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What is a kidney worth?

(Page 6 of 11)

Arie soon discovers buying a kidney is a pretty easy path to take in Israel. In dialysis units, in doctors' offices, even in newspaper classified ads, the names of organ brokers - people who arrange kidney trades - are an open secret. For $60,000 to $150,000, a new kidney can be purchased.

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Arie starts surfing the Web, looking at clinics in the United States that do transplant surgery. A friend suggests a medical-advice hotline run by an aide to an influential rabbi. "People call him and say, 'I need an operation' and 'Who's good?' " says Arie. He tries it and gets the name of a doctor in Tel Aviv. Soon, he's put in touch with a broker who tells him a transplant, done in South Africa, will cost $100,000, with 10 percent paid up front.

It's a lot of money, but Arie figures he can at least manage the down payment from his retirement fund.

Many Israelis, even those without great wealth or savings, find ways to cover the cost. Israel's health-insurance funds reimburse patients as much as $70,000 for any medical procedure done abroad. Technically they're not supposed to pay for illegal operations, but if it's done outside Israel, it's off their radar screen. Critics say the health-care companies are turning a blind eye to an international racket. Government and health officials say there's no way to control what a patient does outside Israeli territory.

There is an attractive economic component to this setup. Paying $70,000 for one kidney transplant is far cheaper than $50,000 a year for life in dialysis bills. But it's more than money. The transplant recipient is healthier, and has a better quality of life than a dialysis patient.

Some argue that since the trade is already flourishing, and is difficult to stop, the best way to protect sellers is to decriminalize it and create a regulated market. Michael Friedlaender is one of Arie's doctors after the operation and heads the kidney-transplant follow-up unit at Hadassah University Hospital in Jerusalem. He once opposed organ sales. Now he advocates a legal market.

Under the current system, he says, if something goes wrong during surgery, or if the financial transaction turns out to be a scam, neither the donor nor the recipient has any legal recourse. A regulated system, he says, would change that, and allow for things like malpractice suits, which help safeguard the process.

In a free market, Dr. Friedlaender argues, it's unethical not to pay for an organ.

"Someone's saving your life," he says, "and you're not going to reward him? We pay for every other service in the world." Donating an organ is one of the most valuable services, "because it saves a life."

* * *

Only a few weeks after making contact with the broker, Arie gets the call. "We have a donor for you in South Africa," the broker says. Then things move fast. Plane tickets are delivered. He gives the broker a $10,000 downpayment, with the rest payable when he's admitted to the hospital for surgery. Suddenly he and Mary are on their way to South Africa.

On April 8, 2003, they arrive at St. Augustine's. With its warm yellow walls, highly polished floors, and views of the ocean, the transplant ward is one of the most luxurious in the country. They're struck by the professionalism of the staff.

But they hit a snag.

It turns out that Arie's donor has high blood pressure and is rejected by the syndicate. This comforts Arie and Mary, and persuades them that the doctors and brokers aren't just trying to scam them or the Brazilians. But the first donor isn't the only Brazilian there. Arie and Mary often hear Brazilian music wafting through the hospital hall, and the TVs are tuned to soccer. After several days of more tests, a suitable donor is found.

Arie soon meets the young man (Arie won't reveal his name) who's going to change his life. He's tall, thin, and youthful. He grins constantly. Through a translator he says he doesn't smoke or drink. He just wants to improve his life by getting married and going to college to become an architect.