It just seems that serfdom and slavery are horror stories from history books. International observers count more than 40 million slaves across the planet. These unfortunates serve for sexual pleasure in brothels, work for food in heavy production, and die with weapons in their hands for the interests of others. The most terrible manifestation of this unlimited power is weaning internal organs, which are given to man by nature. International observers of the $600 million illegal transplant market at the first regional congress on human trafficking that opened in Guatemala. Experts from the United Nations Office on Drugs and Crime (UNODC) closely link this business to the slave trade. Izvestia found out where vital organs are being taken away from people today.
Buy with giblets
Officially, the fight against illegal exploitation of people and the accompanying phenomena arising from it has been going on for 130 years. The first International Congress against the Traffic in Women was held in London in 1899.
The latest data on this problem on the planet suggests that at least 40.8 million people do not belong to themselves in the literal sense of the word. Problem regions, according to the Global Slavery Index (GSI) website, remain several countries in South and Central America, Central and Eastern Africa, the Middle East and Southeast Asia.
More than half of all crimes related to the oppression of people on the planet, according to the GIR, occur in five countries: India, China, Pakistan, Bangladesh and Uzbekistan.
In the Middle East and Southeast Asia, international enclaves involved in illegal organ transplants typically source the majority of transplant donors.
This information should be viewed from a critical point of view, since international statistics may be biased in connection with the current political situation.
Thus, a number of human rights organizations accused the PRC of persecuting adherents of the Falun Gong movement (some Russian researchers consider the organization a destructive sect). In particular, since 2001, conflicting reports and media publications have been made public that hundreds of thousands of followers of the doctrine have been thrown into prison without trial, where they have been tortured and killed. The massacres were allegedly preceded by the removal of organs. These facts have been repeatedly verified by public observers, international organizations, diplomats, but were not confirmed.
In 2013–2014, the American FBI uncovered more than 1.9 thousand fabricated stories about the persecution of Chinese people for dissent for the purpose of immigration fraud. The deception was dictated by the desire to obtain refugee status or residence permit in the United States.
Nevertheless, the situation with the volume of donor organs in the Middle Kingdom worries human rights activists around the world. The country has become famous for having the shortest waiting list for a donor organ (in some cases, the period does not exceed just two weeks). In 2006, the country's authorities admitted that they use the organs of executed prisoners for transplantation. This practice began in the country in 1984 - then the Ministry of State Security decided to help the Chinese in need of a transplant. Now the country is trying to get away from this practice.
Australian doctors recently called for a boycott of all Chinese scientific research on transplantation due to violations of professional ethics. Until the papers provide information about specific donors.
"Hot" buds
Donors are always there where there is war, famine, unrest - in terrible events, human lives are not taken into account. This is what intermediaries take advantage of, supplying human organs to clinics around the world.
According to the UN website, up to 20% of the treasury of ISIS (the organization is banned in Russia) is replenished through human trafficking. It is estimated that in 2014 alone, terrorists earned between $35 million and $45 million from kidnapping - and we are talking about only a few people ransomed from the organization. And the “unclaimed” prisoners will face a sad fate. Some, mostly girls, serve as currency with which the militants pay each other, while others are sent to do hard work.
But the worst fate is for those who are placed on the operating table. The prisoners are disembowelled by teams of “black” transplantologists. This criminal experience of crime appeared during the fighting in the Balkans.
The trade in the internal organs of kidnapped Serbs was one of the financial income sources of the terrorist organization Kosovo Liberation Army (KLA). A terrible detail - a man deprived of one kidney was forced to suffer for some time while waiting for a buyer to be found for his second kidney. In addition to their kidneys, prisoners' hearts were often taken away. The former prosecutor of the Hague Tribunal, Carla del Ponte, found evidence of mass murders aimed at removing internal organs from ethnic Serbs, Roma and Albanians disloyal to the KLA. In particular, a house in the vicinity of Burrel, adapted for a surgical department, was found - there were medicines, traces of blood, bandages indicating specific operations were carried out. The International Criminal Tribunal for the Former Yugoslavia did not investigate these crimes. Del Ponte admitted in her book “The Hunt. Me and the war criminals” that the UN interim administration mission in Kosovo prevented the completion of the investigation into the crimes. This mission was headed by a French doctor, one of the founders of Doctors Without Borders, diplomat (he was the Minister of Foreign Affairs of France) Bernard Kouchner.
According to the Italian publication L’Espresso, internal organs are lost, including by deception. In the context of hostilities in the Middle East, so-called organ theft is flourishing. When a wounded person is “robbed” during a bombing or under fire, for example, of one kidney under anesthesia. The hero of the publication is a soldier from Sulaymaniyah (northern Iraq) who was blown up by a terrorist bomb. He was sent for treatment to Turkey, where the “theft” of the organ took place in a private clinic in Ankara.
According to the publication, such trade brings profits to beneficiaries up to $1.7 billion. Crises in Syria, Lebanon, Iraq, North Africa only plays into the hands of illegal business tycoons.
Clinics of “black” transplantologists are located in Turkey and Egypt. The most frequent clients of these medical institutions are wealthy citizens from the USA, Gulf countries, European Union, Israel and... Russia. Of the 4 million Lebanese refugees, 20 thousand (since 2012) have sold their kidneys. But the circumstances of these transactions are very questionable.
The fight against the top management of the transnational criminal community by international law enforcement services is being carried out carelessly, the publication states. If you wish, it is not difficult to find the roots of evil - of the entire tissue circulation scheme, only the operation itself is legal. Buying and selling is illegal in most countries. But the circulation of human tissue includes powerful medical, business and political forces.
Price issue
Today there is an unusually high demand for organ transplants in the world, which is met only from 5 to 10%. Moreover, not every country’s legislation provides for the possibility of using procedures of this kind, while people need donor organs everywhere.
