Two illegal (former) kidney transplant networks analyzed: the Netcare -and Medicus cases, by Ambagtsheer and Bugter

 There aren't many successful prosecutions resulting from illegal organ trafficking, despite the fact that the prevalence of illegal kidney transplants is estimated by many sources to be high.  Here's a paper that tries to understand the nature of the black market supply chain for kidneys, by examining two prosecutions that led to convictions, connected to a hospital in Kosovo and another in South Africa.

Ambagtsheer, F., Bugter, R. The organization of the human organ trade: a comparative crime script analysis. Crime, Law and Social Change (2022). https://doi.org/10.1007/s10611-022-10068-5

Abstract: "This study fills critical knowledge gaps into the organization of organ trade utilizing crime script analysis. Adopting a situational crime prevention approach, this article draws from law enforcement data to compare the crime commission process (activities, cast and locations) of 2 prosecuted organ trade cases: the Medicus case and the Netcare case. Both cases involved transnational criminal networks that performed kidney transplants from living donors. We further present similarities and differences between illegal and legal living donor kidney transplants that may help guide identification and disruption of illegal transplants. Our analysis reveal the similar crime trajectories of both criminal cases, in particular the extensive preparations and high degree of organization that were needed to execute the illegal transplants. Offenders in the illegal transplant schemes utilized the same opportunity structures that facilitate legal transplants, such as transplant units, hospitals and blood banks. Our results indicate that the trade is embedded within the transplant industry and intersects with the transport- and hospitality sector. The transplant industry in the studied cases was particularly found to provide the medical infrastructure needed to facilitate and sustain organ trade. When compared to legal transplants, the studied illegal transplant scripts reveal a wider diversity in recruitment tactics and concealment strategies and a higher diversity in locations for the pre-operative work-up of donors and recipients. The results suggest the need for a broader conceptualization of the organ trade that incorporates both organized crime and white collar crime perspectives."

***

"Although reliable figures of the trade’s scope are lacking, the World Health Organization (WHO) has estimated that approx. 5000 illegal transplants are performed annually (WHO, 2007). The organ trade is reported to rank in the top 5 of the world’s most lucrative international crimes with an estimated annual profit of $840 million to $1.7 billion (May, 2017). While illegal organ transplants have been reported to take place in countries across the globe, knowledge of the trade’s operational features remains scarce (Pascalev et al., 2016)

...

"At the time of writing, only 16 convictions involving organ trade have been reported to the case law database of the United Nations Office on Drugs and Crime, which is far less than would be expected based on global estimates of the problem (UNODC, 2022). The Organization for Security and Co-operation in Europe (OSCE) has reported 9 additional cases (OSCE, 2013). All reported cases had cross-border features and most involved the facilitation of living donor kidney transplants.

...

"In 2014 the Council of Europe established a new convention against ‘Trafficking in Human Organs’ which calls for a broad prohibition of virtually all commercial dealings in organs. Accordingly, sales that occur with the consent of donors are considered to be ‘trafficking’ regardless of the circumstances involved (Council of Europe, 2015)"

...

[Netcare]"Israeli and Romanian donors were promised $20,000 for their kidneys, the Brazilian donors were promised between $3,000 and $8,000. Most donors were recruited in Brazil by 2 retired military officers (Ambagtsheer, 2021; De Jong, 2017; Scheper-Hughes, 2011). 

Payments and reimbursements: Payments took place throughout all stages of the crime commission process. Patients paid Perry/his company up to $120,000 prior to their travel and transplant. Perry, and later also Meir, subsequently paid Netcare. Netcare in turn disbursed payments to various actors in the scheme, including the transplant surgeons and the blood bank. ... Occasionally, additional payments were made directly in cash to the surgeons by Perry, his company, or his agents. Perry also paid an escort/fixer (Rod Kimberley) and a nephrologist. Kimberley paid low-tier offenders in the scheme, including the interpreters. Kimberley additionally covered the costs of recipients’ and donors’ accommodations and he gave donors pocket money upon arrival in South Africa as an advance to their kidney payment. All donors received the promised amount in cash after their operations. 

...

"Contrary to donors in the Netcare case, none of the Medicus’ donors received the promised amount. Some did not receive payment at all but were promised payment only if they recruited new prospective kidney sellers. Withholding payments to kidney sellers in order for them to recruit new prospective kidney sellers is a tactic in organ trafficking schemes to sustain the transplant program (De Jong, 2017).

