KIDNEY CAPITALIST:Hernani Gomes da Silva sits with his dog outside his house in Recife, Brazil. CHICO BARROS/AGENCIA LUMIAR/SPECIAL TO THE CHRISTIAN SCIENCE MONITOR
Hernani has big dreams for the $6,000 he's expecting to get for one of his kidneys. But he also has doubts. One day as he's walking home - wondering if the South Africans will take a lung or cornea, too, or just abandon him in a country where he can't speak the language - he bumps into a friend who's driving a shiny white Volkswagen. He's heard through the grapevine that this friend is one of dozens from Recife who went to South Africa and came back alive. The early ones got $10,000 for their kidneys, a fortune in a neighborhood where many earn the minimum wage - about $1,000 a year.
Hernani gets in the car. He is not normally the inquisitive type, but today he pelts his friend with questions.
"How much did you get paid?" he asks.
"Do they pay in advance?"
"How were you treated?"
"What is the operation like?"
"Do they take care of you?"
"Will I be OK?"
The friend says all the right things. Ten minutes later, Hernani gets out of the car, his mind at rest. He is going to South Africa to sell his kidney.
* * *
In the months since they met in Egipcio's, Hernani and the little bald man - he calls him Captain Ivan - have become fast friends. Ivan Bonifacio da Silva, a retired police officer, has taken Hernani under his wing, patiently explaining how the kidney switch works, and assuaging his lingering concerns.
He's also been shepherding him into a whole new world. He tells Hernani where to get the tests to prove he's healthy enough for the operation. He's with Hernani when he gets the passport that will allow him to leave Brazil for the first time in his life. And in October 2002, on the eve of Hernani's trip to Durban, Captain Ivan hands him $500 - and assures him there is another $5,500 waiting for him when he gets home.
Six thousand dollars. It's somewhere near the average going rate for kidneys in today's global organ trade. Palestinian men who sold their kidneys in Saddam Hussein's Iraq after the first Gulf War got just $500 to $1,000. They helped make Iraq the organ-trading hub of the Arab world until the latest war broke out. In the slums of Manila, where corneas, livers, and lungs are also offered for sale, kidneys fetch about $2,000, according to Nancy Scheper-Hughes, cofounder of Organs Watch, a group at the University of California, Berkeley, that tracks the trade. Some Israeli organ donors have gotten $20,000, she says. And a few American sellers have gotten $30,000 to $50,000 for their kidneys.
Click on a country to see how its government has dealt with legal issues surrounding organ trade.
BRAZIL: A 1997 law makes it illegal to sell organs and tissue and forbids anyone from soliciting them. Punishment includes three to eight years in prison and a fine equal to as much as 360 days of minimum wage. In 1998, Brazil passed a law making every Brazilian adult an organ donor at death, except in case of special exemption. But "presumed consent" was decried by critics and was subsequently amended a year later to require the consent of relatives. In the 1990s, Brazilian newspapers reported that prisoners were granted furloughs to donate their organs.
SOUTH AFRICA: The Human Tissue Act of 1983 says that no one can receive payment for the transfer of any tissue, including flesh, bone, organ, or body fluid. Violators are subject to a maximum fine of $300 or imprisonment of no more than one year. But a loophole grants a hospital's medical director and pathologist the right to remove tissues and organs without consent, when the identity of the deceased person is initially unknown and relatives have not come forward to claim the body within the period when organ retrieval is medically feasible.
ISRAEL: While it is now against health ministry regulations to buy and sell organs, one bill pending in the Knesset would make it a felony. If it passes, brokers could be fined and receive up to three years in prison, though recipients and donors would not be prosecuted. Another proposal would make it legal to reimburse a kidney donor for healthcare costs.
UNITED STATES: President Bush signed the Organ Donation and Recovery Improvement Act on April 5. While it is still illegal to sell or pay for organs, the act authorizes the federal government to reimburse living donors for expenses and to offer project grants aimed at increasing donations and improving organ preservation and compatibility. And this year, Wisconsin became the first state to give living donors a tax deduction of up to $10,000 for medical costs, travel, and lost salary.
IRAN: Kidney sales are legal and regulated. The trade is organized and controlled by two nongovernmental organizations – the Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD) – both endorsed by the government. The CASKP connects potential recipients and donors, and organizes tests to ensure compatibility. Recipients often offer donors employment or extra money after the transplant.
CHINA: It's illegal to buy or sell organs in China. But a 1984 law allows organs to be transplanted from an executed prisoner if family members don't claim the body right away. Amnesty International says Chinese media reported 1,060 judicial executions in 2002. But it says the actual figure may be as high as 15,000. Most harvested prisoner organs are sold to medical "visitors" from Hong Kong, Taiwan, or Singapore.
INDIA: The Indian government tried to stop illegal organ transplants with a 1994 law that criminalizes organ sales but allows for "unrelated kidney sales," a loophole that has led to corruption. Nonprofit organizations in the area claim the trade is rising now that it has gone underground.
BRITAIN: A British woman may be the first citizen to face prosecution under the country's Human Organ Transplants Act of 1989, which prohibits the sale or solicitation of any organ within the country. Last month, to pay off her legal debts, the woman closed a deal over the Internet to sell her kidney for $50,000 to an American.
But $500 is more than Hernani has ever held in his hands. Captain Ivan tells him to make sure Daisy, Hernani's wife, has enough for when he's gone, and to buy some new clothes.
Hernani hardly has to be told twice. Within an hour, he's walking through the sliding doors of the Shopping Recife mall and into a new life. The lights are bright and the giant windows are filled with personal beer kegs, colorful shirts, and tiny cameras that seem to seduce him, whispering:
You've got money now, you can afford it, come in, buy me.
