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Black Market Organs
Inside the Trans-Atlantic Transplant Tourism Trade

by Nancy Scheper-Hughes
06.03.05

Lucille Hubbard is a tiny woman. She lost 4 inches from osteoporosis, she explains, and she is out of breath climbing to the fourth floor of her tiny Brooklyn bed-sitter apartment that she shares with her fragile and disabled husband. Lucille (not her real name) is African American, poor by US standards, and dependent on Medicaid and Social Security. After leaving the West Indies for New York City, she made her living as a caregiver, but before she reached her 30th birthday she learned that she herself was seriously ill with untreated hypertension and kidney disease. Her physician at Down State Medical Center told Lucille that she needed a transplant, or she would die.

After several frustrating years waiting to get to the top of the United Network of Organs Sharing's transplant list and with her fragile health rapidly deteriorating, Lucille considered the unthinkable: an illegal transplant abroad, relying on a paid living kidney donor. Through her well-connected in-laws, Lucille got in touch with a syndicate of Israeli-led organ traffickers, part of a worldwide network stretching from China to South Africa. The brokers first suggested a transplant tour to Turkey or Romania, but the price of the pre-arranged package deal was an astronomical $180,000, and Lucille feared that she might reject an organ purchased from an Eastern European or Turkish peasant. She needed a cheaper alternative and an organ from a person biologically "closer" to herself. After weeks of anxious waiting, Lucille got the call she was hoping for. A willing kidney seller had been found in Brazil: a strong, healthy, Afro-Brazilian man. However, the double surgery could not take place in that country. Both Lucille and her donor would have to travel halfway around the world, to South Africa, where "special arrangements" had been made through a private transplant clinic in a "five star" hospital in the beautiful, tropical city of Durban. The package was a real bargain in the world of transplant tourism: $65,000, which included the $6,000 promised to a stranger who, like Lucille, was desperate enough in his own way to go along with the strange proposition. Family and friends helped raise the money.

To confirm compatibility, blood was drawn from Lucille in New York and her donor in Recife. Contracts were signed, affidavits witnessed and Lucille and her husband were briefed on what they must do and say when they arrived in South Africa and checked into St. Augustine's Hospital. Lucille would have to pretend that the impoverished stranger with whom she could not communicate, dressed in a royal blue polyester running suit borrowed from his friends, was her first cousin. Luckily-or so she thought-the South African doctors and surgeons were so busy and officious they didn't have time to ask her too many questions, and the whole operation took only a few days.

When she returned to New York with her new Brazilian kidney, Medicaid refused to pay for her expensive regime of anti-rejection medication. Officials wanted proof of her transplant; they demanded to see her medical work-up and hospital discharge records. But Lucille had checked out of the transplant clinic at St. Augustine's Hospital with nothing but her small suitcase of clothes, a few inexpensive souvenirs and a warning from the hospital that she must not disclose what had transpired. Lucille, her donor and their surgeons had broken the law. Similar to the US's National Organ Transplant Act) South Africa's 1983 Tissue and Organs Act prohibits the buying or selling of organs, tissues and other body parts. Moreover, in signing an affidavit falsely stating that her donor, a man she had never met, was a blood relative making an altruistic donation, Lucille was guilty of fraud and conspiracy to commit a crime. Additionally, in traveling with a tourist visa when the intention was to engage in an illegal activity, Lucille and her donor were both guilty of visa fraud.

But Lucille's greatest fear was not of being found out, but not getting the medications she needed: "After all we had gone through to get it, I was terrified of rejecting my new kidney." She contacted the doctors in Durban, and they faxed back a minimalist discharge report stating that Lucille received a kidney transplant at the Netcare clinic in St. Augustine's hospital on August 1, 2003. Lucille got her drugs.

"Put yourself in my shoes," says Lucille's donor, Alberty "Alfonso" da Silva, a semiliterate Brazilian laborer in his late 30s from the slum of Areas near Recife's international airport. After he tucks his children to sleep on a piece of foam on the floor of his mud shack, Alberty steps outside into the garbage-strewn and sewage-leaking front "yard" where he stretches out to sleep under the stars.