...

"The cases diverge with respect to the locations and legal embeddedness. Contrary to the Medicus case where transplants were organized in one clinic that was not licensed to conduct transplants, transplants in South Africa were facilitated in at least 5 hospitals across the country that were legally mandated to perform transplants."

Compensation for kidney donors? The comments on the Washington Post discussion are now complete...

I've updated my earlier post

The Washington Post discusses compensation for organ donors 

to reflect the subsequent discussions, below. (See the original post for whole discussion, which now seems to be complete)

Sally Satel is first:  Generosity won’t fix our shortage of organs for transplants

Taking the opposite point of view (but arguing that we should do more to reduce financial disincentives to donating, by paying for donor expenses): Francis Delmonico and Alexander Capron December 29, Our body parts shouldn’t be for sale

Scott Sumner's headline and sub-headline also speaks for itself:  The moral case for paying kidney donors:  We can save lives and cut costs with one change in policy. 

Will lab-grown kidneys fix our transplant waiting lists?: Benjamin Humphreys is optimistic that they will, eventually.
It’s time to treat organ donors with the respect they deserve: Josh Morrison is a kidney donor and the executive director of WaitList Zero, a nonprofit devoted to representing living donors and supporting living donation.

Scott Carney disagrees, on practical grounds (he thinks that a legal US market would foster badly regulated overseas markets): If you’re willing to buy a kidney, you’re willing to exploit the poor: Legalizing the sale of kidneys in America would lead to a booming black market everywhere else.

Nancy Scheper-Hughes, who has spoken to many black market kidney sellers, thinks that legal markets couldn't funcion much differently: The market for human organs is destroying lives We don't have "spare" kidneys. They shouldn't be up for sale.

The Washington Post discusses compensation for organ donors

Frank McCormick alerts me that the Washington Post yesterday took the recent article he coauthored in the American Journal of Transplantation as a jumping off point to discuss the pros and cons of addressing the shortage of transplantable kidneys by allowing the government to pay donors (the article proposed that only the government could pay, and considered payments of $45,000 for a living donor kidney).

 The  WaPo starts with a general description of the opposing positions:  Compensation for organ donors: A primer.

Their brief discussion sets the stage with lots of links (and will be familiar to readers of this blog who have been following my several posts on  compensation for donors).  

They end with this promise of more discussions, which I'll link to below as they appear (spoiler--Sally Satel is pro compensation, and Frank Delmonico doesn't think it's a good idea):

"Over the next few days, we’ll hear from:

Sally Satel, resident scholar at the American Enterprise Institute and practicing psychiatrist at the Yale University School of Medicine,

Francis Delmonico, Harvard Medical School professor of surgery at the Massachusetts General Hospital, and Alexander Capron, professor of law and medicine at the University of Southern California,

Scott Sumner, economist at Bentley University and blogger at The Money Illusion,

Benjamin Humphreys, program director at the Harvard Stem Cell Institute,

{Josh Morrison, who wasn't on the original list but is a great choice...}

Nancy Scheper-Hughes, founder of Organ Watch and anthropology professor at University of California, Berkeley."

Sally Satel is first:  Generosity won’t fix our shortage of organs for transplants

Taking the opposite point of view (but arguing that we should do more to reduce financial disincentives to donating, by paying for donor expenses): Francis Delmonico and Alexander Capron December 29, Our body parts shouldn’t be for sale

Scott Sumner's headline and sub-headline also speaks for itself:  The moral case for paying kidney donors:  We can save lives and cut costs with one change in policy. 

Will lab-grown kidneys fix our transplant waiting lists?: Benjamin Humphreys is optimistic that they will, eventually.
It’s time to treat organ donors with the respect they deserve: Josh Morrison is a kidney donor and the executive director of WaitList Zero, a nonprofit devoted to representing living donors and supporting living donation.

Scott Carney disagrees, on practical grounds (he thinks that a legal US market would foster badly regulated overseas markets): If you’re willing to buy a kidney, you’re willing to exploit the poor: Legalizing the sale of kidneys in America would lead to a booming black market everywhere else.

Nancy Scheper-Hughes, who has spoken to many black market kidney sellers, thinks that legal markets couldn't funcion much differently: The market for human organs is destroying lives We don't have "spare" kidneys. They shouldn't be up for sale.

