Sergei woke up in pain. My whole body was aching. I couldnt get up. I had a feeling that something was missing inside me. As the anaesthetic wore off, the memories flooded back. He remembered the meeting with Nina, an employment agent in a bar in Chisinau, the capital of his native Moldova. There was the promise of a job in Turkey and the flight to Istanbul. There was the two week wait in a workers hostel and then the news that the job was off and Nina saying that only way he could get the money for the bus back to Moldova was by selling blood. There was the journey to the private hospital on the outskirts of Istanbul, the jab in the arm and now this pain and sense of loss.
The agent, Nina Scobiola, walked into the hospital room. Sergei tried to raise his body upright to confront her, what have you done to me? he shouted, before collapsing back in pain. Weve taken a kidney, she replied, its a fait accompli. Theres nothing you can do. Ill give you £1800 for it. Otherwise, get yourself out of your predicament on your own. Sergei took the money, returned to Moldova and paid off his debts. The money soon went. Six months later, all I had left to remind me of the transaction was a stamp in my passport and a pain in my left side.
Moldovan hardships
Sergei told the Moldovan police about his misadventure. They already knew of the racket run by Nina Scobiola in Istanbul and a second Nina in the village of Mingir where it is the norm for young men today be found with one kidney. Most of them sell them voluntarily. Leaning on the gate of his newly renovated house Vladimir says, I am ashamed that we are doing this. We are a disgrace to our country but there is no other way out of the situation. The situation in Mingir, and most of post-Soviet Moldova today, is one of no jobs and no prospects. Squashed between Romania and the Ukraine, it is today officially Europes poorest country. If a young man wants to marry or buy a house he has only one asset of commercial value to the outside world his body parts.
Major Veleriu Galit, of the Department of Organised Crime in Chisinau says that the Two Ninas, as they are known to police here, have got it all sewn up. The Nina in the village procures the desperate young men (only rarely do they go for a complete deception, as in the case of Sergei) and then she calls Nina Scobiola in Turkey. Once Scobiola gives the go ahead, Nina put them on a bus to Turkey where the operations are carried out to order. The doctors are Turkish. The recipients are mainly Israeli. The police have issued a warrant for the arrest of Nina Scobiola, but cannot find her. They have questioned the Nina in the village of Mingir, but have taken no action against her.
Under the knife in Istanbul
The donors all remember the doctor who carried out the operation. They say his name is Dr Yusuf Somnez, a brilliant kidney surgeon, trained at the Istanbul University Hospital, and now darting from one private clinic to another as the police close in. When his activities were first exposed by a Turkish television documentary in 1997, the Istanbul Health Authority banned him for life from working in the public health sector and, in an attempt to pre-empt him, they refuse to license any private clinic in the city to carry out kidney transplant operations. But somehow Dr Somnez has kept going.
The director of the Istanbul Health Authority, Osman Karaaslan, bristled when I asked him whether Dr Somnez was too smart for him. He lamely defended himself and the reputation of Turkeys medical establishment, saying, well, even if he is still doing it, he is not doing it with the permission of the Health Authority!. Ayan Mimaroglu, of the Fraud Squad, admits that the doctor is a shrewd operator. He gets the donors to sign papers saying that they are donating their organs voluntarily, he explains, which is why the police have not managed to bring about a successful prosecution, yet. They are preparing a new case, bringing in recent Moldovan donors as witnesses, to testify in court.
Meanwhile, Dr Yusuf Somnez has been going around Istanbul boasting that he plans to carry on indefinitely. He is ideally situated in Istanbul as a skilled surgeon with, it is rumoured, an expensive lifestyle. He has an infinite supply of desperately poor, potential donors in an impoverished country to the north and a queue of desperately ill kidney patients in a wealthy country to the south-east. One of the donors told us he overheard a nurse saying that there were 35 Israelis waiting in Istanbul for a new kidney from Dr. Sonmez. Each one was being charged £100,000.
