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NI 472 May 2014 Should we ban halal New newint.org and kosher slaughter? Beyond burnout – trauma takes its toll on activists Internationalist What’s wrong with Putting the world to rights since 1973 electric Cadillacs?

Organ trafficking

Exposing the

UK £4.45 brutal trade

05 in body parts 952014 770305 9 Guest editor’s letter Contents newint.org newint.org

NEW INTERNATIONALIST Agenda Features THE NEW INTERNATIONALIST workers’ co-operative exists to Follow the bodies report on the issues of world poverty and inequality; to focus Stories making the news 38 Beyond burnout attention on the unjust relationship between the powerful and In the early days of the Organs Watch project, when I was first this month Post-traumatic stress disorder powerless worldwide; to debate and campaign for the radical looking into the rumours of ‘body snatching’ and ‘organ stealing’ 8 Ugandan LGBTI is an occupational hazard for changes necessary to meet the basic needs of all; and to bring to life the people, the ideas and the action in the fight for among shantytown dwellers in northeast Brazil, my husband, then community down but activists on the frontline, says global justice. a clinical social worker at a large US paediatric hospital, returned not out Amy Hall. home one evening elated and deeply moved. He had witnessed 8 Roma discrimination The New Internationalist magazine was founded by Peter euters 40 10 reasons to be worried rife in Slovakia R and Lesley Adamson in 1970. Together with a range of other a paediatric transplant that had saved the life of a mortally ill about the trojan treaties publications it is published by New Internationalist Publications 9 PepsiCo says no inaldi / youngster. R Hazel Healy looks at two Ltd which is wholly owned by the New Internationalist Trust 9 Indians ask: how do 8 and co-operatively managed: monster US-led free-trade Michael was almost beside himself in sharing the miraculous event. Distracted, I kiss? Jessica Accounts: Frank Syratt. deals. Advertising: Michael York. I looked up from my writing desk and replied: ‘Really! Whose organ?’ My 9 Introducing Arseniy Yatsenyuk

Administration: Anna Weston. husband’s anger at my ‘heartless’ question, something only an oddball 10 Blanket assault on Cambodian garment workers 388

Design: Alan Hughes, Andrew Kokotka, Ian Nixon, Juha Sorsa. AlamyTim Gainey/ Editorial (Magazine): Vanessa Baird, Dinyar Godrej, Jo Lateu, anthropologist would even think to ask, made me realize that, to the contrary, it 10 East-West strain over Ukraine Lydia James, Hazel Healy, Jamie Kelsey-Fry. was a question that had to be asked. 11 Keeping UKIP out of EU Editorial (Publications): Chris Brazier. My naïve question and my equally naïve method – ‘follow the bodies!’ – 11 Abled people say Mail Order: Bev Dawes, James Rowland. Mixed media Marketing (Magazine): Amanda Synnott, Rob Norman. brought me to police morgues, hospital mortuaries, medical-legal institutes, PLUS: Scratchy Lines by cartoonist Simon Kneebone and 34 Film reviews North American Publisher: Ian McKelvie. intensive care units, dialysis units, blood labs and organ banks all over the world. Reasons to be cheerful. We Are the Best! directed by Lukas Moodysson; An Episode Marketing (Publications): Dan Raymond-Barker, Jude Crozier. Production: Fran Harvey. I traced the missing link – the ‘blood diamond’ of the organ trafficking world in the Life of an Iron Picker, directed by Danis Tanović. Web and IT: Charlie Harvey, Pete Stewart. – the fresh kidneys, which came across borders safely packaged in their warm, The Big Story – Organ tra!cking 35 Music reviews SUBSCRIPTIONS living containers. I met the ‘kidney mules’, recruited by brokers in slums, refugee Underwater Dub by Sly and Robbie; MetaL MetaL by Metá Website: www.newint.org/subscribe camps and mental institutions, and the outlaw surgeons and traffickers behind Metá. Email: [email protected] Phone: +44 (0) 1604 251 046 the illegal flow of human traffic. This edition of New Internationalist reveals 36 Book reviews Phone (from ): CallSave 1850 924 331 the damage wreaked by the criminal , and looks at what it might take The Rise and Fall of Al-Qaeda by Fawaz A Gerges; Fax: +44 (0)1604 251031 Post: New Internationalist, to combat it. A Philosophy of Walking by Frédéric Gros; Charlie Chaplin McGowan House, 10 Waterside Way, Elsewhere in the magazine, Amy Hall meets the activists suffering from post- by Peter Ackroyd; and The Enchanted by Rene Denfeld. Northampton NN4 7XD, UK. traumatic stress disorder, and the Argument on banning religious methods of PLUS: Also out there… ANNUAL SUBSCRIPTION PRICES slaughter goes behind the clamour of the proposed Danish ban. UK: £39.85; Institutions £70. Ireland: €47 Rest of World: Individuals: £44.85/€58/ US$68/ZAR 300. Opinion Institutions £90. 30 Should halal and kosher methods of slaughter be Despatch by air only. banned? Subscribers in Canada, USA, Australia, New Zealand and Japan NANCY SCHEPER-HUGHES should contact their local subscriptions office whose addresses Viva! campaigner Tony Wardle and social commentator can be found at www.newint.org/about/contact/ Mohammed Ansar go head to head. PLUS: Open Window This month’s contributors include: with guest cartoonist Makhmud Eshonkulov. UK OFFICE New Internationalist, Amy Hall is a journalist and Alice Cuddy is a journalist 33 Mark Engler 55 Rectory Road, Oxford OX4 1BW. editor based in Brighton. who has reported from the Tel: +44 (0)1865 811400 Cadillac’s electric dream is a nightmare. She is the News Editor of Middle East and southeast Asia.

Fax: +44 (0)1865 793152 oque/AP/Press Association Images

12 R Email: [email protected] the Transition Free Press Currently based in Cambodia, 43 Chris Coltrane newspaper, which grew out of she works as a reporter for the Pat Carbon stomp. Advertising (magazine & web): Michael York 01865 811420 the Transition movement, and Phnom Penh Post. 12 Perpetual scars PLUS: Polyp’s Big Bad World cartoon. [email protected] also works as a freelance A forensic examination of the persistent problem of tra$cking Contract enquiries: [email protected] journalist. Web queries: [email protected] vulnerable people for their organs, and what it would take to Permissions & general enquiries: Tsvangirayi Mukwazhi is a Victor Sonkin is an academic, stamp it out, by Nancy Scheper-Hughes. Regulars Anna Weston 01865 811401 Zimbabwean photographer journalist and translator working 6 Letters [email protected] who has exhibited in Mali, the in Moscow. His guidebook to PLUS: Stories and opinions from those with personal , Germany and Ancient Rome recently won experience of the trade. Legal protection for whistleblowers and praise for basic income. NEWS TRADE DISTRIBUTOR: COMAG Specialist Division, South Africa. He won the CNN Russia's most prestigious award 7 Letter from Bangui Tavistock Works, Tavistock Road, West Drayton, Middlesex African Photographer of the for non-!ction. UB7 7QX, UK. Tel: +44 (0)1895 433800. Fax: +44 (0)1895 433801. 23 The Medicus a"air Year award in 2002. Ruby Diamonde visits the Ba-aka forest people to !nd out A report from Kosovo on the skullduggery of an international about the impact of missionaries.