Hernani quickly succumbs to the mall's sirens. He buys five or six polo shirts. He buys a new pair of lace-up shoes. He buys two pairs of jeans, tripling the number of long pants in his wardrobe. He goes to the food court and fulfills a lifelong dream of buying a cappuccino. At the supermarket he fills his cart with rice, beans, bread, milk, eggs, and the ultimate luxury food - meat. For about $2 he buys enough beef to feed his family for a month.
This is just the beginning, he thinks, as he sits down later that night at a fancy restaurant. Things are different now. I am somebody. I'm a consumer.
* * *
But when he opens the metal door to his house just after midnight, he realizes money can't change everything. Daisy is lying on the carpet they call their bed. She's angry. She knows he's been to see his mistress, Antonia. And she knows he has spent most of the money on himself, even though it was supposed to be the down payment on their new life. Yet no matter how much she has come to detest him over the past few years, she can't stop herself from worrying.
"Don't go," she tells him as he lies down beside her. "You don't know what might happen. They could do anything, take anything. You don't know who they are or what they want."
"Shut up," Hernani barks. "Let me go to sleep."
"It could be a trap, Hernani," she persists. "You might not get out alive."
Actually, in this brave new world of kidney selling, donors rarely die. But Daisy's fears aren't totally unfounded. In India, about 2,000 people sell a kidney each year. One study there in 2002 found 86 percent of organ sellers saying they had significant declines in their health in the three years after surgery. In the eastern European nation of Moldova, some 300 peasants sold their kidneys between 1999 and 2002. A study by Organs Watch found 79 percent of Moldovan donors with health problems in the months and years after the procedure.
But in the darkness of their house that night, with the promise of a payday to beat all paydays, Hernani ignores his wife's anxious pleading. "Daisy, I'm doing this," he says, cursing her. More harsh words are exchanged, and she flees to the next room to sleep with her son.
The next morning he pecks her on the cheek, slips quietly out the door, and heads to the airport.
* * *
Hernani lands in the lush, hilly city of Durban, which sits on the Indian Ocean. How different and luxurious things are here, he thinks. The house where his hosts keep him and several other Brazilian kidney donors is enormous. The living room alone is bigger than his whole house back home. There's even a hot tub. An interpreter stays with them all day, and a facilitator buys them a CD player so they can dance around the living room to Brazilian songs that remind them of home. Sometimes the hosts take them out to dinner. Hernani, who rarely has enough money to buy even pork, tries ostrich meat.
October 2002 blends into November. Mostly, they spend their days lying about the house, waiting for the call. When it finally comes, Hernani is whisked off to St. Augustine's Hospital, a sprawling modern complex set high on a green hillside overlooking the ocean. He and the others are, after all, here for business.
They are several of the roughly 300 Brazilian and Israeli sellers that police say were brought to South Africa between 2001 and 2003. The syndicate was run, police say, by an Israeli named Ilan Perry. He and the other organizers were making hundreds of thousands of dollars in profits. They probably picked South Africa because it has top-notch medical facilities and one of the world's best transplant-success rates. It also has weak laws regulating the sale of human organs.
Hernani has signed lots of forms, including one that says he's "related" to the man to whom he's about to give his kidney. Finally he meets this man - an Israeli named Amiram Aharoni - for the first time. Walking into the room, it's then that Hernani understands the magnitude of what he's about to do. Mr. Aharoni is all swollen and pale. He cries when he sees Hernani. He's too weak to lift himself up. But his wife passes along their message with a tender hug. "You are part of our family now," she says. "From this moment on, you are our flesh and blood."
Michael Friedlaender
heads the kidney-transplant follow-up unit at Hadassah University Hospital in Jerusalem.
Nancy Scheper-Hughes
is a professor of medical anthropology at the University of California, Berkeley, and director of Organs Watch.
The operation takes place on Nov. 26, 2002, and lasts several hours. Lying in two nearby operating rooms, Hernani and Aharoni undergo surgery at the same time. Hernani has three surgeons operating on him because of the complexity of the procedure, which sometimes involves removing a rib.
When Aharoni wakes up, he has a fresh kidney and a new lease on life. When Hernani comes to, he feels a tightness where the wound has been stitched shut. But three days later, when he finally boards the plane back to Brazil, he is a happy man. He is going to be rich.
* * *
That joy fades fast as he arrives back at his mother's house in Recife. It's been almost 24 hours since his plane landed, and Daisy is scowling at him. She suspects he's been to see Antonia. She's both relieved and depressed to see him alive and back in her life. She's tired of their sad marriage. She's sure he doesn't really care about the three children jumping around the street - or about Daisy herself, who dropped out of school at 14 to set up a home with him. Even after weeks on the other side of the world, the man taking a red bicycle out of the taxi doesn't even look at her.
"Luiza,go and get yourself ready. We're going into town to get you a bicycle," he shouts to his 9-year-old daughter as he hands the new bike to his son, Hernandes. Then he turns his back and walks toward the local plaza.
He's determined to have some fun. After all, he has money in his pocket - $5,500 in crisp new $100 bills handed to him by Captain Ivan under the table at a fast-food restaurant near a local branch of Citibank.
For someone who has been poor all his life, money is to be spent, not saved or budgeted. And spend it he does. In the first few months of 2003, Hernani pays $1,700 to replace the roof, the floor, the walls, the windows, and the wiring in his mother's house. He uses $1,600 to pay off her credit cards. Another $1,200 buys him a brand new Honda CG 125 motorcycle, which he insists the dealer deliver to his house so his neighbors can see. On New Year's Eve, he buys Daisy a new blouse and skirt. He figures that leaves him somewhere between $1,000 and $2,000 to spend on drink and other women. Life is good.
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