POVERTY: Poor enough to sell your kidney?

No one who is not afflicted with a potentially fatal organ disease can really appreciate what it is like to have to wait in desperate hope that an organ donor can be found in time to save their lives. For many thousands of people around the world, salvation comes when a family member volunteers to give up a kidney, or when they are the lucky beneficiaries of an organ donated by a stranger to a hospital or transplant service as a result of a fatal injury. Even if kidney transplants alone are taken into account, these operations certainly save a lot of lives. From roughly one million patients on dialysis globally every year, more than 100,000 are lucky enough to receive a transplant - and the numbers are rising. But tragically for many others, the wait is a hopeless one. No organ becomes available and death almost inevitably follows. It is understandable then why many are tempted, if they can afford it, to try to find a donor through other means - in effect to buy the necessary body part from someone who is prepared to give it up in return for cash. The only problem is that in most countries - and certainly in the countries advanced enough to have the available surgical expertise to carry out a transplant - the sale of body organs is both illegal and regarded as highly unethical by the medical community. Governments and bodies such as the World Health Organisation (WHO) say the reasons for this are obvious; that once money is introduced into any donor/recipient relationship and organs are thereby given a monetary value, there is always a risk that the vulnerable, poverty-stricken or unwitting will be bribed, exploited or even kidnapped in order to extract essential body parts without their agreement. International black market In other words, creating a legal market for trading human organs would inevitably lead to criminality and abuse because demand is always so much higher than supply. It would also only benefit those few who are rich enough to pay whatever it costs to buy themselves a new kidney, heart or lung. MORE INVESTIGATIONS BY JULIANA RUHFUS Juliana Ruhfus has been People & Power's chief reporter since the launch of Al Jazeera in 2006. Cambodia's Orphan Business - People & Power goes undercover to reveal how 'voluntourism' could be fuelling the exploitation of Cambodian children. Pirate Fishing - People & Power takes to the seas off Sierra Leone to investigate the multi-million dollar illegal fishing trade. The Nigerian Connection- Exposing the plight of African women caught up in a web of organised crime, prostitution and human trafficking. Haiti: Seismic Election - Revisiting Haiti 10 months after the devastating earthquake. Nevertheless, despite the best efforts of the authorities to stamp it out, an international black market in vital body organs does exist - and it is flourishing. It is the consequence of a loose but interconnected network of multi-million-dollar criminal enterprises that feed on the desperation of the sick, and the greed of some members of the medical community who can receive huge fees for carrying out - and even in some cases brokering - the transplant of traded organs. These networks are necessarily secretive but every now and then they come to light. One of the most infamous was unmasked in Turkey in April 2007 when police raided a private hospital in Istanbul. After a shoot-out with armed guards, the entire hospital staff was arrested because authorities discovered a secret operating theatre in which surgeons were caught in the middle of illegal kidney transplant operations. The owner of the Istanbul clinic - and its principal surgeon - was one Dr Yusuf Sonmez. So infamous in Turkey that he came to be known as Dr Frankenstein, Sonmez often boasts that he has carried out over 4,000 kidney transplants from live donors. During this particular raid, the police found an Israeli and a South African recipient. They had each paid more than $200,000 for their new kidney. Investigators also found the two donors, Arab-Israelis, who had been paid about $10,000 each to undergo the operation. With such sums in play, the potential profit margins for those who arrange and carry out such operations are obvious. Yet what happened next seems symptomatic of this extraordinary story. When Sonmez eventually came to trial in Turkey earlier this year (he had skipped the country after his arrest and it took time to re-apprehend him) he was sentenced to 10 years in prison. While on bail awaiting an appeal, he disappeared again and has not been seen since. Falling through the cracks As we discovered, in the years between his 2007 arrest and conviction, Sonmez had not been idle. Indeed he had merely relocated to Kosovo where he found suitable premises to carry on with his transplant business as though nothing had happened. However on November 4, 2008, things began to go wrong again, when a young Turkish man, 24-year-old Yilmaz Altun, was picked up by police at Kosovo's Pristina airport. He was found to have a fresh wound across his stomach where his kidney had just been removed. Acting on what Altun had told them, later that day the authorities raided the Medicus clinic in Pristina. They discovered there that Altun's kidney had been transplanted into a wealthy Israeli patient. As the recipient was clearly not a relative of the donor, the police suspected the operation had been illegal. After making several arrests of medical staff, they went in search of the clinic's principal surgeon, Sonmez, but he had already left the country. When investigators across Europe and the Middle East subsequently began comparing notes, it became clear that Sonmez was at the heart of a nexus of clinics, organ brokers, doctors, donors and recipients that may have been responsible for hundreds, possibly thousands, of unlicensed, illegal transplant operations. Some of those involved may have been acting out of a belief that saving lives gave them sufficient cause to act in this way, others were no doubt doing it for the huge sums of money involved - but whichever the case it had clearly been going on for years. As arrest warrants for Sonmez and other were issued and the Turkish authorities began, with a dispiriting lack of enthusiasm, to look for the elusive doctor, an EU-backed prosecution case was assembled against many former Medicus staff in Kosovo. Which all begs several questions - most especially, why has this trade been allowed to flourish for so long, who are the medical staff, patients and donors involved and where exactly is the mysterious Sonmez now?