The New Internationalist is published monthly except that the Alexander Krasnov Jan/Feb and July/Aug issues are combined. gang of medical criminals and the tortuous road to bring them to justice. By Selvije Bajrami. 28 Country Pro#le: The Philippines Coming next month 42 Worldbeater sustainability). The languages we 25 A living donor Bill of Rights Paranoid, arrogant, moralistic and intolerant: step forward, Speaking out for a speak shape who we are and Principles for protection. how we see the world, and are Yahya Jammeh. multilingual world a conduit for and repository of 44 Southern Exposure facebook.com/newint The world’s 7,000 languages are facing a decline our history, culture, traditions 26 Dear Potential Organ Buyer... more rapid than, and potentially as damaging as, the and faith. Their power and If you think the trade on human organs just needs proper Tsvangirayi Mukwashi o&ers an unusual view of @newint planet’s endangered species. With the last speakers of importance are re"ected regulation, read Nancy Scheper Hughes’ exploration of the Zimbabwe’s president, Robert Mugabe. up to half of the world’s languages already alive today, in the pains taken by repressive options. It helps us occasionally to allow carefully screened linguists fear that within two centuries we could all be and colonizing regimes over the 45 Puzzle Page organizations to mail our subscribers. If you do not wish to speaking one global tongue. centuries to silence them. PLUS: Marc Roberts’ Only Planet cartoon. receive their material please write to your subscription office. Yet language matters more than you might The decline in the world’s languages must 46 And Finally © New Internationalist Publications Ltd. 2014 think: at the micro level (being a polyglot is good be reversed, and we all have a responsibility to join Front cover: Supertrooper / Depositphotos ISSN 0305-9529 for the brain!) and at the macro level (the fate the !ght. Next month’s New Internationalist Magazine designed by Alan Hughes and Juha Sorsa. Filmmaker and director Uri Fruchtmann tells Jo Lateu why ISO accreditation 9001-2008 of our languages is inextricably linked to global issues a call to arms – and tongues. All monetary values are expressed in US dollars unless otherwise noted. he supports activists who expose wrongdoing through video.

2 NEW IN TERNATI O NALI S T MAY 2014 NEW INTERNATI O NALIST MAY 2014 3 ORGAN TRAFFICKING The Big Story Men from Baseco, a slum in the port area of Manila, the Philippines, show their scars from kidney sales in a photograph from 1999.

infections including HIV and Hepatitis C. kidney loot in crisp one hundred dollar bills. There was no data on, or discussion of, the An armed guard oversaw the encounter. The possible adverse effects on the kidney sellers, seller requested half in advance. The family who were still an invisible population of refused, but they agreed to hand over the anonymous supplier bodies, similar to deceased money to the seller’s older brother as soon as donors. both parties were under anaesthesia but before In 1997, I co-founded Organs Watch, they knew the outcome of the organ transfer. specifically to draw attention to the then By the time I arrived at the famous ‘hospital invisible population of kidney ‘suppliers’.1 for the Hollywood stars’ in Beverly Hills, Today human trafficking for organs is a small, the surgery was over and Jim was out of the vibrant and extremely lucrative business that recovery room and surrounded by well-wishers. involves some 50 nations.2 His private room was festive with flowers, gifts, smiles and prayers for ‘Kidney selling is No wanted Jim’s recovery. Nurses popped their In the summer of 2009 I received a phone call heads in and out to see if everything no longer a strange that unnerved me. was going well. ‘Are you the Organs Lady?’ a young man It took some sleuthing to locate Ji- or exotic act. It is I’ll call Jim Deal* asked me with a slight tremor Hun, who was tucked away in a corner normal, everyday, in his voice. room several flights above the regular ‘Perhaps,’ I replied. ‘How can I help you?’ post-op recovery rooms. He was a and entrenched’ ‘I just found out that my kidneys are failing delicate young man, weighing no more and my doctor wants me to start dialysis than 55 kilos. He was doubled over with pain, immediately.’ and blushed with shame when I introduced ‘Yes?’ myself to him as an informal ‘kidney donor’ ‘Well, I can’t attach myself to a machine advocate. The nurses tittered anxiously when three days a week. I’ve just started a new I presented my calling card with its Organs company and I can’t lose a minute. I need a Watch logo. They told me that Ji-Hun would kidney now. Where can I go to get one? I have be released that same day, although he had not the resources. Money is not an object.’ yet seen a doctor following his kidney removal. My suggestions to ask his relatives (which He was worried about returning to his one- included several siblings) were rejected – room bedsitter apartment in a dodgy section they were all busy with their careers and of Los Angeles. Before leaving the hospital families. Would he be willing to take the Ji-Hun gave me his cell-phone number. ‘Steve Jobs option’, registering in multiple A few days later Ji-Hun reported that he was transplant centres in different regions of the still in bed, immobilized with pain, and unable Perpetual scars US, increasing the possibility that his number to eat, urinate or defecate. His older brother, a Pat Roque/AP/Press Association Images would be called – Bingo! surly young man who worked as a dish washer ‘No cadavers,’ Jim said. It would have to Secretive and ruthless, the human Hippocrates, was moved. When I asked what be a kidney purchased from a living stranger. he was thinking, he replied: ‘This is too late. Could I recommend a surgeon or a broker The demand for organs outstrips supply tra!ckers controlling the kidney trade Kidney selling is no longer a strange or exotic who could help? Given his family genealogy, Advances in medicine that keep act. It is normal, everyday, and entrenched. We which included a grandparent from Iran, I us alive longer, coupled with 2012 thrive on the desperation of the poor and in the South can agree that it is a tragic turn of told Jim that he might be in luck. Iran had rising levels of type-2 diabetes Pancreas Lung 2.11% Small bowel the sick. NANCY SCHEPER"HUGHES lays events, but the demand comes from outside.’ the only legalized and regulated kidney selling and heart disease, mean that Heart 3.80% 0.15% In the early 1980s a new form of human programme, but it was reserved for Iranian the pool of patients waiting for 5.17% bare the ‘collateral damage’. trafficking, a global trade in kidneys from citizens and diaspora. organs is growing. In any given living persons to supply the needs and ‘I’m not going to go to Iran, if that’s what year, fewer than 1 in 10 waiting for demands of ‘transplant tourists’, emerged in you are saying,’ Jim countered. ‘I want First a donor organ will receive one. The slide on the screen showed several the Middle East, Latin America and Asia. World medicine.’ At the same time, there are Liver 20.91% skinny, dark Filipino men lined up, displaying The first scientific report on the phenomenon, There was no use trying to convince Jim that fewer organs from young, healthy Kidney their sacred wound, the kidney scar, long as a published in The Lancet in 1990, documented Iran had ‘First World’ surgeons. Some weeks people – who make the best 67.85% sabre slice across their convex torsos. More than the transplant odysseys of 131 renal patients later he called to tell me that his family had deceased donors – due to the life- 150 representatives of scientific and medical from three dialysis units in the United Arab found several local, willing kidney providers saving in!uence of car seat belts. bodies from 78 countries stared solemnly at the Emirates and Oman. They travelled with their online through Craigslist. He chose the least Prolonged end-of-life medical photo during the Istanbul Summit of 2008, the private doctors to Bombay (now Mumbai), expensive ‘option’: a kidney from 19-year- care can also mean fewer usable Source: Global Observatory defining moment in the global recognition of India, where they were transplanted with old community college student Ji-Hun*, an organs upon death. on Donation & Transplantation human trafficking for ‘fresh’ kidneys. ‘Is this kidneys from living ‘suppliers’ organized by immigrant from South Korea who could not Nevertheless, the WHO why we began as transplant surgeons?’ one of local brokers trolling slums and shantytowns. afford his tuition, books, room and board, and believes national self-su"ciency through deceased donor organs is the convenors, US surgeon Francis Delmonico, The sellers were paid between $2,000 and who feared deportation if he dropped out. possible – e#orts to retrieve usable organs from the deceased need to asked. ‘Are we comfortable with this? Is this $3,000 for a ‘spare’ organ. On return, these The deal was secured for $20,000. The be maximized. Progress in stem cell research, the creation of workable * Names marked fair? Do we want to participate in this?’ transplant tourists suffered an alarming rate of night before the transplant, two very nervous arti$cial organs and xenotransplantation could help towards meeting the by an asterisk are The man sitting next to me, a Hindu post-operative complications and mortalities Korean brothers met with Jim’s relatives in an demand in the future. pseudonyms. surgeon in white robes, reminiscent of resulting from mismatched organs, and upscale suburb of Los Angeles to count the