The shortage is filled by shadowy transnational criminal groups, which include highly qualified doctors.
Prices on the black market for organs vary. The price of a kidney ranges from $50 thousand to $150 thousand, while its owner, in the case of voluntary donation, receives only $5–15 thousand. A liver, or more precisely a part of it, costs half as much. A piece of cornea costs 10 times less than a kidney.
Transplantation in Russian
Russia has fairly progressive legislation in terms of organ donation. But we are talking about dead people. By law, there is a presumption of consent for transplantation. That is, any adult citizen is ready to be a donor after death, unless previously stated otherwise. Such a prohibition can be expressed by a person either verbally or in documentary, notarized form. These data are entered into the patient's medical record. Spouses or one of the close relatives, who are mentioned in the law “On the Fundamentals of Protecting the Health of Citizens,” can also object after death.
And yet in Russia there are examples of these heinous crimes, of which children also become victims. The fact is that, in accordance with Art. 47 of the same law, the removal of organs and tissues for transplantation is not permitted from a living person who has not reached the age of 18 (except in cases of bone marrow transplantation) or who has been recognized as legally incompetent. But for the sake of their sick child, parents are sometimes ready to commit any crime and even mutilate someone else’s.
Criminal trafficking in organs for transplantation is a topic closed to wide coverage in the country. But, of course, this does not mean at all that trouble has passed us by. Russia is an important element in the international traffic of donor organs and tissues.
Messages that gangs of criminals operating in various regions, kidnapping children in shopping centers, flooded instant messengers in 2014. And, although most of them, as officials claimed, turned out to be fake, Izvestia’s sources in law enforcement agencies confirmed at least one case of forced removal of a kidney from a child in one of shopping centers without specifying details.
It is known that after the mother reported that her son was missing, large police forces were sent to search for him. As a result, a sleeping boy with traces surgical intervention found in the technical rooms of one of the buildings.
The press has repeatedly expressed the idea that it is impossible to remove an organ by hand. In particular, Pavel Vladimirov, an angiosurgeon at the Department of Vascular Surgery and Kidney Transplantation at the Regional Clinical Hospital of St. Petersburg, stated this to prokazan.ru.
- This is impossible, this is a fairy tale! Of course, in five hours you can “cut out” a lot of things, but to recover from the operation, the child would need at least a week, the doctor said.
And yet, world practice proves that this is quite feasible. The metropolitan actor suffered a terrible tragedy in February 2015. He, being tipsy, met a girl, after which he ended up with her in the sauna. He doesn’t remember further events - his companion gave him a potent substance to drink. He came to his senses at a public transport stop with a wild pain in his stomach. At home, he examined himself and found a fresh stitch on his scrotum. The pain turned out to be unbearable, and he called an ambulance. In intensive care he was told that someone had cut out his testicles.
What unites the cases when an adult man and a child were deprived of organs? Both of these cases remained unsolved. In any case, no official statements were made.
Why is the transplantologist not subject to jurisdiction?
It is worth saying that today the fight against “black” transplantology in Russia has been curtailed also because the security forces lost a number of battles at the very beginning of this war.
A landmark criminal trial on this topic can be called the investigation against surgeons at the Moscow Coordination Center for Organ Donation. The case against them was opened by the Khoroshevskaya Interdistrict Prosecutor's Office of Moscow for preparation for a murder committed by a group of persons by prior conspiracy in order to use the victim's organs.
A citizen was admitted to Hospital No. 20 with a severe brain injury. The man, who was still alive, was taken to surgery to remove his kidneys. By the time the operation began, police officers from the Ministry of Internal Affairs burst into the department. Facts were recorded indicating the intent of the doctors to take away the kidneys: the autopsy site was marked on the body with iodopyron, and the hands of the unfortunate man were tightly tied behind his head. According to a forensic medical examination, a drug that slows down blood clotting was injected into the man’s blood. Certificates of ascertainment of biological death and removal of organs for transplantation with signatures of medical experts were also confiscated from doctors. The patient died some time later without regaining consciousness.
The process regarding transplantologists dragged on for years. The Moscow City Court twice acquitted doctors. The defense clung to the fact that the exact moment of the patient’s death could not be established, so attempted murder was difficult to prove.
The medical community also put pressure on the court - prominent doctors and politicians accused the police and prosecutors of incompetence. Information was published through the media that because of the process, transplantologists are afraid to do their work, and people waiting for a kidney are dying. The Supreme Court twice overturned the decisions of the Moscow City Court and sent the cases for a new trial at the request of the prosecutor's office.
Meanwhile, the prosecution's position was not properly covered in the media. The fact is that colleagues of transplantologists reported the monstrous situation with the removal of organs from living people (this was prohibited by law) to the murder department of the Moscow Criminal Investigation Department. One of the resuscitators said that the victims of such shadow schemes were antisocial people, alcoholics, for whose rights there was no one to stand up. According to the law in force at that time, only a person whose brain was dead could be used for transplantation, which must be confirmed by a council of medical specialists. No one confirmed the man’s death at City Hospital No. 20. Nevertheless, the result of the litigation was the acquittal of the defendants.
After this decision, a number of similar processes in the regions ended in nothing - in the Khabarovsk Territory, Novgorod, the department of organ donation and kidney transplantation of the St. Petersburg Research Institute of Emergency Medicine named after Dzhanelidze, as well as in the famous Moscow Regional Research Institute named after. M.F. Vladimirsky.
The prosecutor's office had to apologize to all the defendants and drop the cases. The legal victory became possible under the pretext of not obstructing the progress of domestic science and helping those in need. But the interests of donors and multimillion-dollar profits from operations were discounted.
Perhaps the situation will be corrected due to the creation of a specialized unit in the Investigative Committee for the investigation of iatrogenic (against human health) crimes.
We are constantly frightened by myths about transplantation, both “black” and real.