"The organ detective:" article about anthropologist Nancy Scheper-Hughes

An interesting long article by Ethan Watters in the July/August issue of the Pacific Standard: The Organ Detective: A Career Spent Uncovering a Hidden Global Market in Human Flesh discusses Nancy Scheper-Hughes, her work, and her position on where anthropology should try to position itself between science and activism.

"Scheper-Hughes’ investigation of the organ trade would be a test case for a new kind of anthropology. This would be the study not of an isolated, exotic culture, but of a globalized, interconnected black market—one that crossed classes, cultures, and borders, linking impoverished paid donors to the highest-status individuals and institutions in the modern world. For Scheper-Hughes, the project presented an opportunity to show how an anthropologist could have a meaningful, real-time, and forceful impact on an ongoing injustice.
...
"Since the mid-1990s, Scheper-Hughes has published some 50 articles and book chapters about the organ trade, and she is currently in the process of synthesizing that material into a book, tentatively titled A World Cut in Two. Over the years, she has had an outsize impact on the intellectual trends in her field, and her study of the organ trade is likely to be her last major statement on the meaning and value of the discipline to which she has devoted her life. Whether this body of work represents a triumph of anthropological research or a cautionary tale about scholarly vigilantism is already a hotly disputed question among her colleagues.
...
"In a 1995 debate with the anthropologist Roy D’Andrade in the pages of Current Anthropology, Scheper-Hughes argued for what she called a “militant anthropology,” in which practitioners would become traitors to their class and nation by joining political battles arm in arm with their subjects. The job of the anthropologist wasn’t simply to document the quotidian but to strip away appearances and reveal the hidden forces and ideologies that leave people dominated and oppressed. To do this, she suggested throwing off the traditional guise of the academic—in “the spirit of the Brazilian ‘carnavalesque’”—and joining the powerless in their fight against bourgeois institutions like hospitals and universities.

“The new cadre of ‘barefoot anthropologists’ that I envision,” she wrote, “must become alarmists and shock troopers—the producers of politically complicated and morally demanding texts and images capable of sinking through the layers of acceptance, complicity, and bad faith that allow the suffering and the deaths to continue.”
...
"“With the moral model, the truth ain’t exactly the thing that everyone strives for,” D’Andrade, who is now retired and living in Northern California, told me. “What you strive for is a denunciation of a real evil.” I asked him who prevailed in his public debate with Scheper-Hughes. “I believed that after the kerfuffle that people would get back to asking, ‘How do you know something is true or not?’ But in the end, the moral model swept the country and cultural anthropology stopped being anything that a self-respecting social scientist would call a science. The hegemony of the Scheper-Hughes position became total.”
...
"In the Philippines, kidney sellers she interviewed often pulled up their shirts, displaying their nephrectomy scars with evident pride. They spoke of the surgery as a sacrifice made for their families, and members of their community sometimes compared their abdominal incisions to the lance wounds Christ received on the cross. In Moldova, as she reported in a 2003 paper published in the Journal of Human Rights, people who had sold their kidneys were considered so morally and physically compromised that they were treated as social pariahs. “That son of a bitch left me an invalid,” one Moldovan paid donor said of his surgeon. Young Brazilian men who had been flown to South Africa to sell their kidneys described to Scheper-Hughes how the experience had gained them a pass into the world of tourism and medical marvels. One told her that his main regret was not having spent more time in the hospital. “There were clean sheets, hot showers, lots of food,” he recalled. As he recovered, he went down to the hospital courtyard and bought himself his first cappuccino. “It was like ambrosia,” he said. “I really felt like a big tourist.” In the end, some attested that they would make the deal again, and some regretted the decision.
...
"One convicted broker, Gadalya “Gaddy” Tauber, gave her lengthy interviews while serving out his sentence in Henrique Dias military prison in Recife, Brazil. Tauber, she learned, had facilitated a trafficking scheme that sent poor Brazilians to a private medical center in South Africa to supply kidneys for Israeli transplant tourists. He employed a number of “kidney hunters,” some of whom were young men who had already donated their kidneys, to find new recruits. In the end, it wasn’t difficult. Once the first young men came back from surgery centers in South Africa showing off their thick rolls of cash, Tauber and his associates had more willing donors than they needed. They began to drop the price they offered to donors from $10,000 to $6,000 and then to $3,000, Scheper-Hughes reported in a 2007 profile of Tauber.
...
“Transplant surgeons vie only with the Vatican and its cardinals with respect to their assumption of privilege, irrefutability and of a kind of ‘divine election’ that seems to place them above (or outside) the mundane laws that govern ordinary mortals,” she wrote in one article. “Like child-molesting priests among Catholic clergy, these outlaw surgeons are protected by the corporate transplant professionals hierarchy.”
...
"Although she rejects Rothman’s contention that she is hostile to doctors, Scheper-Hughes has long argued that it is her job to investigate an insulated surgical profession prone to self-glorification. She felt obligated to challenge doctors who talked of “saving lives”—as if the benefits to organ recipients trumped all other concerns. She saw bioethicists who argued for a regulated market in kidneys as “handmaidens of free-market medicine.” And she likewise criticized tame, “clinically applied” medical anthropologists who work closely with doctors to provide the spoonful of cultural knowledge that helps the Western medicine go down.

