Desperate Refugees Sell Their Own Organs To Survive

Organ trafficking is at an all-time high, and impoverished people fleeing war in the Middle East are among the most vulnerable, experts say

Syrian refugees at the Zaatari refugee camp in Jordan — REUTERS
Feb 24, 2017 at 2:47 PM ET

Mayar was just 17 when he left his family and his job at a cell phone shop in Idlib, a city in northwestern Syria, for Cairo, Egypt. Clashes between the regime and the rebels had torn his neighborhood apart, and he feared being forcibly enlisted to fight a war he didn’t support. Five years later, Mayar is among tens of thousands of Syrian refugees living in grinding poverty in Egypt. With no job or income, he’s turned to Facebook to find a buyer for one of the only things he has left to sell: his kidney.

“By God, I don’t know how much money I can make from my kidney, but I have no other solution,” said Mayar, whose last name has been omitted to protect his identity. “Life in Egypt is expensive.”

Mayar is one of a growing number of refugees scattered across the Middle East who are so desperate for cash that they are resorting to an illegal and dangerous practice: organ trafficking. Mayar hopes that by selling one of his kidneys, he’ll be able to pay bills, buy food for himself and his wife, and one day save enough to afford the perilous journey by sea to Europe — which can run upward of $1,000 per person — where he believes he can make a better living.

In January, Mayar posted an ad in the Arabic-language Facebook group “Sell Kidney Online,” describing himself as a “young Syrian man living in Egypt…O positive blood type… interested in donating my kidney in exchange for a monetary sum so that I may be able to survive my circumstances. Please reply as soon as possible.” A price list posted by the Facebook group’s administrator showed that prices ranged for as little as $650 for a kidney from Moldova to sums as high as $300,000 for a kidney in Singapore.

But with new ads appearing frequently across Facebook and other social media platforms such as Whatsapp and Viber, competition for sellers appears to be tight, and Mayar hasn’t yet found a buyer for his kidney.

Caption: Price list in the Facebook group where the price of a kidney varies from country to country, including the United States, China, Turkey, Kenya, and Yemen.

In Egypt, as in most other countries, the purchase of organs is illegal. But experts say that has done little to stem the highly lucrative trade as global organ shortages continue to grow. Of the 1 million people who need organ transplants, only 10 percent get them every year, according to the World Health Organization.

While the illegal organ trade has been around for decades in the Middle East, experts say it has boomed in recent years, fueled by the internet and, in many cases, organized crime networks looking to exploit a growing destitute underclass, including the growing number of migrants and refugees. For example, when Nuredin Wehabrebi Atta, an Eritrean people-smuggling kingpin, was arrested in Italy in 2014, he tipped police off to an elaborate criminal network trafficking drugs, arms and migrants from Africa to Europe. Those who were unable to pay for their voyages “were sold for €15,000 [more than $15,000] to groups, particularly Egyptians, who were involved in removing and selling organs,” Atta told police.

Official data on this shadowy world, which employs criminal rings as well as doctors and private hospital owners, is based on government sources alone and therefore incomplete. The only thing known for sure is that the illegal organ trade is flourishing worldwide, especially in Asia, Mexico, and other Latin American countries, Egypt, Pakistan, and India; with recipients most often coming from Canada, the United States, Western European countries, Australia and Gulf countries like Saudi Arabia.

Earlier this month, leaders of the international medical, legal and aid communities gathered in Rome for a summit on organ trafficking organized by the Pontifical Academy of Sciences of the Vatican. The participants urged cooperation between all levels of society to “combat these crimes against humanity through comprehensive efforts that involve all stakeholders around the world,” according to a published statement.

Here’s how organ trafficking typically works: Someone like Mayar posts an ad in a Facebook group, after which he is contacted by brokers on Whatsapp or Viber to negotiate the details and price. Once a deal is confirmed, the seller and buyer are transported to a surgeon, who is not necessarily an expert in surgeries involving organs but has agreed to perform the procedures for a bribe. The transplant often happens in facilities with lax safety protections. After the surgeries are completed, all parties return to their origin countries. But that doesn’t mean organ sellers get everything they were promised. In some cases, brokers refuse to pay them, leaving them with little recourse.

Traffickers exploit both sellers’ and buyers’ lack of understanding of the risks, experts say. For organ sellers, follow-up medical care is often a necessity following the donation procedure, but few have the means to obtain it. For sick organ recipients, transplants can fail, especially if performed by an ill-equipped surgeon.

“Victims won’t come to the police or to the hospital” because they often fear punishment for violating the law, said Aimee Comrie, an officer from the United Nations Office on Drugs and Crime Unit. “Traffickers are not using violence, people are signing up for their own exploitation.”

For law enforcement, the global organ trade is notoriously difficult to penetrate. It exploits a constantly shifting network of smugglers, forgers, violent criminals, doctors, impoverished people, and sick patients, all of whom have an interest to keep the industry under the radar. At one time, brokers recruited sellers through magazine ads; today, they merely require an internet connection. Regional operational hubs can be set up and torn down quickly enough to stay outside of the purview of the police.

Organ trafficking cases can be complicated and involve multiple countries, making prosecution even more difficult, experts say. “On the simplest level, if you’ve got three murders and six rapes to deal with and someone turns up with an organ trafficking case that takes years and crosses several jurisdictions—there’s just no chance,” said a European official working in an agency fighting organ trafficking, who requested anonymity because he was not authorized to speak to the press.

