Sale kidney

Kidneys for sale: poor Iranians compete to sell their organs
In the only country where the organ trade is legal, the streets near hospitals have been turned into a 'kidney eBay'
Would-be sellers advertise their kidneys by writing their blood type and phone number on posters or walls of the street close to several of Tehran's major hospitals. Photograph: Torab Sinapour for the Guardian
Marzieh's biggest challenge in life is to come up with money for her daughter's wedding. In Persian custom, it is the parents' duty to provide a dowry, known as jahizieh, and as a widow from north Iran, she feels it is important to fulfil her responsibility and protect the family's honour.
To achieve this, she is ready to sell one of her kidneys. If she is successful, she will travel to one of Tehran's kidney transplant centres and have it removed. She will have to cope with only one kidney from then on, but she will have performed her duties by her daughter.
"It is getting too late for my daughter to marry – her moment has already passed," she said.
Iran is the only country where the selling and buying of kidneys is legal. As a result, there is no shortage of the organs – but for those trying to sell a kidney, there is a lot of competition.
In order to advertise her kidney, Marzieh has written her blood type and her phone number on pieces of paper and has posted them along the street close to several of Tehran's major hospitals, home to the country's major kidney transplant centres.
Others have done the same. Some have written in big letters or in bright colours to attract attention; some have sprayed their information on the walls of public or even private properties.
"Kidney for sale," reads one ad, carrying the donor's blood type, O+, and a mobile number, with a note emphasising "urgent", insinuating that the donor is prepared to consider discounts. Another similar ad reads: "Attention, attention, a healthy kidney for sale, O+." Many are handwritten, though some have typed the ads to make them look better. "24 years old, kidney for sale," another reads. "Tested healthy."
Competition means that some ads have been torn down. Some have added their information to ads by other donors. Others have placed their ads on people's doors or simply written them in marker pen on trees where they think they will catch people's attention.
At the heart of the capital, near the Charity Association for the Support of Kidney Patients (CASKP), the number of ads has made the streets of Tehran into a sort of kidney eBay. "My six-month-old baby was paralysed after falling from the hands of my wife," said Ali, 28, from the northern city of Nur in the Iranian province of Mazandaran. "I have to find 20m rials [around £7,500] for my child's operation." He hopes he will get 12m rials for his kidney.
Iran's controversial kidney procurement system, which has been praised by many experts and criticised by others, allows people to sell and buy kidneys under the state-regulated surveillance of two non-profit organisations, the CASKP and the Charity Foundation for Special Diseases. These charities facilitate the process by finding potential vendors and introducing them to the recipients, and are charged with checking the compatibility of a possible donation and ensuring a fair trade.
After the transplant, the vendor is compensated by both the government and the recipient. In an interview with the semi-official Mehr news agency, the CASKP's director, Mostafa Ghassemi, estimated the total official price list to be around 7m rials, of which 1m is paid by the government. Iranians are not allowed to donate kidneys to non-citizens.
"In 2010, a total of 2,285 kidney transplants took place in the country, of which 1,690 kidneys were supplied from volunteers and 595 from those clinically brain-dead," he said. According to Mehr, the majority of people selling kidneys are aged 20-30. Despite the state control, bureaucracy and time-consuming procedures have left the door open for non-official direct negotiations, making the Iranian system more like a kidney market.
Dr Benjamin Hippen, a transplant nephrologist with the Carolinas medical centre in North Carolina, US, has studied successes, deficiencies and the ambiguities of the Iranian system.
Making a judgment about whether the 20-year-old system as a whole has been successful was complicated, he said. "The majority of those selling kidneys in Iran are disproportionately poor, and information about the long-term outcomes for sellers is quite limited. Too, it is increasingly clear that there are many different systems, rather than a single unified system in Iran.
"That said, Iran appears to have successfully addressed the shortage of organs, incentives for organs have not substantially attenuated the growth and development of organ procurement from deceased donors, and reported outcomes for recipients have been favourable."