Back in 1990, she argued that the job of a medical anthropologist was to question, even ridicule, Western medicine.
...
"In the medical community, despite her record of antagonization, many transplant surgeons give Scheper-Hughes credit for bringing widespread abuses to light, and for revealing the voices of donors and middlemen in the transplant trade. “She’s pointed out that underground illegal markets really do exist,” says Arthur Matas, the director of the Renal Transplant Program at the University of Minnesota. While most transplant surgeons like to think that their community would never participate in such a black market, Matas says, Scheper-Hughes has made it clear that they do—“sometimes unknowingly and sometimes knowingly.”



Here are some previous posts in which I've written about Scheper-Hughes and her work on black markets in organs.

Black markets for kidney transplants

miscellaneous black market links I've been collecting, of different vintages:

Nancy Scheper-Hughes in the New Internationalist magazine, May 2014: Human traffic: exposing the brutal organ trade

Arabianbusiness.com reports, April 2014: 410 Saudis said to buy organs on black market
"As many as 410 Saudis have bought organs – mainly kidneys – from the black market for illegal transplantations over the past two years, Makkah daily reported.

Dr Faisal Shaheen, director of the Saudi Center for Organ Transplants, was quoted as saying: “A total of 220 Saudis bought organs for transplants from markets in Pakistan, China and Egypt in 2013 and 190 did the same in 2012 at their own personal expense.”

CNN, March 2014: Lebanese mayor arrested in Spain, accused of attempted organ trafficking
"A wealthy mayor from Lebanon has been arrested in Spain for allegedly offering to pay $55,000 to poor people to obtain liver tissue for his liver transplant, police and a government official announced Wednesday.
...
"The mayor's alleged accomplices recruited and later paid for nine poor people -- eight immigrants and a Spaniard -- to have specialized liver compatibility tests at a clinic in Valencia last summer, police say. The combined tests cost $16,000, which the mayor's aides allegedly paid. Some of the nine people also received small sums of money for taking part, police said.

Just one man, a Romanian immigrant, met the medical criteria for the liver tissue removal and, posing as a legitimate donor, he accompanied the Lebanese mayor last summer to a Barcelona clinic that specializes in liver transplants. But medical workers there, following strict protocols against human organ trafficking, prevented it."

(same story here from another source: http://www.thelocal.es/20140312/police-thwart-first-illegal-organ-sale-in-spain )


Frank Delmonico's 2011 slides: WHO Perspective on Self-sufficiency--Accountability on the National Level calling for countries to develop organ donation sufficient to cover their national needs for transplantation.

The Guardian, in Dec 2010 (with various Eastern Europe mentions): The doctor at the heart of Kosovo's organ scandal As Kosovo's prime minister denies links to organ trafficking, 'Doctor Vampire' is the subject of an international manhunt
"Azerbaijan's prosecutor-general's office said last month that an investigation prompted by information from Ukranian police found "citizens of various countries" had been brought into the country for illegal kidney transplants. Four Ukrainian doctors have been arrested in connection with the alleged racket. Azerbaijani press reported that Sonmez was "involved" in the ring, which also did operations in Ecuador. "

AzeriReport.com reports, August 2010, on Illegal Organ Transplant Mafia Exposed
"The group has been disclosed by the Trafficking Prevention Department of the Ukrainian Ministry of Internal Affairs. The trans-national criminal group was involved in illegal transplantation of kidney and it included 12 members. Yurii Kucher, representative of the Ukrainian Ministry of Internal Affairs, said over three years the group has recruited online and transported Ukrainian, Russia, Moldavian, Belarus and Uzbek citizens to Azerbaijan and Ecuador.
...
The Azerbaijan law enforcement agencies are unavailable for comments. It has been established that the operations were performed in a private clinic inBaku. The lawyers claim if the donors sold their kidney voluntarily, this is not a crime and any accusations are groundless. Many people are ready to sell their internal organs to make money.  A few days prior to the arrests in Ukraine, Yeni Musavat, an Azeri newspaper, sent a journalist to an area in downtown Baku where the illegal organ donor recruiters gathered and formed a market. The Yeni Musavat journalist was offered to go to a hospital to negotiate terms for the kidney removal.  In the clinic, the journalist was asked to consider selling part of his liver."


