Not Just Urban Legend

At first, not even Scheper-Hughes believed the rumors. It was in the mid-1980s, during a study of infant mortality in the shantytowns of northern Brazil, that she initially caught wind of mythical "body snatcher" stories: vans of English-speaking foreigners would circle a village rounding up street kids whose bodies would later be found in trash bins removed of their livers, eyes, kidneys and hearts.

When colleagues in China, Africa and Colombia reported similar rumblings, Scheper-Hughes began poking around. Some stories—especially the ones about kidnapped children, stolen limbs and tourists murdered for organs—were clearly false. But it was also clear that slums throughout the developing world were full of AWOL soldiers, desperate parents and anxious teenage boys willing to part with a kidney or a slice of liver in exchange for cash and a chance to see the world—or at least to buy a car.

Before long, Scheper-Hughes had immersed herself in an underworld of surgeons, criminals and those eager to buy or sell whatever body parts could be spared. In Brazil, Africa and Moldova, newspapers advertised the sale and solicitation of human body parts while brokers trolled the streets with $100 bills, easily recruiting young sellers. In Istanbul, Scheper-Hughes posed as an organ buyer and talked one would-be seller down to $3,000 for his "best kidney." In some of these countries, as the WHO later quantified, 60 to 70 percent of all transplant surgeries involved the transfer of organs from those countries' citizens to "transplant tourists" who came from the developed world.

But not all organs flowed from poor countries to rich ones; Americans, for example, were both buyers and sellers in this global market. A Kentucky woman once contacted Scheper-Hughes looking to sell her kidney or part of her liver so that she could buy some desperately needed dentures. And a Brooklyn dialysis patient purchased his kidney from Nick Rosen, an Israeli man who wanted to visit America.

Unlike some organ sellers, who told of dingy basement hospitals with less equipment than a spartan kitchen, Rosen found an organ broker through a local paper in Tel Aviv who arranged to have the transplant done at Mount Sinai Medical Center in New York. An amateur filmmaker, Rosen documented a portion of his odyssey on camera and sent the film to Scheper-Hughes, whose research he had read about online. The video excerpt that NEWSWEEK viewed shows Rosen meeting his broker and buyer in a New York coffee shop where they haggle over price, then entering Mount Sinai and talking with surgeons—one of whom asks him to put the camera away. Finally, after displaying his post-surgery scars for the camera, Rosen is seen rolling across a hotel bed covered in $20 bills; he says he was paid $15,000. (Brokers, on the other hand, typically net around $50,000 per transplant, after travel and other expenses. In America, some insurance plans will cover at least a portion of the donor's medical expenses.)

The money changed hands outside the hospital's corridors, and Rosen says that he deliberately misled the Mount Sinai doctors, but that no one there challenged him. "One hospital in Maryland screened us out," he says. Tom Diflo, a transplant surgeon at New York University's Langone Medical Center, points out that many would-be donors do not pass the psychological screening, and that attempting to film the event would probably have set off an alarm bell or two. "But the doctors at Mount Sinai were not very curious about me," Rosen says. "We told them I was a close friend of the guy who I sold my kidney to, and that I was donating altruistically, and that was pretty much the end of it." Citing privacy laws, Mount Sinai officials declined to comment on the details of Rosen's case. But spokesperson Ian Michaels says that the hospital's screening process is rigorous and comprehensive, and assesses each donor's motivation. "All donors are clearly advised that it is against the law to receive money or gifts for being an organ donor," he says. "The pretransplant evaluation may not detect premeditated and skillful attempts to subvert and defraud the evaluation process."

Because many people do donate organs out of kindness, altruism provides an easy cover for those seeking to profit. And U.S. laws can be easy to circumvent, especially for foreign patients who may pay cash and are often gone in the space of a day. Diflo, who has worked in numerous transplant wards over the past two decades, says that while they are in the minority, hospitals that perform illegal transplants certainly exist in the United States. "There are a couple places around that have reputations for doing transplants with paid donors, and then some hospitals that have a 'don't ask, don't tell' policy," he says. "It's definitely happening, but it's difficult to ferret out."