On the one hand, on blogs you can read obvious “horror stories” about children who woke up in an ice bath and without one kidney. On the other hand, one may encounter statements that organs are selected based on hundreds of parameters, and since tissue compatibility is very low, there is no queue for organs as such.
This is how things really are.
1. Compatibility is not determined by hundreds, and in just a few key parameters - blood type, six histocompatibility antigens (two HLA-A, B, DR donors to pairs of recipient antigens of the same name). In addition, the kidney must be functional, and the donor must not have any current or history of infection, and must not have certain infections (for example, HIV). It's enough.
2. Even with these parameters you can play. For example, no matter how hard you try, it is very difficult to select an organ that matches all six histocompatibility antigens. Then preference is given to similarities in only one pair - DR, provided that the donor does not have HLA antigens to which the recipient has antibodies.
3. There are waiting lists in all countries of the world, where transplantation programs operate. Except for one country, Iran, where healthy people are officially allowed to sell one of their kidneys. The entire transaction is monitored by the state, which not only controls the amount of remuneration and its fair transfer into the hands of the seller, but also adds a certain monetary compensation for rehabilitation and recovery.
4. In other countries with transplant programs there is a queue and it's big. For each cadaverous (cadaveric) kidney, there is a list of about twenty recipients, arranged in order of “suitability.” To compile the list, a special formula is used, which takes into account tissue compatibility, waiting time, and the degree of immunization of the recipient (it happens that a person has a huge amount of antibodies, and the danger of immediate organ rejection in case of incomplete compatibility approaches 100%; such patients receive absolute priority, regardless of the waiting time), age (in children - an advantage) and several specific conditions (mainly after operations on the genitourinary system, when it is important that a person “get wet” as quickly as possible and not remain on dialysis).
5. Usually, the list of compatible donors is formed by a special computer program , doctors only enter the parameters of a potential donor: age, gender, histocompatibility antigens and blood group. Neither doctors nor other staff have any influence on where a particular patient will be placed on this list. In countries where transplantation is poorly developed, the selection of a recipient can be done manually by a doctor, but taking into account the same parameters. The entire algorithm can be re-run and re-checked, since the criteria are very clear, that is, it would be very difficult to cover up tracks in case of dishonest actions.
6. Donors are divided into living donors, donors with a brain dead but a beating heart, and donors after cardiac arrest.. The largest share of transplantations occurs with the second type of donor. A potential donor's brain death is determined according to a clear algorithm, and the assessment involves a team of doctors separate from the transplant team caring for the recipient. IN different countries The criteria for determining brain death are slightly different, but several requirements remain unchanged: firstly, the declaration must be carried out by two independent specialists with a certain time s m interval. Secondly, confirmation is necessary using objective instrumental clinical studies: EEG (assessment of electrical activity of the brain), angiography and/or perfusion scintigraphy (assessment of blood flow in different areas of the brain). Instrument readings and documents remain in the medical history; it is extremely difficult to falsify them.
7. The media gives the impression that the decision of who, to whom and when a kidney will be transplanted is made by one person, but, as can be seen from the previous paragraphs, this is not the case. Selection of donor and recipient is a cumbersome procedure, break the rules of which in medical institution very difficult. This is not tiptoeing with a flashlight from donor to recipient, this is a ton of documentation, a mandatory conversation with relatives, a mandatory compatibility study (cross-match test) carried out immediately before the operation, when the recipient is already in the clinic, and in each case - more involvement dozens of professionals.
8. Black transplantology exists. Most of all - in underdeveloped countries with a large layer of unprotected and poor people. But this is not at all the initiative of enthusiastic hospital doctors, with their protocols and guide-lines for every point of the “official” transplant process, and, moreover, who are in close connection with other professionals who are required to take part in the procedure. In reality, it is a large and profitable criminalized business, controlled by criminal gangs and located outside the confines of public hospitals. Small private clinics and underground offices are created for it; donors usually do not go through any official documents, the selection and compatibility determination procedure is either minimized or completely excluded from the process.
This practice causes enormous harm to recipients- after a transplant without determining compatibility, as a rule, the kidney is rejected very quickly, while “sensitizing” the patient, which complicates the selection of the next organ for him and puts his life at risk. In a sensitized, complex patient (and such, tired of waiting for an “official” transplant, more often than others turn to illegal methods of transplantation), a blind transplant usually leads to immediate graft failure and often to death.
9. Given the high demand for organs, profitability of illegal transfer business and the cumbersomeness of the official procedure for selecting a donor-recipient pair, looking for “black” transplantologists in clinics, within the transplant program, and placing false blame on single doctors is like looking for a coin lost in a dark entrance, moving under a street lamp, because that it's brighter there.
10. Often the initiators of witch hunts are relatives of the donor who, having lost loved one, direct anger and irritation at doctors because, as it seems to them, they did not do everything possible. Having no medical education and not understanding the procedures, they succumb to emotions, and the media happily inflate unfounded accusations. Sometimes the doctors themselves are also to blame for this. who, in a hurry (when transplanting from a deceased donor, indeed, every minute counts - it depends on how well and how long the transplanted organ will function), do not pay due attention to relatives, giving them the impression that no one was interested in how the patient as a patient, but only as a donor. But that's not true. Doctors fight with all their might for every patient. However, at the moment of death, priority shifts in favor of the living, and this shocks the relatives of the deceased. Therefore, the hospital should have a clear procedure for communicating with the relatives of a potential donor, including a conversation with a staff member. I’m not sure that this is practiced in Russia, and perhaps this is the reason for such frequent scandals initiated by the donor’s relatives.
11. Each attack of hysteria surrounding the allegedly illegal harvesting of organs in public hospitals, “right under the noses of relatives,” causes colossal harm to the development of official transplantology in the country, hinders the development and improvement of relevant programs, deprives many people of the hope of getting a new organ and, as a result, only supports black transplantation. Please remember this.
