What is a kidney worth?
(Page 7 of 11)
As they talk, Arie keeps trying to remember how to say "thank you" in Portuguese.Skip to next paragraph
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"Ob..., Ob...," he stutters.
"Obrigado," Mary chimes in.
Through his interpreter, he asks the Brazilianif he really consents wholehearteldy to giving his kidney. The young man smiles, and says, "Yes." He offers his hand to Arie, and the two men shake as they are wheeled into the operating room.
Surgery falls on the eve of Passover, the Jewish holiday that celebrates the Children of Israel's passage from slavery into the freedom of the Promised Land. As he's lying on the gurney, being wheeled into the operating room, he whispers, "Shma Yisrael," a Jewish prayer that affirms God's oneness and the commandment to love God with all one's heart, soul, and mind.
That evening, back at the hotel, Mary feels lonely and apprehensive. Some local Jewish families have invited her to celebrate Passover with them, but she doesn't feel like being cheery and social. In her room, she lights some candles and reads the Passover story. Perhaps the surgery will finally let her husband find a new freedom of his own.
The next day she sees him, and he doesn't look well. He's pale gray and connected to machines she's seen all her professional life, but it's different when it's her husband. To her relief, the doctors say the surgery was a success.
In the following days, Arie meets his donor again. They pose for photographs. The Brazilian wraps an arm around Arie, flashes a thumbs up sign, and beams. In his bright red shirt, he looks like a fan whose team has just won the championship.
Unknown to him, under South Africa's 1983 Human Tissue Act, Arie and his donor have broken the law. But the organ brokers and doctors are the ones making the biggest profits - and are the real targets of the police. Buying and selling kidneys across three continents is, in some ways, the perfect 21st-century crime. That's what South African investigator Johan Wessels realizes as he gets further and further into his new case. For one thing, it occurs in several jurisdictions, all of which are thousands of miles apart. And it's hard to determine where exactly the crime - handing over the money - takes place. And if one country starts cracking down, the syndicate can hop to another.
In working the case, Johan has teamed up with a group from the elite Commercial Branch, South Africa's equivalent of the FBI's white-collar-crime unit. The team is headed by Capt. Louis Helberg, a reserved man.
By the middle of 2003, the team has a firm idea of what's going on. Donors are getting $6,000 to $18,000 for their kidneys. They're coming from Israel, Brazil, and maybe Russia and Romania, given the Eastern European-sounding names on the hospital records. Two doctors at St. Augustine's appear to be heavily involved. It looks as if some of the South Africans have pocketed as much as $450,000 doing more than 107 operations.
Police say the organizers meet 11 of the 12 criteria for a "syndicate" - a criminal enterprise akin to the mafia. There's only one criterion the group hasn't met: no one has been killed, say the investigators.
* * *
After one long day working on the investigation, Johan, Captain Helberg, and another detective head to a burger joint. They get some weak coffee and fall into conversation about the case.
"How far would you go if one of your kids needed a kidney?" asks one detective. The question opens a debate on the validity and ethics of the very law they've sworn to uphold.
For most people, the initial response to buying or selling a body part is revulsion. It's what bioethicists call "the yuck factor." But the moral underpinning of that feeling - which in turn becomes codified as law - is often hard to articulate, says Walter Robinson, a pediatrician and bioethicist at Harvard Medical School in Cambridge, Mass. "It's a violation of 'naturalness,' " he says. "But 'naturalness' is difficult to describe." It can emanate from people's moral or religious values, subtle prejudices, or tradition.