Organ Trafficking and Transplant Tourism in Eastern Europe
By: Dr. Sam Vaknin
Also published by United Press International (UPI)
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November 13, 2002
Updated March 7, 2005
A kidney fetches $2700 in Turkey and up to
$4000 in the Philippines. Another $6,000-12,000 go to various intermediaries.
According to the October 2002 issue of the Journal of the American Medical
Association, this is a high price. An Indian or Iraqi kidney enriches its
former owner by a mere $1000. Wealthy clients later pay for the rare organ up
CBS News aired, five years ago, a documentary, filmed by Antenna 3 of Spain, in which undercover reporters in Mexico were asked, by a priest acting as a middleman for a doctor, to pay close to 1 million dollars for a single kidney. An auction of a human kidney on eBay in February 2000 drew a bid of $100,000 before the company put a stop to it. Another auction in September 1999 drew $5.7 million - though, probably, merely as a prank.
Organ harvesting operations flourish in Asia (in the Philippines, where it was briefly legal in 2007-8), in Turkey and Iran, in central Europe, mainly in the Czech Republic, and in the Caucasus, mainly in Georgia. Penumbral middlemen and surgeons operate on Turkish, Moldovan, Russian, Ukrainian, Belarusian, Romanian, Bosnian, Kosovar, Macedonian, Albanian and assorted east European donors.
They remove kidneys, lungs, pieces of liver, even corneas, bones, tendons, heart valves, skin and other sellable human bits. The organs are kept in cold storage and air lifted to illegal distribution centers in the United States, Germany, Scandinavia, the United Kingdom, Israel, South Africa, and other rich, industrialized locales. It gives "brain drain" a new, spine chilling, meaning.
Organ trafficking has become an international trade. It involves Indian, Thai, Philippine, Brazilian, Turkish and Israeli doctors who scour the Balkan and other destitute regions for tissues. The Washington Post reported, in November 2002, that in a single village in Moldova, 14 out of 40 men were reduced by penury to selling body parts. In the Philippines, in “one-kidney island”, there are well over 3000 donors.
Four years ago, Moldova cut off the thriving baby adoption trade due to an - an unfounded - fear the toddlers were being dissected for spare organs. According to the Israeli daily, Ha'aretz, the Romanians are investigating similar allegations in Israel and have withheld permission to adopt Romanian babies from dozens of eager and out of pocket couples. American authorities are scrutinizing a two year old Moldovan harvesting operation based in the United States.
Organ theft and trading in Ukraine is a smooth operation. According to news agencies, in August 2002, three Ukrainian doctors were charged in Lvov with trafficking in the organs of victims of road accidents. The doctors used helicopters to ferry kidneys and livers to colluding hospitals. They charged up to $19,000 per organ.
The West Australian daily surveyed in January 2002 the thriving organs business in Bosnia-Herzegovina. Sellers are offering their wares openly, through newspaper ads. Prices reach up to $68,000. Compared to an average monthly wage of less than $200, this is an unimaginable fortune.
National health insurance schemes turn a blind eye. Israel's participates in the costs of purchasing organs abroad, though only subject to rigorous vetting of the sources of the donation. Still, a May 2001 article in a the New York Times Magazine, quotes "the coordinator of kidney transplantation at Hadassah University Hospital in Jerusalem (as saying that) 60 of the 244 patients currently receiving post-transplant care purchased their new kidney from a stranger - just short of 25 percent of the patients at one of Israel's largest medical centers participating in the organ business".
Many Israelis - attempting to avoid scrutiny - travel to east Europe, accompanied by Israeli doctors, to perform the transplantation surgery. These junkets are euphemistically known as "transplant tourism". Clinics have sprouted all over the benighted region. Israeli doctors have recently visited impoverished Macedonia, Bulgaria, Kosovo and Yugoslavia to discuss with local businessmen and doctors the setting up of kidney transplant clinics.
Such open involvement in what can be charitably described as a latter day slave trade gives rise to a new wave of thinly disguised anti-Semitism. The Ukrainian Echo, quoting the Ukrinform news agency, reported, on January 7, 2002, that, implausibly, a Ukrainian guest worker died in Tel-Aviv in mysterious circumstances and his heart was removed. The Interpol, according to the paper, is investigating this lurid affair.
According to scholars, reports of organ thefts and related abductions, mainly of children, have been rife in Poland and Russia at least since 1991. The buyers are supposed to be rich Arabs.
