Kidney Failure - Kidney Sellers, read this!!!

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Kidney Sellers, read this!!!

Homefinders

2004-10-03, 10:20 pm

I read this on the Transplant newsgroup and copied and pasted it here.

Judanne

The article below from NYTimes.com
Tracking the Sale of a Kidney on a Path of Poverty and Hope
May 23, 2004
By LARRY ROHTER

RECIFE, Brazil - When Alberty José da Silva heard he could make money, lots
of money, by selling his kidney, it seemed to him the opportunity of a
lifetime. For a desperately ill 48-year-old woman in Brooklyn whose doctors
had told her to get a kidney any way she could, it was.

At 38, Mr. da Silva, one of 23 children of a prostitute, lives in a slum
near the airport here, in a flimsy two-room shack he shares with a sister
and nine other people.

"As a child, I can remember seven of us sharing a single egg, or living for
day after day on just a bit of manioc meal with salt," Mr. da Silva said in
an interview.

He recalled his mother as a woman who "sold her flesh" to survive. Last year
he decided that he would, too. Now, a long scar across his side marks the
place where a kidney and a rib were removed in exchange for $6,000, paid by
middlemen in an international organ trafficking ring.

Among poor men like Mr. da Silva and others who have migrated to slums here
from Brazil's parched northeastern backlands, word of the market to sell
their organs spread quickly.

Some who had done so were already buying houses, businesses, cars and
refrigerators.

The sums being offered seemed a fortune. The minimum wage here is barely $80
a month, and work is hard to find. Many men struggle to exist on odd jobs
that pay barely a dollar a day. Initially, the organ brokers paid as much as
$10,000 for a kidney - more than a decade's wages.

Donors and recipients were not related, in contrast to the usual preference
for legal and medical reasons. In fact, they did not even know each other.
But they were linked by a trafficking ring that the authorities now say
exploited two very different sets of needs - for money and for life itself -
at opposite ends of a tangled chain thousands of miles long.

Tracing the journey of Mr. da Silva's kidney through that chain, which
spanned four continents and ended in a one-bedroom apartment in Brooklyn,
reveals the inner workings of a network that human rights groups say is by
no means unique. Rather, they say, it is representative of a global black
market for organs, including livers, kidneys and lungs, that touches dozens
of countries and generates many millions of dollars a year.

In Alberty da Silva's case, the authorities here say, the organ's odyssey
began with two middlemen based in this gritty port city of 1.5 million
people: Gedalya Tauber, a former Israeli police officer, and his partner,
Ivan Bonifacio da Silva, a retired Brazilian military police officer.

The pair, since jailed on organ trafficking charges, not only handed out
cash payments, the authorities say, but also arranged for the medical exams
to weed out unqualified donors. They then obtained passports and airline
tickets for the donors to travel to South Africa, where the transplants took
place. Both countries have laws against commercial trade in organs.

"Six grand is a lot of money, especially when you don't have any," Mr. da
Silva said when asked why he had given up his kidney. "No one here warned us
that what we were doing was illegal."

Get a Kidney, or Expect to Die

The American woman who received Mr. da Silva's kidney initially worried that
what she was doing might be illegal. She described herself as deeply
religious and concerned with the ethics of transplants.

But during an interview in April she also recalled the long years of
suffering that made her take the risk of seeking an organ on the
international market. The decision to go abroad for a kidney, she said at
her third-floor walk-up apartment in Brooklyn, was not an easy one, but
necessary nonetheless.

"I had been on dialysis for 15 years and on two transplant lists for 7,"
said the woman, who asked not to be
identified by name, for fear of losing support payments vital to maintaining
the health of her transplanted organ. "Nothing was happening, and my health
was getting worse and worse." Finally, she said, "my doctors told me to get
a kidney any way I could," or expect to die.

She took their warning seriously. The years of dialysis had left her with
worsening heart and lung problems. She also suffered from severe
osteoporosis. "I had seen four other ladies that I knew pass away" while
they waited for kidney donors, she said.

More than 3,300 Americans died last year awaiting kidney transplants, and
the Brooklyn woman was among 85,000 people on waiting lists in the United
States, 60,000 of them in need of kidneys. The average wait can be five
years, says the United Network for Organ Sharing, a nonprofit transplant
information clearinghouse in Richmond, Va.

It is illegal in the United States to pay a donor for an organ. But Nancy
Scheper-Hughes of Organs Watch, a human rights group in Berkeley, Calif.,
that has long tracked the illegal organ trade and denounced abuses, says
irregularities still occur.

"It is a common practice of many larger clinics to advertise on the Internet
for transplant tourists, so we're
up to our necks in it," Dr. Scheper-Hughes said. Transplant doctors, she
says, have developed a "don't ask, don't tell" policy.