Israel funds the trade
It is of some embarrassment to Professor Jonathan Halevy, Director of the Israeli Transplant Centre in Tel Aviv, that his compatriots should have created this production line leading, via Istanbul, to villages in Moldova where men are today walking around with one kidney. Israel has a donor problem. He is trying to encourage more Israelis to carry donor cards but is up against a deep seated belief among most of the Israeli public that they must go whole to the grave and that, if they sign a donor card, this will not be. Over the last four years, hundreds of Israelis have gone west to make up for the lack of spare parts from cadavers or family members willing to donate organs in their own country.
Mike Levinsky was one of the first to go to Istanbul to be operated on by Dr. Somnez. Did he realise that what he did was illegal? I was aware that to pay for a kidney transplant operation is illegal everywhere. He said that he didnt meet the donor, although he was in the adjacent room at the hospital. Was he curious about the man whose part he has inside him? No. It was a struggle for Levinsky, who worked as a security man when he went to Istanbul in 1997, to raise the funds. He got his local mayor and Rotary Club to help. Its much easier now, he says, so many people are doing it that the insurance companies now contribute.
Israeli insurance companies, known as Sick Funds, are part financed by the government. Public money is going towards financing illegal kidney transplant operations abroad. Professor Halevy of the Israeli Transplant Centre confirms this. I cant deny it and I condemn it. But the Sick Funds are facing an enrolee who says, I have no chance of a transplant in Israel at least pay me what you would have paid my hospital in Israel. They give him the money, usually about £25,000, towards buying a new kidney.
Dr Michael Friedlander at Jerusalems Hebrew Hospital faces a similar predicament. I am not condoning it, I do not have to condone. It is the patients decision. The paternalistic idea that we used to have of a doctor telling patients what to do is gone. He says his patients are better informed about the possibilities than he is. They find transplant operations for sale on the internet. They ask him whether he will be prepared to give them post-operative care when they get back. And he does. What else can I do?
A matter of law and conscience
There are queues of kidney transplant operation returnees outside his consulting room. He checks over a fireman who got his kidney in Philadelphia. America is now the preferred destination. Over the last year, Freidlander says, he has been getting patients back from over 30 private kidney transplant clinics in the US where they do a good job and they dont ask too many questions. The scandal is not in buying the kidneys, Friedlander says, but in the middlemen, the agents who charge the patients too much and who dont give the donors a fair share of the transaction. He wants kidney sales legitimised through a central government agency. If you make the system legal, youll cut out the middlemen, he says.
Dr Friedlander argues that there is no harm in having only one kidney. He quotes a recent medical study in Sweden where the group of men with only one kidney compared well with the control group of normal men. But what about the impoverished donor from Eastern Europe who relies on a poor diet and a suspect water supply? Hes probably healthier, Friedlander says, than the majority of obese men in the West. He admits, though, that if the donor later develops a complication with the remaining kidney, he has a problem. There are not too many spare kidneys left in Moldova.
The idea of legitimising the commercial sale of body parts is anathema to most medical establishments in the West, although it is being debated. Some doctors in the UK say that with 5,000 patients currently waiting for kidney transplants and undergoing the wretched experience of dialysis, the idea should at least be discussed sensibly. An article published in the Lancet three years ago (Volume 351, Number 9120 27 June 1998, The case for allowing kidney sales) argued that it was feelings of outrage and disgust that have led to the existing ban on kidney sales. But, the article goes on, if we are to deny treatment to the suffering and dying we need better reasons than our own feelings of disgust.
Patients, like Mike Levinsky, are certain that he did the right thing. It is our duty, he says, to take a person who is not productive and who is dependent and a burden on the local community and to bring him back to being a citizen who can contribute. None of the donors I spoke to were reconciled to their loss. Sergei, who had his kidney stolen and received a £1,800 pay-off, said, What can I say to the Israeli who got my kidney? Even though they got it through deceit, what is done is done. Let him or her be healthy but let it be on their conscience.
