What is a kidney worth?

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.

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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.

Personal or societal definitions of "naturalness" can change, Dr. Robinson observes. They have shifted in the US for instance, regarding interracial marriage and homosexuality.

Revulsion aside, "If one of mine was sick, I'd do anything," even though it's illegal, Johan says, thinking of his two children. "I'd borrow lots of money. I'd even sell the farm," he says, referring to one of his favorite places in the world, a 700-acre spread that's been in his family for four generations.

It's a typical parental response - doing anything for a child. In fact, growing numbers of doctors and ethicists agree that people like Johan or Arie should be able to buy kidneys, and that people like Hernani should be able to sell them. They argue, for instance, that banning organ sales robs sellers, who are often poor, of a rare option to escape poverty. They also argue that high-minded efforts to shield the poor from themselves can be paternalistic or hypocritical. "If the rich are free to engage in dangerous sports for pleasure ... it is difficult to see why the poor, who take the lesser risk of kidney selling ... should be thought so misguided as to need saving from themselves," says Dr. Friedlaender in Israel.

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