Should it be legal for a rich person to buy a poor person's kidney?
Should it be legal for a older person to buy a younger person's kidney?
Every day, all over the world, rich older men are buying kidneys for transplant from poor younger men.
Even the best hospitals in the United States are transplanting kidneys from rich older men to poor younger men.
Nancy Scheper-Hughes has been tracking the illegal trafficking of human organs for many years now.
Her advocacy work for her group Organs Watch has resulted in criminal prosecutions -- most notably in the Levy Rosenbaum case in New Jersey.
And it has been featured most recently in a documentary titled Blood Match made for Irish television.
Scheper-Hughes has three books in the works on the subject -- A World Cut in Two: Global Justice and the Traffic in Illicit Transplants (University of California Press), Kidney Hunter, and The Ghosts of Montes de Oca: Naked Life and the Medically Disappeared (University of North Carolina Press.)
She is a professor of Medical Anthropology at the University of California Berkeley.
For ten years, Scheper-Hughes called the FBI's office in New York City, demanding an investigation of an illegal kidney-hunting network -- a network that brought poor sellers and more well-off patients to the medical centers in the United States from Israel.
And at these hospitals, the kidneys would be taken from the seller -- who sold his kidney for anywhere from $10,000 to $20,000 -- and transplanted it into the body of the patient.
Eventually, the federal agents in New Jersey caught onto the kidney brokering scheme and in July 2012, an Israeli-American, Levy Rosenbaum, pled guilty in federal court in Newark and was sentenced to 30 months in prison.
Scheper-Hughes was at Rosenbaum's sentencing hearing.
"I was at sentencing but they wouldn't let me speak," Scheper-Hughes told Corporate Crime Reporter in an interview last week. "I was sitting right next to the prosecutors and the FBI agents. The room was filled with Rosenbaum supporters. I was the lady in red. Everybody else was wearing very traditional Orthodox black suits. I stood out like a sore thumb."
"At my insistence, they found the seller, who was an African-American Hebrew Israeli," Scheper-Hughes said. "He was in bad shape. His family had rejected him. He didn't like the community."
"He was recruited and brought to the United States. He was not prepared to talk in front of this packed courtroom in New Jersey. But he was very effective. He was extremely polite and humble. He said over and over again that he didn't hold it against the person who got his kidney. He's glad he's alive, but he was forced to do this."
How much was he paid to do it?
"Twenty thousand dollars," Scheper-Hughes says. "That was the going rate. But others from Eastern Europe got less."
"But the African-American Hebrew seller testified in court at Rosenbaum's sentencing that he changed his mind after arriving in the United States once he saw that it was not what he had expected. He thought it was going to be in New York. It was switched to the University of Minnesota. And he's saying -- I'm changing my mind, I don't want to do this. He was protesting even as he was being wheeled into the operating room in Minnesota. Can I get out of it? Sure you can, sure you can, he's told. But before you know it, he's under anesthesia."
Scheper-Hughes first caught on to the trade in illegal kidneys when she was working in Brazil.
"I went to the largest and most prestigious private hospital in Recife," Scheper-Hughes said. "It was called the Royal Portuguese Hospital. It was set up in the 19th century for Portuguese immigrants with money. It had fallen on harder times. They were accepting many patients that had the basic medical health insurance program in Brazil. I was invited to spend a summer observing what was going on in that hospital in the transplant and dialysis unit. And I found that there was a pattern. About 30 percent of the living so-called related donors were in fact employees of wealthy people. They would be bringing their maids in, the rural workers in from the plantation. And they would say that this is an altruistic donation from someone who loves me."
"This is in an area where patron/client relationships are very strong and where people don't work for money as much as they work for basically just things they need to survive. It was clear that this was a softly coercive relationship."
"Meanwhile, I also heard from transplant physicians about a scandal in a place called in Taubate in the interior of Brazil, where there were allegations of a team of transplant surgeons, working with private clinics, who were declaring people brain dead who were not dead, outside of the organized system of transplant in Brazil. There were certain hospitals in Brazil that were official. But these organs were being taken outside of the proper legal mechanisms for defining brain death. And the organs were being distributed to private hospitals. It took 20 years. Only in 2012 did six doctors finally get put in prison. I testified about this."
Scheper-Hughes says that the world's illegal trade in kidneys is primarily the rich preying on the poor.
"Poor people from elsewhere, from other countries, other regions in a country are recruited by special kidney hunters," Scheper-Hughes says. "And that's kind to call them that. They really are thugs. They go to the highways and byways, to mental hospitals -- if you can believe this -- to unemployment centers, to dislocation camps, to brand new immigrants who are shell shocked either because they are political refugees or economic refugees, undocumented people. They go for the vulnerable. They offer them deals. They say -- we can solve your problems if you just give us an excess spare kidney. They don't tell them exactly where they have to go. They don't tell them the circumstances. The people might be illiterate or cannot speak the language of the country where the operation is taking place, so that by the time they get to the country they have signed documents that they can't read."
When a wealthy foreigner comes to a major hospital center in the United States and brings along a poor man, how do the hospitals screen the case and how do they get by with it?
"They are not following the letter or even the spirit of the law," Scheper-Hughes says. "There isn't a uniform standard that says -- before you accept two people who claim to be related, you must have proof that they are related, you must ask them for photos of themselves together, especially if they are from another country. The UK has plenty of foreigners who go there to get transplant surgery. But I've talked to the officials there. And they are very strict. They say -- we know that people are going to come in and bring their maids, or bring some poor trafficked person from Uzbekistan. And so we investigate and find out. Do they speak the same language? Do they understand what they have signed to?"
Is there a requirement in the UK that they be related?
"Either blood related or emotionally," she says.
They can be friends?
"Yes. That's called altruistic donation. But you have to prove that you are friends. You have to prove that the donor is not some poor guy who was found in a back alley somewhere or in a detention center, or just gotten out of prison, or was in a mental hospital."
Major hospital centers in the United States are looking the other way for the money?
"No," Scheper-Hughes. "They love their professions. They love to do transplants. And it's hard to get organs. And of course there is money."
These are the premiere doctors in their field?
"Absolutely," she says. "I know that they know."
How do you know that they know?
"People call me. They will not make it public, but they talk to Organs Watch. They trust me and they say -- I don't want my name used."
What's Scheper-Hughes' proposal to stop this illegal trafficking?
"There have been seven prosecutions worldwide of illegal trafficking of humans to provide kidneys," Scheper-Hughes says. "These prosecutions are important in that they acknowledged the extent of the damage. And many people have been caught in this net, from people in the underworld to some of the largest medical centers in the United States and their best transplant surgeons. To clean up the act, the easiest thing to do is to get the brokers, like Mr. Rosenbaum."
"It's easy to get the brokers. Brokers are easily replaceable. But it's more difficult to get the surgeons and the hospitals. In the Netcare South Africa case, the surgeons got off because they have lawyers and standing in the larger community. They also say that they were lied to. But the Netcare Corporation, the largest medical company in South Africa, plead guilty in 2010 to illegal organ transplants -- relying on paid sellers who were brought into the country."
"I've written an organ donor's/seller's bill of rights. If you cannot bear being on dialysis and you have to have a transplant and you don't want to wait for your turn to come up, then find a living person. And pay them. But it better be somebody that you know and who you care about. You are linked together in a kind of a bond as if it were a family bond."
[For the complete transcript of the Interview with Nancy Scheper-Hughes, see 28 Corporate Crime Reporter 2,(8), January 13, 2014, print edition only.]