Yosuke Shimazono, "The state of the international organ trade: a provisional picture based on integration of available information, Bulletin of the World Health Organization Volume 85, Number 12, December 2007, 901-980


HT: various correspondents

Anthropology celebrates Scheper-Hughes for her work on the illicit trade in organs

Dr. Nancy Scheper-Hughes Named First AAA Public Policy Award Winner

"The American Anthropological Association (AAA) is pleased to announce that its Committee on Public Policy has selected medical anthropologist Nancy Scheper-Hughes as the first recipient of the new Anthropology in Public Policy Award. Dr. Scheper- Hughes is a nationally-recognized expert on several important health issues, including hunger, illness and organ trafficking.
...
"Dr. Scheper-Hughes’ body of work and research, especially in the area of organ trafficking, has shaped how governments and international bodies address the issues of illegal transplantation.

"In 1999, Scheper-Hughes helped found the Berkeley Organs Watch Project, an organization dedicated to research on human organ traffic worldwide, including examining the transnational networks that connect patients, transplant surgeons, brokers, medical facilities and so-called “live donors.” Almost ten years later, in 2008, her investigation of an international group of organ sellers based in the East Coast of the United States and Israel led to multiple arrests by the Federal Bureau of Investigation. In recent years, she has served as an advisor or consultant to the European Union; the United Nations, Division of Law Enforcement, Organized Crime and Anti-Laundering Office on Drugs and Crime, and the Human Trafficking Office of the World Health Organization in Vienna. She has also testified as an expert before the US Congress, the Council of Europe and the British House of Lords.

Compensation for donors: it's not just kidneys

I'll be speaking later this year about deceased donation at a conference of the International Society for Heart & Lung Transplantation. When I went to their website to arrange some hotel details, I saw this announcement about the Society's position that "the sale of organs from both live and deceased donors is unethical and violates the Universal Declaration of Human Rights."

NEW: ISHLT Position on the Trafficking of Donor Organs
"Tales from the Organ Trade” and similar documentaries are reminders that organ trafficking remains an important international problem. In line with the previously stated ISHLT position and in concert with other national and international transplantation societies, the ISHLT strongly and emphatically endorses the Declaration of Istanbul which seeks to abolish the illegal and immoral trade in donor organs which is supported in part by so called “transplant tourism”. As a corollary of which,  the Society values and supports every effort to improve the availability of donor organs by legitimate process thereby providing community access to these life sustaining therapies.


They link to their 2007 position statement, reproduced here:

International Society for Heart and Lung Transplantation
Statement on Transplant Ethics
Approved April 2007

Thoracic organ transplantation improves the length and quality of life of patients with severe
heart or lung disease. It is a societal endeavour bound by ethical principles. The donation of
organs from a deceased patient must always be made freely and without coercion. The gift
of an organ by a live donor, such as a pulmonary lobe transplant, must be made in the same
fashion and with informed consent. To ensure that these principles are adhered to, the
transplant process must be transparent, legally regulated and open to both national and
international scrutiny.

The ISHLT endorses the view of the World Medical Association that the sale of organs from
both live and deceased donors is unethical and violates the Universal Declaration of Human
Rights.

Obtaining organs for transplantation from the bodies of executed prisoners contravenes the
principle of voluntary donation. A condemned prisoner and his relatives cannot consent
freely. Furthermore, such practices provide a perverse incentive to increase the number of
executions and it lays the judicial process open to corruption.

ISHLT members should discourage patients from seeking transplantation in countries where
transplantation is not open to external scrutiny and the ethical standards of the ISHLT
cannot be assured, regardless of whether payment for organs is involved. ISHLT members
should work with their own governments to ensure that such ‘transplant tourism’ that
contravenes these ethical principles is made illegal.