Comparing Iran with Pakistan, where organ trafficking is nominally illegal but still occurs, Hippen, who is an associate editor of the American Journal of Transplantation, said: "It seems to me that if Iran had not developed a system of incentives, the situation there today would look very much like the state of affairs in countries such as Pakistan."
In the US, more than 100,000 people were estimated to be on the waiting list for kidney transplants in 2010 – waiting lists were eliminated in Iran in 1999.
Hippen has pointed out that "since 1999, more than 30,000 US patients with kidney failure have died waiting for an organ that never arrived".
Arguing in favour of allowing people to sell their kidneys, Sue Rabbitt Roff, a senior research fellow at the University of Dundee, said last year that it was time to "pilot paid provision of live kidneys in the UK under strict rules of access and equity".

Organ trafficking: a deadly trade
A kidney? £84,000. A heart? Up to £1 million. With the number of organs now critical, wealthy patients are spending a fortune on illicit transplants. But it is the desperate 'donors' who are paying the ultimate price.

Angry kidney sellers show scars caused by operations to remove their kidneys in Lahore, Pakistan Photo: AP
By Julie Bindel
7:00AM BST 01 Jul 2013
One January night in 2004, Susan Sutovic was woken from her sleep by a persistently ringing phone. “It was an international call from Belgrade,” she says. “Telling me my son Petar was dead.” Twenty-four-year-old Petar Sutovic was, at the time of his death, staying in his mother’s holiday apartment in Belgrade and studying law. Petar’s body was allegedly discovered in his bed late at night by his flatmate.
Paramedics were quick to the scene, and, although no death certificate has ever been issued, the pathologist that authorised the release of Petar’s body to be flown home to Britain said that the cause of death was a drugs overdose.
“Paramedics claimed that a needle was found protruding from his arm,” says Susan, “but my son was not an addict.” Almost a decade on, neither a toxicology nor post mortem report from Serbia has ever been seen by the British authorities. The death scene, Sutovic insists, was “staged”. In Britain, a second post mortem examination of Petar’s body was undertaken. The pathologist who led this examination noted that the heart and pancreas were absent from the body, “no injuries were seen” and that “death was associated with a potentially fatal blood level of morphine”.
When she viewed her son’s body upon his return to Britain, Sutovic noticed a number of facial and other injuries on Petar that had not previously been recorded. She began to form her own theories about what had happened to her son: in her opinion he was the victim of organ traffickers.
“My son was murdered, but the Serbian and British authorities have put me through hell, forcing me to uncover the truth and blocking me all the way,” says Sutovic when we meet in her west London home. “I do not want the 10th anniversary of Petar’s death to pass before I have laid him properly to rest.” Sutovic’s belief is that Petar was killed to “get at me” by people who then realised they could sell his heart for a fortune; or perhaps the hit man was paid with the organs.

would be easy to dismiss Sutovic as grief-crazed, desperate to refute claims that her son was a heroin addict who died as a result of his own actions. Except there is compelling evidence, accepted by human rights organisation Amnesty International, several forensic and medical experts, former senior police officers and, more recently, the Serbian judiciary, that Petar’s death was suspicious.
Prior to these tragic events, Susan Sutovic was a prominent human rights lawyer. Working in Britain, she had gained a reputation for legally assisting those who had opposed the government of former president Slobodan Milosevic. She had many dangerous enemies. So, in July 2004, after repeated prevarications by both the British and Serbian authorities, Susan decided to go to Belgrade herself, with two private detectives, both of whom were former police officers and experts in murder investigations.
The detectives thoroughly examined the apartment in which Petar died and found blood in the bedroom, hall, bathroom and kitchen, suggesting there had been a violent struggle. This conclusion was lent extra weight when Susan finally saw the photographs taken by police on the night Petar died, which showed Petar’s face badly beaten and his bed soaked in blood.
Subsequent tests also revealed that the brown liquid in the spoon on Petar’s bedside table – supposedly heroin – was in actual fact holy oil from Jerusalem that Petar carried with him in a small glass bottle, and the morphine in his blood was not the type produced by heroin, but the type associated with a prescription painkiller, Tramadol, which Petar had been using since a road traffic accident in 2000. Susan believes whoever killed Petar beat him up, changed his clothes, rearranged the room to make it look like he’d taken an overdose and then, at some point, took his heart to sell on the black market.