Advertisements for the purchase and sale of human organs appear on specialized websites and in relevant groups on social networks every day. At the same time, there is not a single criminal case about “black transplantologists” in the Russian legal field. "Snob" studied how the market for human organs works in Russia and on post-Soviet space
Photo: Romeo Ranoco/Reuters
Applicants
Asia I’m ready to sell a kidney or a liver, it doesn’t matter. She thought for a month before writing the ad. “I don’t drink, I don’t smoke, I need money.” I came up with the text quickly. Two years ago, she could not have imagined that she would have to think about this. “My husband and I lived in Almaty for ten years, without knowing grief, we raised two children. And then he was laid off from the car dealership where he worked,” says Asiam. My husband tried to get a job for several months, but was unsuccessful. “We had a loan for renovations we were doing on the house. We took another one to pay it off, but in the end we still didn’t have enough to live on. The husband decided to take a risk and started playing slot machines and cards. And he was sucked in. And after some time, he lost more than we owed - 9 thousand dollars. In general, I signed a mortgage on the house in which we lived,” says Aziyam. When bandits came to take away their house for debts, Asia managed to find intermediaries who took out another loan for her. Six months later she managed to pay off the debt. Around the same time, the husband again squandered the house at cards. “So I stayed on the street with two children. My husband disappeared when we were evicted.” Asiam doesn’t know where he is—maybe he found another family, or maybe he committed suicide. “I’m tired, I don’t have the strength,” says Asiam. -Can you help me find who needs a kidney or a liver? I understand that everyone has their own problems, and there are a million people like me. I do not know what to do. Probably hope for something good.”
Andrey ready to sell any organ, “the absence of which will not cause problems later if it is not there.” You can sell a lot of things: the cornea of an eye, part of the bone marrow, a testicle, a kidney or a liver, and earn from 3 to 100 thousand dollars. Prices vary greatly. Andrey needs about 15 thousand dollars for an operation that his sick mother requires. Relatives are not aware of his attempts. “I can’t earn money any other way.”
Orhan is looking for money to open his own business - he was banned from entering Russia for three years, and in Baku, where he now lives, he cannot make money. “The bank doesn’t give 15 million, but to win, you have to take a risk. There is no fear, we all die someday. I believe in Allah, everything will be as he wants. My victory is my paradise. And yet, I don’t have anyone. After I lost my brother, I was left alone.”
Sergey hopes to get an education. “Last year I entered a Moscow university. I studied for the first months, although it was difficult. Once, a blogger from Japan, whom I follow, came to Moscow to meet with subscribers,” says Sergei. Representatives were at the meeting educational institutions from Japan, they told how everything works. Sergei was eager to go. “Of course, it cost a lot of money. I started filling my head with all sorts of ideas about making money, and before I knew it, the first semester was over, and I didn’t pass a single exam—or rather, I wasn’t even admitted to them,” says Sergei. “And recently I saw a headline on the Internet about organ donation and decided to sacrifice something to pay for my studies. Perhaps there may be health problems later, but I think this is the beginning, and then I will get better. Still, it depends on the person’s health. How many people live quite normally with one organ!”
Each author of advertisements posted on numerous “exchanges” has his own sad story. It is unlikely that most of these people will be able to sell their organ: even if they decide to go all the way, they will fall for scammers who will lure them out of money for mediation, but will not connect them with a buyer. These scammers contemptuously call them “dodiks.” Real buyers, who, however, also call them rather contemptuously - “spare parts”, are much more difficult to find.
Scammers
In March of this year, Asiam found buyers for her kidney - she was offered 4 million rubles. She contacted the customer via email. “What you told about your problems and debts, sorry for the directness, interests me the least,” a person with the nickname vstranechudesaliska wrote to Asia. “You come to us in Irkutsk, yourself. At the same time, they shouldn’t lose you at home for about a week. There will be no communication with the outside world. We will meet you and take you to the right place. You take tests for four days, and if everything is normal, we’ll cut it out for you.”
Two months have passed since this conversation. Despite being tired of debts, Asiam still can’t decide whether to go to Irkutsk or not. Her interlocutor did not give any guarantees and refused to pay the advance. Aziyam is afraid to return back without money or not at all: friends say that she could be sold into sexual slavery. However, stories about kidnappings of people who want to sell their kidneys are from the realm of rumors; the leader of the “Alternative” movement, Oleg Melnikov, who rescues people with his own money, for example, from brick factories in Dagestan, told “Snob” that he had never encountered such cases in his long practice.
Konstantin from Bratsk tried to sell a kidney four times: he needed money to buy a computer powerful enough to work as a web designer; With the rest of the money, he wants to buy a tent in Irkutsk, which he will rent out. Konstantin is an orphan, visually disabled from childhood. On the Internet, he negotiated services with intermediaries. “For some reason I trusted the girls all four times, I don’t know why. They all turned out to be scammers. I even understand that, most likely, these are not photographs of them, maybe, in general, a guy is sitting at a computer. They explained that they were providing services—they were connecting me with a doctor. You need to pay money for this. In just six months I gave away 18 thousand. Every time after payment the person disappeared. I don't even know how I, such an idiot, did it so many times. However, I continue to look for opportunities, I didn’t have any money, and I still got into debt. Can you help me sell a kidney?”
