Europe's poorest country supplying organs to its neighbours 9/7/01

SERGHEI TIMUS (TRANSLATION):
I woke up and it was all over without me knowing. I had a feeling that something inside me was missing. My whole body was aching.

DR MICHAEL FRIEDLANDER:
(Kidney Specialist, Hadassa University Hospital)
There are middle men making a lot of money, it's one of the worst things that is happening in the illegal operations.

MIKE LEVINSKY:
I was aware that to buy a kidney transplant is illegal everywhere in the world.

SUE LLOYD-ROBERTS:
Our story begins in the former Soviet Republic of Moldova, which abandoned Communism, flirted with capitalism and has elected a Communist government back again. Not that it's done them much good. 90% of the people earn less than $2 a day, less than they earned under Soviet rule. Moldova is officially the poorest country in Europe, which brings it, economically, on a par with the developing world. Those countries have survived on one major asset, cheap labour. But in Moldova, as in much of the former Soviet Union, manufacturing industry has collapsed, leaving people here with only one asset of any economic value, their bodies. It was two years ago that Niculae found himself with a pregnant wife, a child with another on the way, and heavily in debt. In despair, he asked around.

NICULAE BARDAN (TRANSLATION):
I'd heard about this business from another villager. He'd gone there and when he returned home, I saw he had a car. I asked him, "Where did you get the money to buy a car?". And he said, "Ask Nina down the road, she sent me to Turkey and I sold one of my kidneys".

LLOYD-ROBERTS:
Nina Ungureanu arranged for Niculae to sell his kidney. She charged him $100, as did her partner, Nina Scobiola, who met him in Istanbul. After spending $100 on travel, Niculae was left with $2,700.

BARDAN:
I bought this house, but what's the use? I'm no longer the person I used to be, I gave away my health.

LLOYD-ROBERTS:
Serghei didn't want to sell his kidney, he wanted a job in Turkey. He was sent to Istanbul, where he was met by Nina Scobiola. She told him that the job was off, and that the only way she knew that he could get the bus fare back to Moldova was by selling some blood. She took him to a private clinic.

SERGHEI TIMUS:
They put me on an operating table and gave me an injection. It must have been an anaesthetic because I didn't feel anything. I woke up, and I had a feeling that something was missing inside me. My whole body was aching. I couldn't get up, I lay there for two days on a drip. It was New Year and I was on an operating table! I was furious. I had a big row with Nina. But she presented me with a fait accompli and offered me money. She said, "Either you take the $2,700 I am offering or you get out of this predicament by yourself." Of course, I had no alternative but to agree. I was already $1,500 in debt, so I payed it off, and the rest soon went. Six months later, all I had left was a pain in my left side, and a stamp in my passport. That was it.

LLOYD-ROBERTS:
Serghei, who never wanted to surrender a kidney, is now worried about his health. He has an appointment with Dr Adrian Tanase, Moldova's leading kidney specialist. Using an ultrasound, Dr Tanase takes a closer look at Serghei's remaining kidney.

DR ADRIAN TANASE (TRANSLATION):
On the right side, we can see his kidney, it's there. Its size and structure are normal. On his left side, the kidney is not there. It is absent from the place where it should be.

LLOYD-ROBERTS:
Serghei is reassured, for the time being. Dr Tanase thinks a medical time bomb is counting down in Moldova, problems. He fears a future in which those with only one kidney will develop renal problems, and there will be little anyone can do for them. Stories involving kidneys are familiar to the Moldovan police. In the village of Mingir alone, they have interviewed 14 young men who'd sold their kidneys through the two Ninas, as the women are now known.

MAJOR VALERIU GALIT (TRANSLATION):
(Department of Organised Crime)
The working relationship between the two women was as follows, people who wanted to sell their kidneys went to Nina Ungureanu in the village, who would sort out their documents and travel. Then she would call Nina Scobiola in Turkey. Once she gave the go-ahead, these people would be taken to Istanbul where they'd be operated on to order.

LLOYD-ROBERTS:
A warrant has been issued for Nina Scobiola's arrest, but the police don't know where she is. However, the other Nina, Nina Ungureanu is still at her home back in Mingir. Victor, in the white T-shirt, wants Nina's help. He'd borrowed money to look for work abroad, but lost all his documents in a fire, and now his creditors are after him.

VICTOR (TRANSLATION):
There's no other way I could pay back my debts. In our country, you don't mess around with things like that. Things could happen, to me, to my family. In this country, you could disappear. Of course I am afraid. I'm afraid about how I'll get there, how the operation will go. I am afraid that I might be cheated out of my money or worse still.

LLOYD-ROBERTS:
Despite his fears, Victor goes to the village of Mingir to try and strike a deal with Nina Ungureanu. One of our team accompanies him with a secret camera. Victor asks her how many people she usually sends to Istanbul.

