Organs for Sale

An Ethnographic Examination of the International Organ Trade

Susanne Lundin

• Publisher: Palgrave Pivot
• Year: 2016
• Print ISBN: 9781137539847
• eBook ISBN: 9781137539854
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

In this book, Susanne Lundin explores the murky world of organ trade. She tracks exploited farm workers in Moldova, prosecutors in Israel and surgeons in the Philippines. Utilizing unique source material she depicts a rapidly growing organ market characterized by both advanced medical technology and human trafficking.

1

The Sellers in Moldova

Abstract: This chapter is based on those who sell their organs. Moldova is one of Europe’s poorest countries where a quarter of the population is abroad in search of work in the black market. Since a few years, this also applies to selling organs. Typically, these organ sellers are contacted at home in Moldova and then attracted to, for example, Turkey with the promise to earn big money. In the end it turns out that these people are forced to give away a kidney, either against a very small amount of money, or simply are being robbed of this body part.

Lundin, Susanne. Organs for Sale: An Ethnographic Examination of the International Organ Trade. Basingstoke: Palgrave Macmillan, 2015. DOI: 10.1057/9781137539854.0004.

Moldova lies wedged between Romania and Ukraine, with a small opening to the Black Sea. The airport of the capital city, Chisinau, is small and unpretentious. Moldova is no tourist destination and few travel there. Several men in business suits with briefcases on their knees are talking on their mobile phones as soon as the plane lands. The other passengers are men, women, and children with large suitcases and plastic bags filling the baggage compartments. People who travel to Moldova fall mainly into two categories: business people and Moldovans returning home from working abroad.

“Professor Lundin, Susanne!” I hear someone calling. It’s Marius Nicolaie, the Moldovan doctor who will help me get contacts for my research, who has come to meet me at the airport.¹ takes my suitcase and points to the parking lot just outside the arrival hall. About twenty minutes later we are in the very center of Chisinau.

We park close to the city’s most fashionable street, Boulevard Stefan cel Mare, where modern shops and boutiques coexist pleasantly with magnificent seventeenth-century buildings. This is a beautiful city, but it has seen better days. On the streets, handcarts jostle with buses that seem on the verge of breakdown. It is dark in the foyer of my hotel, and it is dark in my room too. Electricity is available only a few hours a day. So is water.

I set off at once to hunt for Moldovan currency. There are ATMs and branch offices of banks everywhere. Signs mounted above bank doors display numbers indicating the exchange rate for various currencies, and I see well-dressed officials climbing ladders to update the figures. It feels like a direct extension of the international stock exchange but with old-fashioned methods. It turns out, however, that neither ATMs nor banks are able to supply money. There are exchange rates, but no cash. I turn to the hotel receptionist, and an hour later he has exchanged my American dollars in the black market.

Moldova is one of Europe’s poorest countries and was formerly part of the Soviet Union. It successfully supplied other Soviet republics with fruits, vegetables, and wine. Today the country is destitute. Life is possibly a little easier for its people today than it was around the turn of the millennium, when a full 73 percent lived below the level of absolute poverty. But the people of Moldova are still living under very meager conditions. Unemployment is enormous. More than one-fourth of the country’s population is outside the country in pursuit of work and money. Many take informal sector jobs as domestics or construction workers. Others get caught in organized begging or prostitution. In recent years a new source of income has arisen in the black market. People are traveling abroad to sell their organs.

Though the organ trade is a relatively new phenomenon in Moldova, it is an established enterprise at the time of my visit. In the first years of the new century, Marius Nicolaie had started coming into contact with people who were seriously ill. They all had ugly, badly healed scars on their torsos. Many were deeply depressed and alcoholic. At first none of them wanted to disclose what had happened. Eventually it emerged that they had sold one of their kidneys in order to provide for their families. “It’s said that in just a few years over three hundred people have become victims of this filthy trade,” says Marius Nicolaie, “and almost everyone has come from the countryside.” One of them was Constantin.