Of the several dozen people posing as intermediaries on the Internet, Marina () is the only one who agreed to talk with “Snob”. Marina has several fake VK accounts - she bought them in bulk, about fifteen pieces at once, on one of the exchanges of hacked pages. “They are already shopping with friends. I fill out my profile so that it can be seen that I lead an active life. I repost all sorts of quotes. I choose photos that are cute, but not too cute - just a nice, pretty girl. So that both men and women can be led.” Marina says that people come to her with requests for help to sell a kidney several times every day. For meeting a doctor who performs such operations, she asks from three to five thousand rubles. “The majority refuse, but up to seven people are recruited per month. After transferring money, I either immediately block the person or feed him breakfast for a while. These Dodiks are so tired of life that, as a rule, they have no strength to complain. If they block it, don't worry. Accounts cost pennies, and there are too many people interested.” Marina lives in a small town in the Urals and is raising a small child alone. The money he earns is enough to give him everything. “We have few options: either as a saleswoman or on the track. So I settled in okay,” she says. Marina does not feel any remorse: “People want easy money instead of working. I want it too, only I'm smarter. Everything is fair." In her opinion, it is impossible to find a real intermediary via the Internet. “I have never heard of anyone actually being able to sell. In my opinion, there is simply no such thing.”
According to transplant doctor Mogeli Khubutia, this business simply cannot exist. “This is all fiction, just stories, you know? The profession of transplantologist is so rare that doctors simply do not need it. After all, this is dangerous for your reputation. The professional world is a very narrow one, where everyone knows each other. This is the first thing. The conditions for the operation must be appropriate - this is the second thing. Qualification, again. Have you ever heard of this yourself? There were no criminal cases or anything like that. If someone did this, they would definitely get caught,” says Khubutia.
Photo: Keith Bedford/Reuters
Spare parts
Sergey from Ukhta found a real intermediary after giving money to two scammers. Sergei was not selling a kidney, he was looking for where to buy it for his wife, who really needed it.
“I would be happy to tell you, but you yourself must understand that all this is illegal. “I’m afraid,” Sergei begins the conversation. “I’ve already been burned several times by these intermediaries.” Then I saw one agency and decided to contact them. I don’t know why I made up my mind - it’s just that the situation was already becoming hopeless.”
“Snob” contacted several agencies offering similar services in Russia. The standard answer looks something like this: “The cost of the liver is from 4 million rubles. The cost of a kidney is from 6 million rubles. Our clinic provides electronic tickets for fast trains or planes, it all depends on your location. To cooperate, you must pay a registration fee of 12,300 rubles. This contribution is made by the potential donor for the preparation of documents and is a guarantee of the seriousness of your decision. Upon admission to the clinic, you will begin to undergo examination from the first day, after which, based on all indicators, a fee will be announced.”
Sergei was very worried whether he would be deceived again, since first of all he had to pay. “In general, there was no, I sent my wife’s data. I waited for a week, then they told me that they had found it. They offered two candidates - we chose the one who asks the least.” After that, Sergei paid half the amount - 15 thousand dollars. They told him the city and the date to arrive. “My wife and I arrived in the city of N, they met us there. Those who met did not hide their faces. We were put in a car and taken to the clinic, it was located within the city. They took tests and had surgery the next day. The doctors are intellectuals, wearing masks, I didn’t see their faces. After the operation I paid the balance, that's basically it. The kidney has taken root, everything is fine.”
Lyudmila Lazareva- one of the few who publicly spoke about having undergone such an operation in Russia. In 2014, in order to pay off her foreign currency mortgage, she took a desperate step and sold her kidney. Doctors I knew helped organize the operation in one of the clinics near Moscow, the name of which Lazareva did not specify in a conversation with journalists. According to her, they looked for a buyer for about two weeks, then she underwent an operation, after which she “lay in a regular ward with some kind of usual diagnosis.” A week later, Lazareva was discharged. She received only 150 thousand rubles for the organ, which was barely enough for the monthly mortgage payment.
“My health is the same as it was before. Only my hair stopped growing, and I lost a lot of teeth,” she said in an interview two years after the operation. After several TV shows that Lazareva attended in 2016, her traces are lost.
Torpedoes and donkeys
There are no references to criminal cases under Article 127.1 of the Criminal Code, paragraph “G” - trafficking in persons for the purpose of removing human organs - in any database of court sentences. Those who sell organs, as Snob found out, are not too afraid of prosecution by the law. “Snob” managed to find a real mediator who explained why. Arseny Potapov (fictitious name on VK. — Approx. ed.) lives in one of the neighboring countries. “You may have heard that a group of people who facilitated the donation were detained? Each person receives 35 thousand dollars, and we again work in a world where everything is bought and sold,” explains Potapov. — Let’s imagine that you decide to sell your kidney. There are very few intermediaries, I know about five other people, all of them do not live in Russia. So there is a 96% chance that you will be deceived. People are fooled by exorbitant sums; they are offered, for example, 400 thousand dollars in fees and half at once. This is how one woman recently got $500. There are a lot of scammers, however, I also did not immediately become an intermediary.”
Several years ago, Potapov urgently needed money, and he was offered to work as a “torpedo”. “This is a job related to the transportation of drugs, most often in own body; I hid it in other places. The pay was good, but six months later I was offered to go to a less dangerous job - as a mediator, or “donkey.” “Donkey” is the one who picks up the client from his city and takes him to the clinic. Now every month from two to four people pass through Potapov. He charges one and a half thousand dollars for his services. Potapov sends me the price list of one of the Moscow clinics. “In Russia, livers are not transplanted; for this operation we provide the opportunity to fly abroad. All other procedures: kidney, bone marrow and stem cell transplants are performed in our clinic. Stem cell transplant – 10 thousand dollars, bone marrow – 70 thousand dollars, liver – from 130 thousand to 300 thousand dollars (including flight), kidney – 200 thousand dollars.”
