Aliaksei Yafimau shudders at the memory of the burly thug who threatened to kill his relatives. Yafimau, who installs satellite television systems in Babrujsk, Belarus, answered an advertisement in 2010 offering easy money to anyone willing to sell a kidney.
He saw it as a step toward getting out of poverty. Instead, Yafimau, 30, was thrust into a dark journey around the globe that had him, at one point, locked in a hotel room for a month in Quito, Ecuador, waiting for surgeons to cut out an organ, Bloomberg Markets magazine reports in its December issue.
The man holding Yafimau against his will was Roini Shimshilashvili, a former kickboxer who was an enforcer for an international organ-trafficking ring, according to evidence gathered by police in Kiev. Yafimau says that when he pleaded with Shimshilashvili to let him get out of the deal and go home, the big man sliced the air with Thai-boxing moves and threatened him.
“He said if I didn’t go through with it, he would leave me in Ecuador and kill my family,” Yafimau says.
Doctors removed Yafimau’s left kidney in July 2010 and transplanted it into an Israeli woman, according to the Kiev police investigation. On the plane back to Belarus, on the western border of Russia, Shimshilashvili told Yafimau that if he wanted to live, he shouldn’t talk to police.
“I am afraid for my life,” says Yafimau, standing outside his mother’s Babrujsk apartment building, a nine-story, Soviet- era edifice that’s surrounded by weeds and trash. The traffickers paid Yafimau $10,000. He says it wasn’t worth the fear that haunts him today.
Violence and Coercion
Yafimau is one of the faceless and neglected victims in a sprawling global black market in organs -- where brokers use deception, violence and coercion to buy kidneys from impoverished people, mainly in underdeveloped countries, and then sell them to critically ill patients in more-affluent nations.
The middlemen form alliances with doctors in leading hospitals who do these transplants for a fee, no questions asked.
Organ trafficking is on the rise, as desperate people seek transplants in a world that doesn’t have enough donors. About 5,000 people sell organs on the black market each year, according to Francis Delmonico, an adviser on transplants to the World Health Organization.
It’s against the law to buy or sell an organ in every country except Iran, says Delmonico, who is president-elect of the Montreal-based Transplantation Society, which lobbies governments to crack down on illicit procedures.
“There have been successes fighting organ trafficking around the world,” Delmonico says. “But organ trafficking continues to flourish because criminals exploit shortages of organ donors.”
Bloomberg Markets reported in June that U.S. citizens and others from the Americas suffering from kidney failure were going to Nicaragua and Peru to buy organs in a shadowy trade that injured and killed donors and recipients.
That U.S.-Latin American connection is dwarfed by a network of organ-trafficking organizations whose reach extends from former Soviet Republics such as Azerbaijan, Belarus and Moldova to Brazil, the Philippines, South Africa and beyond, a Bloomberg Markets investigation shows.
Many of the black-market kidneys harvested by these gangs are destined for people who live in Israel.
Not Enough Donors
With a generally well-educated population of 7.4 million and a modern medical system, Israel has an acute shortage of organs, in part because of religious beliefs. Just 12 percent of Israelis are registered donors, meaning they have consented to let their organs be used for transplants after they die, according to the Israeli National Transplant Center.
That compares with 40 percent of Americans. About 730 Israelis are currently waiting for a transplant, which is 13 times more than the number of such surgeries performed legally in Israel in 2010, according to the center.
Delmonico, a professor of surgery at Harvard Medical School, has spent the past six years lobbying governments and doctors around the world to combat organ trafficking. He says Israel’s government is cracking down.
The Knesset, Israel’s legislative body, passed the Organ Transplant Law in 2008, setting penalties, including imprisonment of up to three years, for buying and selling organs and requiring hospitals to scrutinize transplants by nonrelatives and foreigners.
Breaking up Gangs
In an effort to draw more legal organ donors, the law also offers volunteers compensation for lost wages and travel expense and provides them with additional health insurance. Israeli police have been among the most aggressive in the world against organ traffickers, breaking up three international gangs since 2008.
The government has also banned insurers from funding most transplants outside Israel.
Investigators on five continents say they have uncovered intertwining criminal rings run by Israelis and eastern Europeans that move people across borders -- sometimes against their will -- to sell a kidney.
