How Does Kidney-Trafficking Work?

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A man shows the scar from the removal of a kidney as he sits outside his house in the shantytown of Baseco in Manila

On July 23, a lengthy FBI probe into corruption in New Jersey ended in the arrests of 44 people, including two mayors, a prominent real-estate developer and several rabbis. But amid the bribery and money-laundering allegations, the element of the sweeping sting that grabbed the most attention was the accusation that Levy Izhak Rosenbaum, a New York City resident, had tried to orchestrate the sale of a human kidney for $160,000. The black-market kidney trade is a growing problem — the World Health Organization estimates that organ-trafficking accounts for 5% to 10% of all kidney transplants worldwide. So how do kidney sales work?

The organ market is largely made up of impoverished and desperate sellers, wealthy, ailing customers and predatory middlemen. Most sales take place in developing countries, where a kidney can often be purchased for the price of a high-end TV. In Iran — the only country in the world where organ sales are legal — a healthy kidney retails for about $6,000. The going rate is less than half that amount in India, which has an abundance of doctors capable of performing the procedure and destitute masses often unable to raise cash any other way. In January 2008, police busted an organ racket outside New Delhi that allegedly conned or forced poor laborers to relinquish their kidneys to wealthy clients. Investigators say the ring operated for years and included a doctor, Amit Kumar, who would use scouts to spot potential marks. Another kidney ring flourished in South Africa from 2001 to 2003, and black markets thrive in nations like China, Pakistan and the Philippines.

Buying or selling a kidney in the U.S. is much more difficult, not least because there are easier ways to make a buck. Selling organs has been illegal since 1984, and is punishable by five years in prison and a $50,000 fine. Even if breaking the law doesn't deter you, it's difficult to hoodwink a doctor into believing that a fraudulent organ donor's motives are purely altruistic. U.S. hospitals run donor-recipient couples through a series of interviews, including a meeting with a social worker, who checks to make sure that no money is exchanging hands and ensures that both parties understand the details of the surgery. Dr. Arthur Matas, renal-transplant director at the University of Minnesota's medical school, says that hospitals ask unrelated donor-transplant couples how they met each other, but that there is no "hard rule" or set of fixed guidelines to help authorities determine if the donor is receiving payment.

Donors also must meet an array of requirements before a hospital will operate. You must be healthy enough to withstand a four-hour operation. You must be free of disease — HIV, hepatitis or cancer will disqualify you — and, of course, you need to have the same blood type as the recipient. It takes an average of three months for hospitals to assess and approve a transplant. Kidney donation is a major commitment — you can't drive or lift anything for six weeks, and it can be over a month before you're ready to return to work.

Rosenbaum would be the first person to face federal organ-trafficking charges in the U.S. According to investigators, he called himself a "matchmaker" who connected those in need of a transplant with those in need of cash. Rosenbaum allegedly found sellers in Israel, where a network of operatives targeted recent immigrants to the country. He is said to have paid donors an average of $10,000 for their services and charged recipients more than ten times that amount.

More than 80,000 people are currently awaiting a kidney transplant in the U.S. The climb to the top of the waiting list takes anywhere from one to six years, and the delay is both agonizing and potentially deadly — each year, some 6% of patients die while waiting to be matched with a donor. Given those grim statistics, some argue kidney sales should be legalized. Paying in the ballpark of $100,000, Matas argues, is a better economic bet than our current system, in which Medicare pays for indefinite dialysis treatment — which is both costly and debilitating — for nearly all Americans.

But for many people, the concept of a legalized market for human organs is repugnant. "Payments eventually result in the exploitation of the individual," Francis Delmonico, a Harvard University professor, told the Wall Street Journal in 2007. "It's the poor person who sells." But Matas disagrees, noting that compensating kidney donors is no different from sanctioning sales of other body parts. "People get paid to be surrogate mothers. People get paid for sperm and hair," he says. "People say, 'Oh, those are safe and replenishable, but egg donation and surrogacy are risky, and yet they're legal.'" A legal market for kidneys may still be a long way from being socially and politically palatable, but at least it would cut down on cases like Rosenbaum's.