I meet Constantin. He lives in a run-down apartment building in one of the many poor neighborhoods that exist in Chisinau. Constantin is the youngest son of a large family of agricultural laborers and had already realized as a teenager that it would be impossible to support himself at home in the village. One day, a man came to see him. This man, who had once lived next door to the family, had left the village several years before to work as a waiter. Now he was home visiting his parents. But this ex-neighbor had other things to do in the village, too. One of these was offering young village residents work in the informal sector. He asked Constantin if he’d like a well-paid job in a restaurant abroad. In Turkey. Constantin had just turned twenty and was tempted by the idea of quick money. Most of all, he longed to leave his native village and see the world. “But to be honest,” he says, averting his gaze, “I knew from the start that it might be about selling a kidney. People were talking about that sort of thing.”

Constantin said yes to the neighbor. After that, everything went quickly. Constantin and two other men from the village were driven to Chisinau. A doctor examined them and established that they were healthy. Next they were given identity documents and then they were off to Turkey. Constantin started working as a dishwasher in a restaurant in Istanbul. The job was hard. They worked from early morning until late at night. The food, which was included in their pay, wasn’t very good and consisted mostly of leftovers. “They called it benefits attaching to wages, but we had to share it with the dogs.” He tells me their housing was an additional attachment to their wages. “A room in a dirty, windowless basement without a heater, but with lots of lice!”

After two months, neither Constantin nor his neighbors from the village had received any pay. They decided to give notice and went to the restaurant manager to collect payment for their work. He was enraged. They would only get the money if they agreed to “donate” one of their kidneys. “We tried to get our passports and escape for home,” Constantin says. “One of us ran off without his passport, but I went back to my boss and said, ‘Give me the passport – I don’t need any pay – just let me go.’ But I was told that if I refused to give away my kidney they would shoot me.”

Constantin decided to forget about both the passport and the money. Early one morning before his shift began he slipped out of the cellar room and headed for the outskirts of the city. The plan was to try getting a lift to the border and then smuggling himself in a truck bound for Bulgaria, and eventually Moldova. But the restaurant manager’s men found Constantin and locked him in the cellar. The next day he was driven to a hospital south of Istanbul. He was anesthetized, and when he woke up one of his kidneys was gone. “The pains were so bad that I couldn’t move,” he says. “It took six days before a doctor came and gave me my medicine.”

Shortly after that, Constantin was back at the restaurant in Istanbul. He resumed his job washing pots and pans. The aftereffects of the operation meant that his body did not have the strength to do as much as before. The work was heavy going. In the end, the restaurant manager gave him permission to leave and paid Constantin US$2,350 for five months of work and one kidney. Constantin returned to Moldova. He did not want to go back home to his village but stayed in the capital, Chisinau. “I was too ashamed to go home,” he says.

Today he lives with his wife and their daughter in one room with a kitchenette. In their neighborhood, begging children and youths wander aimlessly, smoking or sniffing glue from plastic bags. Constantin’s flat has neither electricity nor running water. He cannot afford a better apartment. His wife is unemployed and Constantin’s pay as a temporary construction worker does not go far. Furthermore, he can only work sporadically because he has been having problems with his remaining kidney since the operation. “I’m a failure. I can’t work and take care of my family,” he says with tears in his eyes as our conversation comes to an end. “If I’d only known all this from the very start. But when my neighbor came and asked me, everything was more like a joke at the time. I didn’t understand that he’d sold, himself – and that he’d turned into one of them, someone who fixes up organs!”

The meeting with Constantin was my first with Moldovan organ sellers. There would be more during my visit in the country. Marius Nicolaie is affiliated with the Renal Foundation, a small organization that consists of three to four people who work entirely on a voluntary basis. They have a close collaboration with two international organizations: the International Organization for Migration (IOM), which works for a just migration policy, and the Organization for Security and Co-operation in Europe (OSCE), which deals with security issues in Europe. Together they travel around to different villages to inform people about human trafficking.