12 NEW IN TERNATI O NALI S T MAY 2014 NEW IN TERNATI O NALIST MAY 2014 13 ORGAN TRAFFICKING The Big Story ‘My heart weeps inside me’ honest girls, young ones. She even asked me about my own girls. The seller needed. Many of the ‘kidney hunters’ who seek They wanted nice, healthy village girls. And she was willing to pay out new candidates in poor localities are former me $3,000 for each of my girls. Can you imagine! C was 38 when she was taken sellers, recruited by crime bosses. When I returned, I was a di#erent person; I was hardly able to Top: Nicolae, a father to a hotel in Turkey from her The transplant and organ procurement of three children, village in Moldova. She was kept walk. I showed them the scar, and we all wept together. They started to reproach me, saying: ‘Mother, you brought so much shame upon traffic is far-flung, sophisticated and extremely suffers from chronic under constant supervision and us, now we can’t even go out to the disco to have a good time. All the lucrative. Although trafficking in human hypertension. He fears he tricked into surgery to remove her kids are talking about you, saying that you sold your kidney.’ organs is illegal in almost every nation, the will not see them grow up. kidney. She took home $2,500 for For that !rst week home I did not get out of the house. I was specifics of the laws differ, making prosecutions Middle: Vladiumir, her organ. The recipient was an walking with di"culty, all bent over, so everybody could see me. And that can involve three or more nations a judicial recruited at 18, died from nightmare. In some countries it is illegal to sell 80-year-old man from Israel. they would shake their heads. ‘What some people would do just for post-surgical infection money!’ That’s what they would say. a kidney but not to purchase one. In others it and kidney failure on We were always in hiding. It was obvious Because of what I did, I walk with my head bent down, not with is illegal to buy and sell within the country but return from botched that the people we were involved with it up, because when I run into a neighbour and we have any kind not to buy and/or sell abroad. surgery in Turkey. were like bandits. I wanted to escape, of disagreement they are likely to say, ‘ Shut up, you! What do you Organ trafficking made its début as a much- Bottom: Viorel is furious ‘Mother, you but I did not know the language, I did know? You sold your kidney!’ I feel so stained by it all. I just hate it. contested add-on to the 2000 United Nations because his kidney was brought so much not even know where I was. There was a They should stop this kind of thing, stop it completely. Palermo Protocol on Human Trafficking, removed under duress. young man from our village who changed I saw a doctor once because of my problems [chronic pain]. I which recognizes that even willing participants Both he and Vladiumir shame upon his mind and he managed to escape didn’t want to tell him about it, but he saw the scar and right away he in underworld illicit kidney were operated upon by us. All the kids with some Romanians. They were young, said, ‘This is not a surgery that took place in Moldova. Where did you schemes can be counted as the prolific Turkish outlaw they were part of a group. I was older, a go to have this butchery?’ victims. Indeed, most are surgeon Yusuf Sonmez. are talking about woman, and alone. I began to weep, but Sometimes we argue, my husband and I. When I am angry I tell coerced by need, not physical you, saying you what was the use? My passport was in him, ‘Look, I built you a house from my kidney money.’ [They were threats or force. Some even pay contained problem, one that their hands, and all I knew was that on the able to carry out repairs on their un!nished house with the money.] significant amounts of money could be dealt with efficiently sold your kidney’ hotel key it was written ‘Hotel Ali Baba’. And he answers back, ‘Who the devil asked you to go there and do to be trafficked. with the political will to do so. I did not know that I was going to that?’ I tell him that he is the man and he should have sold. He should As it is covert behaviour, it Turkey to sell a kidney. N [the recruiter] told me they were going to have protected me because I am a woman. And he says, ‘But who is difficult to know with any Complex co-ordination !nd us work, maybe to bake bread or to sew leather jackets. Had I even knew you would go? You did this on your own.’ degree of certainty how many Unlike other forms of known, I would not have gone for anything on earth. people are actually trafficked for trafficking that unite people C continued to su!er from health problems and died before she was 50. My heart weeps inside me. They tricked us; they cheated us. All their kidneys, but a conservative from shady backgrounds, the The Moldovan police managed to stop the tra"cking operations in her because of that woman [the tra"cker in Turkey]. Oh! She was the estimate, based on original organ trade involves those village. devil alright. She had a lover there and they were both into organ research by Organs Watch, is that at the highest – or at least tra"c, but also into tra"cking girls. She was always looking for clean, Organs Watch at least 10,000 kidneys are sold middle-class – levels of society: each year. Human trafficking for surgeons, doctors, laboratory

Images: Nancy Scheper-Hughes organs is a relatively small and technicians, travel agents, as in a fast-food restaurant, was angry with Organized crime well as criminals and outcasts him. He had no medical insurance, and the That is the future. For now, transplant tours from the lowest. $20,000, which had been handed over to his are more usual. They can bring together actors Transplant professionals brother in a public toilet on the surgical ward, from as many as four or five different countries, are reluctant to ‘name and was already all but gone after settling unpaid with a buyer from one place, the brokers from shame’ those of their colleagues bills along with student tuition and remittances two other countries, the mobile surgeons involved in the trade, thereby creating a screen for their parents in Korea. After a few brief travelling from one nation to another where that conceals and even protects the human calls, Ji-Hun’s phone went dead. the kidney operations actually take place. In traffickers who supply the surgeons. And Jim, anxious about disclosure, emigrated to these instances, and the case of a private clinic because trafficking living donors for organs is another country and on last report was married in Kosovo is perhaps the best example (see a traffic in ‘goods’ (life-saving ‘fresh kidneys’) and able to work. The head of the surgical staff ‘The Medicus affair’, page 23), the participants not traffic in ‘bads’ (drugs or guns) there is of the complicit hospital refused to discuss appear and disappear quickly, with the guilty reluctance, even on the part of the justice the case, citing patient confidentiality. The parties, including the surgeons, taking with system, to recognize the ‘collateral damage’ it Unlike other consulting nephrologist who worked shifts at them any incriminating data. When the police inflicts on vulnerable bodies – and the harm to forms of the private hospital contacted me to say that finally arrive at the scene, they discover the society and the profession of medicine itself. he had seen many other instances of bartered bloody remains of a black-market clinic, with Organ brokers are the linchpins of these tra!cking that kidneys, but was loath to be a ‘whistleblower’. traces of forensic evidence, but the key players criminal networks, which handle an onerous While most illicit kidney transplants take long since disappeared. feat of logistics. They co-ordinate three key unite people place in the so-called developing world – India, Over the course of more than 17 years populations: (1) kidney patients willing to from shady Pakistan, Bangladesh, Egypt, the Philippines, of dogged field research, my Organs Watch travel great distances and face considerable risk and more recently Central Asia and Central colleagues and I had realized that we were and insecurity; (2) kidney sellers recruited and backgrounds, America – future transactions are likely to not dealing with a question of medical ethics. trafficked from the urban slums and collapsed resemble the above story. Facilitated by the Rather, we had gained entry into the world villages of the poor world; (3) outlaw surgeons the organ trade internet, organ ‘suppliers’ will be drawn of international organized crime. Following willing to break the law and violate professional involves those locally from the large pool of new immigrants, fieldwork in Turkey, Moldova, the US, Israel, codes of ethics. Well-connected brokers have refugees and undocumented workers. The Brazil, Argentina, the Philippines and South access to the necessary infrastructure such at the highest transplants will be arranged in private hospitals Africa, it became apparent that organ brokers as hospitals, transplant centres and medical levels of society, where the transactions are reported as were human traffickers involved in cut-throat insurance companies, as well as to local altruistic, emotionally related donations. deals that were enforced with violence, if kidney hunters, and brutal enforcers who like surgeons

14 NEW INTERNAT I O NALI S T MAY 2014 NEW IN TERNATI O NALI ST MAY 2014 15 ORGAN TRAFFICKING The Big Story ‘There was no freedom of