Nancy Scheper-Hughes, an anthropologist at the University of California at Berkeley and co-founder of Organs Watch, a research and documentation center, is also a member and co-author of the Bellagio Task Force Report on Transplantation, Bodily Integrity and the International Traffic in Organs. In a report presented in June 2001 to the House Subcommittee on International Operations and Human Rights, she substantiated at least the nationality of the alleged buyers, though not the urban legends regarding organ theft:
"In the Middle East residents of the Gulf States (Kuwait, Saudi Arabia, and Oman) have for many years traveled to India, the Philippines, and to Eastern Europe to purchase kidneys made scarce locally due to local fundamentalist Islamic teachings that allow organ transplantation (to save a life), but prohibit organ harvesting from brain-dead bodies.
Meanwhile, hundreds of kidney patients from Israel, which has its own well -developed, but under-used transplantation centers (due to ultra-orthodox Jewish reservations about brain death) travel in 'transplant tourist' junkets to Turkey, Moldova, Romania where desperate kidney sellers can be found, and to Russia where an excess of lucrative cadaveric organs are produced due to lax standards for designating brain death, and to South Africa where the amenities in transplantation clinics in private hospitals can resemble four star hotels.
We found in many countries - from Brazil and Argentina to India, Russia, Romania, Turkey to South Africa and parts of the United States - a kind of 'apartheid medicine' that divides the world into two distinctly different populations of 'organs supplies' and 'organs receivers'."
Russia, together with Estonia, China and Iraq, is, indeed, a major harvesting and trading centre. International news agencies described, five years ago, how a grandmother in Ryazan tried to sell her grandchild to a mediator. The boy was to be smuggled to the West and there dismembered for his organs. The uncle, who assisted in the matter, was supposed to collect $70,000 - a fortune in Russian terms.
When confronted by the European Union on this issue, Russia responded that it lacks the resources required to monitor organ donations. The Italian magazine, Happy Web, reports that organ trading has taken to the Internet. A simple query on the Google search engine yields thousands of Web sites purporting to sell various body parts - mostly kidneys - for up to $125,000. The sellers are Russian, Moldovan, Ukrainian and Romanian.
Scheper-Hughes, an avid opponent of legalizing any form of trade in organs, says that "in general, the movement and flow of living donor organs - mostly kidneys - is from South to North, from poor to rich, from black and brown to white, and from female to male bodies".
Yet, in the summer of 2002, bowing to reality, the American Medical Association commissioned a study to examine the effects of paying for cadaveric organs would have on the current shortage. The 1984 National Organ Transplant Act that forbids such payments is also under attack. Bills to amend it were submitted recently by several Congressmen. These are steps in the right direction.
Organ trafficking is the outcome of the international ban on organ sales and live donor organs. But wherever there is demand there is a market. Excruciating poverty of potential donors, lengthening patient waiting lists and the better quality of organs harvested from live people make organ sales an irresistible proposition. The medical professions and authorities everywhere would do better to legalize and regulate the trade rather than transform it into a form of organized crime. The denizens of Moldova would surely appreciate it.
Interview granted to the Romanian newspaper Adevarul
Q. Do you think there are huge networks of traffic in organs that operate in Romania? How many Romanians it is estimated, in your opinion, annually sell organs?
A. "Huge" would be an exaggeration. Globally, about 10,000 organs are illegally harvested and transplanted each year. Donors in Moldova receive c. $3000 per kidney and in Romania - double this amount. There are c. 600 known donors in Moldova and no figures available for Romania. Still, it would be safe to assume that more than 2000 Romanian citizens have sold their organs in the last decade. Each year, about 100 Romanians sell kidneys to Israeli brokers who work with South-African hospitals and another 200-300 sell organs, mostly kidneys, to criminal rings and networks with connections to Turkey, Brazil, Italy, and the USA. Romanian organs are expensive and so organ harvesting has shifted to Asia and parts of Latin America.
Organ sellers - euphemistically called "donors" - are mainly poor, unemployed, and Roma. Romanians who want to emigrate or are in debt sometimes end up selling their organs or brokering such sales from prisoners, soldiers, and even adolescents. It is easy to find advertising related to organ trafficking on the Internet and even in the daily papers.
Q. What method is used more often in the case of Romania? Romanians who want to sell their organs are taken abroad to have their organs removed? Or, they are operated in Romania, then the organs are removed from the country? Or both methods are used?