Before her son died, Sutovic ran a successful legal practice and tells me her life was full and happy. These days she mostly devotes her time to uncovering the truth of Petar's death.
Chain-smoking, Sutovic pushes the police photographs of Petar towards me. “You can see my son,” she says. “Could you believe what they did to me, that the pathologist said there were no injuries? There’s blood everywhere, his nose is badly broken and split at the bridge, there are blood bubbles in the corner of his mouth that suggests he was still alive when the photograph was taken.”
I ask who she believes killed him. “All I know is that he was murdered. I remember Petar saying to me, ‘If you can learn to live in Serbia you can live anywhere in the jungle.’ You expect corruption there. I did not expect I would have to battle for justice here in Britain.”
Last year the first case of illegal organ harvesting in Britain was unveiled by the Salvation Army, which provides support to victims of human trafficking. In a report, the organisation said a criminal gang had brought an unnamed woman into the country with the intention of removing her organs and selling them on to patients desperate for a transplant. It was unclear from the report whether the plot was uncovered before the organ removal took place, but the signs are clear: international organ trafficking is a growing trade.
The growth is down to two factors. First, a reduction in the number of legitimate organs available for transplant – due, in part, to better seatbelt legislation, which has cut the number of healthy young adults dying prematurely in road traffic accidents. And, second, an increase in the number of people waiting for transplants which have become more routine in recent years. As a result, organised criminals can now make a fortune from unethical clinics who will buy a heart, kidney or pancreas for wealthy patients.
It is now possible to order an organ on the internet. It’s also possible, if you are poor, desperate, and willing to part with, say, a kidney, to broker a deal with traffickers. Recent research by the World Health Organisation (WHO) found that traffickers illegally obtain 7,000 kidneys each year around the world.
Organ trafficking operates in various ways. Victims can be kidnapped and forced to give up an organ; some, out of financial desperation, agree to sell an organ; or they are duped into believing they need an operation and the organ is removed without their knowledge. Some victims are murdered to order if a large sum has been paid in advance. This is what Susan Sutovic thinks happened to her son.
This illegal trade has risen to such a level that an estimated 10,000 black-market operations involving purchased human organs now take place annually – more than one every hour – according to WHO. It estimates that organ trafficking accounts for five to 10 per cent of all kidney transplants worldwide.
Children, especially those from poor backgrounds or children with disabilities, are often targeted. In May this year, an eight-year-old British schoolgirl died at a clinic in India, and her family say they suspect she was “murdered” by medics intent on harvesting her organs. Gurkiren Kaur Loyal’s parents took her to see a doctor in the Punjab, when she began suffering from dehydration, and within seconds of receiving an injection she collapsed and died. During the post mortem, Gurkiren’s organs were removed and have not been returned. The Birmingham coroner told the family that without them, or the Indian post mortem report, he is unable to record a cause of death.
But the most grievous case so far unocovered is in the former Yugoslav republic of Kosovo. Last month five men were convicted of involvement in an organ-trafficking ring that performed at least 24 illegal kidney transplants at the Medicus clinic on the outskirts of the capital, Pristina. Lutfi Dervishi, the clinic’s director, and his son, Arban, were sentenced to eight and seven years respectively. They had promised donor victims about £12,500 each for kidneys that were then sold on the black market for as much as £84,000 a time, but donors had often gone unpaid and, in the words of the lead prosecutor, Jonathan Ratel, were “literally cast aside at the airport”.
The case came to light in late 2008 when a young Turkish man, Yilmaz Altun, collapsed at Pristina airport before boarding a flight to Istanbul. Doctors discovered a large, fresh wound on his abdomen and he later admitted he’d struck a deal with the clinic to have his left kidney removed. When police arrived at Medicus they found an elderly Israeli man on his way to the operating theatre to receive Altun’s kidney. Most of the organs harvested by Medicus had been sold to recipients in Israel, Canada, Poland and Germany.