The World Health Organization issued guidelines in 1991 to avoid the
coercion or exploitation of organ donors. They were endorsed by 192
countries, including the United States, Brazil and South Africa. But the
guidelines are not binding, and the recommendations have been widely
ignored. At least one country, Iran, has a legally regulated system to trade
organs.

As medical science advances and health care increasingly becomes a
marketplace transaction, a fierce debate about commercializing transplants
has emerged.

On one side, said Alexander M. Capron, the director of the ethics department
of the World Health Organization, are "transplant surgeons who believe that
a good way to remedy the shortage of organs would be to offer payments," and
bioethicists and philosophers who see organ trade as an extension of the
principle of autonomy.

But an opposing group, Mr. Capron said, "fears that the line between selling
organs and actually selling people is a rather fine one" and that, as in sex
trafficking, the marketplace is one in which coercion and exploitation may
be unavoidable.

In the case of the Brooklyn woman, her husband had relatives in Israel who
had heard of a syndicate that
brokered transplants, and reached out to them. The woman and her husband
said that relatives and the brokers reassured them that an operation abroad
would be perfectly legal.

"I felt helpless, because she was going to die," said the woman's husband,
who is in such fragile health himself that he receives disability payments.
"Helping her get that kidney was the best thing that I have ever done for
anyone in my entire life."

`Mr. Big' or `the Wrong Guy'?

The syndicate that organized the American woman's transplant, the
authorities say, also arranged kidney
transfers for at least 100 Israelis. It was led, they say, by a 52-year-old
organ broker in Israel, Ilan Peri.

"He's Mr. Big, the one who started the whole thing," Johan Wessels, a
forensic investigator in South Africa who works for the Department of Health
in KwaZulu-Natal Province and has had access to hospital records there, said
in Durban.

Mr. Peri works out of a Tel Aviv suburb through a company called TechCom. He
faces charges of tax evasion in Israel, accused of improperly declaring
nearly $4 million said to have been earned as an organ broker and is also
under investigation in connection with inflating the invoices that he did
submit to Israeli health care programs.

When reached by telephone in Tel Aviv and asked to comment on the charges,
Mr. Peri said: "I have never been involved in kidney transplants. You are
talking to the wrong guy." He eventually hung up the telephone, but not
before amending his statement. "I'm not involved in that anymore, so I can't
help you," he said.

To those who monitor organ trafficking, it was no surprise that Israel
should emerge as the focal point of a
syndicate. Organ donation rates in Israel are among the lowest in the
developed world, about one-third the rate in Western Europe, in large part
because of what Health Ministry officials and doctors describe as a
widespread impression that Jewish religious law prohibits transplants as a
"desecration of the body."

In reality, religious law is far more nuanced. But influential Orthodox
rabbis have been reluctant to make
public statements that would encourage either live donors or the harvesting
of organs from the deceased.

Israelis needing transplants have suffered as a result. More than 1,000
people in a nation of about 6 million are on Israel's waiting list for
organs, more than half of them for kidneys. The list grows by more than 20
percent each year, health officials say. In an average year, more than 80
people die waiting, proportionally a slightly higher rate than in the United
States.

To meet Israeli's growing demand for organs, middlemen calling themselves
brokers, from prominent doctors to a former spokesman for a health
maintenance organization, have rushed into the market to set prices for a
scarce product that can reach $150,000 for a kidney. Some advertise openly
in Israeli newspapers and on radio stations, soliciting recipients and
donors.

"As of today, there is no law in Israel that forbids trafficking in human
organs," Meir Broder, a legal adviser
to the Health Ministry, explained in an interview in Jerusalem. "There is no
criminal aspect at all."

A bill drafted by the Health Ministry that would make trafficking illegal
and forbid organ donations for money awaits action in the Parliament. But
medical specialists say it faces strong opposition and may not pass.

For now, allowing the brokers to operate with few restrictions in effect
benefits the state by exporting
Israel's organ shortage overseas. The patients who do go abroad "save the
country a lot of money," explained Dr. Michael Friedlaender, a kidney
specialist at Hadassah Hospital in Jerusalem, "not only in terms of what
doesn't have to be spent on dialysis, but also by opening places for other
people who are on the list."

For operations in Israel, the Ministry of Health relies on elaborate
procedures to ensure that donors and recipients act for "altruistic" motives
and do not exchange money. But another ministry directive also allows
Israelis who go abroad for transplants to be reimbursed as much as $80,000.

Much of the remaining costs can often be obtained from insurance plans,
though Israeli health maintenance
organizations are supposed to ask for proof when donors and recipients say
they are related in "voluntary" operations.

Israeli doctors say those requirements are often ignored, and the government
says it has no obligation to monitor operations done abroad. "In the end, a
country can only be responsible for what happens within its own borders,"
said Mr. Broder, the Ministry of Health lawyer.