A. Actually, organ sellers are often flown from other countries (even from Israel) INTO Romania. The organs are then harvested in Romania. Rarely, the organs are transplanted in Romania using fraudulent affidavits claiming that the donor and recipient are relatives. More frequently, the organs are flown to other countries, such as South Africa and Turkey, where the operations take place.
Many people are involved in these networks: from petty criminals to politicians and from medical doctors to businessmen. In Romania, the typical organ broker is a donor: someone who sold his kidney. Small-time criminals are also involved as well as officials in Customs and Immigration and, to a lesser extent, the Police and the Airports. Even hospital directors are in on the take.
A typical patient pays c. $120.000 per transplant, so there is a lot of money to divide. It is no wonder that Romania was the only country not to attend the conference that yielded the Istanbul Declaration against organ trafficking and transplant tourism!
Generally speaking: trafficked organs are either sold domestically, or exported to be transplanted into patients from the US, Europe, the United Arab Emirates, Saudi Arabia, and especially Israel.
Q Have you heard or seen cases in which the Romanians sold their organs?
A. Yes, and so have you: Robert Mihaly in 2005.
Q. What are the organs most commonly trafficked from Eastern Europe?
A. Kidneys are the most sought after, extracted, sold, and transplanted. Harvesting a kidney poses few risks to the donor. Kidneys are tiny and easy to conceal and smuggle. About 10,000 kidneys are harvested illegally each year.
Q. Are the rumors about harvesting organs from adopted children true?
A. No, they are not. Children's organs are often ill-suited for transplantation for histological and immunological reasons. So, the stories about Israeli adoption agencies which work in tandem with Israeli doctors to extract organs from Romanian children are nonsense and merely the latest version of the medieval anti-Semitic blood libel. Still, I am ashamed to say that Israeli doctors are very prominent in the organ trafficking and transplant tourism business.
Interview granted to El Pais
Q. Why do Israelis buy more organs for transplantation than other nations?
A. Because Israeli doctors and businessmen (and, more generally, Jewish doctors in places like South Africa) are heavily involved in the trade. Jewish religion forbids the donation of organs from a living person. So, in Israel, there is an enormous shortage of organs coupled with a sizable purchasing power. It is simply easier for an Israeli to find the right connections as all the roads lead to Tel-Aviv.
Q. Which countries provide the most donors?
A. In Europe: Moldova, Romania, Belarus, Ukraine, and, to some extent, Albania, Kosovo, and the former republics of Yugoslavia (Serbia, Bosnia-Herzegovina, Macedonia). In the Americas: Mexico, Haiti, Bolivia, Peru. In Asia: Indonesia, Philippines, Malaysia, and Vietnam. In Africa: Nigeria and the countries of sub-Saharan Africa. But there are donors who hail from rich countries as well: even from Israel. Still, demand gravitates to where supply is abundant and cheapest. In Moldova and Turkey donors sell a kidney for 200-500 euros; in Romania, Romas sell the same organs for double or triple that; while Israeli donors demand up to 10,000 USD per kidney. Normally, buyers prefer Moldovan or Turkish donors.
Q. How does a person how want to buy an organ find his way?
A. Predominantly through his doctors. In a few cases, he may know someone who has had a similar procedure. There are even Internet chat rooms, bulletin boards, and forums where such information is exchanged.
Q. How many organs have been bought in the last 2 years in the Middle East?
A. Arab patients in the Gulf States, Israelis, Egyptians, Iranians and Turks are the most numerous clients for such operations. But the surgical procedures themselves – harvesting the organs and then transplanting them – take place in other locations: Kosovo, Turkey, South Africa, Morocco. In total, about 12,000 organs are illegally traded every year the world over. Middle Eastern patients account for c. 2400 of these.
Q. Has the organ trade decreased or increased in the last 10 years in this area?
A. Increased dramatically as the business has been taken over by organized crime networks, aided and abetted by businessmen, financiers, hoteliers, truck operators, politicians, customs officers, local doctors, judges, police officers, and other officials, including representatives of the international community. Everyone has been corrupted by this scourge.
Q. How much can an organ cost? (let’s say a kidney)
A. The patient pays between 100-150,000 USD for a kidney transplant, including two weeks of convalescence in a five-star hotel for him and his immediate family.
Q. How much does the donor /seller receive?
A. Donors typically receive between 1000-2000 USD per kidney (about 1-2% of the cost to the recipient patient). Many donors in distress or those who want to emigrate sell organs for much less. Retinas, hearts, lungs, even bone marrow are also harvested and sold.