make sure that ‘willing’ sellers actually get up Most brokers, however, offer themselves choice, it was blackmail’ on the operating table once they realize what as altruistic intermediaries promising a better The kidney buyer’s the operation actually entails. They can count life to donors and recipients. The commonest on both government indifference and police scenario is of vulnerable individuals easily daughter protection. recruited and convinced to participate in the The complicit medical professionals perform trade. The pressures are subtle; the coercion In 2009, Ricky Shay’s ailing father expert teamwork – technicians in the blood and hidden. was on dialysis in Israel when tissue laboratories, dual surgical teams working in In Baseco, a dockside slum and notorious he was approached by a broker tandem, nephrologists and post-operative nurses. ‘kidney-ville’ in Manila, brokers recruit young who promised him a transplant There are ‘transplant tour agencies’ that can men (and a small number of women) who are in a modern university hospital organize travel, passports and visas. distant kin, related by blood or marriage or In the Middle East and in the US, religious informal fosterage. in . Her father later phoned organizations, charitable trusts and patient Ray Arcella, a famous broker from the area, her from his hospital bed, barely advocacy groups are often fronts for such could often be seen with his arm slung loosely conscious, saying that he was international networks. around the shoulders of his young recruits, dying and begging her to come some of whom referred to Ray as their uncle Tactics of persuasion iscoop.co.il to his rescue. or their godfather. Ray’s less than avuncular Some brokers in Moldova used underhand tactics advice to his many ‘cousins’ and ‘nephews’ was My father came back from China in a wheelchair. He was not the same that had already been honed in recruiting naïve that kidney selling was the best way of helping man who walked on to that plane with a lot of hope and optimism. The Moldovan women into sex work. They offered out one’s family – since mechanized containers kidney never functioned and so he had to go back on dialysis in a much the opportunity of work abroad to unemployed had rendered dock work, once Baseco’s main weaker state than when he started out. He lived for a year and three youth, or household heads in debt or in need of source of employment, obsolete. Nancy Scheper-Hughes months after the botched surgery in a $lthy private clinic before dying of cash to support sick spouses or children. Brokers will hire local kidney hunters – an infection. On arrival, the young men were kept in often former sellers – to do the dirty work the favelas and slums of northeast Brazil, and Nancy Scheper-Hughes with The broker and his partner were not put on trial for what they did. They safe houses, had their passports confiscated, of recruiting their neighbours and extended Andean Indians. Alberty Alfonso da Silva, did not pay the price, which was my father’s life and the life of an entire and were reduced to total dependency on the family members. In these seemingly consensual Most enter willingly into a ‘transaction’ in who was recruited from a family. After my father’s death my mother also died. The deepest injustice brokers (women were exceptions, see ‘My heart transactions, controlling behaviour, fraud and which they agree to the terms, which are Brazilian slum to provide is that the people responsible were not charged, despite my complaints weeps inside me’). A few days later, the brokers manipulation are well hidden. verbal, but only realize later how they have an organ to an American brought to all the o"cials, police, the State Attorney and the Attorney would break the news that it was not painting been deceived, defrauded or cheated. Few are woman from . General. or ironing trousers that was needed from the The sellers informed enough to give His donor was a Chinese girl who was only 16 years old. Immediately illegal ‘guest workers’ but their kidneys. Those Kidney sellers are predictably poor and consent. They do not under- after the surgery her condition was very, very severe and they transferred who refused outright were threatened or beaten. vulnerable: the displaced, the disgraced or the stand the seriousness of the Sum of the parts her to another hospital where we were told by her mother that she died. One young man, Vladimir*, explained the stark dispossessed. They are the debtors, ex-prisoners surgery, the conditions under Average amount (US$) received by Her mother came back to the hospital when ‘choice’ that faced him in Istanbul: ‘If I hadn’t or mental patients, the stranded Eastern which they will be detained kidney sellers, select nationalities. I was in the village trying to rescue my father given up my kidney to that dog of a surgeon, European peasants, the Turkish junk dealers, before and after the operation, 30,000 but the broker’s wife didn’t want to let me His donor was my body would be floating somewhere in the Palestinian refugees, runaway soldiers from or what they are likely to face speak with her. She was trying to warn me, Bosphorus Strait.’ Iraq and Afghanistan, Afro-Brazilians from with respect to the discomfort she told me: ‘You must also leave and go to a Chinese girl 25,000 another hospital.’ who was only $30,000* So, who was responsible? Many people, 16 years old – ‘If I hadn’t given up 20,000 beginning with the bureaucracy that failed my kidney to that us, the organ broker who even sold the story she died 15,000 to the media for money, and who was never dog of a surgeon, punished because he has a lot of connections. $10,000 10,000 $20,000 - But I can also talk about my father’s mistaken decision. My father took a my body would be $7,500 0 risk so that he would have a chance to live. He didn’t want to be in the same $6,000 state as my mother who lost her legs to diabetes. But he regretted the death !oating some where 5,000 $2,700 $10,00 of his donor. He said that if he had known that girl was going to be his donor, in the sea’ $1,500 he would not have taken it. But he was lied to about everything. The broker 0 Watch Organs Source: organized the seller who was paid only $5,000 out of the $100,000. This was

or immediate inability to Peru Israel Brazil pure exploitation. resume their normally Turkey I think the most important thing is freedom of choice. This means that physically demanding jobs. a person is responsible for their body, for their organs. If there’s a proposal, Some in the slums of States United the buyer and the seller have to consider it without being forced into it; that Manila, as in the slums of Philippines, India Philippines, *Asking price means not out of necessity, not from a very su#ocating place. To make a Brazil, were underage teens Romania Moldova, choice they have to feel free, inside themselves, to decide in relation to their who were counselled by brokers body and to the circumstances. But in our case it was like blackmail. We were to fabricate names and add a told by the broker: ‘You buy a kidney, or you die’ and the seller was told: ‘You few years to their age to make them ‘acceptable’ sell a kidney, or you die.’ And, in the end that’s what happened – both of to the surgeons. Many of those trafficked deny them died. That’s my story. Life in Baseco, Manila, an area the ‘sale’, saying that what they were paid was Ricky Shay has become a powerful advocate against transplant tra!cking. which provides easy pickings too small to constitute a sale for something for kidney hunters. as ‘priceless’ as a non-renewable body part. Organs Watch Ben Lewis / Alamy In these unconventional transactions, the

