The deal brought together two people who had nothing in common. They were from different cultures, spoke different languages and would never meet. The only thing they shared was desperation.
It was 2008 when a wealthy, 74-year-old businessman from the western German state of North Rhine-Westphalia decided to ignore the law and morality in order to save his own life. The businessman's first name is Walter, and he had suffered from high blood pressure since the age of 50. He had been forced to take strong drugs for 20 years, but now his kidney, responsible for sifting toxins out of the blood, were failing. Walter needed dialysis.
But he didn't tolerate dialysis very well. He suffered from cramps, pain and anxiety. He was also having trouble with his heart, so doctors inserted stents to improve blood flow. There were complications, and Walter had to be operated on again and again. The doctors diagnosed two infarctions and Walter was taken to the hospital in an ambulance. His wife and his son looked on as his body began to fail. His immune system declined, as did his mental state.
Doctors told him he had just a few months left to live -- and he knew that he was far down on the waiting list for a new kidney. It would likely be years before his name rose to the top. His family members became increasingly bitter. They no longer perceived the German doctors as helpers but, rather, as dialysis gangsters who were primarily interested in collecting the 70,000 ($88,000) they could bill annually for his regular dialysis treatments and medications.
But then the family saw a television documentary about the illegal organ trade. The journalist in the report sharply criticized organ traffickers and their shady operations. But with Walter's health declining from day to day, the villains in the program began to seem like potential saviors to his family. They tried to call one of the organ traffickers featured in the program, but he either didn't want to or couldn't deliver. Then, says the son, they called the TV reporter to ask about a second contact she had mentioned in the story.
Looking for a Better Life
In July 2008, Walter boarded a flight to Istanbul, where he was to meet with one of the middlemen the family had contacted. From there, he took a propeller plane to Kosovo.
Vera Shevdko, 50, a hotel maid from Israel, was on the same flight. She had emigrated from Moscow only a few months earlier, leaving her 10-year-old daughter behind with her ex-husband.
Shevdko had hoped to find a better life in Israel but, instead, she was now saddled with debt. Life in Tel Aviv is expensive, and she had rashly spent too much money on a party. And then there was Nastja, her daughter, who would always cry on the phone when she called.
As a hotel maid, Shevdko didn't make enough money to pay for flights, and she certainly couldn't afford to bring Nastja to Tel Aviv to live with her there.
In the spring, she had picked up a free Russian-language paper from the ground at the Tel Aviv bus terminal. There was an ad in the paper that read "Looking for Kidney Donors." It promised good pay and included a telephone number. She had kept the paper, and now she remembered it and called the number. The man who answered the phone promised her $10,000 (about 8,100). Shevdko agreed to sell her kidney.
She says that she saw Walter for the first time in Istanbul. It was only a brief encounter. He was standing in front of her in the customs line after the plane had landed in Pritina. According to Shevdko, he was tall and was holding hands with his wife. Walter and Vera didn't speak to each other, but they were going to the same place: the Medicus Clinic on the city's outskirts, which was partially funded by a German doctor.
At first glance, the story of Walter and Vera would seem to be an account of two adults who wanted to improve their situations and, driven by both hope and hopelessness, made a deal with each other. But a closer look at their story reveals the structure of international gangs that profit from the desperation of human beings. The market is worth billions, based as it is on the tens of thousands of seriously ill people like Walter around the world. In many cases, they don't have enough time to wait until their names move to the top of long waiting lists.
Further Up the Waiting Lists
A recent scandal involving a transplant surgeon in the German city of Göttingen shows how easily matters of life and death can lead to criminal activity. Presumably to improve his patients' survival odds, but also to secure lucrative surgeries for the university hospital where he worked, the surgeon allegedly manipulated patient laboratory results so that they would be moved further up the waiting lists.
Criminal organ trafficking rings have an even easier time of it because there is a practically limitless supply of people like Vera Shevdko: poor, unknowledgeable and willing to sell parts of their bodies for a few thousand euros. Of course, organ traffickers do their best to remain in the background when presenting their cynical business model to surgeons and middlemen. Their illicit activities are rarely exposed, and convictions are even less common.
But, in the case of the Medicus Clinic in Pritina, the criminal network is now well documented. Tall and lanky, with piercing eyes, Canadian prosecutor Jonathan Ratel came to Kosovo in 2010 to aid in the development of a constitutional system within the framework of the European Union Rule of Law (EULEX) mission. It wasn't long before Ratel had turned his attention to the illegal activities of organ traffickers at the Medicus Clinic.
Ratel, 51, is convinced that unscrupulous transplant surgeons removed kidneys from 20 to 30 people and implanted them into wealthy patients at the partially German-owned clinic. The middleman was from Israel, the buyers of the organs were from all over the world and the surgeon, referred to in the press as "Dr. Frankenstein," was from Turkey. The organ "donors" were from places like Istanbul and the Moldovan capital Chisinau, or they had recently immigrated to Israel. The system could only work, says Ratel, because Kosovar doctors and government officials helped cover it up.
SPIEGEL reporters spent months tracing the organ mafia from the Medicus Clinic, following a trail that led to Israel, Turkey, Belarus -- and Germany. The results of Ratel's investigation and SPIEGEL's research now provide deep insights into the structures of the trade in human replacement parts. The case of Walter, the German businessman, shows how deeply Germans are involved in the business dealings of international organ traffickers. It's a business, says Special Prosecutor Ratel, in which "obscene profits" can be made. And, as Europol warns, it's also a "rapidly growing" commerce involving criminal gangs.
Medical advances have opened up new opportunities to the traffickers, with doctors now able to take parts of the liver and lungs from living donors. But the kidney is still the most sought-after organ. According to United Nations figures, some 10,000 kidneys are illegally transplanted each year, although some experts believe that the number could be as high as 20,000. And with both an expanding and aging global population, the demand for organs continues to grow.
In Europe alone, 40,000 seriously ill patients are waiting for a new kidney. That number includes 8,000 in Germany, of which only 2,850 received a replacement kidney through official channels last year. Three Germans who are on organ donor lists die every day, most of heart or liver disease.
The organ mafia thrives because people fear that their time will run out before they become eligible for a transplant. As they face the prospect of death, they are willing to ignore moral qualms and the law -- and to brutally exploit another human being to extend their own lives. Some even choose this route because they would prefer to have a fresh organ from a living body than an old organ from someone who just died.
Organ brokers offer such customers "kidney packages" at prices of up to 160,000 -- all-inclusive, meaning that expenses and bribes are covered. The people who agree to have their body parts removed receive only a fraction of the money. In India and Bangladesh, organ traffickers offer 750 for an operation that will supposedly rescue a donor from poverty. And once a donor has agreed, there is no turning back. Local overseers apply pressure to those who are plagued by doubts or become concerned about the effects on their health. Not uncommonly, the victims are even cheated out of their miserable pay after the organ removal.