“Of course, even if you find a real intermediary, you will receive 30 thousand dollars for a liver or kidney. The rest goes to pay for the operation, part of the amount is taken by the intermediary, part goes to doctors and those who turn a blind eye to this matter. The donor himself will never find anyone without an intermediary, so the money goes away,” explains Potapov. In addition to donation, he is involved in several other “related” businesses. “I take young girls who have been abandoned by their boyfriends or are simply disappointed in life to India for egg donation. This is better than cutting out a kidney, and the fee is around 7 thousand dollars. Plus it's legal. There is one more know-how, you will laugh. Wealthy ladies are willing to pay for young guys with good looks. Now a woman from Estonia, 57 years old, asked to find a young guy based on her criteria. Looking for a dandy - tall, weight no more than 90 kilograms, athletic build.”
At the end of the conversation, Potapov promises to send me a video in which there is a “real major intermediary.” This is a recording of a 2014 program for Ukrainian television. He will also advise how to reach him - introducing himself as a donor, write a letter to the administrator on a specialized website.
First thing Alexander G. tells me that most of what is said about him in the media is lies. “I got into this story like most people. At first I wanted to sell my kidney. In most cases, people are used to searching on the Internet, but I read an advertisement in an Israeli paper newspaper in Russian. We were looking for a kidney donor for a fee. I was young, graduated from the Faculty of Medicine at Tel Aviv University. There was no apartment, no car, I had to work as a doctor for more than 10 years to earn all this.”
G. was born in Ukraine and is now about 30 years old. He is considered an ex-member of the international criminal gang of the Turkish doctor “Dr. Zis” - the main player in this business in the post-Soviet space and in Europe. G. himself admitted this in a conversation with “Snob”. In 2008, he called the number listed in the newspaper, where he was offered to meet. “I met with group member Boris Volfman, he said that there are people who need a transplant, and if I am ready, I can be a donor. They promised me 80 thousand dollars. I gave the go-ahead. They conducted an examination and paid an advance.”
What saved Alexander from donating was that the buyer of his kidney died while he was applying for a Canadian visa - the operation was supposed to take place there. “Wolfman told me to wait and they would find another person. After some time, I assessed the situation, understood how these people make money, and persuaded Wolfman to take me into the business. At first I wanted to look for donors, but Boris said that there was no problem with this and that we needed to look for buyers. I know Hebrew, Russian, Ukrainian, English, and even before studying medicine, I worked part-time as an IT specialist. I found several American forums where people who needed a transplant gathered. I looked at the data of these people, sent them letters, told them that I knew about their problem and could help. 8 out of 10 agreed to the services. This is how I found my first clients. I was promised 10 thousand dollars from each. I figured this would be a great option to earn money for an apartment in Tel Aviv.”
Photo: Pierre-Philippe Marcou/AFP
Doctors and bosses
Then Alexander came up with a more reliable scheme for finding clients - getting his doctors to work in hemodialysis departments in expensive private clinics in Europe. The plan was implemented. “It was very important to know who you were dealing with. Someone was charged 80 thousand dollars for a transplant, but if they understood that a person could pay 150 thousand, then they charged one hundred and fifty,” says G. “There were 25 people in our group. Some were looking for donors, others were doing analysis, and others were providing support. Everyone had their own responsibilities, but no one knew each other, so that if one was pulled, nothing would happen to the others. Some were parasites who did nothing but received money.”
At some point, according to Alexander, he began to be paid less and less, and his dissatisfaction with Wolfman’s work methods accumulated. “I didn’t know how much donors actually received. They were usually paid after the operation. Over time, I learned that donors were not paid the promised money; they received 10-15 thousand dollars in their hands, and sometimes they did not receive anything at all. People were afraid to go and complain; they thought they were breaking the law. I understood that this was wrong and sooner or later it would all crack. I decided to leave and went to talk to Wolfman. As a result, 10 people took me out into the desert and beat me for wrong thoughts. They said that I would not leave the case. Then I had to go to the police. Everyone was detained, there was a scandal.”
Alexander temporarily moved to Egypt and was thinking about what to do next. During his work, he understood well how the business works and decided to do it on his own. “There is a lower level - “donkeys” - the only people who risk being subject to criminal prosecution. They transport people across the border and get paid pennies for it. Next come various intermediaries - those who look for clients and work on organizing the process. The highest level is the doctor for whom we work. He personally operates or negotiates with other doctors. There are about six such doctors - Albania, Turkey, Azerbaijan, Kosovo,” explains G.
About a month passes from the date of the meeting to the operation. “I need to find a buyer, negotiate with him, many want personal meeting, you have to fly, these are expenses,” says G. “At this time, the donor leaves an advance, I give him a list of tests that need to be taken. Then I call the doctor and send the donor there at my own expense. Next, it is necessary to calculate before the operation, then the operation. This is where my services end."
To prevent the donor from running away, G. takes his passport and a receipt, where he indicates that he received money for the upcoming donation and understands that he is breaking the law ( The law is different in different countries, but sale is prohibited everywhere. — Approx. ed.). “It never came to the point where I applied somewhere with a receipt. But there are guys who, if anything happens, will break their legs.”
In this business, according to G., everyone is somehow connected with Wolfman or Zis. “There’s really no competition - just pay money, bring normal clients, and you’ll be welcome,” says G. “I know that Wolfman works in Albania. There is nothing stopping me from coming there and agreeing on the operation. He won’t say a word to me - the main thing is money.”
He himself does not feel any shame about being involved in this business. “I always warn people what this could mean for them. Moreover, I always make people sign a paper that describes the consequences. In the worst case scenario, a person may then look for a donor on his own, which he will not be able to pay for. But this is a business where everything cannot be clean. However, like anyone else. It's like having a store."
Myth one: in Russia organs can be bought and sold
Evgenia Lobacheva, administrator of Rusfond groups on social networks, notes that sometimes it feels like people, on the contrary, are not afraid of anything. “We often get comments like this on the website and on social networks: “buy a kidney from me.” Or: “I am willing to become a heart donor for a child in need.” It is unclear whether people understand the consequences for themselves. Or, for example, they write: “I am ready to become a bone marrow donor, my blood type is such and such. How much does it cost?" Many honestly admit that they want to close their loans, they find it difficult to pay off, and therefore are ready to sell their organs.