Members of the ISHLT should not participate in or support the transplantation of organs
from prisoners or the sale of organs for transplantation. Any ISHLT member who has been
found to have contravened this ethical principle may have their rights and privileges as a
member suspended or removed by the ISHLT Board.

Individuals submitting data about clinical transplantation, or the use of human tissue, for
presentation at any of the ISHLT’s meetings, to the Society’s Registry or for publication in
the Journal of Heart and Lung Transplantation will be asked to sign a personal statement
confirming that the principles of both the Declaration of Helsinki formulated by the World
Medical Association and of this ethical statement by the ISHLT have been adhered to.

References
Rothman DJ, Rose E, Awaya T, Cohen B, Daar A, Dzemeshkevich SL, Lee CJ, Munro R,
Reyes H, Rothman SM, Schoen KF, Scheper-Hughes N, Shapira Z, Smit H. The Bellagio Task
Force report on transplantation, bodily integrity, and the International Traffic in Organs.
Transplant Proceedings 1997; 29: 2739-45. Also available at the International Committee of
the Red Cross web-site:
http://www.icrc.org/Web/Eng/siteeng0.nsf/iwpList302/87DC95FCA3C3D63EC1256B66005B3
F6C (accessed 1st May 2007)
Declaration of Helsinki. http://www.wma.net/e/policy/pdf/17c.pdf (accessed 1st May 2007)

The blackest of kidney black markets

Can some black markets be blacker than others? Two longtime observers of black markets for kidney transplants nominate some.

Ethan Gutmann writes chillingly of The Xinjiang Procedure: Beijing’s ‘New Frontier’ is ground zero for the organ harvesting of political prisoners.

"Thirty-six scheduled executions would translate into 72 kidneys and corneas divided among the regional hospitals. Every van contained surgeons who could work fast: 15-30 minutes to extract. Drive back to the hospital. Transplant within six hours. Nothing fancy or experimental; execution would probably ruin the heart. 

"With the acceleration of Chinese medical expertise over the last decade, organs once considered scraps no longer went to waste. It wasn’t public knowledge exactly, but Chinese medical schools taught that many otherwise wicked criminals volunteered their organs as a final penance. 

"Right after the first shots the van door was thrust open and two men with white surgical coats thrown over their uniforms carried a body in, the head and feet still twitching slightly. The young doctor noted that the wound was on the right side of the chest as he had expected. When body #3 was laid down, he went to work. "

*****

And Nancy Scheper-Hughes writes of The Rosenbaum Kidney Trafficking Gang, and of kidney black markets more broadly (as well as of her difficulties in getting others to see these things as she sees them).

"Some of the victims of US organs trafficking are bonded servants from Syria and Jordan brought into the US to provide kidneys to their patron royal families from the Gulf States. The Cleveland Clinic has a transplant wing that for many years has catered to these so-called “transplant tourists.” UCLA had its heyday with wealthy Japanese Yakuza crime “family members” who were given priority for liver transplants from the UNOS waiting list, livers that technically belonged to US citizens.

