Not Just Urban Legend

By the time her work brought her back to the United States, Nancy Scheper-Hughes had spent more than a decade tracking the illegal sale of human organs across the globe. Posing as a medical doctor in some places and a would-be kidney buyer in others, she had linked gangsters, clergymen and surgeons in a trail that led from South Africa, Brazil and other developing nations all the way back to some of her own country's best medical facilities. So it was that on an icy February afternoon in 2003, the anthropologist from the University of California, Berkeley, found herself sitting across from a group of transplant surgeons in a small conference room at a big Philadelphia hospital.

By accident or by design, she believed, surgeons in their unit had been transplanting black-market kidneys from residents of the world's most impoverished slums into the failing bodies of wealthy dialysis patients from Israel, Europe and the United States. According to Scheper-Hughes, the arrangements were being negotiated by an elaborate network of criminals who kept most of the money themselves. For about $150,000 per transplant, these organ brokers would reach across continents to connect buyers and sellers, whom they then guided to "broker-friendly" hospitals here in the United States (places where Scheper-Hughes says surgeons were either complicit in the scheme or willing to turn a blind eye). The brokers themselves often posed as or hired clergy to accompany their clients into the hospital and ensure that the process went smoothly. The organ sellers typically got a few thousand dollars for their troubles, plus the chance to see an American city.

As she made her case, Scheper-Hughes, a diminutive 60-something with splashes of pink in her short, grayish-brown hair, slid a bulky document across the table—nearly 60 pages of interviews she had conducted with buyers, sellers and brokers in virtually every corner of the world. "People all over were telling me that they didn't have to go to a Third World hospital, but could get the surgery done in New York, Philadelphia or Los Angeles," she says. "At top hospitals, with top surgeons." In interview after interview, former transplant patients had cited the Philadelphia hospital as a good place to go for brokered transplants. Two surgeons in the room had also been named repeatedly. Scheper-Hughes had no idea if those surgeons were aware that some of their patients had bought organs illegally. She had requested the meeting so that she could call the transgression to their attention, just in case.

Hospital officials told NEWSWEEK that after meeting with Scheper-Hughes, they conducted an internal review of their transplant program. While they say they found no evidence of wrongdoing on the part of their surgeons, they did tighten some regulations, to ensure better oversight of foreign donors and recipients. "But that afternoon," Scheper-Hughes says, "they basically threw me out."

It's little wonder. The exchange of human organs for cash or any other "valuable consideration" (such as a car or a vacation) is illegal in every country except Iran. Nonetheless, international organ trafficking—mostly of kidneys, but also of half-livers, eyes, skin and blood—is flourishing; the World Health Organization estimates that one fifth of the 70,000 kidneys transplanted worldwide every year come from the black market. Most of that trade can be explained by the simple laws of supply and demand. Increasing life spans, better diagnosis of kidney failure and improved surgeries that can be safely performed on even the riskiest of patients have spurred unprecedented demand for human organs. In America, the number of people in need of a transplant has nearly tripled during the past decade, topping 100,000 for the first time last October. But despite numerous media campaigns urging more people to mark the backs of their driver's licenses, the number of traditional (deceased) organ donors has barely budged, hovering between 5,000 and 8,000 per year for the last 15 years.

In that decade and a half, a new and brutal calculus has emerged: we now know that a kidney from a living donor will keep you alive twice as long as one taken from a cadaver. And thanks to powerful antirejection drugs, that donor no longer needs to be an immediate family member (welcome news to those who would rather not risk the health of a loved one). In fact, surgeons say that a growing number of organ transplants are occurring between complete strangers. And, they acknowledge, not all those exchanges are altruistic. "Organ selling has become a global problem," says Frank Delmonico, a surgery professor at Harvard Medical School and adviser to the WHO. "And it's likely to get much worse unless we confront the challenges of policing it."

For Scheper-Hughes, the biggest challenge has been convincing people that the problem exists at all. "It used to be a joke that came up at conferences and between surgeons," she says. "In books and movies, you find these stories of people waking up in bathtubs full of ice with a scar where one of their kidneys used to be. People assumed it was just science fiction." That assumption has proved difficult to dismantle. In the mid-1980s, rumors that Americans were kidnapping children throughout Central America only to harvest their organs led to brutal attacks on American tourists in the region. When those stories proved false, the State Department classified organ-trafficking reports under "urban legend." Scheper-Hughes's evidence, which is largely anecdotal and comes in part from interviews with known criminals, has not convinced department officials otherwise. "It would be impossible to successfully conceal a clandestine organ-trafficking ring," Todd Leventhal, the department's countermisinformation officer, wrote in a 2004 report, adding that stories like the ones Scheper-Hughes tells are "irresponsible and totally unsubstantiated." In recent years, however, the WHO, Human Rights Watch and many transplant surgeons have broken with that view and acknowledged organ trafficking as a real problem.