Related News:Markets Magazine · Science .Desperate Americans Buy Kidneys From Peru Poor in Fatal Trade
By Michael Smith - May 12, 2011 12:01 AM ET Bloomberg Markets Magazine
(Bloomberg) --
Francis Delmonico, a Harvard Medical School professor and surgeon, talks with Bloomberg's Michael Smith about the illicit market for organ transplants. Affluent, often desperately ill patients travel to countries such as Egypt, Peru and the Philippines, where poor people sell them their organs. Elisabeth Tercero, whose son died after having a kidney removed in Nicaragua, and Vilma Bramon, a victim of botched surgery in Peru, also speak through translation. (Source: Bloomberg)
Luis Picado’s mother remembers the day her son thought he had won the lottery. He came home to their tin-roofed cinder-block house in a Managua, Nicaragua, slum and said he’d found a way to escape poverty and start a new life in the United States.
An American man had promised to give Picado, a 23-year-old high school dropout who worked as a construction laborer, a job and an apartment in New York if he’d donate one of his kidneys. He jumped at the deal, his mother says.
Three weeks later, in May 2009, Picado came out of surgery at Managua’s Military Hospital, bleeding internally from the artery doctors had severed to remove his kidney, according to medical records. His mother, Elizabeth Tercero, got on her knees next to her son’s bed in the recovery room and prayed, Bloomberg Markets magazine reports in its June issue.
“I told my boy not to worry, that I would take care of him,” Tercero, 49, says. “But it was too late.” Picado bled to death as doctors tried to save him, according to a coroner’s report. “He was always chasing the American dream, and finally, it cost him his life,” she says.
Matthew Ryan, the American man, suffered a similar fate. Ryan, a 68-year-old retired bus company supervisor in New York, died two months after receiving Picado’s kidney in the same hospital.
Nicaraguan postmortem reports cited the transplant as a cause of death for both men. Prosecutors in Managua are now investigating whether anyone broke a Nicaraguan law that prohibits paying a donor for an organ.
Illicit Market
The two men were participants in a growing and illicit market for organ transplants that spans the globe. Every year, about 5,000 gravely ill people from countries including the U.S., Israel and Saudi Arabia pay others to donate an organ, says Francis Delmonico, a Harvard Medical School professor and surgeon. The practice is illegal in every country except Iran, Delmonico says.
Affluent, often desperately ill patients travel to countries such as Egypt, Peru and the Philippines, where poor people sell them their organs. In Latin America, the transplants are usually arranged by unlicensed brokers. They’re performed -- for fees -- by accredited surgeons, some of whom have trained at the world’s leading medical schools.
The global demand for organs far exceeds the available supply. In the U.S., 110,693 people are on waiting lists for organs, and fewer than 15,000 donors are found annually.
Americans who go abroad for illicit transplants can contract infections or HIV from unhealthy donors, posing a public health threat when they return, Delmonico says.
‘Exploit the Patient’
“With all the anxiety in getting a transplant, they exploit the patient,” says Delmonico, who is president-elect of the Montreal-based Transplantation Society, which lobbies governments to crack down on trafficking. “It’s big money.”
The illegal organ trade is the ugly side of the otherwise legal medical tourism industry, in which people travel to other countries for cut-rate hip replacements, tummy tucks and gastric bypasses. The legitimate medical procedures generated about $100 billion in revenue in 2010, according to a report by Deloitte Touche Tohmatsu Ltd.
For decades, wealthy Brazilians, Mexicans and Saudis have gone to U.S. and European hospitals for medical care they couldn’t get at home. In the past decade, that pattern has changed. Hospitals from Puerto Vallarta, Mexico, to Medellin, Colombia, now lure middle-class Americans with promises of high- quality care at a fraction of what it would cost them at home.
Medical tourism company MedToGo LLC, based in Tempe, Arizona, says it will offer kidney transplants in Mexico and Costa Rica for about $50,000, a fifth of the cost in the U.S.
Preying on the Poor
In the illegal organ trade, brokers scour the world’s slums, preying on the poor with promises of easy money and little risk in exchange for a kidney. Inside hospitals, people are injured or killed by botched surgery as doctors place money above ethics, criminal investigators say.
In Colombia, 321 foreigners got transplants from 2005 to 2010, according to the country’s National Health Institute. Juan Lopez, a doctor who oversees Colombia’s organ transplant system as director of the NHI, says many of these surgeries are driven by profit for hospitals, doctors and brokers.
“I don’t want my country to be a Mecca for transplant tourism,” Lopez says. He’s gone to court to try to stop 23 organ transplants for foreigners since 2010, he says.
In Peru, Rafael Peraldo, a taxi driver who’s under investigation for being an organ broker, has plied Lima’s dusty slums since at least 2005, according to five people who say in interviews that they sold kidneys to him.
‘Spare-Parts Bank’
Peraldo paid as little as $5,000, the five people say.
Patients who bought these organs paid as much as $150,000, prosecutors have found.