"So, Rosenbaum’s network, though extensive, represents only one of many forms of transplant trafficking into and out of the United States. Transplant trafficking is a public secret within the transplant profession, something that everyone knows about but which within the corporatist culture of the transplant profession — as secretive as the Vatican — is never discussed.
...
"Caught in the dragnet Rosenbaum admitted that he charged a lot to set up these illegal transplants in some of the best hospitals on the east coast, including Mount Sinai in NYC , Albert Einstein in Philadelphia, and Johns Hopkins in Baltimore.
...
"Nobody cared about, or even believed in, human trafficking for organs. I went to the media, to CBS, to 60 Minutes and then to 48 Hours which did send an investigative reporter, Avi Cohan, to meet me in Israel where we spoke to patients who had had “undercover” transplants at hospitals in NYC Philadelphia, the Bay Area, and Los Angeles. CBS decided not to do the exposé. I was stumped. No one wanted to accuse surgeons, or prevent a suffering patient from getting a transplant, even with an illegally procured kidney from a displaced person from abroad. The Israeli origins of the trafficking network did not help either. It smacked of bias, blood libel, or worse. “Don’t Indians and Pakistanis broker more kidneys than Israelis”, I was asked? Why pick on Israel?
...
"What I imagine is that the complicit surgeons loved the Rosenbaum option because they didn’t have to go through UNOS, the United Network for Organ Sharing, which until 2007, had nothing to do with living donors, related or unrelated. Hospital administrators loved it because foreign patients paid cash so there was no waiting for Medicare or insurance premiums. And there was minimal responsibility for the aftercare of the recipients or their kidney providers. Both were speedily returned to their respective communities and countries. Should they ever get caught red-handed, surgeons can cite patient confidentiality (their privacy oath), the hospitals could pretend they had been duped, the transplant coordinators could say that they followed the transplant protocols for living donors, but they are not, after all, detectives. Everybody wins. Lives were ‘saved’, transplant surgeons got to do what they do best, poor people got a ‘bonus’ for being charitable with their ‘spare’ kidneys, and everybody was happy.
...
"Meanwhile, complicit transplant doctors collude and protect each other, while the best ones tried to fix the problem from inside the profession without the help of the DOJ or the courts getting involved. Bioethicists argue endlessly about the “ethics” of what is in fact a crime and a medical human rights abuse. Economists and moral philosophers launch arguments based on rational choice theory for regulation rather than prosecution, as if prosecutions were going on every day. In fact, as the Rosenbaum history shows so well, human trafficking for organs is a protected crime. It is protected by the charisma and awe-inspiring ‘ miracle’ of transplant. The Rosenbaum guilty plea is the first prosecution in the United States for organs trafficking. On February 2nd Rosenbaum could be sentenced to five to 12 years in prison and a fine for illegally brokering organs in New Jersey. But the larger and deeper story of his international kidney dealings, his hired traffickers, kidney hunters, ‘enforcers’, money laundering operations, false charity organizations, Medicare fraud is yet to be told. And in the meantime, “life saving” for some at the cost of diminishing the lives of others ,the invisible kidney sellers of Chernobyl, Kiev, Nazareth, or the Negev desert, will continue undeterred.

Misc. organ transplant commentary and news

The Times of London reports on how one deceased donor can donate many organs: How one organ donor can save the lives of nine people
There is a worrying shortage of organ donors — and gaining consent from grieving relatives is a delicate task

A living donor is unhappy with the way they have been treated: The Hypocrisy of OPTN's Committee Goals "UNOS has had the OPTN contract since 1986 (yet they cared so little for us they didn't even collect LD social security numbers til 1994); they've had policy to collect follow-up data on living donors since 2000 (but the transplant centers were 50-80% non-compliant), yet it wasn't until 2005 they decided it should be "clinically relevant and validated". And since 2005, independent researchers, UNOS officials and SRTR personnel have all criticized UNOS' data collection as 'woefully inadequate', and worthless as far as any meaningful analysis goes. "

A columnist quotes Adam Smith in support of making compensation for donors legal: Dying people shouldn’t be beggars "It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their own interest. ... Nobody but a beggar chooses to depend chiefly upon the benevolence of his fellow-citizens."
—Adam Smith, "Wealth of Nations"


A living donor is declined by a hospital: Kidney Donation Canceled Because Donor and Recipient ‘Bonded’ and THE MATCH (UN)MAKERS: Why did Einstein halt life-saving transplant? both report a hospital's decision not to accept a donation from a donor who had met his potential recipient via the matchingdonors.com website. The WSJ piece says, by way of of explanation: "As the WSJ has reported, hospitals may be reluctant to agree to this kind of altruistic donation, fearing that donors may have been paid or that participants won’t make it through the rigorous psychological evaluation process, or because the practice sidesteps the official organ waiting lists."

Alex Tabarrok at MR reports on Changing Views on Organ Prohibition and reports that the anthropologist Nancy Scheper-Hughes, who has studied black markets for organs, is in favor of careful trials of ways to ethically compensate organ donors.

California, New York mull changes to organ donor laws
"A California bill may soon create a living donor registry -- the first for any state.
Spurred by Apple co-founder and transplant recipient Steve Jobs, the bill has gained support from major politicos, including California Gov. Arnold Schwarzenegger, and is expected to land on his desk this summer.
Meanwhile, on the East Coast, a far more sweeping transplant bill would make every person an organ donor who doesn't opt out. This would create an organ donation system in New York similar to the ones used in several European countries, but the measure is already facing opposition."
The California bill seems to be aimed primarily at promoting kidney exchange...

Commodification of the body, in Economic Sociology

The November 2009 issue of Economic Sociology, The European Electronic Newsletter, is largely devoted to discussion of "commodification of the body." Here are the articles, which concern cadavers, organs for transplantation, blood, and eggs and sperm.