Eulex, Europe’s rule of law mission to Kosovo, which brought the case, is now investigating whether any government figures were involved in the scandal. Nato documents, leaked in 2011, claimed Kosovo’s prime minister, Hashim Thaçi, was the head of a “mafia-like” network responsible for organ trafficking and other criminal activities.
Prices vary, but a heart can fetch up to £1million. And parts are not only used for transplants; there is a demand for illicit experimentation on whole cadavers by unethical scientists, as well as a market in hip and knee replacements. Penises and foetuses have been used in juju rituals, also known as “black magic”, and used to instill terror into vulnerable victims. Last year a Nigerian-born man living in Kent was convicted of trafficking children into prostitution whom he had initially subjected to juju.
In Britain, it is illegal to sell an organ, although some desperate folk have been tempted. (With at least a million people worldwide waiting for a kidney transplant at any given time, the demand is unquestionably out there.)
One man attempted to sell his kidney on eBay, only to have it pulled by the site – but not before the price reached $5,750. And in 2011, 24-year-old Nicky Johnson, from Stockport, placed an advert on a Russian website, offering to donate a kidney “if the money was right”. One of more than a dozen Brits on the site, Johnson said he would travel abroad for surgery. The operation takes up to three hours and requires a two-day stay in hospital. Post-operative infection is a serious risk.
In one of the most tragic cases to come to light, a disabled single mother in Spain was found attempting to auction off one of her kidneys, corneas, a lung and a piece of her liver online because she cannot afford her monthly rent and is facing eviction.
The inquest into the death of Petar Sutovic opened in London in 2004. An open verdict was recorded after concluding Petar had died from an overdose of morphine. “It was the wrong result, and not based on the evidence available,” says Sutovic. After a two-year campaign, during which she, along with private detectives, gathered huge amounts of new information, Susan was granted a second inquest, which she hoped would return a verdict of unlawful killing. But the inquest never happened, because legal arguments ensued about whether or not it was necessary to exhume Petar’s body.
The newly appointed coroner had applied for exhumation of the body after the Metropolitan Police gave the view that it was crucial to any new investigation. But Sutovic, supported by Petar’s brother and father, strongly opposed the move on religious grounds. The family argued that the truth about Petar’s death could be established by evidence that had already been put before the coroner, as well as by other avenues of inquiry that would not require a third post mortem. To date, over £1 million of public funds have been spent arguing about the inquests and exhumation.
Today, Susan Sutovic continues her fight for justice and has instructed Belgrade-based lawyer Djuro Cepic to represent her. Cepic tells me he is hopeful that the truth will soon emerge, and that the Serbian High Court has just granted his request to open a full investigation into the circumstances surrounding Petar’s death. “This is very good because it will involve interviewing the doctors who first dealt with this young man’s body, hopefully with myself and Ms Sutovic present,” says Cepic.
I ask Sutovic what it is she hopes for. She answers clearly and without hesitation. “I can’t bring my son back but he has a right to a soul, to rest in peace. This was a young man in the prime of his life, and I know he did not die of an overdose, and there are those out there who know the truth. How can either of us rest until we find out exactly what happened on that night?”

Illegal kidney trade booms as new organ is 'sold every hour'
World Health Organisation estimates 10,000 black market operations involving human organs take place each year
Organ donor Hu Jie, 25, a Chinese migrant worker, who changed his mind about selling his kidney but could not escape surgery once he had signed for it. Photograph: Nicola Davison

The illegal trade in kidneys has risen to such a level that an estimated 10,000 black market operations involving purchased human organs now take place annually, or more than one an hour, World Health Organisationexperts have revealed.
Evidence collected by a worldwide network of doctors shows that traffickers are defying laws intended to curtail their activities and are cashing in on rising international demand for replacement kidneys driven by the increase in diabetes and other diseases.
Patients, many of whom will go toChina, India or Pakistan for surgery, can pay up to $200,000 (nearly £128,000) for a kidney to gangs who harvest organs from vulnerable, desperate people, sometimes for as little as $5,000.
