Scarred For Life

Nina Ungureanu is tired of having visitors come to her gate. "They all want the same thing," says the Moldovan housewife, 40. That is, to join the ranks of the other seemingly lucky villagers, like Ungureanu, who have mortgaged their bodies to buy a roof over their heads. Recently a shepherd stopped by, demanding information on how to sell a kidney. Before him came a man asking how to sell one of his eyes. He had heard someone in Europe was looking for a blue one.

Many of the impoverished citizens of the former Soviet republic are looking to score a windfall by selling an organ to a wealthy recipient, often relying on criminal middle-men to secure the deal. "At first I didn't agree," says Ungureanu, recalling her trip to Istanbul in December 1998 to sell a kidney, "but then my relative told me I'd get $3,000 if I did the operation." Thus began a complicated odyssey that would take her twice to Turkey, once to the Ukrainian port city of Odessa, and once to a hospital in Tbilisi, Georgia. It was there that she met the people who hoped to benefit from the organ she was donating. "The [potential] recipients were all Israelis--a young girl, a woman and two men." (By chance she learned that the kidney she was selling for $3,000 would fetch around $100,000.) "I was so afraid," she says. "But I had to go because our life was so bad. I had four children I couldn't feed and no work. Now our house has been finished. But the money is gone, and so is my kidney."

In itself, the trade in human organs is nothing new. Advances in medical technology have rendered many kinds of transplant operations (especially involving kidneys) virtually routine. The ease of international travel and the rapid flow of information allow buyers from prosperous countries to connect with sellers from poor ones. As early as the 1980s experts began to notice what would come to be known as "transplant tourism," when Japanese and other prosperous Asians began traveling to India and parts of Southeast Asia to receive organs from poor donors. Since then other routes have opened up, from Brazil to the Philippines, and countries from Argentina to China have been accused of selling off the organs of prisoners.

Moldova is an ideal setting for the trade: it has increasingly impoverished people as well as the skills of the once well-endowed Soviet health system. It is also close to Turkey, a country that has been playing a growing role as a proxy in the East European organ business. Investigator Valeriu Galic, of the Moldovan Interior Ministry's organized-crime unit, says that his country is only part of a much bigger picture. "Moldovans organize the donors, a second country organizes the recipients and a third country handles the operations. Everyone is involved." At the top of Galic's list is Turkish surgeon Yusuf Sonmez, one of 22 doctors he suspects is involved in the kidney trade (no charges have been filed). Two of the Moldovans interviewed for this article identified Sonmez from a photograph as the surgeon who operated on them. But in a NEWSWEEK interview, Sonmez denied ever working in Georgia. "Donors have come from Ukraine, Belarus, Romania--other people operate on them and when they complain it's attributed to me," says Sonmez, emphasizing he operates only after donors prove to a committee they are volunteers.

The Moldovan trade also illustrates a basic verity of globalization: the gap between wealthy and poor can prove a powerful drive to the market. For 28-year-old Nicolae Birdan, also from Ungureanu's village, the $3,000 he received in return for his kidney went a long way. He paid off his debts and bought a $900 home for himself and his 25-year-old wife, Vera. There was enough left over to buy a ton of lumber, a ton of hay and two bicycles. Now Birdan sits in the yard of his ramshackle home, eating sunflower seeds and recalling his trip to Istanbul: "We were taken directly from the airport to an apartment. There were 10 people waiting there... They fed us well and took blood tests." His operation, in a Turkish hospital, went well. "I stayed in the hospital for six days. There was a football player from Europe who took my kidney. I don't remember his name, but I remember that we shook hands." He was taken back to the apartment for one night, and paid. It took a 24-hour bus ride to get back home. "The doctor warned us not to sit for long, so I kept getting up to get tea or coffee." Birdan's wife says that now her husband "is healthy, but it hurts if he lifts something heavy."

Apologists for the grisly trade argue that it gives desperate recipients a new lease on life. Demand for organs has far outpaced the resources of the transplant-tourism circuit. According to the U.S.-based Center for Organ Recovery and Education, more than 73,000 Americans are awaiting organ transplants. about 16 will die each day without receiving one--and that's in a country with a relatively generous rate of organ donation. Nowhere in the world are there enough donors to go around. And many Asian or Muslim countries have cultural or religious taboos against donation, meaning that patients in need of transplants have to travel elsewhere to find the organs they need. (Most of the customers in the Moldovan trade are Israelis, citizens of a country where strict religious prohibitions make the rate of organ donation one of the lowest in the Western world.) So why stop an illicit trade if it saves lives--both medically and financially?

Because it's not true that transplants are no-risk operations, argues Nancy Scheper-Hughes, an anthropologist at the University of California who coined the phrase "transplant tourism" and created the group Organs Watch to monitor abuses in the burgeoning industry. She argues that since so much of the trade is carried out in the black market, poor people are compromised both legally and physically. "Many live in utter squalor, in shantytowns where there is a high medical risk to their remaining kidney later in life." Though international rules ban the sale of organs, she says, doctors are doing little to stop the trade: "These desperate sellers are considered nothing more than a package of spare parts."

Ion Cazan, 31, who lives in the southern Moldovan village of Crihana Veche, is a case in point. Last year he agreed to travel to Turkey to give blood. But he quickly discovered that it was not his blood he was expected to give, but his kidney. "I didn't think I'd make it home alive if I disagreed... Besides, my children were hungry." With part of his $3,000 he purchased a home with no heat, no carpeting and no indoor kitchen or plumbing. The rest of the money is gone. His neighbors say they give the family soap and bread, and watch the children as Ion and his wife go into the fields to make--on a good day--15 lei ($1.15). Ion's job? He drives workers to the fields in a horse-drawn cart. He's too weak for physical labor. And he can't afford a doctor.