The dark world of the kidney trade25.04.07
Evening Standard
This week a man became the first in Britain to face jail for trying to sell a kidney. And as this Mail investigation reveals, he's by no means the only one:
The young man sitting opposite me appears tense as he puts down his cup and leans across the table towards me. "I'm willing to sell you my kidney," he says, "for £75,000, plus medical expenses."
The proposal is as desperate as it is disturbing. And it's made all the more alarming because our meeting point is not a dimly lit backstreet in India or Pakistan - the conventional trading posts for such transactions - but a popular cafe in Bridlington, Yorkshire.
Dan, an architecture graduate, is willing to risk his life by putting his kidney up for sale on eBay. "Buy my kidney," his advert read. "I'm a fit, healthy 24-year-old who hardly drinks". Bidding started at £60,500.
Although website regulators had spotted his ad and removed it within hours, dozens of people had already replied to him. I was one of them - posing as the wife of a desperately ill man who needed a transplant.
Selling body parts for transplant is illegal in most countries, including the UK, but increasing numbers of people are doing it. A macabre black market has sprung up, with the internet often facilitating the transactions.
In fact, it's become such big business that some organisations are setting themselves up as 'transplant co-ordinators'.
With organs selling for as much as £100,000, potential donors can make a small fortune. But despite the often huge financial rewards, the risk of even offering an organ - let alone going through with the operation - is considerable.
Just ask Daniel Tuck. This week, the 25-year-old from Birmingham became the first person in Britain to be charged with trying to sell a kidney on the internet.
He had posted an advertisement on a website for dialysis patients in a bid to pay off £24,000 worth of debts. It read: "I am a white male of completely perfect health. Why risk getting a kidney from a Third World country? You don't have to!"
He was caught and pleaded guilty to 'inviting the supply of human tissue for transplant' and faces up to three months in jail and a £5,000 fine.
But it seems even a jail sentence will not deter my potential seller. In the cafe in Bridlington, Dan, a boyishlooking lad with a thick Yorkshire accent, has agreed to meet me to talk 'details'.
He has already acknowledged that what he's doing is illegal and - in an e-mail - advises that bids will be called 'expenses' rather than payment.
When I contacted him, he assured me he was serious and demanded £10,000 simply to undergo tests to confirm whether or not he was a match for the putative recipient. If he was not, he said, the £10,000 was not refundable.
If he was a match, he wanted the balance to be paid before the operation went ahead. He also demanded all his private medical costs, transport and accommodation be met by the buyer.
Within days, he e-mailed again, claiming to have had an offer for £72,000 from an American couple, adding: "This offer was great, but I don't know how comfortable I would be having such extreme surgery abroad and away from family.
"Think you will be glad to hear that I would prefer to undergo the procedure in the UK rather than the States, and am therefore more inclined to accept your offer (once I know what it is!)."
Which is how I come to be sitting opposite Dan on a drizzly, windy day in Bridlington. "I'm destitute," he tells me when I ask him what motivates him to make this astonishing offer.
"I owe about £25,000 and I'm being taken to court. I'm homeless and jobless. I'm sleeping on friends' floors at the moment and at my mum's and dad's places.
"I decided to do this after seeing something on the news about it a few weeks ago. I looked into it and found out you can donate your corneas, kidney or some of your liver.
"I thought the kidney would be best because you can live with just one. I know something could go wrong with the surgery, or the one kidney I've got left could fail, but that's a chance I'm willing to take."
Dan tells me he is paying a mortgage on a house he bought in Sheffield, and spent a lot of money buying furniture for the place. He goes on to tell me he had given up his job at a joinery company and fled back home to Bridlington just after Christmas.
"I'm desperate to get out," he says.
"There are no jobs here. I went to the Jobcentre the other day and there were only three jobs - all for care homes and paying the minimum wage. If I stay here, I'll never be able to buy a house or even take a girl out for the evening again.
"My mum is against me selling my kidney and was saying things would get easier. Buy why wait? I can sell this now and use the money for a deposit on a house and a better life. I can enjoy it while I'm young.
"I do feel guilty about how much money I'm asking for - but I'm not selling drugs or robbing old grannies. And I am doing something to help someone. They need my kidney to live."
Dan, whether his true motivation is desperation or greed, seems to have thought the plan through step by step.
"The reason I've asked for £10,000 upfront and unrefundable is because if I had to undergo tests to see if I was a match, they might be invasive and leave me scarred.
"And if I wasn't a match and had to give back the money, I would have nothing. The same applies if the person died before I could donate."
As the law stands, only relatives and friends of those requiring surgery can donate organs. But the lack of donor kidneys in Britain is so serious that one leading surgeon is now calling for the law to be changed so people can sell their organs.
Professor Nadey Hakim, president of the International College of Surgeons, says: "I'm convinced that the only way we can solve Britain's kidney crisis is by allowing the living to receive a substantial financial reward for giving one of their kidneys."
The demand is so great that desperate patients stuck on waiting lists for livers and kidneys are willing to pay almost anything to save their own lives.