It is an oppressively hot August day as Marius and I make our way to the village of Susleni. Marius has rolled the windows down to let in a little air. Suddenly he slams on the brakes in the middle of the road. He gets out of the car and takes hold of a branch hanging low over the road. “Taste the walnuts,” he says. “These are Moldova’s gold!” I open the car door and get out to stretch my legs. In spite of the few kilometers, we have been driving for more than two hours on potholed roads, and my body feels it. We stand in the shade of a cluster of lush walnut trees. On the horizon, I see gentle hills and old orchards. Close at hand, things look different. Ramshackle houses stand all along the road. I’m guessing they were once painted blue. Now the color has flaked off both walls and window frames. Far off, in sun-scorched fields, I see two broken tractors. They have sunk deeply into the ground and it seems they must have been abandoned a very long time ago.

We park in the middle of the village. Beside us, a horse hitched to a wagon stamps. When I peer down into the wagon I see a young boy lying there fast asleep, his hat pulled down over his eyes. Otherwise, the village seems deserted.

A steep stone staircase leads up to the town hall. It is a two-story structure that was once certainly both well kept and well used, but now most of the white stucco has fallen off and chickens scratch in the parched flowerbed that runs around the building. A bit further away I glimpse small outbuildings, one of which – I understand eventually – accommodates the town hall’s privy. A multitude of flies buzzes around the hole in the ground. Outside, pigs root.

Inside the hall, the walls provide glimpses of what have once been important issues in the village. Offers of seed at good prices, a faded bus schedule. A tempting notice for a film to be shown on a date long past. And then there are posters with pictures in vivid colors and text like: “Do you know what trafficking is?” “You have the right to information.” “You have the right to help if you have been subjected to trafficking.” “Turn to IOM.”

The meeting room is empty except for a large table with chairs. The Moldovan flag hangs on one wall, and on another a painting of the former president, Vladimir Nicolae Voronin. Some ten or twelve people are seated around the table. I shake hands with an elementary school teacher, a policeman, a social worker, a shopkeeper, a postal employee, several interested residents of the village, and a young man from IOM. Lidia Stancu, who works for IOM, opens the meeting.² She passes out an agenda with discussion points: Do people know what an organ transplant is? Do people know that an illegal trade in organs is going on? Are organs and transplants something you should be able to buy? Do you have the right to sell your organ? Who might encounter this and be exploited? Who has this been happening to? Who are the organ brokers?

The meeting gets intense. Participants talk at the same time. A few stand up and march around the table, agitated, and a moment later someone leaves the room, only to return a moment later with a cell phone at his ear, deeply absorbed in conversation. Who is he talking with, and why just now? The teacher says she thinks that “anyone obviously has the right to decide about her own body” and to sell both her labor and her organs. The shopkeeper absolutely disagrees, totally dissociating himself from people’s “doing violence” to their own body, that it is against “God’s will.” The policeman gets louder and louder, asking how he’s supposed to be able to stop the organ brokers who come to the village.

The opinions are many. But it is obvious that for the people in the village of Susleni, what weighs most heavily are the economic conditions. It is poverty that leads to desperate efforts to earn money. And it is poverty that trumps most of the existential and sometimes even the religiously based arguments.

As the meeting is drawing to a close, a young man steps into the room and stations himself unobtrusively in the farthest corner of the room. This is Nicolae, the organ seller Marius had been given a tip about and who is the reason we are here on this day. It was to him the man with the cell phone made the call during the meeting. Nicolae’s experiences resemble Constantin’s. They began with the offer of a job outside the country. This offer came from a man who had previously lived in the village but had moved to Turkey. Nicolae jumped at the chance, thinking that a construction job abroad ought to pay good money. He and six other men from the village were given counterfeit identity documents. The trip took them to the village of Aksaray in Turkey, but what awaited them there was totally different from what had been promised. To begin with, the men were locked in a warehouse. “They said we’d be living there until the construction job started, but I realized fast that something was wrong,” Nicolae says.

A week went by. The men spent their days sleeping and playing cards. Anger and fear lay in wait the whole time. What was going to happen? Would they get jobs? After a time, a nurse came to the warehouse. As she was examining them and determining their blood types, a man entered with papers in his hands. Nicolae and the other men were forced to put their signatures on the papers. “I had no idea what it was,” says Nicolae, “but we understood that we had to sign.”