“The criminal here is the middleman who profits from the sick and the poor,” says Bahat, who investigated an organ- trafficking ring in Jerusalem. “It touches my heart that people will sell part of their body because they need money to live.”
Criminals see an opportunity to make big money in the organ trade, where they can sell a kidney for 15 to 20 times what they pay, police throughout Europe say.
“They recognize the obscene profit that can be made in the expanding black market in body parts,” says Jonathan Ratel, a Pristina, Kosovo-based prosecutor who has been investigating organ trafficking over the past two years. “It keeps happening because there is so much money in this.”
Traffickers typically pay $10,000 to a seller for a kidney and collect $150,000 when selling it to a patient.
Traffickers prey on the most-vulnerable people. Moldova, the poorest country in Europe, is one of their prime hunting grounds.
Dorin Razlog, a shepherd with an eighth-grade education who lives in Ghincauti, says recruiters for a trafficking ring told him cash for a kidney would lift him out of poverty. After doctors in Istanbul cut out the organ in August 2002, they paid him $7,000 -- $3,000 less than they’d offered. Of that, $2,500 was in counterfeit bills, he says.
Writhing From Pain
“They told me they would send people to destroy my house and kill my family if I went to the police,” Razlog, 30, says. Today, the money is long gone, and he sleeps on a musty mattress inside the rusting hulk of an abandoned Russian van next to a pigsty. At the end of some days, Razlog says, he’s writhing from pain in his remaining kidney.
“The only way out is death,” he says.
The Ukrainian Interior Ministry broke up the ring that bought Razlog’s kidney and arrested its leader -- a Ukrainian- born Israeli national -- in 2007.
In Mingir, Moldova, the organ black market cost a man his life. Vasile Diminetz, a frail retired farmer, says his son Vladimir grew ill after a broker bought his kidney in Turkey for $2,000 in 1999.
Haunted by Memories
Vladimir died in 2003 at the age of 25, after his remaining kidney failed, according to the Renal Foundation of Moldova, which has documented dozens of cases of organ trafficking.
Vasile, 70, stands outside the stone cottage where he lives alone, haunted by the memories.
“If I only knew, I could have saved my boy,” he says. “Maybe I could have done more, and I will regret that until I die.”
Prosecutors in nine countries have been conducting criminal probes of organ trafficking involving Israeli patients since 2003. The largest case dates to that year, when the Brazilian Federal Police noticed people from two slums of Recife, a coastal city 2,110 kilometers (1,311 miles) from Sao Paulo, flying to Durban, South Africa.
They returned home in so much pain from incisions across their abdomens that they needed assistance to get off the plane, says Karla Gomes de Matos Maia, the investigator who led the probe.
‘Suspect Organ Trafficking’
“Here you had people who didn’t fit the profile of tourists going to a strange destination and coming back after having major surgery,” Maia says. “We began to suspect organ trafficking.”
The Brazilian case is still wending its way through international courts. In November 2010 in Durban, Netcare Ltd. (NTC) -- South Africa’s largest hospital company -- pleaded guilty to violating the Human Tissue Act, which prohibits buying and selling organs.
Netcare paid 7.8 million rand ($848,464) in fines and penalties. It admitted to allowing 92 transplants in which donors from Brazil, Israel and Romania sold kidneys to Israeli patients. Four doctors are awaiting trial on trafficking charges.
In Brazil, 12 people connected to the Netcare case were convicted and jailed, with sentences from 15 months to 11 years.
In Kosovo, Ratel, who has dual citizenship in Canada and Great Britain and was appointed by the European Union to help restore the country’s criminal justice system, is overseeing a pivotal organ-trafficking case. It includes participants and victims from Belarus, Moldova, Turkey and four other countries.
Center for Trafficking
The EU has administered the courts in Kosovo since 2008, the year the country the size of Connecticut declared independence from Serbia after a civil war. Ratel, who arrived in March 2010 as part of the European Union Rule of Law Mission in Kosovo, says the country has become a center for organ trafficking.
Ratel built a case against nine doctors, hospital administrators and recruiters on charges of buying and selling kidneys for patients in Georgia, Germany, Israel, Poland and Ukraine, as well as Canada and the United States.