In the mid-1990's, many of the Israeli organ brokers took their patients to
Turkey, flying in teams of Israeli
surgeons and relying on donors from Moldova, Romania and Russia. But after
some patients died and Dr. Scheper-Hughes of Organs Watch and the Turkish
and European news media raised ethical questions, the brokers were forced to
search for new locations.

For both the medical expertise available and its low costs, South Africa
emerged as a logical alternative.

The South African Connection

It was there, in South Africa, the authorities say, that Mr. Peri's ring
brought together Mr. da Silva and the woman who ultimately received his
kidney.

After long negotiations in Israel, which she said were conducted by
relatives of her husband, the Brooklyn woman flew to South Africa for a
transplant. Because of her unusual circumstances, it cost her just over
$60,000, which other kidney recipients who dealt with Mr. Peri said was less
than half the price the syndicate usually charged.

Even so, that amount was 10 times the payment Mr. da Silva received, though
organ recipients in Israel said Mr. Peri routinely told them that the
Brazilian donors were being paid $25,000.

While money initially motivated Mr. da Silva to sell his kidney, he said he
also came to be moved by the chance to help a stranger. The change, he said,
occurred after he, too, arrived in South Africa, his first trip out of
Brazil, in what he saw as an adventure that would allow him to see lions,
giraffes and elephants.

Instead, after 10 hours of flying last August, Mr. da Silva found himself in
Durban, a resort city of 1.4 million on the Indian Ocean, where he was
shuttled to a safe house. Later, at St. Augustine's Hospital, he met the
American woman and learned of her long ordeal.

"It's hard for me to imagine how a person might feel when a relative is
about to die, so I don't blame anybody for trying anything to get a new
kidney," Mr. da Silva said.

He said he also made friends with hospital orderlies and a nurse called Mama
Tchuka. Mr. da Silva said hospital employees joked openly about the illegal
nature of the transplants and the fact that he and the woman receiving his
kidney were of different ethnic backgrounds and could not even speak each
other's language.

"It was only when I got to South Africa and was told to sign a document
saying that the recipient of my kidney was my cousin that I realized that
something was wrong," Mr. da Silva said. "But by then it was too late to
turn back."

In interviews, Mr. da Silva and several other of the Brazilian men who
donated organs said they were treated well in South Africa. But
investigators say the donors did not get the same quality of care as the
Israelis who received their organs.

The Israelis, for example, like the American woman, were lodged in
beachfront hotels before the operation and, afterward, kept under intense
observation and given detailed records to be handed over to their doctors
back home. The donors, by contrast, were monitored "for a maximum of three
days," Mr. Wessels, the South African investigator, said. Some of that time,
they were not even in the hospital, but at the safe house the syndicate
rented.

"Then they were put on a plane without much further ado," he said.

Based on a detailed study of confiscated records, South African authorities
say the kidney transfer between Mr. da Silva and the Brooklyn woman was one
of more than 100 suspect transplants performed in less than two years at St.
Augustine's.

Today, the director of the kidney transplant unit there, Lindy Dickson, and
another employee, Melanie Azor, are among seven people arrested and charged
with acting on behalf of the illegal organ ring. Government officials say
more indictments are on the way. "Not all the invitation cards have been
sent out yet," Barent Groen, the chief government prosecutor in the case,
said in an interview in Durban.

Also arrested was Shushan Meir, an Israeli-born South African who
authorities said acted as a middleman for Mr. Peri, the Israeli broker.

"He visited transplant clinics in Durban, Johannesburg and Cape Town," Mr.
Wessels said of Mr. Peri, "and
correspondence shows that he was in touch with the doctors and the
transplant clinic staff here. The impression I get is that he was making
sure his investment was running smoothly."

At a court hearing, Mr. Meir said that beyond the 100 or so transplants done
in Durban, he had organized "probably about 35" more in Johannesburg. But
South African investigators estimate that the actual number is probably
closer to 200, divided among hospitals in Johannesburg and Cape Town.

All the hospitals under investigation belong to the same private health care
chain, Netcare, which on its Web site boasts of "aiming to uphold South
Africa's reputation as `the transplant capital of the world.' " Since the
mid-1990's, the company has been buying up facilities like St. Augustine's,
originally a Catholic missionary hospital, and demanding a strong
bottom-line performance.

Netcare's chief executive officer, Michael Sacks, declined a request for an
interview. Through a press spokeswoman, Martina Nicholson, Netcare has
denied conscious involvement in any wrongdoing.

"We do not know of anything untoward having taken place at all," Ms.
Nicholson said. "We still firmly believe that there has been no
transgression at any of our hospitals or by any of our staff members."

