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How Kidneys Are Bought And Sold on Black Market

Six months ago, Ronen came to the United States from Israel on a life-or-death mission. He needed a kidney transplant, or he would die.

Soon after he arrived and moved into a donated basement apartment in Brooklyn, a man approached him and offered to give him what he wanted most in the world — for a fee. Ronen would have to pay $160,000 for a kidney; the “donor” would get $10,000.

Ronen is 35, and he has endured nightly dialysis sessions for 15 years. The Forward is not publishing his last name to protect his privacy. Because of his failing health, he cannot work. His rabbi raised money to get him to New York because organ donations are so rare in Israel. Today, his dream is simple: to get a kidney transplant and “to live a normal life, to marry and to work, and to make a family.”

But there were two problems with the broker’s offer: He could promise only that the black market kidney would match Ronen’s blood type, not his antibodies, and Ronen didn’t have anywhere near the asking price. So he turned down the man — but not without some regrets.

“He says to me, ‘Even if you are nice, even if you make a lot of contacts, you need a kidney, Ronen, not just talking,’” Ronen said. “And he’s right.”

Ronen is still looking for a donor. The man who, by all indications, approached him, Levy Izhak Rosenbaum, is looking at a possible five-year federal prison sentence.

Rosenbaum was arrested July 23, and charged with conspiracy to transport human organs. It is perhaps the most bizarre subplot of the FBI’s massive money laundering and corruption investigation that yielded 44 arrests in New Jersey and Brooklyn, including the mayors of Hoboken, Secaucus and Ridgefield; two state assemblymen; five rabbis, and numerous other public officials.

According to the criminal complaint filed in the U.S. District Court of New Jersey, Rosenbaum told an undercover federal agent on July 13 that he’d been brokering kidney sales for 10 years from his home in Brooklyn.

“I am what you call a matchmaker,” Rosenbaum said, according to the complaint, before assuring the undercover agent that he’d brokered “quite a lot” of kidney transplants, including one two weeks prior to their conversation.

Rosenbaum is the first person charged in the United States with trafficking in live human organs, medical ethicist Arthur Caplan said. His arrest has illuminated a dark side of the medical world, where the desperately poor sell body parts to the desperately ill, brokers make a profit and medical centers turn a blind eye.

“There is probably more of this going on,” said Caplan, who serves as director of the Center for Bioethics at the University of Pennsylvania and is co-directing a United Nations task force on international organ trafficking. “It is a very lucrative business.”

The exposure of the organ-trafficking operation surprised most of the medical establishment, who knew of such activity happening overseas but not in the United States. But Rosenbaum’s alleged business was an open secret for years among a certain community of Jewish transplant seekers.

“Over the years, dozens of people have asked me to help them get in touch with ‘Isaac — the organ broker from Brooklyn.’ I always refused to do so,” said Robert Berman, founder and director of the New York-based Halachic Organ Donor Society, which encourages organ donation among observant Jews in the United States, Israel and other countries.

Berman said that while he personally supports the idea of changing the law to allow people to get paid for giving someone else a kidney — after all, he noted, doctors get paid for doing the operation — he does not condone any illegal activity.

“The black market is obviously not ideal. People get ripped off,” he said.

Berman founded the Halachic Organ Donor Society to combat the notion that Jewish law does not permit organ donation. Because of that misperception, he said, Israel has one of the lowest organ donor rates in the world, which is why many Israelis travel to the United States in hopes of finding a match.

“Jews have no problem putting themselves on the list to get an organ, but when it comes to donating, they have a lot of religious reasons not to,” Berman said.

An expert in the organ black market said that Rosenbaum was America’s main broker for an international trafficking network. Nancy Scheper-Hughes, a professor of medical anthropology at the University of California, Berkeley, said she told the FBI about Rosenbaum’s operation back in 2002.

Scheper-Hughes did not respond to interview requests; however, she told the New York Daily News and WNYC public radio that Rosenbaum recruited impoverished kidney sellers from Moldova — where, she said, she visited a village where 20% of the men had sold a kidney. According to the criminal complaint, Rosenbaum told potential clients that the kidney sellers came from Israel.

Scheper-Hughes said that the kidney sellers described Rosenbaum as a thug who threatened them with a pistol if they expressed hesitation once they arrived in the United States for the operation.

But to potential clients, Rosenbaum presented a kind and caring face.

“He tried to help me,” Ronen said of his would-be broker. Ronen related that even after he turned down the offer, the broker called and gave him advice on how to find a volunteer kidney donor. “My feeling is that he is a good person, I can trust him,” Ronen said.

Medical centers interview potential transplant donors to make sure they are suitable matches, and a psychological screening is usually included, as well. Because paying for organs is illegal, Rosenbaum would create fictional relationships between the recipient and the seller, according to the criminal complaint, and would coach both of them on what to say.

“I put together the story,” Rosenbaum said, according to the complaint. “Could be neighbors, could be friends from shul, could be friends from the community, could be friends of his children… business friends.”

More careful screening probably would expose fake relationships, Caplan said, but clearly that didn’t happen, as Rosenbaum allegedly operated his trafficking ring successfully for a decade without detection.

“Some hospitals just don’t care,” Caplan said, noting that medical centers make about $100,000 per kidney transplant. “They want to make the money and do the transplant — they’re not picky.”

Caplan opposes legalizing the sale of human organs, saying that exploitation is inevitable no matter what the legal status. Medical centers should standardize and tighten their donor screenings, he said. According to Caplan, the going rate for kidney sellers ranges from $500 in India to $10,000 in Israel.

“The people who sell are almost always incredibly poor. They’re usually up to their eyeballs in debt,” Caplan said. “The people who are involved in this are past the point of desperation. They’re not making some sort of calculated decision.”

The black market for kidney donation is thriving because demand far outstrips supply. More than 80,000 people are on the kidney transplant waiting list in the United States, and every year about 4,500 die while waiting, according to the National Kidney Foundation. Last year, 16,517 transplants were performed in the United States: 10,550 with cadaver organs from people who died, and 5,967 from living donors.

For people like Ronen, who have been playing by the rules, there’s not much to do but wait and hope — even though time is running out.

“It is very difficult,” Ronen said. “We need a miracle.”

Contact Rebecca Dube at [email protected]

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