In fact
According to the legislation of the Russian Federation, selling and buying organs is prohibited by law.
In the USA, for example, you can get a 5-year prison sentence for trading them.
It is worth recognizing that in some countries, selling a kidney is one of the options for making money for the poor, and the state pretends not to see anything - it does not particularly object to this business.
This applies to third world countries, for example, one of the leaders in this direction is India. American doctor Barry Jacobs organized an “international kidney exchange” there in 1983; sales amounted to up to 2,000 organ units per year. And the buyers were citizens of Kuwait, Saudi Arabia, UAE, Bahrain, Oman. By 1995, India had passed a law banning organ trafficking, but not in all states.
Several years ago, the former prosecutor of the Hague Tribunal, Carla del Ponte, published the book “The Hunt”, in which she stated that the Prime Minister of the Republic of Kosovo, Hashim Thaci, was guilty of the murders of 300 Serbs - they were allegedly taken to Albania, where they were used as donors in some underground clinics internal organs.
In Russia, donation is carried out exclusively free of charge; the sale of organs is a criminal offense.
Myth two: the donor will be sorted for organs and no one will find the person
“We had a case where a 22-year-old young man from Chelyabinsk was ideal as a bone marrow donor,” says Anastasia Kaflanova, Director of the Charitable Foundation “Fund against Leukemia”. “And when we called him and told him about it, invited him to come to Moscow, he was very happy and inspired. But his parents were against it and forbade him to go, they were afraid that he would become a victim of black transplantologists.
Everything was resolved only thanks to the intervention of his aunt, who lives in the USA and works in medicine. She told the family that bone marrow transplantation and donation are commonplace in the States, and he should definitely go. “This is very important, you will save someone’s life.” And he still went.”
In fact
Contrary to many misconceptions, he explains Konstantin Gubarev, surgeon, head of the National Association in the field of donation and transplantology, head of the surgical department for coordination of organ donation of the State Scientific Center FMBC named after A.I. Burnazyan FMBA of Russia , Organ collection is not carried out in a morgue or other similar premises, but, like all surgical operations, in an operating room, under sterile conditions.
From the outside, organ explantation looks like a normal operation, with one exception - the patient is already dead, and the “removed” organs are not sent to the pathology department for study, but are specially packaged in sterile sealed bags with a preservative solution and placed in isothermal containers to maintain temperature 2-5 degrees Celsius.
Multi-organ explantation (when three or more organs are removed) involves three to five transplant surgeons. And in general, an ordinary surgeon, even a good and experienced one, will not be able to perform such an operation without appropriate professional training, and transplantologists are second to none, so some kind of underground operation in an underground clinic is impossible.
It is also not possible to perform organ removal and transplantation by a “narrow circle” of specialists. “In addition to the medical operation itself, sometimes up to 100 people are involved in organizational work: transplant doctors of hospitals where recipients awaiting transplantation are treated, general practitioners, nephrologists, hepatologists, cardiologists, who are also involved in maintaining the waiting list and examining (preparing) recipients for emergency transplantation.
Also, there are nurses and department aides, laboratory immunologists, who are involved in immunological examination of the donor and selection of donor-recipient pairs. The administrative staff of the clinics is engaged in processing the necessary documents,” explains Konstantin Gubarev.
And in cases where donor organs are transported by road and/or air, then drivers, airport employees, and aircraft crews are also involved.
“In addition, caring for a patient who has received donor organs is a lifelong matter; it will not be possible to do it underground,” notes Maya Sonina, director of the Oxygen Foundation, most of whose clients require lung transplants.
“There is a proverb: what three know, everyone knows. It is impossible to hide or keep secret information known to so many people from law enforcement. Especially after they were notified by the forensic expert,” emphasizes Konstantin Gubarev.
Myth three: if you consent to the use of your organs after death, you will be found, caught and disemboweled.
Therefore, Russian residents are afraid to give written consent to donation. Olga Demicheva, an endocrinologist, one of the founders of the Moscow Center for Palliative Medicine and the League for the Defense of Doctors' Rights, participated as an expert in the discussion of the bill on organ donation in the State Duma, which was recently adopted.
Nevertheless, we were left with a presumption of consent, because, experts decided, our population is not yet ready to leave a will on their organs; if this is allowed, then transplantation in Russia will stop altogether.
In fact
One of the sensational cases several years ago was the story of Alina Sablina. The student died in an accident; in intensive care, the girl was declared brain dead, after which a number of Alina’s organs were removed for transplantation. The girls' relatives were outraged when they discovered this: no one informed them. The defense reached the European Court of Human Rights. However, everything was done within the law.
The fact is that there are two approaches in the world - the presumption of agreement and disagreement. In some states, there is a presumption of disagreement: if a person during his lifetime did not leave a will with permission to use his organs after death, then they cannot be used. And if he left such a paper, then he will become an organ donor after death (if, of course, his organs are suitable for transplantation). In Russia and a number of other countries, a presumption of consent has been adopted: this means that a priori, in the event of brain death, when the body is still alive, organs can be taken - and this does not require the consent of relatives or the consent of the donor.
“People simply don’t realize how difficult it is to obtain a donor organ. – Olga Demicheva notes. – Firstly, the organ may not be suitable for transplantation. And the fixed idea that you can simply take an organ from someone in the hope that it will suit the millionaire Ivan Ivanovich is a myth.
The body must meet a number of criteria. Even an organ from relatives is not always suitable. It's not like changing a part on a car. In addition, the organ can also later be rejected by the body - it’s a foreign protein. So it won’t be possible to carry out such an operation underground.” Olga Demicheva worked for many years in the 11th city hospital, which was once the first organ donation center in Russia, and knows from the inside how this mechanism works.