Some in the legal community have pushed for something called universal jurisdiction, which would grant a nation’s courts the power to try and punish perpetrators of particularly heinous acts for crimes against humanity regardless of where they occurred. But that idea is still deeply controversial and unlikely to become reality at a time when the world is putting up walls and global good will is in short order.

Myths and misinformation also contribute obstacles to rigorous prosecution, experts say. “When you mention organ trafficking to the general public, the connotation is what you see in Hollywood films: you’re a backpacker in India and you wake up in a bucket of ice,” said the European official.

According to the European Society For Organ Transplantation (ESOT), the average age of an illegal organ “donor” is 28.9 years old, from the world’s developing countries, earning an annual income of $480. The average organ recipient is 48.1 years old, from the world’s developed countries, with an annual income of $53,000. Observers say the illegal trade is only expanding as diabetes, obesity, and other ailments are causing kidney failure— a debilitating condition known as end-stage renal disease — to rise throughout the world.

While there are parts of the liver, the pancreas and intestine available on the black market, kidneys are the most in-demand organ. They can command a price of a few hundred thousand dollars, but most of that money goes directly to the brokers, leaving only a few thousand dollars for the destitute donors, said Campbell Fraser, an organ trafficking researcher at Griffith University in Australia who has interviewed over 1,000 buyers and sellers across the globe. The sum seems like a pittance given the sacrifice, but for a refugee with no other option, it’s equal to years of income.

Caption: An ad with contact details for a buyer in the Facebook group “Buy and sell human organs,” which has 1,100 members.

In recent years, Fraser said he has identified a common organ trafficking route that involves Turkish brokers who recruit undocumented Syrian refugees living in Lebanon, providing them with visas and forged documents so that they can fly to a surgery in Egypt — long a trafficking hub. Since passing a 2010 law banning the sale of human organs, Egypt has attempted to crackdown on the illicit trade by imposing severe restrictions on transplant operations for foreigners and stipulating long jail sentences and huge fines for violations. Experts say that has forced networks to move further underground. Indeed, it seems that years later, some of the biggest organ trafficking rings are still in place. In December, Egyptian police arrested dozens of doctors, nurses and medical university professors who were in possession of millions of dollars and a bullion bar of gold.

Only recently has the international community been forced to pay attention to the role of Syrians and Iraqis in the organ trade. In 2015, Iraqi ambassador to the United Nations Mohamed Alhakim told reporters that the mutilated bodies of 12 doctors in Mosul, Iraq, killed after refusing to remove organs from bodies, clearly indicates “something bigger than we think.”  Since then, the United Nations has investigated whether part of the billions of dollars exchanged every year through the illicit organ trade are being funneled to ISIS, al-Nusra, and other terrorist groups operating out of Syria and Iraq.

While the illicit organ trade is particularly booming in the Middle East, international organizations have found that the phenomenon exists in all corners of the developing and developed world. The trade’s vast web of cross-border loopholes is empowering traffickers like Heidar, a 22-year-old, self-described pizza chef from Najaf in central Iraq, who is using Facebook to connect people in his war-torn country with patients from across the region and in richer parts of the world like the United States, where patients languish for years on transplant lists. He says he can provide all the necessary forged documents and connections, and that he can help arrange a surgery in Turkey or Iran.

“The procedure of organ transfer is no big deal, not scary at all,” he says. He says that he was also once a kidney buyer, and that his work is “a form of help, in the path of God,” adding that the whole deal can be finalized as soon as the blood match is determined, for $38,000.

Caption: A Facebook ad from a 23-year-old seller in Iraq with B positive blood type.

At the Vatican, surgeons from across the world agreed that it was incumbent upon the medical community to step up its efforts to prevent organ trafficking. In the Middle East, it’s an open secret that doctors practice commercial transplants in countries like Turkey, Lebanon, and Egypt, as well as other refugee host nations, said Dr. Bassam Said, the president of the Middle East Society For Organ Transplanation (MESOT).

“I’m totally convinced that the private sector is hosting organ transplants, for money interests, especially in the Arab world, where transplants might be a doctor’s only way to supplement his income,” said Said, adding that even when the laws catch up to reality, “it is not obvious that everyone will adopt your cause. We cannot rely on people’s goodwill. We need practical, legal ways to translate that attempt to translate our ideas of medical ethics into fact.”

But not everyone at the summit agreed on the scope of the problem. Over coffee in between the plenaries, Turkish transplant surgeon Dr. Mehmet Haberal, founder and president of the Turkish Transplantation Society, denied that refugees were selling their organs through his country. “There is nothing there, definitely, zero,” he said.

Haberal spearheaded a 2008 resolution that pushed the medical community to take responsibility for illicit organ trafficking. But when questioned about the government’s attempt to confront the illicit trade now, he said, “There is black market activity everywhere in the world, but we are scientists doing our job, we are not police.” According to at least three ongoing cases documented in indictment orders obtained by Vocativ, Israelis have been regularly organizing organ transplants in Turkey over recent years.

As the debate continues, Mayar, the Syrian refugee in Egypt, focuses on survival from day to day. Since fleeing the war, the priority has been “to fight for my life,” he said. “For me, [selling my organ] is about dealing with this crisis, it’s not an issue of fear.”