Alberty came up hard as a child. His mother was forced into sex work to feed her 11 children, and as a small child Alberty knew both hunger and humiliation: "My mother had to sell her own flesh to keep us alive, but her sacrifice made us all into outcasts. I never forgot it and I didn't want my own children to suffer the way I had." So when he first heard the rumors circulating in the bars and market stalls of Areas that you could sign up to sell a kidney for $10,000, Alberty sought out the organ brokers: a retired and alcoholic military police captain, Ivan Bonefacio, and his lean and nasty sidekick, Gadalya "Gaddy" Tauber, retired from the Israeli defense force.

"We thought that this Gaddy was a German, " said Alberty, who remembered years back when many Germans came to vacation on the beautiful beaches of Boa Viagem. "We were surprised to learn he was from Israel and that most of us would be donating to Israeli patients."

"Can it work that way?" Alberty asked Captain Ivan. Ivan assured him that there would be no problem, because "under the skin, all men are brothers." Ivan first offered Alberty $10,000 (payable after the surgery, with $200 in cash up front). Alberty would get a free trip to South Africa, be kept in a good hotel, receive the best medical care at a private luxury hospital, and might even get to do a little touring afterwards.

"Ivan told me that only one kidney works while the other one sleeps. The doctors would take out my sleepy kidney and leave me with the good one. So I said, 'Okay, I'm in. Sign me up.'"

By the time Alberty's blood was tested at a local clinic in Recife and his passport and visa procured by Gaddy, the payment for a fresh kidney had decreased to just $6,000. Competition among "wait-listed" kidney sellers was so keen that the organ brokers could afford to be choosy. Between May and November 2003, more than 100 people from the outskirts of Recife had signed up to sell a spare part; 34 of them, including Alberty, completed the trip. When he returned in August, even more poor people were lining up to sell their organs, and by November the price paid for a kidney had dropped to just $1,000. Still, they were willing to go.

Then, just as suddenly as it began, the kidney express derailed. In early November the South African police got a call at their central station in Johannesburg. Two men, both Israeli, had been picked up at the Johannesburg International Airport, one accusing the other of stealing $18,000. Something about a kidney was mentioned. By the end of the day, the police had proof of what they had suspected for several months-foreigners were being trafficked in and out of some of South Africa's finest private hospitals for the buying and selling of transplantable kidneys. In this case, Slomo Zohr, a young married man with young children from a seaport town south of Tel Aviv, answered an ad in his local newspaper soliciting kidney sellers. Slomo had just lost his small fruit juice business, and he quickly agreed to travel to South Africa and donate a kidney for $20,000 (white kidneys from first world donors command a better price than "slum kidneys" from black people in the third world). His wife traveled with him.

Once in Durban and after learning what was entailed-a major operation that would be followed by weeks of pain-Slomo began to get cold feet. But there was no wiggle room. The South African handlers reminded Slomo that "a deal was a deal" and he had to give up a kidney or pay a stiff penalty: his expenses plus those of his recipient. Seeing no way out, Slomo agreed, and the night before the surgery his wife was paid $18,000. But while Slomo was waiting to be anesthetized and rolled into the operating theatre of St. Augustine's Hospital, he grabbed his clothes, ran down a back stairwell of the hospital, called his wife on his cell phone and told her to meet up with him at the airport.

By late November, 14 people were arrested in a police sting in South Africa and Brazil. They included the Israeli and Brazilian organ brokers, a nephrologist, a lab technician, an Israeli kidney buyer and two Brazilian kidney sellers.

Sitting on a broken stool in his mud hut, Alberty was temperate and philosophical about the arrests of some of his kidney seller friends. He, too, had been detained by Brazilian police on his return and made to give a deposition at the Assemblea Legislativa in downtown Recifen. The Brazilian police could not confiscate his money, because there wasn't any left. As soon as he returned from Durban , he paid off some of his debts and shared his illicit earnings with his family; after that Alberty was left with only with some spare change jingling in his pockets. Today he has nothing to show for his transplant caper except a stamp in his passport and a large disfiguring scar.

"I'd like to apologize," Alberty said, "but I don't know for what. I didn't even know it was a big crime to sell something that belonged to you."

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