16 NEW IN TERNATI O NALI S T MAY 2014 NEW IN TERNATI O NALIST MAY 2014 17 The Big Story ORGAN TRAFFICKING

Main routes of the organ trade boundaries between gift, commodity and theft transplant tour junkets that bring together Canada are decidedly blurred. relatively affluent kidney patients from Japan, Male kidney sellers tend to minimize the Italy, Israel, Canada, Taiwan, the Kidney sellers trauma they experienced to protect their pride. and Saudi Arabia with the impoverished sellers Kosovo Azerbaijan But their reserve often crumbles under gentle of healthy organs. US are poor and but probing questioning of how their lives have Transplant brokers and organ traffickers Israel Japan been affected. Some male sellers in Moldova are ever more sophisticated, changing their China vulnerable: denied that they were ‘trafficked’ because the modus operandi, realizing that their engage- Egypt Saudi Arabia the displaced, language of trafficking made them sound like ments with public and private hospitals in Taiwan female ‘prostitutes’, a stigma they could not foreign locations are severely time-limited. the disgraced live with. Others become obsessed with the Israeli brokers, for example, recently confided Gulf kidney sale and attribute all the misfortunes that they either have to pay to gain access to Costa Rica states the Philippines or the Panama that occurred before or since to that one act deceased donor pools in Russia or Latin America Key: dispossessed of ‘stupidity’. (Colombia, Peru and Panama in particular), or Colombia Countries where Countries where buyers travel from buyers travel to Among a group of 40 Moldovan kidney they have to set up new temporary sites and Ecuador Source: Organs Watch sellers we followed from 2001 to 2009, locations (Cyprus, Azerbaijan and Costa Rica) there were deaths from suicide, failure of the for facilitating illicit transplants quickly and for remaining kidney, and even from battering a short period of time, already anticipating The buyers picked up a second surgeon. ‘One takes by angry villagers who felt that the sellers had police, government and/or international Transplant tourists are a varied but determined out and the other puts in,’ was the simple disgraced their village. Some were banished interventions. They are always prepared to and risk-taking population, willing to travel explanation. Only in Istanbul was David told from their homes and disappeared. move quickly to new locations where they to ‘parts unknown’ to purchase a stranger’s that his transplant would take place in Kosovo, have established links to clandestine transplant kidney. They pay for a package deal; they do a country he knew nothing about. The day The brokers units, some of them no more sophisticated not know – nor do they want to know – the before flying there, the broker announced that The brokers, who may be transplant surgeons, than a walk-in medical clinic or a rented ward exact price that will be paid to the person who police had broken into the Medicus Clinic in or organized crime figures, co-ordinate in a public hospital. will deliver their fresh kidney. They do want to Pristina, and that the planned transplant there know whether the purchased organ will come was now unavailable. However, he was willing from a healthy person, an educated person, to offer, at a cut-price rate, another option that a person of acceptable race and ethnicity. had opened up in Baku, Azerbaijan. And that (Ethnicity matters to them because it might is where David finally received his kidney, from ‘I am a surgeon, not a detective’ signify a ‘closer’ or a ‘better’ match.) They a seller from Central Asia. want a kidney that has not had to work hard The transplant surgeon the psychologist who screened the unrelated donors ruled them out. The new generation He thought that maybe the donor was being compensated or was for a living, and they want their surgeon Spanish surgeon F was active in under pressure. So, here we took the moral high ground, and then to make sure they get access to the seller’s Following the Istanbul Summit in 2008, the we learned that they went on to Los Angeles and found a transplant healthiest kidney. Declaration of Istanbul Custodian Group was the kidney transplant "eld for 20 There is a preference for male donors instituted. For the last eight years, it has been years in the US. He is now retired. centre there. It didn’t make any di#erence, and we lost out to a competitor. between the ages of 20-30 years. Transplant working closely with The Transplantation He performed kidney procedures I don’t think it was such a great deal, $nancially, for the hospital. tourists are asked to pay a great deal of money – Society, the World Health Organization on unrelated pairs from both the Maybe they charged $5,000 or $6,000 extra than what we would get normally somewhere between $100,000 (WHO), and a vast network of transplant US and Israel (who were part of a from a Medicare [US state social insurance] transplant coverage. But I and $180,000 – of which the sellers receive a professionals to negotiate with public health transplant tourism operation). believe that it wasn’t done [by the surgeons] just for money, nor was mere fraction. and other government officials to create it done just out of humanitarian sentiments, it was done because it Some buyers refuse kidneys from women, new laws to encourage deceased donor Kidney trans- I do recall operating on some of the Israeli built up the reputation of the transplant unit as a place that attracted expressing a kind of old-fashioned chivalry, programmes, promote transplant self- plants by patients, maybe 10 or 12 pairs. When I people from other countries, it built up our practice, it was good others an old-fashioned sexism. Men are by far sufficiency within nations, and discourage numbers was $rst presented with this idea, it felt for the hospital. And yes, the foreign patients pay cash up front, no the greatest purchasers. transplant tourism. It has also exerted reasonable to do it. We were doing a lot Medicare forms to $le, insurance forms, etc. In 2010, I was paid a visit by a sixty- pressure on hospitals to stop sheltering something man from southern California the outlier surgeons who perform of kidney donations between unrelated There are always suspicions with unrelated donors. But I am not Around 70,000 US citizens [late 1990s and after]. That was a big change in ethical going to ask these questions. I am a surgeon, not a detective. who insisted on setting me straight on certain transplants involving foreign patients each year thinking from the early 1990s when we wanted the donor and Some of the donors were less well-o# economically, that was matters. David* wanted me to know what it felt and trafficked kidney suppliers. recipient to be related, biologically or emotionally. clear. The recipients tended to be wealthy and spoke good English like to be in his shoes. ‘Dialysis is like a living But illicit transplant trafficking at least 20,000 Then by the mid to late 1990s we thought, ‘Well, if it works for the most part, while the donors tended to be working class, and death,’ he said. ‘You get cataracts, problems schemes remain robust, exceedingly from live donors of which with the emotionally related [spouses, for example] why not many did not speak English at all. I couldn’t communicate with them. in your gut, you can hardly eat. You lose your mobile, resilient and generally one with somebody they met in church, or even I met them before the surgery and tried to libido, you lose the ability to relieve yourself step ahead of the game. at least 10,000 somebody that they had just met at Starbucks We rejected at least speak with them, but it was more di"cult until finally you stop urinating altogether. You The new generation of organ from tra!cked donors next door to the hospital?’ The idea that there with the donors. I did not want to get into lose your energy, you become anaemic, and you traffickers is also more ruthless. might be some compensation going on was two pairs from Israel… their feelings. That’s not what I do. are cold all the time. You get deeply depressed.’ During the Beijing Olympics, always a possibility. But many in my profession We took the moral high For sure, I knew that some of the donors He was put into contact with a surgeon brokers had their supply cut off just don’t see the di#erence between the selling were paid. But the answer is regulation. and his broker in Tel Aviv, who required him after foreign access to organs of kidneys and the selling of sperm or eggs. ground, and then we In the end, I don’t really think that anyone to settle the entire package – $150,000 – in harvested from executed Chinese What is the di#erence? learned that they went on was harmed by this. Never did we have any advance for a transplant at an undisclosed prisoners was shut down. But, even so, if there was any suspicion complaints from the kidney ‘donors’. They location. Putting his fate in their hands, David Undeterred, they began to pursue that the donor and recipient had made a deal to Los Angeles and found a left and that was it. Never heard from again. travelled to Israel, and following cursory transplants from living donors, behind our backs then we ruled it out. So, we transplant centre there medical exams, he flew with the Israeli surgeon some of them trafficked rejected at least two pairs from Israel because Organs Watch and his broker on to Istanbul where they Vietnamese, others naïve Sources: WHO, Organs Watch

18 NEW INTERNATI O NALI S T MAY 2014 NEW IN TERNATI O NALIST MAY 2014 19 Source: Global Observatory on Donation & Transplantation. ORGAN TRAFFICKING The Big Story ‘Most kidney sellers are scum’

The broker I worked with another woman for several years, we were the When New Jersey biggest in Israel, we had the best name. She would take care of 10-15 federal agents caught Levy Izhak Rosenbaum, ‘The doctors are just after G was an extremely active $nding and grooming the donors, which was the part that I hated, years and I would take care of the transplant patients. When two older life span of a a hyperactive inter- broker, arranging paid women approach a client about this kind of thing, it makes it look kidney from a national kidney money’ kidney donor transplants deceased donor trafficker who had sold more believable, less frightening. The activist within Israel and inter- I understand all the [moral] issues, When people sat 15-20 transplant packages for nationally. She also operated but before you shut us out, come upwards of $180,000, together in the years the FBI had no idea Amihan Abueva "ghts against in Moldova, Russia and up with another solution. There are life span of a what a ‘kidney salesman’ human tra!cking and for child South Africa. After being people on the other side that need dialysis wards, kidney from a to live, not just improve their lives, living donor was. The prosecutors protection in the Philippines. She detained by police in Israel they would talk but live. Those who work against Source: Explore could not believe that served as regional director for the a few years ago, she moved paid sellers are both judge and about me. One Transplant prestigious US hospitals NGO Asia Against Child Tra!cking with her family to Bulgaria. executioner. patient brings and surgeons had been (Asia ACTs) which closed in 2013 Look, most of the kidney sellers complicit with the scheme, due to lack of funding. I developed a second sense, to see if people are serious. This one are scum. They’d try to exploit another or that the trafficked sellers had been deceived guy changed his mind twice, his decision to sell, two hours before and squeeze me, they’re generally and at times coerced. The federal case ended I have worked on child protection since the the surgery. But he $nally went ahead and did it because he needed mentally unstable, because whoever comes to me and they’re in that in a plea bargain in 2011 in which Rosenbaum late 1980s. In 2001, the issue of tra"cking the money. I lost sleep over it because I’m responsible for $nding a condition to do this, they’re a certain type of person. People who admitted guilt for just three incidents of for the sale of organs cropped up. I realized

