Black Market In Transplant Organs
By Brian Kates, Daily News Staff Writer
Originally published in the New York Daily News, August 25, 2002
An international transplant Mafia based in the former Soviet Union is capitalizing on America's organ-shortage crisis by smuggling live donors into the country to sell their lungs and kidneys, the Daily News has learned.
Illicit organ donors from Moldova, the poorest country in the former Soviet Union, enter the United States—mostly at Kennedy Airport—on false student or tourist visas. They are whisked to hospitals where their organs are removed and sold, government sources said.
The Moldovan connection, the first organized-crime organ-selling ring uncovered in the United States, takes advantage of the vast difference between the need for lifesaving organs and the scarcity of supply.
About 86,000 Americans are currently waiting for a transplant; 6,124—about 17 a day—died last year for want of an organ.
The Brooklyn U.S. attorney's office, which is spearheading the Moldovan case, declined comment.
But a source involved in the investigation confirmed the FBI and the State Department's visa fraud section is closing in on the gang ringleaders, whose operatives match desperately impoverished donors to equally desperate patients.
There have been no arrests, but suspects are cooperating in the investigation, the source said.
The source, who spoke on the condition of anonymity, called the ring global and said it operates in several states—including New York, where 8,000 people are currently waiting for transplants.
In some cases, the Moldovans have duped doctors into believing they are giving their organs altruistically to family members. But, the source said, "There are clearly some doctors who knew what the entire deal is about" and profit from it.
Some of the ring's beneficiaries are believed to be children whose parents pay huge sums to save their lives.
Illegal business
The sale of human organs is illegal in the United States and transplants are strictly regulated by a complex congressionally mandated priority system that results in years-long waits.
In New York, where the crisis is among the worst in the nation, more than 3,360 New Yorkers have died waiting for an organ transplant since 1995, according to the United Network for Organ Sharing. The lives of another 562 patients deteriorated so badly that they were deemed ineligible when an organ finally became available—a virtual death sentence.
The numbers are sobering:
New York State has a waiting list longer than every state except California, and the need for organs grows faster than everywhere but California and Pennsylvania. Yet New York ranks only fifth in the number of organs donated and transplanted each year.
The number of organ donors in the city is staggeringly low and dropping. In 2000, only 17 deceased New Yorkers per million residents donated organs, down from 18 in 1999. Compare that to the Albany area, where there were 31 donors per million population in 2000, up from 30 the year before.
The backlog for kidneys, the most frequently transplanted organ, is so great here that only 14% of those who became eligible in 1999 have received a transplant. New Yorkers wait four to six years for a kidney—nearly double the national average.
Faced with insurmountable backlogs, New York patients frequently register for transplants in organ-rich states like Florida, Wisconsin and Pennsylvania, where high donation rates often reduce waiting time to months rather than years.
Additionally, the United Network for Organ Sharing estimates 200 to 300 Americans a year, many of them New Yorkers, buy organs in shady overseas transactions.
"Some of these outlaw transplant operations are cloak and dagger, others operate in the gray nether world of loopholes and soft corruptions of waiting lists for tightly regulated and rationed organs," said University of California anthropologist Nancy Scheper-Hughes, who has tracked organ profiteers in eight countries over five years.
Prison connection
More and more patients are traveling to China, where at least 68 offenses carry the death penalty and executed prisoners provide a rich source of supply.
The Chinese government vehemently denies the practice, but only last month a patient died after receiving an executed prisoner's kidney in Guangzhou, according to a report in the Hong Kong newspaper Cheng Bao.
"We have patients who have received a kidney in China," said Dr. Mark Hardy, director of renal transplantation at Columbia Presbyterian Medical Center. "We take care of them even if they abuse the system. In some cases their decision is not so unreasonable."
Other patients pay donors to come to them.
One, a wealthy 70-year-old New York dialysis patient, was told that because of his age and other factors he would have to wait as long as 12 years for a kidney even after he had registered at 10 U.S. transplant centers.
Instead he found a doctor who arranged for an African donor to come to the United States for an illicit operation that cost more than $100,000, a family member told The News on the condition of anonymity.
The man's nephrologist "certainly knew what was going on, but the operation could not be done at his hospital [in New York], so we had to go out of state, where the doctor would not question too closely," the family member said.