With operatives of Mr. Peri's syndicate now jailed in Brazil and South
Africa, and Mr. Peri under pressure in
Israel, his ring has apparently been smashed. But the transplant waiting
list in Israel continues to grow, and
recent reports from kidney specialists say Israeli organ brokers have
appeared in China, among other places.

"This is obviously a well-oiled syndicate that knows how to move from one
country to another,' R. W. Green-Thompson, superintendent general of the
KwaZulu-Natal provincial department of health, said in an interview in
Durban. "I'm sure that this problem will pop up again in another country
soon. The only question is which one."

Unexpected Consequences

These days, Mr. da Silva works 44 hours a week as a security guard, but
still earns less than $175 a month, money that is the sole support for the
10 other people he lives with. Even that income was jeopardized when he and
other kidney donors were arrested and briefly jailed early this year on
suspicion of violating Brazilian laws against trading in human organs. He
and more than a score of other donors still faced criminal charges here.

In the 18 months that ended last November, when the authorities shut down
the ring, so many residents from the slums of Recife had volunteered that
the middlemen had begun offering just $3,000 for a healthy kidney.

All told, the police in Brazil estimate that about 100 men, nearly all poor
or unemployed, ages 20 to 40, agreed to sell kidneys. Though some would
eventually be rejected for having an unusual blood type, frail health or
signs of drug use, more than 60 men are believed to have gone to South
Africa.

Recife and its slums had become so lucrative a source for organs, in fact,
that Brazilian investigators believe that by late 2003, Israeli brokers, in
an effort to swell their earnings further, were considering moving their
operations to hospitals here and in other nearby cities.

With poverty offering up an unquenchable pool of volunteers, the local
authorities say the ring had also
begun inquiring about buying other vital organs from poor residents,
including lungs, livers and corneas.

"Even after all of this fuss, I'd do it again," said Orley de Santana, a
26-year-old laborer, who went to South Africa but was unable to sell his
kidney for $6,000 before the police broke up the ring. "In order not to have
to steal or kill, I thought it better to sell my kidney."

Among the men who did give up a kidney, some say they have experienced
health problems that no one warned them about.

"For me, the complications began almost immediately," said José Carlos da
Conceicao da Silva, 24, a day laborer who hauls produce. He said he required
a second operation in South Africa on a lung three days after his kidney was
removed. Since returning to Brazil his health has worsened, he said.

"I'm tired all the time and can't lift heavy weights, which I have to be
able to do if people are going to hire me," he said. "My blood pressure goes
up and down, and I feel pain and numbness where the scar from the operation
is."

Worse still, after his flight back to Brazil, Mr. da Silva, who is not
related to Alberty da Silva, said he was robbed of nearly all of the $6,000
he was paid for his kidney when he went to São Paulo during a layover on his
flight home. "I begged and pleaded for them not to take the money, telling
them that I had sold my kidney abroad and showing them the scar," he
recalled, near tears.

Another donor, Rogerio Bezerra da Silva, not related to the others, also
lost his kidney and his cash, which South African authorities confiscated
after the ring was exposed late last year, and is now the object of mockery
in his slum neighborhood.

On occasion, Alberty da Silva says, he shows pictures of his trip to South
Africa to the neighborhood children. During the interview, he showed them to
a reporter, too, including some of him in Durban with the woman who received
his kidney. He also displayed a letter she later wrote, thanking him for
"the gift of life."

The American woman continues to correspond with him and, though hardly
wealthy herself, says she intends to send cash gifts each Christmas and on
his birthday.

"They never want you to see the donor," she said of the traffickers. "But I
kept insisting that we meet because I know that he is now part of my being.
I have a piece of him inside of me, so who wouldn't want that bond?"

http://www.nytimes.com/2004/05/23/i...cf3383839efa618

---------------------------------
Copyright 2004 The New York Times Company

Meadowlands NJ

2004-10-03, 10:20 pm

Re: Kidney Sellers, read this!!!

You're assuming kidney sellers know how to read and comprehend things! LOL

Donna T

Anyway, no drug, not even alcohol, causes the fundamental
ills of society. If we're looking for the source of our
troubles, we shouldn't test people for drugs, we should
test them for stupidity, ignorance, greed and love of
power. -- P.J. O'Rourke

Extended Partition

2004-10-03, 10:20 pm

"Meadowlands NJ" <meadowlandsnj@aol.comgabbagoo> wrote in message
news:20040607180444.07406.00000701@mb-m03.aol.com...
> Re: Kidney Sellers, read this!!!
>
> You're assuming kidney sellers know how to read and comprehend things!
LOL
>
> Donna T

I don't think that kidney sellers have any problem reading and comprehending
things. The problem is that they allow their greed to get ahead of their
common sense and heart.

Anthony