kidney donor. I would always be afraid that the patient or the donor want quick money, because most of them are heavy gamblers or in brokering kidneys for payment, although he Iris Gonzalez there are parallels with child sex tra"cking would back out. debt to loan sharks. acknowledged having been in the business for and tourism in the sense that the buyers There were always patients, the word spread through word of On the other hand, I felt terribly sorry for them, with economic over a decade. are both foreign and local, and the sellers are local. mouth. When people sat together in the dialysis wards, they would hardship and the like, I sort of pitied them. One donor, when I asked At the sentencing in July 2012, the judge The estimated package deal is around $60,000, of which the hospital talk about me. One patient brings another. him to dress well for the ethical screening committees, looked at me was impressed by the powerful show of support cost would be roughly $20,000. The seller would get $1,000 to $2,000. The After the surgery, we would completely disengage. Out of 200 as if I was speaking Chinese. He had none! So I went out with him from the transplant patients who arrived to surgeon would get around $27,000. He gets the bulk of the money and patients I assisted I’m only still in touch with $ve, and these are and bought him clothes, even underwear. I never made them feel organizes his own [medical] team. really special cases. They have some shame about what they did. I unwanted. I never told them what I really think: ‘Goddamn, you’re a For the donors, the bene$ts are short-lived. The money runs out but also have to disconnect so they don’t blackmail me. As soon as the poor excuse for a human being!’ Transplant tourists are a varied the long-term e#ects linger. Many don’t know that they have to quit donors [kidney sellers] went through with the surgery, I saw the but determined and risk-taking smoking and drinking; they don’t go for check-ups. The doctors are really shame they experienced as well. It fell heaviest on them. Organs Watch just after money. population, willing to travel to With the information we gathered, we worked with the government, ‘parts unknown’ to purchase a the police and the church to stop the trade. So we put pressure locally and South African Police villagers in parts of China where blood-selling The famous Netcare case in Durban, internationally. Eventually, we got some results. Captain Louis Helberg, programmes had groomed people to accept South Africa, is a case in point. A total of stranger’s kidney The DOH [Philippines’ Department of Health] seemed unaware that there who cracked open the kidney selling as another possibility. 109 illicit transplants were performed at Saint is an Anti-Tra"cking Law [in the Philippines] forbidding the sale of organs, Netcare case and The sites of illicit transplants have expanded Augustine’s Hospital, including five in which praise the trafficker and beg that he be shown that there’s criminal liability. So we put pressure locally and internationally. con fis cated the Saint within Asia, the Middle East, Central Asia, the donors were minors. A police sting resulted mercy. The one kidney-selling victim, Elhan The DOH disallowed foreigners from getting Augustine Hospital Eastern Europe, Central and Latin America, in several plea bargains from various brokers Quick, presented as a surprise witness by the transplants in the Philippines. However, it did Sometimes transplant files. Europe and the United States. As for the and their accomplices. Netcare, the largest prosecution, was a young black Israeli, who not stop the internal tra!cking of poor people recruitment of kidney medical corporation in South Africa, pleaded had been recruited to travel to a hospital in to wealthy people, including diasporic Filipinos the police just sellers, they can be guilty to having facilitated the transplants. Minnesota to sell his kidney to a 70-year-old returning for a transplant. lose the case found in almost any The immediate result was the plummeting of man from Brooklyn. Although Mr Cohen had A hospital ethics committee should now nation. One crisis after Netcare stocks. 11 adult children, not one was disposed to make sure this does not happen but it’s despite the another has supplied the The four surgeons and two transplant donate a life-saving organ to their father. frustrating because there were many hospitals evidence that market with countless co-ordinators who were indicted held fast to They were, however, willing to pay $20,000 involved. As an NGO, we have to co-operate political and economic their not-guilty plea. Their defence was that to a stranger. with the authorities. Sometimes the police just we gathered refugees who fall like they had been deceived by the company and Quick testified lose the case despite the evidence that ripe, low-hanging fruit its lawyers, who had stated these international that he agreed to the we gathered. into the hands of the surgeries were legal. In December 2012, they donation because he 114,690 There were people who did not like what I was doing. When I was in Istanbul at an international conference on organ transplants [in 2008], human traffickers. were given a permanent stay of prosecution was unemployed at the organs reported transplanted one of the participants came to me and said ‘Don’t you know that more Prosecutions are and the state was ordered to pay their legal time, alienated from his in 2012 than half of the people here stand to lose millions because of the work difficult. In most costs. It is fair to state that rogue transplant community and hoped to you’re doing?’ instances a few culprits, surgeons operate with considerable immunity. do a meritorious act that 77,818 For now, things look a bit quiet but it’s not yet over. In 2012, Asia ACTs usually lower-ranking This is unfortunate because they constitute would improve his social kidneys tried to hook up potential donors with local governments so that they brokers and kidney the primary link in the transplant-trafficking standing. On arrival at the transplanted in 2012 can provide alternative sources of funding [welfare and work schemes as sellers, are convicted. business. transplant unit, however, an alternative to selling organs]. The Department of Social Welfare and The surgeons, without he had misgivings and ≤10% Development has promised to provide projects. With our contacts in the whom no organ A victimless crime? asked his ‘minder’, Ito, the of global demand hospitals, we still keep an eye on what’s happening. The [illicit] network is trafficking crimes can Because human trafficking for organs is seen Israeli enforcer for still there. be facilitated, and the to benefit some very sick people at the expense the trafficking network, Source: Global Observatory As for me, I really got burned out and when that happens, one just has hospital administrators of other, less visible or dispensable people, some if he could get out of the on Donation & to stop to regain one’s energy. often escape, pleading prosecutors and judges have treated it as deal as he had changed Transplantation

Nancy Scheper-Hughes ignorance. a victimless crime. his mind. These were the As told to Iris Gonzales.

20 NEW IN TERNATI O NALI ST MAY 2014 NEW IN TERNATI O NALIST MAY 2014 21 The Big Story ORGAN TRAFFICKING ‘A breach of contract’

The lawyer the guy says, ‘You know what? I changed my mind. I don’t want to do it.’ What do you mean changed your mind? That’s a breach of Israeli lawyer S claims contract, right? his job is to ‘defend all The dealers just say, ‘No, you can’t go back on this. Because if you The Medicus the slavers’, whether sex do we will $nd you and we will take our money back, everything that tra!ckers or organ dealers it cost us to arrange this. It is our money, it was a deal, and we will and their enforcers. He get it back from you’. thinks kidney sellers are The kidney sellers take advantage of the situation to sell their pathetic stories. But this is just a business. People want and need a"air prone to exaggeration. prostitutes. People want and need kidneys. So the brokers $nd a match for them. There are hundreds When an international organ tra!cking gang in Kosovo was exposed, One guy said he was coerced of sellers who are happy that they sold The kidney when he tried to back out of the [a kidney], who got, tax free, gifts of it was the local players that got caught. Nevertheless, as SELVIJE BAJRAMI deal. No problem. Sellers can sellers take $20,000-$25,000. Meanwhile hundreds reports from Pristina, it was a landmark case – the #rst in which doctors get out of the deal, but they have to pay back all the expenses. of people are alive today thanks to advantage of This is a serious thing. It is all explained to them: You have a man them. were jailed. who needs a kidney. You agree? OK, you agree. You understand the situation