NINA UNGUREANU (TRANSLATION):
Four, five, sometimes six people.

VICTOR:
Just one person at a time?

UNGUREANU:
No, that would be a waste of a journey. We put them on the coach to get there. It was routine. Up until recently, people would go over there and make good money. Those who knew how to look after money got a good start in life. The drunks just wasted it.

VICTOR:
It sounds a bit illegal to me.

UNGUREANU:
Totally illegal! It was illegal and now someone's gone and spilled the beans and they've dragged us into it too. At least I've made some money from it. Thank God! I need it badly. But we have had to stop for a while. The police are going to make us sweat for a bit, and then they'll just drop it.

LLOYD-ROBERTS:
Clearly, Nina Ungureanu won't be able to help for now, but Victor reckons if so many people have done it before, he'll try his luck in Istanbul on his own. Nina has told him that wealthy Israelis are currently paying around $200,000 for the operation. He can only expect to get about 1% of that, but he hopes it'll be enough to pay off his debts. He's got some names of Moldovans who may be able to help him when he gets to Istanbul. He asks us to keep out of the way, he doesn't want anything to spoil his chances. While Victor sets out on his own, we set about finding the doctors and agents who are charging thousands of dollars for kidney operations and who are, apparently, operating openly and with impunity. It's well known in Turkey who the "Dr Big" in the illegal transplant business is, Dr Yusuf Sonmaz, referred to by fellow doctors in Turkey as "our very own Dr Frankenstein". Dr Sonmaz was first exposed four years ago, but is still operating. Part of the problem is that video material is not admissible as evidence in Turkish courts. Dr Sonmaz has been secretly filmed negotiating with donors and telling them to sign papers stating that they are voluntarily donating their kidneys, to make it look legal. After this was broadcast, he was arrested, investigated and later released. Dr Sonmaz was banned from working in the public sector for life because of his illegal work, by the Istanbul Health Authority, who also told us that no private clinic is licensed to perform kidney transplants in the city. So how is it that Dr Sonmaz has continued to operate?

OSMAN KARAASIAN (TRANSLATION):
(Director, Istanbul Health Department)
If organ trading is the issue here, I must insist that it is not the state that is doing it. It is this individual's concern. But even if this individual is doing it, we are not allowing him to do it within the existing law. This person is not doing what he is doing with any kind of permission from the health department! If he is doing it, he is doing it illegally.

LLOYD-ROBERTS:
The health authority told us that they'd shut down every hospital where Dr Sonmaz has been found carrying out kidney transplants, including this one, where he was found performing operations earlier in the year. But we found the windows were open and people were going in and out. A caretaker told us that Dr Sonmaz came to hospital daily. We left a letter asking him for an interview. When we called again two days later, we got a frosty reception. I asked why, if the hospital was closed, were there so many people in and around the building.

UNNAMED NURSE (TRANSLATION):
No, ma'am, the hospital is closed. Can you please tell her the hospital is officially closed and that they are committing an offence. It is sealed! It is officially closed!

LLOYD-ROBERTS:
There is a car outside making deliveries!

UNNAMED MAN (TRANSLATION):
It's the lunch, they carry in the lunch. There is a clinic upstairs and the food goes there.

LLOYD-ROBERTS:
So the hospital is still working? What is your job at the hospital?

NURSE:
I am a nurse here.

LLOYD-ROBERTS:
For kidney transplants?

NURSE:
No. I am a nurse at this hospital. Dr Sonmaz has a different crew.

LLOYD-ROBERTS:
The caretaker told us that Dr Sonmaz comes here every day. Why?

NURSE:
I really don't know how he came to be here, or how he picked up the letter you left. I just don't know.

LLOYD-ROBERTS:
We were asked to leave, and told there'd be no interview with Dr Sonmaz. The police in Istanbul told us that they believe he's still working in the city, and has been ever since he was so publicly exposed. Back in Moldova, Serghei is testament to this. He'd had his kidney stolen after the medical authorities took action.

TIMUS:
Yes, yes, this is Dr Yusuf. I know him. He carried out the initial medical examination before my kidney was stolen. And after the operation, he was the first person I saw. It's him!

LLOYD-ROBERTS:
And Niculae?

BARDAN:
Yes, it's him, the doctor who took out my kidney.

LLOYD-ROBERTS:
A picture is emerging of Dr Yusuf Sonmaz as a talented but arrogant man, who's been going around Istanbul saying that he plans to carry on operating indefinitely. There are infinite possibilities for a skilled surgeon living in Turkey, with a country of desperate poverty to the north, and a country with a queue of wealthy, eager kidney patients to the east. Nearly all the donors we spoke to said that the recipients of their kidneys were from one country. Mike Levinsky was one of the first Israelis to travel to Istanbul to Istanbul to get a new kidney from Dr Sonmaz. A security man, Mike didn't have enough money to pay the $60,000, the going rate four years ago. He called on the local mayor and his rotary club to help raise the money. What did Mike think of Dr Sonmaz?

