Soon after Lucille returned to New York with her new kidney, she encountered the first of several aftershocks. Medicaid would not cover anti-rejection medication until she showed her transplant records and hospital discharge papers. She had checked out of the transplant clinic at St. Augustine’s Hospital with nothing but her clothes, a few souvenirs, and a warning from the broker not to disclose what had transpired. Lucille, her donor, and their surgeons had broken the law: South Africa’s 1983 Tissue and Organs Act prohibits the buying or selling of organs, tissues, and other body parts. In signing a false affidavit stating that her donor was a blood relative donating his kidney freely and altruistically, Lucille was guilty of fraud and criminal conspiracy. In traveling with a tourist visa to engage in an illegal exchange, Lucille and her donor also committed visa fraud.

Lucille contacted the doctors in Durban. They faxed back a discharge report stating that Lucille received a kidney transplant at the Netcare clinic in St. Augustine’s hospital on August 1, 2003. And so Lucille got the drugs she needed.

Her second aftershock was worse. It occurred when she opened the New York Times on December 8, 2003, and saw a photo of two young Brazilian men and a headline that read: “14 Arrested in the Sale of Organs for Transplant.”

The Supplier

“Put yourself in my shoes,” said Alberty da Silva, a semi-literate 38-year-old laborer and night watchman from the slum of Areas, near Recife’s international airport. Despite his reputation as a notorious ladies man and the father of a few children by different women, Alberty is anything but a deadbeat dad. After he tucks his children to sleep on a piece of foam on the floor of his shack, Alberty stretches out in the garbage-strewn front “yard” to sleep under the stars.

Alberty came up hard as a child. His mother was forced into sex work to feed 11 children, and as a small child Alberty knew hunger and humiliation. “My mother had to sell her own flesh to keep us alive,” he said, “but her sacrifice made us all into outcasts. I never forgot it and I didn’t want my own children to suffer the way I had.” When he heard rumors circulating that you could sign up to sell a kidney for US$10,000, Alberty sought out the brokers: a retired military police captain, Ivan Bonifacio, and his sidekick, a tall, “mean-looking” guy with a thick accent named Gaddy.

To Alberty’s surprise, Gaddy was Gadalya Tauber, a retired 67-year-old Israeli Defense Force policeman. On learning that Brazilians would donate to Israeli patients, Alberty asked, “Can it work that way?” Gerson, a nephew of Captain Ivan, assured him that there would be no problem because “under the skin, all men are brothers.” Gerson offered Alberty US$10,000, airfare to South Africa, and all his expenses. He was promised excellent medical care at a luxury hospital, and he might even get to travel afterwards—just for giving away a kidney he didn’t need. Gerson told Alberty that one kidney works while the other sleeps; the surgeons would remove his sleepy kidney and leave the good one.

By the time Alberty’s blood was tested at a clinic in Recife and his passport and visa were procured, the payment for a fresh kidney had fallen to US$6,000. Competition among kidney sellers was so keen that the brokers could be choosy and pay less. Between May and November 2003, more than a hundred people from Recife had signed up as sellers; 34 of them, including Alberty, made the trip. When he returned, even more poor people were lining up to sell organs. The price paid for a kidney had dropped to just US$1,000.

Operation Scalpel

Just as suddenly as it began, the kidney express derailed. In early November 2003, on a tip from a dissatisfied Brazilian seller, South African police set up a sting operation at St. Augustine’s Hospital, trapping a paid donor and his Israeli recipient, a middle-aged father. By late November, 14 people had been arrested in parallel police operations in Durban and Recife. More arrests followed in 2004. Those detained, arrested, and convicted included brokers, surgeons, nephrologists, technicians, insurance agents, two kidney buyers (to serve as state witnesses) and more than a dozen Brazilian sellers, among them Alberty.

“Look how they lied,” said Captain Louis Helberg, head of the South African police’s Commercial Crime Unit and head of the sting operation. Helberg and his team of Afrikaner and Zulu cops stormed St. Augustine’s Hospital and confiscated all medical records from the private transplant clinic rented by Netcare, South Africa’s largest HMO. They also raided the South African Blood Service, carrying off the blood and records used to facilitate the illegal transplants. Going over the records in February 2004, Captain Helberg read incredulously: “August 1, 2003. Recipient: ‘Lucille Hubbard’ (New York City), age 48. Donor: Alberty Alfonso da Silva (Recife, Brazil), age 38. Living related donor.”

“Do you think the transplant surgeons really believed that a poor Brazilian was related to a wealthy New Yorker?” he asked. “These doctors turned everyone into family members—one big, sick, unhappy family,” he said disgustedly. “I won’t rest until every last one of the surgeons, nephrologists, nurses, transplant coordinators, translators, insurance company managers, HMO administrators and their international brokers are arrested and charged with organized crime.”

In August 2005, four South African transplant surgeons and several associates were charged with “fraud, assault with intent to do grievous bodily harm, and contravening the Human Tissues Act.” Their trial takes place in early 2006.

The Lasting Effects

Sitting on a broken stool in his shack, Alberty was philosophical. The police could not confiscate his money—there wasn’t any left. Two ex-girlfriends, the mothers of his children, made off with a large chunk of it, and with what remained Alberty bought a used car to look for work. When he couldn’t make his monthly payments, Alberty traded the car for an old jalopy, which promptly broke down and was traded for a secondhand bicycle. The bicycle and a pair of running shoes are all Alberty has to show for the transplant—except for a huge, saber-like scar across his mid-section.