Johan is embarking on what will become one of the toughest cases of his career - not only a test of his detective skills, but also of the ethical and religious values he holds dear.
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