The trial began in October and is expected to continue into 2012. He has sought assistance from investigators in 11 countries in the case.
Ratel says he’s stunned by the callousness of the criminals who run the organ rings. Traffickers in Kosovo threatened one kidney seller with death if he testified in court, so the court had the man placed into a witness protection program.
‘Threats of Violence’
“This is organized crime,” Ratel says. “There is significant coercion and threats of violence.”
Organ traffickers search the world for hospitals willing to perform illicit transplants. Sometimes, sellers are flown to cities just to wait for procedures, and then traffickers move them to other parts of the globe when they find a recipient and a hospital willing to cooperate.
While the illegal organ trade may be run by seasoned criminals, it depends on the complicity of doctors and hospitals, says Oleg Liashko, a member of Ukraine’s parliament.
“I doubt this could happen without the hospital and doctors knowing about it,” says Liashko, who has investigated organ trafficking and is calling for more-severe criminal penalties in organ transplant laws. “They either know or look the other way because of the money involved. This is corruption, pure and simple.”
Doctors must be held criminally accountable when they perform surgery with an organ that’s been sold, Ratel says.
“Ignorance is not a defense,” he says. “That is willful blindness. A doctor involved should know all the relevant facts, including whether the donor is a blood relative or not.”
People have two kidneys that filter toxins out of the bloodstream. A patient with failure in both kidneys will die quickly unless he or she is hooked up to a dialysis machine or gets a transplant.
Transplants prolong lives, and patients who receive organs from living donors have better survival rates than those who receive organs from deceased donors.
Of patients who get organs from a living donor, 90 percent survive at least five years; for those receiving an organ from a dead donor, the figure is 82 percent, according to the Washington-based Organ Procurement and Transplantation Network. Legitimate organ donors are usually relatives of the patient.
In Israel, an unresolved religious debate hampers organ donation -- from both the living and the dead. Rabbi Yosef Shalom Elyashiv, a leading arbiter of Jewish law in Israel, advises that donating body parts violates religious tradition, which holds that upon death, a body should be buried intact.
“It is not permitted to remove any organ,” Elyashiv, who’s 101 years old, said in a public statement in March 2008.
Shmuel Eliyahu, the chief rabbi of Safed, Israel, is leading a drive to get 100 colleagues to sign a document advocating organ donation. He says the Torah tells people to help others when they can, especially if it means saving a life. He says donating an organ is a mitzvah, or good deed.
“I hope that many more Jews will become part of the organ donation network,” Eliyahu says.
Aliaksei Yafimau has never been to Israel. He says he was drawn into the organ-selling business in Belarus in 2009. Yafimau, a wiry man with gray eyes and close-cropped blond hair, wanted cash to win back an ex-girlfriend, he says. So he answered an Internet advertisement offering cash for organs.
Two Ukrainian recruiters for the Kiev ring -- Ruslan Yakovenko and Ievgen Sliusarchuk -- told Yafimau by e-mail that selling a kidney was a painless way to earn $10,000, according to an October 2010 indictment.
“They lied to me,” Yafimau says.
After an exchange of e-mails and phone calls, the traffickers wired Yafimau $100 to buy a ticket on an all-night train to Kiev. Yakovenko and Sliusarchuk took him to a one-room apartment in Kiev, where two other kidney sellers were staying, he says. That was a base for men and women waiting their turn to sell a kidney, according to Yafimau.
In mid-June 2010, the traffickers told Yafimau they had found an Israeli woman who would buy his kidney and the transplant would be done in Ecuador, 11,000 kilometers west of Kiev. The gangsters had Yafimau fly from Kiev to Quito, with a stopover in Amsterdam.
In Quito, he met two other organ sellers and Shimshilashvili, the stocky former kickboxer, according to the Ukraine criminal case.
‘Locked in That Room’
When they arrived in Quito, on June 26, 2010, Shimshilashvili confined the three organ sellers to a small, cream-colored unit at Lugano Suites, a nine-story hotel, Yafimau told investigators.
“We were locked in that room with him, and he watched us all the time,” Yafimau says in Russian, his first language. “He wouldn’t let anyone go outside alone, and we didn’t have any money.”