These proved to be forms on which the men certified that they were voluntarily donating their kidneys. Documents of this kind are extremely important for organ brokers. It means that they have a line of retreat open if someone were to ask awkward questions. For Nicolae, the document signified that he promised to make a gift of a part of his body.

The men signed their names and the nurse drove them to the hospital in Aksaray. “We went down to the basement, which was fully equipped as an operating room,” Nicolae says. “I got a needle in my arm, and after that I don’t know anything more.” When Nicolae woke up, an unknown man was lying in the hospital bed next to his. The man spoke a language that was foreign to Nicolae. Later, Nicolae learned that the man had one of his kidneys in his body.

Nicolae left the hospital several days later with barely US$2,600 in his pocket. He bought a bus ticket and went back to Moldova. His destination, just like Constantin’s, was Chisinau, where he rented a room with three other organ sellers. They stayed for five months before they went home. “We stayed in the city to get better,” he said. “In our village the work is hard, and they’d notice right away if we were weak and sick. We didn’t want anyone to know what we had done. I didn’t want to make my parents sad and disappointed.”

At IOM, I speak with a psychologist who has been working for several years with victims of human trafficking. Like many Moldovans of the same age, she has received her training in the former Soviet Union and therefore prefers to speak Russian with me. Our conversation winds its way forward in a mix of Russian, Romanian, English, and German. Despite the halting conversation, the psychologist’s message is clear: in Moldova the culture creates feelings of impotence and guilt in many men. “In spite of the socialist idea of an equal society,” she says, “Moldova was and is a patriarchal society where men make the decisions.”

The burden of supporting a family weighs heavily on these men. Some of them see selling an organ abroad as a way of assuming their responsibility for family. Nearly all of them are cheated and return to Moldova almost empty-handed. There are many societies in which it is a blow to men’s self-esteem when they are not able to live up to their role as head of the family. Moreover, the Soviet legacy that marks Moldova seems to engage the men’s sexual identity in an altogether special way. Or as the psychologist from IOM explains it, “We still live according to the Soviet model here, hoping that the state will take care of us and that we have civic rights.”

The Soviet ideals of equality and citizenship still exist. The victim role that men who sell an organ end up in runs directly counter to both the ideal of masculinity and the ideal of citizenship in Moldova. This leads Constantin and Nicolae to see themselves as failed men and breadwinners. They are only two of many for whom shame at having become a victim makes them keep quiet about the organ trade. There are also reasons other than poverty and shame that make people secretive about the organ trade. One of them is fear.

Mingir is a typical Moldovan village where few residents earn more than US$46 a month. The village, which is about forty kilometers southwest of the capital, landed on the international map in 2003 when it emerged that a large number of village residents had sold one of their kidneys. Police officer Pjotr Sernibovskij investigated the so-called Mingir case and reported that it involved about forty individuals. But only fourteen chose to cooperate with the police.

Lidia Stencu and I drive to Mingir one day in early November. As we get out of the car, the wind is blowing ice cold around the corners of the buildings and the few people who are visible have their caps and kerchiefs pulled low on their foreheads. It isn’t much warmer in the small shop in the middle of the village. On the shelves are flour, grain, cookies, and canned goods. In one corner of the shop are baskets of potatoes and root vegetables, while the refrigerated case beside the cash register gapes mostly empty. Having been out in the country without food for an entire day, we want to buy something we can eat. I point to a chocolate bar, but it’s not for sale. In fact, it’s a wrapper without contents, and when I look around among the shelves it becomes apparent that there are more wares of this kind. Empty packaging that seems to have the function of testifying to what it had been possible...

Table of contents

• Cover
• Title
• Introduction: The Buyers in Sweden
• 1  The Sellers in Moldova
• 2  The Brokers in Israel
• 3  The Doctors in the Philippines
• 4  The Syndicate in South Africa
• Conclusion: Can the Organ Trade Be Stopped?
• Epilogue
• References
• Index