Meanwhile, transplant tourism is booming. The World Health Organisation estimates that in 2004, ten per cent of the 61,000 kidney transplants performed around the world were the result of a traded organ.
Dr Luc Noel, head of the transplant unit at the WHO, says: "Organ transplant tourism has clearly blossomed in the past five years."
A brief look at the statistics is enough to explain the boom. While there are 8,000 people on the NHS transplant waiting list, just 3,000 operations are carried out each year.
A survey at the Queen Elizabeth Hospital in Birmingham in 2002 revealed that 29 NHS patients in the UK had bought a kidney and had it transplanted abroad. But in more than half the cases the organ failed and of the 29, one in three died.
Even more worryingly, a recent study found that one in eight patients who travel abroad - usually to Third World countries - for a kidney transplant is dead within two months.
Even so, many dialysis patients see such surgery as their only option.
Shoaib Quraeshi was told he would die in three months without a transplant after his kidneys failed shortly before Christmas 2004. The former chief finance officer of a large computer company, he was 58 when he decided he couldn't face years waiting for an organ.
Even though he is British, he would need an Asian kidney - something even rarer in this country as ethnic groups are less likely to carry donor cards because of the religious implications of giving away body parts.
"I decided I would do whatever it takes to fight for my life," he says. "This was not just desperation - it was massive desperation. There was a feeling of horror; of life and death. My life and my death.
"I decided I would take the transplant option. I would have offered money for a kidney in Britain, but I was told it was not legal.
"I understand the moral issues, but there is a great deal of hypocrisy surrounding it.
"While the government outlaws the sale and transplantation of organs, it is quite happy to receive money from the public by allowing 24-hour drinking, which ultimately can cause liver cancer. Where is the morality in that?"
At his request, doctors at his British hospital provided Mr Quraeshi with a detailed synopsis of his medical history - crucial for doctors performing a transplant overseas.
After researching the subject, he found Pakistan was the only suitable country where a kidney could be purchased legally. But when he travelled to Karachi, doctors there refused and he ended up in Lahore.
"Although time was running out, I checked out several hospitals before finding one I considered suitable," he says.
"In each case, I asked to see operating theatres and was dismayed at the lack of hygiene and inadequate provision for aftercare.
"At the hospital in Lahore, I was told I could buy a kidney from a live donor for £5,000. I told the hospital that I first wanted to meet the prospective donor, because I didn't want them to exploit some poor fellow whose life they might spoil.
"The hospital refused until I produced a briefcase containing the cash in U.S. dollars. They then reluctantly conceded I could meet the man - providing I did not ask the donor how much money he had received.
"In my opinion, they were crooks, so I asked the question anyway. The donor, a 28-year-old unemployed labourer, said the hospital had paid him £1,000.
"I was furious and I gave the man a further £5,000 in rupees. When he saw the money, he fell to the floor and cried. 'Listen,' I told him. 'You saved my life. You have made a very huge sacrifice for me.' Yet, despite his precautions, after his operation Mr Quraeshi suffered excruciating pain - with worse to come.
"At first my body rejected the transplanted kidney," he says.
"A further two operations followed to correct leakages, but by that stage I had had enough and wished I could die.
"I checked myself out of the hospital into a five-star hotel, then flew back to Britain against the advice of my Lahore surgeon. I was taken to the St Helier hospital in Surrey, where surgeons had to operate twice more to stop the leakage, which was caused by a gash in my bladder.
"In all, I had been treated for nine months and will be eternally grateful to the doctors and nurses here."
Despite his horrific experience, Mr Quraeshi says he would do it again. "It was a question of life or death," he says simply.
But it's not just Pakistan that helps foreigners buy kidneys. China is infamous for using prisoners as a convenient organ bank and attracts many transplant tourists. Nepal is also involved in the trade.
Around the world, only Iran legally operates a market in body organs - and even then only for its own citizens.
Saudi Arabia controversially passed a law last year that allows up to £7,000 to be paid by an organ recipient to an unrelated donor.
In Britain, live donors can be related or just friends. Of course, this can be exploited by people claiming to know each other when, in fact, money has changed hands, but transplant expert Keith Rigg, consultant surgeon at Nottingham University Hospitals NHS Trust, believes the system would spot such deals.
He says: "Before any transplant takes place, an independent assessor from the Human Tissue Authority comes in and speaks to both the donor and the recipient.
"They do this to make sure their stories corroborate and to get a feeling about how well the individuals know each other from how they interact. But, of course, where there's a will, there's a way.
"For the donor, the risk of death in a live kidney transplant is around one in 3,000. So with the financial incentives on offer, it is hardly surprising that so many people are prepared to make money out of others" suffering.
This week's conviction of Daniel Tuck, however, proves that the authorities are willing to stamp down on this dangerous and illicit trade to prevent a black market springing up in Britain.
Mr Tuck - and the young man who tried to sell me a kidney - may have seen it as a quick route to make money, but it seems they and others like them will be the ones who are out of pocket in the end.
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