They spent the time sleeping and watching so much television in Spanish that they picked up some of the language. As they waited, their minders took them often to Metropolitano Hospital for medical tests, Yafimau says.
Soon, a 55-year-old Israeli woman suffering from kidney failure arrived from Tel Aviv, documents in the Ukrainian investigation show. The traffickers put a sworn statement -- in English, Spanish and Russian -- in front of Yafimau and told him to sign it, saying he was voluntarily donating a kidney.
‘I Can’t Investigate’
They took him to Metropolitano Hospital, where kidney specialist Gustavo Salvador sat down with Yafimau. Salvador, who did his medical training at Central University of Ecuador, says Yafimau showed him the document saying he wanted to donate a kidney.
“If someone comes to me and says, ‘I come to voluntarily say that I want to donate,’ then that’s as far as we go,” says Salvador, sitting in an office adorned with Salvador Dali prints. “I can’t investigate the life of the person. That’s not my job.”
Salvador says he was paid $800, his normal fee for referring a patient to a surgeon.
Surgeons removed Yafimau’s left kidney on July 27, 2010, documents compiled by Ukrainian police show.
The Ecuadoran government began an investigation into organ trafficking in 2010 and found 11 cases of transplants of kidneys from mostly Ukrainian donors to Israeli patients since 2009, says Diana Almeida, the director of the nation’s organ transplant agency.
The probe, which is looking into Metropolitano Hospital, led Ecuador’s congress in March 2011 to pass a law banning foreigners from having transplant procedures in the nation’s hospitals. No one at Metropolitano has been charged.
Alfredo Vega, Metropolitano Hospital’s medical director, says in an e-mailed statement that the hospital hasn’t broken any laws and can’t talk about transplant cases because of patient privacy concerns.
“We want to make it clear that we reject any claims of wrongdoing by Metropolitano Hospital or its employees,” he says.
Damage from the international organ trade extends beyond the donors.
In Belarus, Karina, a thin 22-year-old woman with short blond hair, sits in her kitchen, weeping about her husband, Sasha. Prosecutor Ratel placed her husband in witness protection, and the District Court of Pristina on July 12 prohibited publication of the family name.
‘I Don’t Know’
Sasha left his family suddenly after he agreed to sell a kidney to the same gang that bought Yafimau’s organ. That ring worked with another gang in Kosovo led by an Israeli of Turkish descent, investigators in Ukraine and Kosovo say.
“I don’t know where he is,” Karina says, whose cramped apartment is in a country that suffered widespread poisoning from radioactive fallout caused by the Chernobyl nuclear disaster 25 years ago. “I don’t know if he’s OK, sick, anything.”
As her 2-year-old daughter plays in a corner, Karina describes how her world began to fall apart in late 2008. Sasha, 29, wanted cash to pay off debts, she says. One day, he told his wife that he’d found work abroad and was leaving home for that reason. The truth was that he had answered an Internet ad offering $10,000 for a kidney.
What followed was a frenzied journey across eastern Europe, from Belarus to Istanbul and, finally, to a hospital in Pristina, Kosovo, according to investigators. He had been recruited by Yuri Katzman, a Belarussian-born Israeli.
Lying at the Border
Halfway into the journey, Katzman handed Sasha over to an organ-trafficking gang led by Moshe Harel, an Israeli who was born in Istanbul, according to charges filed in Kosovo. Sasha landed in Pristina on Oct. 26, 2008. Katzman had told Sasha to lie to border guards, claiming he was getting treatment for a urinary tract infection, according to the Kosovo criminal case.
A man working for Harel rushed him to Medicus, a private clinic in a small, run-down building in Pristina, where doctors ordered him to shave his own pubic area and put on a green smock. They took him into surgery and a Turkish surgeon removed Sasha’s kidney, according to the criminal charges.
The surgeon transplanted the organ into an elderly Israeli man who lives in New York, according to the court case. Sasha awoke in pain after the procedure, and when he looked at his belly, he saw a surgical drainage tube coming out of a long incision, according to the charges. The doctor is free on bail, as the Kosovo trial continues.
