Focus on illegal organ trade

Kassim Fadhel, a 58-year-old businessman in the southern Iraqi city of Basra, has been waiting for more than three years to find a reliable kidney donor to replace one of his own failing organs. Frustration led to him having to buy a kidney on the black market in the capital, Baghdad. "I had to save my life, I did not want to die. We couldn't find one relative of mine who could be my donor, but thank God I found someone who sold me their kidney" Fadhel said. Poverty in Iraq means there are currently plenty of people willing to sell their kidneys, with middlemen bringing vendor and buyer together. According to the Ministry of Health (MoH), renal disease is common in the country and more than 5,000 Iraqis currently require urgent kidney transplants. Decades of poor diet, unclean water and lack of medical care have contributed to the high levels of kidney disease. The main gate of Baghdad’s Karama hospital is the place to go if you want to trade a kidney. A man, who calls himself Bashar, hovers by the entrance, his front business is selling tea and soft drinks but his real trade soon becomes apparent. "I can get you a healthy kidney. It will cost you US $2,000 to $3,000, you just have to give me your blood type and I will get it for you even before you have finished a cold pepsi," Bashar said, smiling. Donors are taken into the hospital laboratory where blood tests to establish compatibility are carried out. Fadhel's new kidney came from a man who initially asked $4,000 but was bartered down to $3,000 after long hours of negotiation. The kidney, tests, two operations – one on the donor and the other on the recipient – along with two weeks in hospital, gave Fadhel a bill of $10,000. The Baghdad kidney market trade in Iraq has even attracted interest from abroad. ‘Medical tourists’ from neighbouring countries are keen to buy the cut-price organs. POVERTY DRIVING THE TRADE The man who sold Fadhel his kidney, Ali Hussein, is a 32-year-old unemployed domestic servant, from al-Sadr district, one of the poorest suburbs the capital. Hussein, who looked slim and desperate, explained why he had been forced to make the sale. "I'm a father of four and my wife is very sick. I do not have work and need money desperately to support them and for this reason I decided to sell my kidney." Donors are supposed to be referred to a special committee at Karama hospital that determines their suitability. The reality is that most donors are forced to sell due to poverty. Donor records inspected by IRIN, indicate that nearly 90 percent of recent donors are from poor suburbs of the capital or from low income parts of the country. IRIN met four potential donors standing by the main hospital gate waiting for buyers to offer a good price for their kidney. They were all there because they were penniless and had relatives to support, they said. While many doctors disapprove of the illicit trade outside their hospital, if a transplant patient turns up with a willing donor, they tend not to ask too many questions due to the difficult circumstances in the country. "At the end of the day it is saving a life. We don't believe in the buying and selling of kidneys, but these are very difficult times in Iraq, " Dr Karima Abbas, from the transplant department of the Al-Khayal hospital in the capital, said. "I would like to make it clear that no single kidney has been transplanted in our centre at al-Karama hospital from unrelated donors except for those patients with heriditary renal disease or a patient who was a kidney donor himself. Those patients could not count for more than 10 patients during the last 16 years," Dr Shawqi Gazala said. SURGERY But Dr Zein al-Moswi, a renal surgeon, told IRIN that the transplantation process was not without risk. "Kidney transplants have a better chance of success when there is a family relationship between the donor and beneficiary. The closer this is, the less the chance of the new organ being rejected,” al-Moswi said When there is no biological link between the two, doctors are often forced to use dangerous techniques to reduce the chance of the recipient's body rejecting the organ. "Agents that slow the immunity system are required to prevent rejection, usually they are very harmful to the patient future in the long run, making him or her more susceptible to other diseases," al-Moswi added. The donor, obviously is left with just one kidney which can be put under pressure and eventually fail, doctors say, particularly given the poor diet and lack of medical facilities in Iraq. ETHICS "Selling a part of the body is something against medical ethics. The reason behind an organ donation should be humanitarian," Dr Qusai Lateef, a senior official in the Basra Health directorate, said. Lateef added that people used to freely donate their kidneys for humanitarian and religious purposes but that the buying and selling was a new phenomena. The Ministry of Interior (MoI) has formed a new section specialising in tracking down the gangs responsible for inducing people to sell a kidney for money. Lt. Col. Abdul Jabbar, head of the Crime Investigation Department (CID) of the MoI, said that they had recently arrested three negotiators and one donor. The donor was forced to sell his kidney to pay back money that he had borrowed from the gang. "The negotiators will be charged according to the law because selling parts of the body is unfair and a crime," Jabbar added. The World Health Organisation (WHO) in Iraq, told IRIN that the marketing of organs is an international crime and those responsible should be punished. The health body acknowledged that it was important to tackle poverty, the root cause driving the trade, according to Dr Nabil Amin, head of WHO in Iraq.