A Market for Human Cadavers in All but Name by Michel Anteby

The Tyranny and the Terror of the Gift by Nancy Scheper-Hughes

Honestly Embracing Markets in Human Organs for Transplantation by Mark J. Cherry

Between Gift and Commodity: Blood Products in France by Sophie Chauveau

Debt and Gratitude by Lea Karpel

Corruption and kidneys in New Jersey and Brooklyn

The NY Times reports on a corruption investigation resulting in 44 arrests in New Jersey and Brooklyn: In New Jersey Case, Nervous Jokes and a Cereal Box of Cash

Almost as an aside, the story reports that a broker for transplant kidneys was caught in the net:

"Another man in Brooklyn, Levy-Izhak Rosenbaum, was accused of enticing vulnerable people to give up a kidney for $10,000 and then selling the organ for $160,000. Mr. Dwek pretended to be soliciting a kidney on behalf of someone and Mr. Rosenbaum said that he had been in business of buying organs for years, according to the complaint."

Part of the repugnance to the transaction seems to be the buying and selling prices. (Would we/should we feel differently if the kidneys were bought for $100,000 and sold for $115,000?)

Steve Leider points me to an Indiana Jones connection: Anthropologist's 'Dick Tracy moment' plays role in arrest of suspected kidney trafficker. (The anthropologist in question, Nancy Scheper-Hughes, writes frequently about black markets for kidneys, and apparently indentified Mr Rosenbaum some years ago, although the story doesn't suggest to me an immediate connection to the recent arrest.)

Parag Pathak points me towards Benyamin Cohen's story in Slate, following up on the Jewish connection: The arrests of rabbis who trafficked body parts uncover more complicated issues, that suggests some of the nuances of Jewish religious jurisprudence about organ donation and sales.

Trying to figure out Jewish law directly from the Bible skips a couple of centuries of subsequent interpretation. Here's what I wrote about kidney sales in a footnote of my paper Repugnance as a constraint on markets:

3 While there is no central authority on the application of Jewish law to modern concerns such as transplantation, the most authoritative opinions are contained in various “responsa” or answers to particular questions by rabbis acting as legal “deciders” (poskim), whose authority arises from the respect of their peers. The consensus on the matter of live kidney donation, for example, seems to be that live donation is allowed (since it saves lives), but it is not required (since the donor becomes wounded and takes some risk to his own life), and hence it falls into the category of things for which compensation could be offered and accepted (unlike actions that are either forbidden or required). See, for example, Eisenberg (2006), Grazi and Wolowelsky (2004), Kunin (2005), and Israeli (1997) who cite eminent modern poskim such as Rabbi Shlomo Zalman Auerbach and Rabbi Moshe Feinstein."

"For example, Avraham (2004, p. 271–2) reports the opinion of the eminent Rabbi Shlomo Zalman Auerbach that someone who sells a kidney with the intention of saving a life does a good deed “even if he would not have donated his kidney only to save life.” But he goes on to note, “[I ]n spite of all that has been said above, it seems to me that it is the community that needs soul-searching for allowing a person to reach such a depth of despair that he must sell a kidney, either because of poverty, debts, or the inability to pay for a relative’s medical expenses.”

Although mainstream Jewish authorities support organ donation, some streams of ultra-orthodox Judaism do not: here's a disturbing article brought to my attention by Miran Epstein, from Yediot: Heart recipient's father: We'll never donate organs
It goes on to note
"The father's words angered Prof. Yaacov Lavee, director of the Heart Transplantation Unit at the Sheba Medical Center. "This is outrageous," he said. "I've heard such statements from many of my candidates (for a transplant), who weren't ashamed to admit they wouldn't donate organs.
"Such statements led me to initiate the bill that prioritizes transplants for people who have signed an organ donor card. This is clearly immoral behavior," he added.
The new transplant law, which will go into effect in May, states that any person in need of a transplant and who has had an organ donor card for at least three years will be given priority on the organ transplant waiting list. "

This makes some aspects of Israeli transplant law resemble parts of Singapore's transplant law, which also gives priority for organs to those who are registered as donors. (I wrote about this near the end of an earlier post.)

Update: Sally Satel's take is in the WSJ: About That New Jersey Organ Scandal It’s not surprising when 80,000 Americans are waiting for kidneys, and a background piece from Time magazine: How Does Kidney-Trafficking Work?