"We had to pretend we knew this person, that he was an old friend who was doing this," the relative continued. "I am sorry that our system made this necessary but I am so grateful to see him playing with his grandchildren."
The life-and-death dilemma creates serious ethical and legal problems for patients and doctors.
"At some point, you cannot turn over every rock looking for trouble," said Dr. Ian Tellis, a renal transplant surgeon at Montefiore Medical Center in the Bronx. "We are obligated not to facilitate something terrible, but if the circumstances seem reasonable we go ahead."
Tellis said suspicious donors are carefully screened by a panel of psychologists.
'Only the rich'
With organs harvested from less than half the 15,000 potential donors nationwide, the American Medical Association is considering a system of modest financial incentives to bolster donations.
"The basic concern is creating a system where only the rich can afford organs," said Dr. Frank Riddick, former chairman of the AMA's ethics committee.
In several countries—Belgium, Austria and Spain among them—organs can be harvested from all deceased citizens unless they had signed legal papers prohibiting it. The practice, known as presumed consent, is illegal in the United States.
"Presumed consent certainly would increase donations," Hardy said. "To my mind, it is the correct way of going."
Hardy, like most other transplant surgeons, concedes "most Americans would resist Big Brother determining what could happen to your body after you die."
But he said the shortage of donated organs is a crisis that "invites criminal activity."
SIDEBAR
Bizman Hooks Up Patients With Overseas Operations
Need a heart? Who you gonna call?
Jim Cohan. He says he'll get you an overseas transplant for a mere $240,000. How about a kidney? Or a lung? Or a liver? They're yours for $125,000, installation included. Or so Cohan says.
A self-described "international organ transplant coordinator," Cohan says he bypasses years-long American waiting lists by hooking up patients with doctors in countries where organs are plentiful.
He demands $10,000 upfront, and he warns that the procedure is not covered by insurance. "This must be taken into account before contacting us," his ads say.
Transplant experts call the Los Angeles-based Cohan a con man who preys on the fears and the pocketbooks of the desperately sick. He has been investigated by the FBI and the California attorney general's office. His activities landed him in an Italian jail for five months.
But he is undaunted. Now, he says, he is setting up a "nonprofit, pro bono organ transplant clinic" with the esteemed international group Doctors Without Borders.
Problem is, Doctors Without Borders knew nothing about the alleged relationship until it popped up on Cohan's Web site. The group filed a cease-and-desist order last month, said spokesman Kevin Phelan, but the information is still posted on the Internet and Cohan does not disavow it.
Cohan is vague about his operation. He told the Daily News he has relationships with "30 to 40 doctors" in "Singapore, China, South Africa, the Philippines, Brazil, Peru"—places where people must opt out if they don't want their organs harvested when they die.
The policy, called "presumed consent," is illegal in the United States. But, Cohan insists, "6,000 a year would not die in this country if we had presumed consent."
Many legitimate experts agree. But none condone Cohan's practices.
"Cohan is notorious," said Nancy Scheper-Hughes, director of Organs Watch, a nonprofit watchdog group. "He is part con man and part zealot."
According to Dr. Kim Solez of the Nephron Information Center, which provides information to kidney transplant patients, Cohan obtained the group's membership list and bombarded members with postcards and E-mail solicitations.
The New York Organ Donor Network, the California Medical Association and the Association of Organ Procurement Organizations have filed complaints about Cohan. In 1998, he was arrested in Italy for allegedly trying to broker a kidney transplant. While he was behind bars, FBI agents raided his office in Los Angeles.
None of the charges stuck, but Cohan remains a shadowy figure.
He is not a physician, and he concedes he does not personally know most of the transplant doctors he says are affiliated with him.
"It's about telephone relationships," he said. "I really don't know them until I've worked with them a few times. I just put them in contact with perspective recipients."
In the past 10 years, Cohan says, he has arranged some 350 transplants, most by U.S-trained doctors. Although he says that, "I've never had a problem," he can't provide the names of any of his success stories.
Cohan says he gets "only a few thousand dollars" from the transactions and that he earns his living primarily as a nutritionist. He boasts a degree from Donsbach University School of Nutrition. The nonaccredited school was founded by Kurt Donsbach, a health huckster with a long rap sheet.
But Cohan thinks big. "I have begun working on gene therapy, and I will coordinate human cloning when it becomes available," he told The News.
