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What is a kidney worth?

By Abraham McLaughlin, Ilene R. Prusher,, Andrew Downie / June 9, 2004

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.

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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.

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.

* * *