IoS investigation: Shortage of kidney and liver donors creates new international transplant trail

British patients with kidney and liver failure are being invited to buy replacement organs from living donors abroad by a broker who is promoting transplant operations in the Philippines, according to a charity.

The anonymous broker is offering the organ transplants at an undisclosed price via the website It was highlighted by the charity Organs Watch, which monitors the trade, as one of the first seeking European customers. A Filipino kidney can be bought for $1,300 (£780) and the operation is carried out in a private hospital in Manila, the charity says.

Yesterday the website, which gives a telephone number in the Netherlands but is registered in Paris, declared: "You can travel to us for our surgeon. Live donations gives [sic] the best match. Things for the donor are legal." It singles out the US and the UK as countries where there is a shortage of donor organs.

The website does not give the costs of the operation or the surgeon's fee but says patients will need $1,000 for the round-trip ticket, between $400 and $1,800 a month for accommodation and $200 for a pre-paid mobile phone. It says the average wait for the operation is two weeks.

In response to an inquiry to the website, The Independent on Sunday received an emailed reply, signed by Mitch Michaelson, which said the website was about "getting transplant surgery, not selling organs". It added that live donor transplants were permitted "as long as you follow the rules" and that the arrangements made by were "within the legal structure of the Philippines and their regulations".

Elizabeth Ward, president of the British Kidney Patient Association, condemned the trade. "I am absolutely horrified and sickened. It shouldn't be allowed." She said it was immoral to put live donors in poor countries under pressure to give up their organs when there was a ready but untapped supply from cadavers in this country. "There is not enough pressure on the Government to change the law to prevent these organs being burned and buried."

The route from Europe and the US to the Philippines is only one on the transplant trail. The international trade in human organs is growing as wealthy patients in the West are turning to countries in the developing world where they can buy kidneys on the black market, despite an international ban on trafficking in human organs.

A donor can live a normal life with one kidney and can also give up part of the liver without harm, but there are risks involved in the operations.

Other transplant trails identified by Organs Watch, based at the University of California, Berkeley, include that followed by Israeli patients who fly to Turkey, where they are matched with kidney sellers from Moldova and Romania.

Brokers in Brooklyn, New York, posing as a non-profit organisation, traffic in Russian immigrants who provide organs to foreign patients. They are transplanted in some of the best medical facilities on the east coast of America, according to Nancy Scheper Hughes, a founder of Organs Watch.

She has also identified a Nigerian doctor/broker who links wealthy American patients with poor Nigerian kidney sellers for operations either in South Africa or Boston. In Britain, as elsewhere, the trade is fuelled by the desperate shortage of organs available for transplant. A survey of UK transplant units conducted by specialists at Queen Elizabeth Hospital, Birmingham, last year found 29 NHS patients had travelled abroad to buy kidneys illegally. In more than half the cases the kidney failed and more than a third of the patients died.

Kidney failure is a particular problem among Asians who represent 4 per cent of the population but 14 per cent of those on the waiting list for kidneys. Patients from British-Asian families are among those who have gone to India to buy organs. But the donors, who are mostly poor, may be duped into agreeing to the operation.

A 16-year-old boy from the Punjabi capital Amritsar, interviewed for BBC Radio 4's File on Four, described how he was taken to a safe house near a hospital and introduced to the patient he was being paid to help - without being told the truth. "I'd been told I was donating blood but the doctor said he had removed a stone," he said. "It was when I left hospital I found out they had removed my kidney."

A police investigation into at least 2,000 questionable transplants in and around Amritsar found that 22 donors had died after giving their kidneys. A leading doctor has been accused of culpable homicide.

To curb the trade and boost the supply of organs in Britain, specialists have suggested radical measures to attract living donors. Last week Professor Nadey Hakim, of St Mary's Hospital, London, who is president of the Royal Society of Medicine's transplant committee, suggested payments of up to £2,000 could help to persuade donors to come forward. "If it's done safely the donor will not suffer," he said.

The Department of Health is due to publish a White Paper on organ donation following a consultation paper last year which outlined a number of ways of boosting transplants.

Banned in Britain

The sale of organs was banned in Britain in 1989 after three doctors who offered kidney transplants using paid Turkish donors were found guilty of serious professional misconduct by the General Medical Council.

Despite the ban the trade continues, fuelled by the shortage of organs. About 7,000 patients are waiting for kidney transplants in the UK but only 3,000 operations are conducted each year. Some kidney patients spend years on dialysis before a replacement organ becomes available.

The number of kidneys available has been falling because safer roads have led to a steep decline in fatal accidents, one of the main sources of cadaver organs. The growing recognition that kidneys taken from living donors are more successful, doubling life expectancy to 20 years, is also driving the trade.

Last year Bhagat Singh Makkar, a London GP, was struck off the medical register for offering to procure a kidney for a patient, and a second GP, Jarnail Singh from Coventry, was suspended from the register after being found guilty on a similar charge. Jarnail Singh was reinstated to the register in April.

Both doctors were exposed by undercover reporters from a Sunday newspaper posing as patients seeking a kidney for the father of one of them.

Three years ago Mick Taylor, 26, a dialysis patient from Halifax, Yorkshire, who won £4.1m on the National Lottery, was inundated with offers after he said at a news conference that he would swap his winnings for a new kidney.

A small but growing number of transplant surgeons around the world say the sale of organs should be made legal to improve the supply and to safeguard those involved, given the desperation of patients and the readiness of donors to sell their body parts on the black market.

One suggestion is that governments could control the trade by inviting living donors to donate kidneys to a "pool" in return for payment. The organs would be allocated from the pool to the most suitable recipient and the safety of the donors would be assured by careful screening and monitoring of their care.

Governments could have an interest in such a scheme because of the huge cost of maintaining kidney patients on dialysis: £20,000 to £30,000 a year, double the cost of maintaining a transplant patient and for a worse quality of life.

Case study

Jennifer Ainsworth scans the website that promises to change her life. The 44-year-old mother of two has had to live with kidney failure for the past seven years. She needs constant dialysis treatment and has been waiting for a kidney transplant for the past five years. But the website raises more concerns than interest.

"This is clearly a hard-sell website and is not done out of any altruistic motives," said Jennifer, an office worker from Glasgow, who was diagnosed with kidney failure as a result of systemic sclerosis.

"There is no way I would go to doctors I didn't know or contemplate going abroad to buy a kidney, but I can see how others might be tempted. A commercial site like this just shows how dire the problem is becoming in finding donors." Jennifer is faced with the prospect of never again being able to lead a "normal" life. Everything she, her husband George and their two teenage children do revolves around her medical care three times a week at Glasgow Royal Infirmary.

"What we need in this country is an opt-out system where everyone can be considered a donor unless they carry a card expressly wishing that their organs are not used for transplant," she added. "This site plays on the desperation of people, especially liver patients, who face death unless they get a transplant."

Paul Kelbie