Two days later, Katzman paid Sasha $8,000 and minders hustled him onto a flight back home, according to court-filed documents.
24 Illegal Transplants
Doctors performed 24 illegal transplants at Medicus Clinic in 2008, for patients from Canada, Israel, Germany, Poland and the U.S. who paid for the life-saving operations, according to the Kosovo criminal charges. Ratel’s office accused Harel on June 6 of leading that organ-trafficking gang.
Harel was released on bail, and prosecutors say he fled to Israel. Harel, 61, who is wanted by Interpol, couldn’t be reached for comment.
Back home, after the surgery, Sasha slid into a reclusive life of depression and heavy drinking, his wife says. Finally, he abandoned his family. What his wife didn’t know was that Sasha’s descent came as thugs were threatening his life. That’s why Sasha, who is the principal witness in the Kosovo case, is being protected by the court.
Across Eastern Europe
The gang that bought Sasha’s kidney used a system to move other sellers across eastern Europe to hospitals willing to participate in their scheme, according to the indictment by Ukraine’s Interior Ministry. Doctors performed at least 18 transplants for the ring for patients from Israel, Ukraine and Georgia, according to the Ukrainian indictment of the surgeon.
Katzman recruited two men with promises that having a kidney removed was as safe as an appendectomy, court records show.
In September 2009, Renat Abdullin, a computer programmer from Tashkent, Uzbekistan, traveled to Kiev, where he waited in an apartment in Akademmistechko, a sprawling, garbage-strewn slum. It was one of three apartments in Kiev that traffickers used as a way station for kidney sellers, documents in the criminal case show.
‘A Way to Make Money’
Abdullin says six other people from across eastern Europe came and went as buyers were found for their organs.
“They saw us only as a way to make money,” says Abdullin, 28, a thin, bespectacled man with pale skin and dark hair. Katzman told Abdullin within a week that he’d found a recipient for his kidney in Baku.
Abdullin and Andriy Kuleshov, a former professional gymnast from Bila Tserkva, Ukraine, went to the Kiev airport and met Ukrainian vascular surgeon Vladyslav Zakordonets, the two men say.
In Baku, the organ traffickers ran into a snag. They lost a suitcase carrying drugs needed for the transplants. The traffickers kept the organ sellers in a room at ABU Clinic for three days as Zakordonets sent to Kiev for more drugs, according to evidence gathered in the Kiev criminal case.
“When I saw the hospital, I wanted to backtrack,” Abdullin says. “But I didn’t have any money for the tickets back, and I was afraid.”
‘So Much Pain’
Once the drugs arrived, Zakordonets removed a kidney from each man. Three days later, Katzman took the two men from the hospital to the Baku airport, along with Zakordonets, Abdullin and Kuleshov say.
“I was in so much pain, I could barely sit, but no one seemed to care,” Abdullin says. On the five-hour flight to Kiev, Kuleshov sat next to an anesthesiologist who assisted in the surgery, Kuleshov says. “Of course, the doctor knew what was going on,” he says.
Zakordonets is now in Lukyanivskyi Detention Center in Kiev, where he’s been jailed on human-trafficking charges with Katzman and four other men since October 2010. The doctor says in a written statement from jail that he performed about 40 transplants in Baku, starting in May 2009.
He says he never met the patients until the day of the operation and didn’t know donors were paid.
“It was an opportunity to work at an international level, an opportunity to grow in my profession,” he says. “I have not been a human trafficker.” The case isn’t yet scheduled to go to trial.
First U.S. Prosecution
The Israeli-eastern European organ-trafficking rings have also extended their reach to the U.S. In July 2009, the Justice Department charged Levy Rosenbaum, an Israeli living in New York, with conspiracy to commit human organ trafficking.
A Federal Bureau of Investigation agent says he caught Rosenbaum, who lives in Brooklyn, New York, offering to sell a kidney for $160,000. Rosenbaum was the first, and so far the only, person arrested for organ trafficking in the U.S. since the activity was outlawed in 1984.
Rosenbaum, 60, pleaded guilty on Oct. 27 to brokering the sale of human kidneys. Free on bail, he could be sentenced to five years in prison. He declined to comment.