You know how the police found Visar Kryeziu/AP/Press Association Images the circumstances? You sure you still want to do it? You want to go these whiners [plainti#s in a case to sell their there, to travel abroad, you will give your kidney, and you will su#er When Yilman Altun, who had been writhing space of January to 4 November 2008, Top: A signpost for the clinic against a high-level broker who S was pathetic stories pain after the operation. You understand all this? Yes, I do. And you defending]? The police went to the in pain, lost consciousness at Pristina 23 illegal transplants could be documented. that was the hub for criminal are still willing to travel? Yes, I am. You will have pain, you will not Russian TV station [in Israel, Channel 9] asking for the names of all International Airport while waiting for his It is suspected twice as many were actually activity. be able to work right away? You understand? Yes. You realize that the people who sold their kidney and are not happy about it... So return flight to Turkey in November 2008, performed. Lutfi Dervishi, the owner of the Below: Dr Lutfi Dervishi, I have to set everything up. It’s a big operation. It is not an easy now all the weirdos come forward. They complain that they were it set in motion a chain of events that made clinic, was placed under arrest. foreground right, and his son, thing to arrange. I have to pay everyone. It costs a lot of money. I forced, that they were beaten. They were threatened. There was legal history. Arban (on the steps), outside Tortuous and complex have to pay the hospitals, the doctors, the airfares, the hotels, the extortion. So suddenly one of these poor guys sits up and says, ‘Oh Altun was an unlikely visitor to the newest court after one of the hearings translators. A big deal. my God, look what happened to me! I was tra"cked!’ So, what was country in Europe. Kosovo had declared its The investigation and court hearings were of the case. You get it? Yes, I’m ready for it. So, OK, let’s go. I’ll set up the this guy thinking for all that time before he came to the police? independence from Serbia just nine months tortuous. After initial investigation by the Bottom: Surgeon Yusuf Somnez, tests, I’ll get your visa, I’ll get the airplane tickets, I’ll contract earlier and was not exactly a happening tourist police, prosecutor Jonathan Ratel took aka Dr Vulture, during a local the doctors, I’ll get the patient prepared. Oh – then suddenly Organs Watch destination. The 23-year-old Turk, who was in over the case in March 2010, working for court appearance in Turkey. He desperate need of money, was no tourist. EULEX, the European Union Rule of Law remains at large – and wanted. A doctor who was called in to examine Highest rates of donation from last words he uttered before going under and sometimes no home. They have to be him at the airport found a fresh wound on his deceased persons (per million anaesthesia. made accountable. abdomen – his left kidney had been removed. population), 2012 His testimony had no impact. The judge Until we can revolutionize the practice Altun had been trafficked to Kosovo 40 concluded that it was a sorry case. She hated of transplantation, a case needs to be made through a broker in Istanbul with the promise Source: GODT to send Rosenbaum to a low-security prison for a more modest medicine that realizes of a $20,000 payoff. The Medicus clinic on 35 in New Jersey for two-and-a-half years as our lives are not limitless. This is a difficult the outskirts of Pristina did not have a licence she was convinced that deep down he was a message to convey when transplant patient to conduct transplants and the surgeons Yusuf 30 ‘good man’. She argued that Elhan Quick advocacy groups and religious organizations Somnez, of Istanbul, and his partner, Zaki had not been defrauded; he was paid what have sprung up demanding unobstructed Shapira, of Tel Aviv, were flown in to conduct 25 he was promised. ‘Everyone,’ she said, ‘got access to transplants and to the life-saving the surgeries, aided by two other doctors, something out of this deal.’ ‘spare’ organs of ‘the other’, as if this were Lutfi Dervishi, a Kosovar urologist, and Kenan 20 a moral crusade. Dermirkol (also from Turkey). Closing down the networks The kidney is the blood diamond of our Seventy-four-year-old Bezalel Shafran, who Convicted brokers and their kidney hunters times. The organ trade is one of the more had travelled from Israel, went under the knife 15 are easily replaced by other criminals – egregious examples of late capitalism where to receive Altun’s freshly excised kidney. Just the rewards of their crimes ensure that. poor bodies are on the market in the service a few days later, Altun was told to return to Visar Kryeziu/AP/Press Association Images 10 Prosecuting transplant professionals, on of rich bodies. his country with the promise that the money the other hand, would definitely interrupt would be transferred to his bank account. 5 the networks. Professional sanctions – Nancy Scheper-Hughes is Professor of Medical Shafran and Altun had signed a declaration such as loss of licence to practice – could Anthropology at the University of California, Berkeley, that the kidney transplant had occurred of their 0 be very effective. Outlaw surgeons and and an activist in many social movements. Her classic free will, an altruistic act by Altun rather than 1993 study Death without Weeping: the Violence of

US their colleagues co-operate within a code a commercial transaction. Later investigations Everyday Life in Brazil was the basis, 20 years ago, for an Spain Malta of silence equal to that of the Vatican. of banking records would reveal that Shafran’s France Croatia Estonia

Austria Austria edition of New Internationalist. Belgium Slovenia Portugal International bodies like the UN and the daughter had paid Moshe Harel, the Israeli EU need to take concerted action on the 1 Organs Watch was co-founded with Lawrence Cohen. recruiter and fixer of the organ-trafficking legal framework in order to prosecute these They are both professors of medical anthropology at the gang, $125,000 in October. University of California, Berkeley, who had made initial international crimes. anthropological forays into the various sites where illicit A few days later police raided the clinic and Prosecutors look kindly on kidney buyers transplant operations were arranged. Over the years they closed it down. By this time Yusuf Somnez had because they are sick and looking to save have been joined by a number of independent medical escaped, taking with him all his patient files. their lives. But buyers have no qualms about human rights activists from the countries in which they What was left behind were the blood-matching have worked. 2 As identi$ed by Organs Watch, WHO, taking a kidney from deprived persons The UN O"ce on Drugs and Crime and the Declaration of files which enabled investigators to outline the

without any medical insurance, any future, Istanbul Custodian Group. illegal trade in human kidneys. In the short Ibrahim Usta/AP/Press Association Images

22 NEW IN TERNATI O NALI ST MAY 2014 NEW IN TERNATI O NALIST MAY 2014 23 The Big Story ORGAN TRAFFICKING

1 All humans have the right to bodily integrity. Mission in Kosovo. EULEX had been invited Harel was arrested in 2009 in Kosovo and to Kosovo after independence in order to spent three months in jail, but was released on 2 Organ harvesting should be considered strengthen the rule of law in this fragile state. bail on the grounds that he had to return to in terms of a post-Cartesian notion of ‘We had to find evidence in foreign Israel to conduct the mourning of the death of jurisdictions, 17 in all, including the US, his mother. The court ruled that he had to pay the person. Not ‘I think therefore I am’ Germany, Israel, Britain, Canada, the Russian €20,000 ($27,600) and ordered him to return but ‘I am self-consciously embodied, Federation, Moldova, Kazakhstan…’ recalls to Kosovo within a month. He has never been therefore I am’ . Ratel. ‘So it was a complex investigation with back since. Both Somnez and Harel are still serious technical issues.’ During the trial ‘there wanted by Interpol. 3 Recognize organs as one’s birthright, were 85 witnesses in total, 26 of whom were one’s bodily inheritance. heard by international video link.’ Case not yet closed Yilman Altun, however, was not to be found. The case in Kosovo wound down in April 4 Recognize that there are no ‘spare’ Ratel suspects that he might be dead. At least 2013, after more than 100 court hearings organs. one Israeli recipient died soon after returning and a 13,000-page dossier of evidence. Lutfi to Israel. Among the donors who testified was Dervishi defended his innocence to the last 5 Green donation (deceased donors) a Ukrainian man who had been lured by an and addressed the court before the verdict: should be the default system. Red internet advertisement promising $30,000 for a ‘My goal has been to provide service to my donation (living donors) should kidney. He was dumped at the airport without people. Despite the fictional events and media be viewed as the exception, not the He was the cash and minus his kidney. Many of the campaigns, I have not lost the confidence of recipients (who came from Israel, Canada, patients, colleagues and my people.’ rule. Living donation should be dumped Germany, Poland, Ukraine and Turkey) also He was sentenced to eight years in prison acknowledged as a major sacrifice and at the airport gave evidence. and a €10,000 ($14,000) fine for organized not as a moral imperative. ‘It is unusual for crime to take place in a crime and human trafficking. His son, Arban without the clinical setting; you don’t usually think that Dervishi, who had managed the Medicus 6 Establish safeguards that recognize cash and doctors can be involved in organized crime,’ clinic and enabled the transportation of the the existence of vulnerable donor says Ratel. ‘But we were able to prove to the victims to and from Kosovo, was sentenced populations – young people, the minus his court that this clinic was the crime scene, and to seven years and three months and a fine A living donor that doctors were part of the conspiracy to of €2,500. Father and son were also ordered unemployed, prisoners, the mentally ill, kidney engage in organ trafficking.’ to pay seven of their victims €15,000 each as guest workers, the uninsured, economic What the investigation also revealed was compensation. and political refugees, those in debt. that ‘the Medicus clinic was one clinic in a Lutfi Dervishi’s conviction also included constellation of clinics,’ according to Ratel, the charge of serious bodily injury. On this 7 Establish a principle of solidarity with two common links, the notorious Turkish same charge, anaesthesiologist Sokol Hajdini with the weak, the frail, the sick and surgeon Yusuf Somnez (dubbed variously Dr was sentenced to three years in prison, while the existentially shaken, both kidney Vampire, Dr Vulture and Dr Frankenstein two other anaesthesiologists, Islam Bytyqi and in the press) and Moshe Harel, the Israeli Sulejman Dulla, received suspended sentences patients and kidney sellers. strongman of Turkish origin. of two years each. Bill Recognize that the consequences and According to Nancy Scheper-Hughes who The linchpins, Somnez and Harel, may 8 scars of kidney selling are often hidden. Doughty prosecutor followed Somnez from 2001, he has been active remain at large, but the case sent the first legal of Jonathan Ratel. in illicit transplants since the 1990s, though he signal that medical professionals are part of the Living unrelated donors – paid or always made the trafficked kidney sellers illegal network of organized crime and are not unpaid, altruistic and family members sign consent forms claiming they were immune to such charges. – can feel used and ignored, deprived altruistic donors. He had been arrested Ratel points to the ‘huge profit’ to be four times in Turkey and banned from made. ‘If, for instance, organized crime has and worthless and empty, following working in the public-health sector traditionally been involved in trafficking sex kidney removal and partial liver Rights there. However, this had not stopped slaves or narcotics or weapons, it is because donation. him hopping from clinic to clinic there are profits. But instead of thousands in different countries – he claims to of for trafficking persons for sex or for 9 While altruistic living donation have performed close to 2,400 ‘legal’ labour, you can talk about profits in tens or a is permissible and ethical, an transplants. hundred thousand for an organ.’ independent donor advocate should The Turkish authorities, while During the lengthy investigation and the providing co-operation, had their trial, much fresh evidence emerged and a new represent the living donor. hands legally tied when it came to investigation is now underway into a further No living organ donation by persons the matter of extraditing Somnez. eight individuals ‘for the criminal offences 1 0 Forewarned, Somnez was on the of organized crime, trafficking in persons, without medical insurance. run the day before police raided grievous bodily harm, abusing official position Proposed by Organs Watch the Medicus clinic. It is likely he of authority, fraud and trading in influence’, is moving between South Africa according to EULEX. and Azerbaijan, where he was back in business trafficking in Selvije Bajrami is a Pristina-based journalist working transplants with kidney sellers for the news daily Zëri. In 2010 and 2013 she was declared Read Hanneke Hagenaar’s account of working with soon-to-be-bereaved families in her job as a transplant from Jordan and Central Asia, best print journalist for anti-corruption reporting by the co-ordinator for deceased organ donors on our website: nin.tl/1fznRPI