But we cannot introduce a presumption of disagreement, Olga Demicheva is convinced. Because people will not care about signing such papers in advance. “You cannot bury something in the ground that can save people’s lives - this should become our principle,” says Olga Demicheva.
Myth four: if I end up in intensive care, I may be specially killed to collect donor organs
Many are afraid of ending up in intensive care: what if, here, where the patient’s relatives can hardly get to, he will be disconnected from vital equipment and used as an organ donor?
In fact
Organs can be removed only if a person is declared brain dead or biological death, that is, breathing and heartbeat have stopped. To diagnose brain death, a special council must meet. Its members study medical history and conduct tests designed to determine the presence or absence of brain activity (this CT scan brain, breathing check and so on). And the decision about brain death cannot be made earlier than after 6 hours of observation of the patient.
By the way, if the patient took sedatives, and this often happens in intensive care units, brain death can be diagnosed later - the wait can reach 20 hours. But during this time, decay processes begin in the body, and organs may no longer be suitable for transplantation.
And one more thing: in those intensive care units where the process of diagnosing brain death and the process of posthumous donation are organized, the mortality rate is lower than in those intensive care units where this is not the case. “It would seem an amazing paradox? However, there is nothing surprising - a patient who has been poorly treated cannot become a donor, explains Konstantin Gubarev. – Why transplant affected organs? On the contrary, a donor is a patient who has been treated very well, but due to a stroke or injury, his brain is permanently damaged. Against the background of these injuries, due to the fact that the patient was carefully treated, despite the fact that brain death occurs, the general condition of the organs and systems remains good. And then he becomes a potential donor.
In those intensive care units where the process of posthumous donation has been established, a “reflex is developed” to approach the treatment of patients carefully and not lose sight of the little things. Thanks to this, overall treatment rates are improved and mortality is reduced.”
Myth five: there is no child donation in Russia, because children are protected from black transplant surgeons
There are also such fears. Many are sure that it is for this reason that in our country it is prohibited to take organs from a child donor. Abroad, it often happens that doctors bow down to a young donor who bequeathed, after his death, to donate his healthy organs to some other child. This doesn't happen with us.
This is not entirely true.
In fact
We do not have a ban on child donation. “The fact is that until recently it was legally impossible to ascertain the death of a patient under 18 years of age based on a diagnosis of brain death,” explains Konstantin Gubarev. – There was simply no protocol approved by the Ministry of Health of the Russian Federation. But the situation changed for the better, the protocol was approved by order of the Ministry of Health of Russia dated December 25, 2014 N 908n “On the Procedure for establishing the diagnosis of human brain death.”
However, it seems that there was no such thing as child donation, and therefore no child transplantation. With the exception of transplantations performed from living related donors, and isolated cases of transplantations performed from posthumous adult donors with suitable anthropometric indicators. Why? The answer is simple. “For a long time, a vicious circle formed - children were not put on the waiting list, because there was no point - there would be no donor anyway, both doctors and parents believed. And now we have the opposite effect. A potential child donor appears, and whose parents themselves insist on organ removal after his death, because they want his death not to be in vain.
But we can’t do anything, since there is no waiting list for children for transplantation, it is impossible to find a suitable child recipient, we tried.
Formally, it turns out that there is no need - after all, there is no one to transplant. We are currently actively working to change the situation for the better.”
Myth six: black transplantologists are hunting for “useless” orphanages
There is a horror story that a child living in orphanage, or a graduate of an orphanage may become the target of a hunt for black transplantologists. Like, no one is watching his fate, why not use such a “donor”?
In fact
This is legally impossible, notes Olga Demicheva. The fact is that only parents can give consent to organ donation in the event of the death of a minor - therefore a child from an orphanage cannot be a donor.
In addition, if a “criminal” (that is, violently injured) patient or body is admitted to the hospital, law enforcement agencies are immediately notified. A forensic medical examination is ordered. And this will again become an obstacle. After all, if the donor died as a result of injury or violent death, forensic experts are required to send a notice to the prosecutor’s office that they have given permission to remove organs, explains Konstantin Gubarev.
The prosecutor's office supervising legality is notified of these medical operations.
One more point: if the body is unidentified, that is, it is unknown who the deceased person is, then this is also an obstacle to organ collection. And not only because this person’s illnesses are unknown, but because his citizenship is unknown. And on the territory of the Russian Federation, organ collection is possible only from Russian citizens. Well, if it turns out that this person is the same graduate of the orphanage, then we return to point one - such a person cannot become a donor, since he does not have parents who have the right to authorize or prohibit the taking of organs.
And yet, it is unlikely that the underground client himself, for whose sake all this will be arranged in order to have an organ transplanted without a queue and quickly, will agree to such a risk. Indeed, without a thorough study of the health of a potential donor, there is a danger of incompatibility and subsequent rejection of the transplanted organ and possible death of the patient.
Myth seventh: in military conflicts, doctors “let the wounded get their organs”
“We are communicating with both sides of the armed confrontation. And there are strong myths that they want to disassemble people for organs. Allegedly, doctors from the Red Cross or Doctors Without Borders are doing this, says Ilya Bogomolov, head of the charity organization “International Medical Aid”. – As a result, both sides of the conflict do not believe in the philanthropic work of doctors. By the way, such myths are generally common in wars in different countries.”
The demonization of humanitarian organizations is clearly beneficial for someone, Ilya believes. It is very scary when stereotypes develop in mass society, among ordinary people.
In fact
We return to the same idea again. Too many specialists are involved in the operation of organ collection and subsequent transplantation (and this is done urgently, the clock is ticking, the organs cannot lie somewhere in the refrigerator and wait in the wings). In conditions of military operations, this is simply impossible - neither technically, nor even from the point of view of meeting the time and temperature requirements for storing and delivering a donor organ. And it is also impossible to maintain absolute sterility in war.