Q. How much does the doctor get? How much does the clinic and the stuff performing the operation? How much the mediators?
A. A typical operation involves 2 surgeons, 1 anaesthesiologist, 2 nurses, and 1 specialist (cardiologist, nephrologist, etc.) The surgeons receive 20,000 USD each; the specialist (who only monitors the patient and serves as a consultant) about 10,000 USD; the anaesthesiologist about 5000 USD; and each of the nurses about 2000 USD per operation. The rest goes to the long chain of mediators involved. The brokers pay off everyone else: truck drivers, receptionists at the hotels; customs officers; judges; policemen; and midlevel politicians.
Q. What is the role of Turkey in all this? Are Turkey’s clinics or doctors into this illegal business?
A. Turkey is a major junction in the trafficking of illicit organs. Turkish doctors work closely with Israeli and Jewish doctors the world over. They operate on both donors and recipients. They run illegal clinics all over the world, including in Turkey, where many transplants take place as part of a phenomenon of “transplant tourism” (mostly next to Antalian resorts). They recruit donors. The whole business would be unimaginable without the Turks. Recently, Israeli and Turkish networks have started to infiltrate Russia (with the help of the Russian mafia) and the Turkic former republics of the USSR as well as Kazakhstan and through these, China. This is the next “growth market”.
Interview granted to Zaman daily in Turkey, January 2013
- As you mentioned in the same interview; in Israel harvesting and transplantation are banned. Do you know these activities are carried out illegally in Israel as well?
There are no harvesting operations in Israel, but organ
donations and transplantations do take place, especially after a 2008 law
regulated the field by legalizing certain activities and criminalizing the
trading, trafficking, or brokering of organs.
- You claimed "Organ trafficking would be unimaginable without Turks" Why do you think Turks (Probably you mean Turkish doctors) have a strategic place in this illegal business?
Because it is a fact. And I do mean "Turks": Turkish doctors, Turkish nurses, Turkish criminals, corrupt Turkish policemen and customs officers, corrupt judges and local politicians, Turkish tour operators and hotel staff, and Turkish bankers and financiers. Turkey is no longer the main center of organ trafficking as it used to be until 2004, though: it has lost some business to South-Africa, China, Russia, and countries throughout Asia. Still, it is a major center for this illicit activity.
- How Turkish and Israeli doctors get connected for the aim of trafficking organs?
Many of them meet each other in medical conferences, but in the majority of cases they are introduced to each other by organ brokers and financiers.
- You said there are illegal clinics where the transplantation operated. Are there any in Turkey? Where exactly in which cities?
They are in Turkey, mainly in Antalya (some of them adjacent
to tourist resorts.) Most of the clinics that used to operate in Istanbul in
the 1990s were shut down over the last decade by the Turkish authorities.
- Do you agree if I would say some security officials and politicians are also in this business?
Yes, I would: relatively low-level police officers
(especially the border police), customs officials, and municipal politicians.
- What is the importance of Turkey in the regional and global organ trafficking?
Turkey is one of the main centers where the actual
transplantations take place. Organ brokers fly in with the refrigerated and
containerized organs from all over Europe; tour operators reserve rooms for the
patient and his family in a resort hotel whose staff is paid to look the other
way; doctors fly in from Israel, team up with Turkish doctors and nurses and do
the operations. The patient recovers in the resort and then returns home.
- Are there any Israeli donors who went out of the country for selling his organ or can this operation take place illegally in Israel as well?
Israeli donors fly to other destinations (in Africa and
Asia) to have their organs harvested. Organ donation is legal in Israel only
after the brain death of the donor has been certified by 2 doctors.
- How can we get the numbers of the people in Israel who waits for a transplantation operation for kidney and other organs? Do you have any info about this?
There are more than 1000 patients on the official waiting
list for organs maintained by the National Transplant and Organ Donation
Center, mostly kidneys.
- What is the importance of South Africa in organ trafficking? What about Jews living in other parts of the world?
Owing to its large Jewish population, South Africa has become a major center of organ transplantation, similar to Turkey. Jews - mainly orthodox Jews - and Israelis are involved in organ trafficking all over Europe and Africa, South America, and North America. Most of the illegal trade in organs in Asia does not involve Jews, except in China, where Israeli doctors have set up several clinics recently.
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