Laura Hasani according to Scheper-Hughes. UNDP in Kosovo.

24 NEW IN TERNATIONALIST MAYM AY 2014 NEW IN TERNATIONALI ST MAY 2014 25 ORGAN TRAFFICKING The Big Story

and you see the sale of organs as the rational If, in the meantime, you are still determined solution, then we need a few things first. to pay someone for a kidney (or for a liver Transplantation must be based on the values lobe) then, before looking to a stranger from of fairness, dignity, solidarity and transparency. a foreign land, look closer to home and pay Dear Potential Organ Buyer… Nations should strive for organ self-sufficiency someone you know, someone you care about, and not look to poor nations to supply the fresh someone who you will be in contact with organs that cannot be found at home. Kidney should their health fail and, turning the tables, transplants between living non-blood relatives they need you to give them a helping hand. should be contained within national borders You cannot put a price on life, but you can to prevent the tragedy of human trafficking for exchange money within a regulated system that organ procurement. acknowledges the need for mutual trust and If compensated kidney donation is something care. People do this all the time within their a nation’s population can live with, then each families and friendships. Anthropologists call state must create its own regulated system it open-ended reciprocity and it is what makes (similar to that of Iran) in which living, social life possible and meaningful. unrelated organ providers are compensated It is not money that is the culprit, it is the for an act of kindness and solidarity for reduction of the donor from a life-sharer or life- another citizen. The system should be aware of saver to a commodity, a living body reduced to vulnerable individuals who should be screened a sack of spare parts. out of selling: the homeless, the mentally fragile or incompetent, the black sheep of the Present options and futures family or community looking for validation, the A present option is universal donation hopeless, the hapless and the unhappy, as well of organs and tissues at death unless Kidney patients deserve our compassion and the best possible care. But as those who have been trafficked from abroad one actively opts out – with a guarantee If kidney recipients or are political refugees, new immigrants or that the poor are as likely as the solidly often refer to their is it at all possible to create an ethical and regulated trade in organs? An guest workers. middle class and affluent to receive The compensated donors should be treated this gift. This ‘green’ option requires transplants as the open letter from NANCY SCHEPER!HUGHES. with respect and receive proper medical surveil- re-imagining the deceased body as lance before, during and after surgery. There a commons, a site of compassionate day they were reborn, If you are thinking of paying a person you kidneys, kidney regret, kidney impotence, needs to be an organ providers’ bill of rights. social solidarity that has been trampled kidney sellers in do not know, a total stranger from another bodily emptiness (‘the body without organs’), Sellers need to be informed of the long- over by the dominant market-oriented corner of the world, to pull you from the queue chronic pain at the site of the surgical scar, term risks – medical, social, economic and view of the body as commodity. Bangladesh refer to of those patiently waiting for a deceased donor burning, itching spaces, floating organs, psychological – they may face. They need to What else can we hope for? Stem- their nephrectomies organ, or from the onus of asking a relative or ‘strangled’ kidney, and the attribution of all be protected from being treated like living cell research that will lead to the close friend to rescue you from dialysis, you subsequent life troubles to the ‘missing organ’. cadavers, as containers of recyclable biological development of artificial kidneys, for as ‘the day I died’ should know that you are entering a moral, Social-science and medical surveys have and medical material and energy to be siphoned one. Xenotransplantation – kidneys social and political grey zone. Be aware of the confirmed that virtually all kidney sellers off to the highest bidder. from pigs, unsuccessful so far – for collateral damage – to the families of kidney describe themselves as physically and financially Even a regulated system will have to rely on another. Experimental new bio- sellers and to the economically battered ‘worse off’ after the event. Because most are ‘matchmakers’ and intermediaries. Hospitals technologies that could one day realize communities where kidney brokering and selling poorly educated, unskilled labourers who and transplant teams should not be the organ the possibility of artificial, 3-D copy has destroyed trust and livelihoods and has rely on the strength of their bodies, they are brokers in the legally mandated paid donation kidneys. broken homes. In hard-hit villages and slums frequently excluded from work that requires of living people’s organs. Transplant teams in The real answer to kidney disease from Latin America to Eastern Europe to Asia, them to lift heavy objects, to leap and jump, to the US have failed to identify cases in which is a strong public health system the obligation to sell a kidney to save the family climb and cling, and to be unconcerned about force, coercion and fraud have motivated that identifies and provides early is being passed down from the father to his wife the effects of ordinarily rigorous work demands seemingly willing and informed consent to intervention for diseases like type-2 to oldest sons and even to underage children. on their (as they see it) diminished, depleted, forfeit an organ. Public committees should diabetes that are simultaneously The kidney is not a ‘spare’ organ, despite evacuated body. carry the burden of approving compensated ‘epidemic’ and preventable. Providing what you may have heard from some surgeons Kidney sellers fear premature death, due kidney donors following strict government support in the poor parts of the or transplant brokers. If you were able to talk to a combination of guilt, shame, fear and guidelines. Majority World, where kidney to kidney sellers the world over, you would find misinformation. If kidney recipients often refer Beyond that, paid kidney providers need disease is caused by polluted water that even years after the operation, many are still to their transplants as the day they were reborn, independent advocates as guardians of their supplies, contact with toxic waste, and suffering from its effects on their bodies, minds, kidney sellers in Bangladesh refer to their bodies. These advocates should have nothing environmental degradation. Clean social status, intimate relations and working lives. nephrectomies as ‘the day I died’, referring to to do with the medical or financial aspects water is a primary necessity for healthy Medical journals do not report on the largely their economic, psychological, spiritual and of the organ transplants, and can verify that kidneys, as is universal healthcare and invisible long-term consequences of kidney social death. the compensation is equitable, just, voluntary early diagnosis. selling, which include: decreased physical and and that there are no other social, material or Kidney buyers have it right – mental wellbeing, weakness, chronic pain, The rational solution? psychological reasons for prohibiting the sale. kidneys are a valuable human resource depression and suicide, self-hatred, distorted Buying, selling or brokering a kidney is against Kidney sellers constitute the poorest, without which the end-stage kidney body image (‘half-person’), anger, social the law in most countries today. Underground weakest and most vulnerable people on the face patient is adrift in an existential hell. rejection, stigma and isolation. There are new markets run by outlaw surgeons, brokers and of the earth with little or no bargaining power. They deserve our compassion and the psycho-social syndromes that will never appear kidney hunters trawling poor communities They need unions and collective bargaining. best medical care available. in the latest revision of the Diagnostic and exploit the desperation of both buyers and sellers. They will all require adequate medical Transplantation is a valuable, but last RioPatuca / Alamy Colin Crisford / Alamy Statistical Manual of Mental Disorders: phantom If your reply is, ‘Don’t criticize, legalize’, insurance – for the rest of their lives. resort treatment.

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