BIG DECISIONS:In 2003, with his kidneys failing, Israeli Arie Pach, shown here with his wife, Mary, decided to travel to South Africa to get a transplant. ILENE R. PRUSHER
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.
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.
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.
But as the detectives' coffee cools, they weigh the other side, too. They wonder if rumors about "organjacking" - people being killed for their organs - might be true. Critics say the current system has already jump-started a dangerous commodification of the human body, which could turn the world's slums into reservoirs of body parts for the rich. Today, in Manila's slums, the selling of kidneys has led to sales of lungs and corneas.
As the detectives talk it through, Johan's views develop. "Life is already really cheap in our society," he says later. "People will kill each other for a firearm and a little cash." And if you start giving people money for their kidneys, "you're going to start finding a lot of dead bodies with no organs."
These kinds of gruesome scenarios are what seal Johan's opinion. The detectives get up from the table, strengthened in their resolve to break open the case.
* * *
A few weeks later, Johan adds another plank to his position. As he's eating breakfast, he tunes into an American TV news show. A reporter is interviewing a mother whose 17-year-old son, as Johan recalls, was killed in a car crash. With the mother's consent, doctors salvaged 47 organs and tissues from the boy's body - corneas, kidneys, liver, lungs, heart. "I didn't know they could get that many organs from one body," Johan thinks to himself.
The reporter asks if the mother thinks she should be paid for all the organs her son gave away freely.
How could I take money for them? Johan remembers her saying.
God gave each of us the body we use when we're alive. He gave it to us for free. How could we charge someone else for part of it? He calls his wife right away.
"This makes more sense to me as a Christian than anything else I've heard," he says to her.
* * *
The detectives have been toiling for months now, slowly piecing the trafficking puzzle together. But in late November they get a major break. The police team gets a call, out of the blue, from an officer at a nearby police station. The cop has two Israelis with him. One is accusing the other of stealing $18,000, and there's something about a kidney. When the detectives later question the two men, they can't believe their ears.
One man, known as S. Zohr, admits he received $18,000 for agreeing to sell his kidney. He'd actually been lying on the operating table at St. Augustine's, just moments away from surrendering his organ to an ailing Israeli man named Agania Robel, when he got spooked. Zohr jumped off the table, grabbed his clothes, and bee-lined for the airport, trying to take the $18,000 with him.
But then, a man named Shushan Meir, who later is charged with being part of the syndicate, called the police and told them Mr. Zohr was stealing the money. Mr. Meir apparently hoped, strangely enough, that the cops would help prevent this illegal deal from going sour. It was the final confirmation the police needed to bust up the ring.
On the morning of Nov. 27, 2003 - a year and a day after Hernani went under the knife - Johan, Helberg, and a police team that includes a photographer and several plainclothes detectives converge on the back parking lot at St. Augustine's. They walk quickly up the hill into the facility's transplant division.
Helberg, the team leader, announces that they have a search warrant and will be seizing files. Johan adds that he's an independent investigator looking into crimes committed under the Human Tissue Act. He doesn't need a search warrant and can look at any of the clinic's files at any time. He steps into a side office where a whiteboard hangs on the wall. Scrawled on it are two names - "A. Robel" and "Rogerio Bezzera" - and today's date.
"What are those?" he asks Lindy Dickson, a staff member who would later be arrested and charged with complicity in the scheme. She tells him the two men are, at this moment, on operating tables upstairs.
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.
Robel. That's the guy who was left stranded when Zohr jumped off the table last week, Johan realizes. And he's already been paired up with another donor, a Brazilian named Rogerio Bezzera da Silva. With this, Johan gets a glimpse of the efficiency and sophistication of the syndicate. Only days after one donor gets cold feet, the group has another one on the operating table. This one, he will learn, is getting only $6,000 for his kidney. Robel, the recipient, is paying $45,000 for a new organ.
Police decide against arresting the two men while they're on operating tables, but several days later, they make three arrests. Robel, the recipient, pleads guilty. He's fined about $770 and returns to Israel. Two apparently low-level syndicate operatives, including Meir, are charged. One makes a plea bargain, while Meir will be tried beginning July 13. Mr. Bezzera da Silva isn't charged, but he forfeits his $6,000.
That same week, Brazilian police also arrest two Israelis and nine Brazilians.
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Richard Berry stands in a former Sunday School classroom in the basement of Trinity Evangelical Free Church. The room has been turned into a men's homeless shelter.
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