Rosenbaum worked with Sammy Shem-Tov in Jerusalem to lure young men and women to sell kidneys, according to Avichai Osuna, who says he was recruited to sell a kidney by both men.
Osuna, an unemployed 27-year-old man in Be’er Sheva, a city in the Negev Desert south of Jerusalem, moonlighted as an apprentice for Shem-Tov, before he became a seller. Shem-Tov paid Osuna 1,500 shekels ($410) a month to use his ability to speak English to arrange illegal organ transplants with foreign hospitals, Osuna says.
‘Off My Back’
Shem-Tov, 67, asked Osuna to sell his own kidney in June 2008, says Osuna, a heavyset man who wears an earring in his left ear.
“Just to get him off my back and because I needed a little cash, I said all right,” he says.
Soon, Osuna told Shem-Tov that he had changed his mind, concerned about the dangers of giving up an organ, according to Shem-Tov’s indictment in Jerusalem District Court.
Late one evening, Shem-Tov called Osuna to a meeting in Be’er Sheva. Next to him were two men Shem-Tov described as mafia enforcers, the indictment says. Shem-Tov told Osuna that if he didn’t sell a kidney, he’d be in debt to the two men and the mafia group, the indictment says.
“He said, ‘You don’t want to back out now,’” Osuna says. “I felt trapped.”
Shem-Tov flew him from Tel Aviv to New York on July 31, 2008, because the trafficker thought he could arrange a transplant in New York, according to Shem-Tov’s indictment. Rosenbaum met Osuna at the gate and took his mobile phone and passport.
He had Osuna and other prospective organ sellers housed and constantly watched by a minder in a house near Brooklyn’s Prospect Park.
Rosenbaum kept Osuna waiting for six months, Osuna says. While in New York, Rosenbaum brought Osuna to Mount Sinai Medical Center for a blood test, Osuna says. Sander Florman, director of Mount Sinai’s Recanati/Miller Transplantation Institute, says the hospital does all it can to avoid illicit procedures.
“We make them jump through incredible hoops,” he says. “We have all the rules. People find ways around them.”
Threats of Retaliation
The transplant recipient backed out, and Osuna says Rosenbaum sent him back to Israel. A year later, Shem-Tov flew Osuna from Israel to Manila. Osuna tried again to cancel the deal, and his minders threatened him with mafia retaliation, the indictment says.
He says he felt trapped, and a few days later was taken to Cardinal Santos Medical Center. Surgeons removed his left kidney on Oct. 21, 2009, the indictment says.
Four days later, Osuna was on a flight back to Israel, and the recipient, a Tel Aviv man, paid him 94,000 shekels ($26,000). Osuna says he couldn’t recover in peace, for fear of what would happen when he got home.
“When I look in the mirror and see that scar, it’s a daily reminder of what I went through,” he says. “I feel this raw grievance inside.”
Cardinal Santos Ethics Committee Chairman Juanito Billote says the hospital can’t comment on specific cases to protect patient privacy. The hospital scrutinizes every transplant to ensure it complies with all laws, he says.
‘We Make Sure’
“In doing any foreign-to-foreign transplant, we make sure that the rules are adequately addressed,” he says.
The laws and rules designed to prevent the trafficking in organs aren’t working. While prosecutors in places such as Israel, Brazil, Kosovo and Ukraine have successfully crippled some of the organ-trading gangs, they’re fighting powerful economic forces.
As long as there’s a worldwide shortage of legal donors for life-saving transplants, the exploitation of the poor will only grow, Kosovo-based prosecutor Ratel says.
“There’s burgeoning organized-crime activity in trafficking of human organs,” he says. “It will take serious efforts by governments and hospitals to stop it.”
Governments around the world need to cooperate to enforce existing laws on illicit procedures, Harvard’s Delmonico says. Nations have to ensure they have systems making it safe and easy for people to donate voluntarily, he says. Unless that happens, the traffickers will continue to cultivate a growing legion of impoverished organ sellers who can end up with a quick infusion of cash -- and a lifetime of humiliation, pain and illness.
To contact the reporters on this story: Michael Smith in Santiago at Mssmith@bloomberg.net
To contact the reporter on this story: Daryna Krasnolutska in Kiev at email@example.com