MIKE LEVINSKY:
Professionally, I thought he was excellent. He was a very sympathetic person.

LLOYD-ROBERTS:
Did you know that what he was doing is illegal in Turkey?

LEVINSKY:
I was aware of the fact that to pay for a kidney transplant is illegal everywhere. But there is a Jewish saying, "Don't pass judgement on another person before you've been in their situation". Any solution that frees you from the prison of the dialysis machine is the answer, no matter what.

LLOYD-ROBERTS:
As a pioneer of the Turkish solution to the problem, Mike now gets letters from kidney patients in Israel, begging for advice. He is able to reassure them that funding is no longer the problem it was five years ago, when he had to raise the money. In Israel, the medical insurance companies, known as sick funds, are part financed by the Government. These companies now partly reimburse patients who have gone abroad for kidney transplants. Israel also has the lowest number of donors per head of population of any country in the developed world. It's widely believed here that you must go to the grave intact. Little wonder that hundreds of Israelis have created a production line that starts in the villages of Moldova, where men today are walking around with one kidney. Professor Yonatan Halevy is the director of the Israeli National Transplant Centre. You cannot deny that public funds being used in Israel to fund illegal kidney transplant operations abroad.

PROFESSOR YONATAN HALEVY:
(Director, National Transplant Centre)
Well, indirectly, I don't deny it, I condemn it. I don't deny it, but the sick funds are facing an enrollee who says, "I have no chance of a to get, in the foreseeable future, a transplant in Israel. At least pay me what you would have paid my hospital in Israel to perform the transplant". And they give him the money. In an indirect way, this is public money that may be going towards purchasing of organs.

LLOYD-ROBERTS:
In a queue of patients waiting for check-ups in the kidney unit at Jerusalem's Hebrew Hospital, almost half those who've had transplants have had them abroad. The leading doctor supports them, but isn't he condoning a crime?

DR MICHAEL FRIEDLANDER:
(Kidney Specialist, Hadassa University Hospital)
I am not condoning. I do not have to condone, it is the patient's decision. The paternalistic idea that we used to have a doctor who told a patient what to do is gone. Patients come to me with much more information about the subject than I have myself. But it's becoming absurd in the last year. We have patients coming back from the US, having bought kidneys from paid donors. As far as I can ascertain, there are 20-40 centres in the US who don't ask too many questions a patient. They don't want to know.

LLOYD-ROBERTS:
Dr Friedlander wants the whole business to be put above board.

FRIEDLANDER:
For the next year or two, we will allow donors to come and be paid not by the patient but by a sick fund or the Government. Middlemen are making a lot of money. It's one of the worst things happening in the illegal market. If you make the system legal, you cut out the middleman.

LLOYD-ROBERTS:
The middlemen are kept busy. With 800 patients on the list for transplants in Israel, and with very few legal organs from cadavers, the brain dead, there's a four-year wait for kidneys here. With a secret camera, we arrived for an appointment at the smart Tel Aviv offices of one of the middlemen. I was posing as the wife of a very ill kidney patient, so ill that he wouldn't stand a chance of a transplant operation in Britain. But I was told that a "private transplant" for my husband could be easily arranged. Mr Dayan was anxious to make it all sound above board.

KOBI DAYAN:
We only work with cadavers and we will do it in Europe. It'll take three or four months.

LLOYD-ROBERTS:
How long might he have to wait?

DAYAN:
Three months, four months, let me see.

LLOYD-ROBERTS:
I don't understand, in London, I've been told there's no hope as the waiting list is so long.

DAYAN:
But this is our business to do it, Susan.

LLOYD-ROBERTS:
That is wonderful. The operation could not be done in any of the countries of the European Union, where there are strict rules in force and years-long waiting lists. We can only guess as to where in Europe Mr Dayan is currently sending his clients. Who knows? It could even one day be to Moldova where, it's rumoured, Israelis are negotiating to buy this hospital, to convert it into a private kidney transplant clinic. The production line could be coming full cycle. The idea of legitimising the kidney business remains anathema to most medical establishments. More likely, the business will remain clandestine and illegal, with the main beneficiaries being the middlemen, the doctors, and the kidney recipients.

LEVINSKY:
The important message I want to give to you and the outside world is that it is our duty to take a person who is not productive, and who is dependent, and to bring him back to being a citizen who can contribute to the community.

TIMUS:
I do not know exactly who received my organ. There were two men and one woman there, all Israelis. It would have been one of them who got my kidney. What can I say to that person? Even though they got it through deceit, what is done is done. Let him or her be healthy, but let it be on their conscience.