The vast sums to be made by both traffickers and surgeons have been underlined by the arrest by Israeli police last week of 10 people, including a doctor, suspected of belonging to an international organ trafficking ring and of committing extortion, tax fraud and grievous bodily harm. Other illicit organ trafficking rings have been uncovered in India and Pakistan.
The Guardian contacted an organ broker in China who advertised his services under the slogan, "Donate a kidney, buy the new iPad!" He offered £2,500 for a kidney and said the operation could be performed within 10 days.
The resurgence of trafficking has prompted the WHO to suggest that humanity itself is being undermined by the vast profits involved and the division between poor people who undergo "amputation" for cash and the wealthy sick who sustain the body parts trade.
"The illegal trade worldwide was falling back in about 2006-07 – there was a decrease in 'transplant tourism'," said Luc Noel, a doctor and WHO official who runs a unit monitoring trends in legitimate and underground donations and transplants of human organs. But he added: "The trade may well be increasing again. There have been recent signs that that may well be the case. There is a growing need for transplants and big profits to be made. It's ever growing, it's a constant struggle. The stakes are so big, the profit that can be made so huge, that the temptation is out there."
Lack of law enforcement in some countries, and lack of laws in others, mean that those offering financial incentives to poor people to part with a kidney have it too easy, Noel said.
Kidneys make up 75% of the global illicit trade in organs, Noel estimates. Rising rates of diabetes, high blood pressure and heart problems are causing demand for kidneys to far outstrip supply.
Data from the WHO shows that of the 106,879 solid organs known to have been transplanted in 95 member states in 2010 (legally and illegally), about 73,179 (68.5%) were kidneys. But those 106,879 operations satisfied just 10% of the global need, the WHO said.
The organisation does not know how many cases involved the organ being obtained legitimately from a deceased donor or living donor such as a friend or relative of the recipient.
But Noel believes that one in 10 of those 106,879 organs was probably procured by black marketeers. If so, that would mean that organ gangs profited almost 11,000 times in 2010.
Proof of illegal trafficking is being collected by networks of doctors in various countries known as "custodian groups". The groups work to support the Declaration of Istanbul, the 2008 statement against global organ exploitation that was agreed by almost 100 nations.
Made up of hospital specialists who treat patients with end-stage kidney failure who survive on dialysis, and surgeons who operate on those lucky enough to get a new kidney, the groups monitor reports of black market activity in their own country or involving compatriots abroad.
A medical source with knowledge of the situation said: "While commercial transplantation is now forbidden by law in China, that's difficult to enforce; there's been a resurgence there in the last two or three years.
"Foreigners from the Middle East, Asia and sometimes Europe come and are paying $100,000 to $200,000 for a transplant. Often they are Chinese expats or patients of Chinese descent."
Some of China's army hospitals were believed to be carrying out the transplants, the source added.
The persistence of the trade is embarrassing for China. The health ministry in Beijing has outlawed it and has also promised to stop harvesting organs from executed prisoners by 2017, a practice that has brought international condemnation.
John Feehally, a professor of renal medicine at University Hospitals of Leicester NHS trust, said: "Since the Declaration of Istanbul the law on trafficking has been changed in the Philippines – which was one of the centres of transplant tourism – and the Chinese government realises that things have to change." Feehally is also president of the International Society of Nephrology, which represents 10,000 specialist kidney doctors worldwide. "Trafficking is still continuing – it's likely that it is increasing," he said. "We know of countries in Asia, and also in eastern Europe, which provide a market so that people who need a kidney can go there and buy one."
The key issue, Feehally said, was exploitation. "You are exploiting a donor if they are very poor and you are giving them a very small amount of money and no doctor is caring for them afterwards, which is what happens.
"The people who gain are the rich transplant patients who can afford to buy a kidney, the doctors and hospital administrators, and the middlemen, the traffickers. It's absolutely wrong, morally wrong."
Noel wants countries to defeat the traffickers by maximising the supply of organs from deceased and living donors, and encouraging healthy lifestyles to stop people getting conditions such as diabetes in the first place.
• This article was amended on 31 May 2012. In the original, the forename of Prof John Feehally was incorrectly given as Jim.