What is a kidney worth?

Religious beliefs often figure in decisions about organ trading. They're invoked both to encourage and discourage it. The Old Testament story of Hagar bearing a child for Abraham (because his wife, Sarah, is "barren"), is often cited as the first case of surrogate motherhood. Some people use this scripture to justify paying someone to be a surrogate for an organ, says Dr. Scheper-Hughes of Organs Watch. Or as one Israeli doctor said to her, "God performed the first transplant" when he took a rib out of Adam and created Eve. In many Christian circles, too, there's the belief that "your body is a gift from God," says Scheper-Hughes, "or that you have use-rights over your body, but that it belongs to God."

Yet one reason Israelis rarely donate organs after death is that many Jews believe the body is sacred, and should be whole at the time of burial. Orthodox Jews believe that the deceased should be intact for the Resurrection they believe will follow the coming of the Messiah. But views are shifting.

"If someone needs to save his life and the only way to motivate someone to help him do that is by financial incentive, then I don't think they should prevent people from doing that in order to save lives," says Robert Berman, the founder of the New York-based Halachic Organ Donor Society, which has enlisted prominent rabbis to encourage donation.

"The fact is that people are dying and that there are not enough organs going around to save their lives," he says. "There's a widespread misperception that organ donation is categorically prohibited by Jewish law. It is not. Jewish law supports saving lives."

Meanwhile, after many conversations, Arie and Mary agree they're making the right choice. "This decision," says Mary, "completely changes the course of your life."

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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.

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.

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