“The poor have become a spare-parts bank for the well-to- do,” says University of California, Berkeley, anthropologist Nancy Scheper-Hughes, who specializes in organ trafficking.
The Peruvian National Prosecutor’s Office is investigating 61 transplants in seven of Lima’s top hospitals since 2004, documents in the case show. Peraldo is one of 150 brokers, doctors, nurses and others under investigation, says Jesus Asencios, the prosecutor leading the probe.
Peraldo says in a telephone interview that he’s done nothing wrong; he says he won’t say more until the investigation is completed.
Because people with kidney failure are always in poor health, a transplant is never a guaranteed cure. Still, legal transplants have a high probability of success. More than 75 percent of the recipients of kidney transplants in the U.S. live for more than 10 years, according to the National Institutes of Health.
Perils Abound
Donors usually do fine; they can live a normal life span with just one of their two kidneys. In the illicit trade, by contrast, perils abound for all participants.
Organs removed by surgeons in Peru from 2004 to 2010 went to ill men and women from the U.S., Chile, Mexico, Spain and Venezuela, according to hospital records and prosecutors’ interviews with donors and doctors.
One of those patients was Oscar Soberon, the wealthy founder of a Mexico City computer systems company. After about a year of enduring dialysis sessions to survive kidney failure, Soberon negotiated a transplant at a Lima hospital with Peruvian doctor Christian Miranda, for $125,000, Soberon told prosecutors before he died.
On Nov. 1, 2009, doctors transplanted a kidney from a baker into Soberon. Eleven weeks after surgery, Soberon was dead, his body ravaged by infection, his medical records show.
Waiting Lists
The kidney is a fist-sized organ that continuously filters blood to clear waste from the body. Toxins are flushed into the bladder, which removes them. When a kidney fails, doctors use a machine system called dialysis to circulate and clean blood. A patient with kidney failure will die quickly without dialysis or a transplant.
In legal transplants, a kidney patient typically turns to relatives willing to donate one of their kidneys, or goes onto a waiting list if no one volunteers. A hospital screens potential donors, reviewing their health records, blood type and body tissue to ensure they’re medically compatible.
The illicit organ trade is dangerous for the donor and patient because criminals take shortcuts, such as accepting organs from people who are sick and wouldn’t be approved by hospitals in the U.S., says Gabriel Danovitch, medical director of the kidney and pancreas transplant program at the University of California, Los Angeles.
“It’s a filthy business in the same subcategory as the sex trade and child pornography,” Danovitch says. “That is why it has to be stopped.”
It’s hard to stop critically ill people who are in a race against death from seeking solutions outside the official transplant system, especially if they have the money and connections to do something about it.
Ryan, the retired New York bus line supervisor, used his son-in-law in Managua to set up a deal for a kidney, says Picado’s boss, who overheard the offer. The chain of events that brought Ryan together with the 23-year-old Picado began in 2009.
Ryan, known by relatives as a quiet, levelheaded man who rarely got angry, had been living a grueling existence since his kidneys failed in 2007. He lived in Cedarhurst, New York, near John F. Kennedy International Airport, with his wife, Lily Molina, an immigrant from Nicaragua, and underwent four-hour dialysis sessions three times a week.
Welts covered his arms, where medical workers inserted tubes into his veins. Like many kidney patients, Ryan was seeking a transplant.
“He was on a waiting list but was suffering a lot,” says Molina, 53, who first met Ryan when she worked at a Wendy’s restaurant in 2001. They married in 2005.
In March 2009, Ryan traveled to Nicaragua for vacation. He stayed with his stepdaughter, Julissa Molina, and her husband, Elvis Hernandez, in their two-bedroom home near Managua’s Augusto C. Sandino International Airport.
The house was being remodeled by Picado and his boss, Erick Bermudez, who remembers how the subject of transplants came up.
“Elvis said Ryan’s kidneys were bad and he needed a transplant,” says Bermudez, sitting in the windowless, dirt- floored room he rents in Managua.
Two months later, in May 2009, Ryan offered Picado a deal, says Bermudez. He says he heard the entire conversation as he stood a few feet away. Using his stepson as an interpreter, Ryan said he would arrange for a coyote, or human smuggler, to transport Picado illegally to New York if he donated a kidney, Bermudez says.
Picado went over the details of the offer several times, he says.
“Luis said they would give him a $5,000 gift for his kidney,” Bermudez says. “They told him everything he wanted to hear.”
For years, Picado, who had a round face and thick, curly black hair, had talked about going to the U.S. to escape the poverty that plagued just about everyone he knew, says his mother, Elizabeth Tercero.
“Luis said the gringo would take him to New York and he’d never have to worry about anything else,” Tercero says. “I begged him not to do it. It could be dangerous. But he wouldn’t listen.”
Hernandez says there wasn’t any promise of compensation for Picado.
“Luis did it altruistically,” he says. “Maybe Matthew said he would try to help him out, but there was no offer of any money.”
Ryan’s widow, Lily Molina, says her husband told her Picado had donated voluntarily and he never gave him any cash.
