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Doctor Said No
Tenorio, who trained in nephrology at Lapeyronie Hospital in Montpellier, France, told Ryan he recommended against a transplant because of his age, according to his statement to police. Ryan asked for a second opinion, so Tenorio asked fellow nephrologist Orlando Granera, who was educated at National Autonomous University of Mexico, to look at Ryan.
Specialists like Tenorio and Granera earn about $500 a month at a public hospital in Nicaragua. Ryan had agreed to pay $20,000 in fees to the medical team for the transplant, Hernandez says. The two doctors declined to say how much they stood to earn. Both told police they weren’t paid anything after Ryan died.
Granera, 37, arranged to do the transplant at Military Hospital, which consists of a pair of long, mildew-stained buildings with cracked windows on a Managua hillside. Granera told police he asked Picado to sign a notarized statement saying he was volunteering his kidney at no cost.
“I clarify that I am doing it for humanity and without any profit,” the May 23, 2009, statement says.
Granera, in an interview at his office at Metropolitan Hospital, says he wouldn’t have taken the case had he known Picado was offered money.
‘Strictly Friendship’
“They said it was strictly based on their friendship,” he says. Tenorio says he hasn’t done anything wrong and has spent his career following the highest ethical standards. “I don’t know anything about any compensation,” he says.
Luis Callejas, a Nicaraguan congressman and a surgeon trained at Tulane University in New Orleans, doesn’t believe Picado agreed to donate an organ for free.
“An American doesn’t meet a stranger in Nicaragua and get an organ just because they like each other,” says Callejas, who supports a proposal to regulate transplants.
The Picado case led the Nicaraguan Ministry of Health to start writing tougher rules on transplants, and Congress will decide whether to approve them. It’s illegal in Nicaragua to sell an organ, but the law is vague and bans transplants only if there’s no proof of the donor’s consent, says Norwin Solano, a human rights lawyer in Managua.
Different Laws
Brazil, Colombia, Ecuador and Peru have passed laws restricting or banning organ donations by people who aren’t related to the patient.
Since Nicaragua permits organ transplants for foreigners, Picado and Ryan were wheeled openly into operating room J-5 at the end of a red-tiled corridor in the Military Hospital on May 30, 2009. Granera, who isn’t a surgeon, chose Javier Melendez -- a surgeon who had done 10 previous kidney transplants and had trained in urology at National Autonomous University -- to remove Picado’s kidney.
Melendez, 37, told police he severed the left renal artery, which leads from the kidney to the heart, and stitched it shut with silk sutures. Then he severed the ureter, which connects the kidney to the bladder, and removed the organ, the doctor told police on July 24, 2009.
Melendez handed the kidney to Jose Borgen, a urologist and surgeon who had also studied at National Autonomous University. Borgen later told police he transplanted the kidney into Ryan without complications.
Blood Surged
Less than an hour after the surgery, Picado’s blood pressure plummeted and he stopped breathing, a coroner’s report says. Blood surged from the severed artery, and doctors tried to rescue him. By the time Picado died, he’d lost 80 percent of his blood, hospital records show.
Within five days, Ryan’s body began to reject Picado’s kidney, his immune system attacking it as if it were a virus. Surgeons removed it. Ryan died on Aug. 8, 2009.
Nicaragua’s health ministry found in February 2010 that the hospital had violated regulations by failing to examine Picado properly before surgery. The ministry is investigating whether the doctors were qualified.
Solano, the Nicaraguan human rights lawyer, says he hopes this case forces the nation to toughen its laws.
“Our country may be an organ shop for the rich,” he says. “This organ-trafficking business is a sleeping giant that is being awoken.”
61 Cases
In Peru, Latin America’s fifth-most-populous country, prosecutors are conducting a much more extensive investigation. They’re looking at 61 cases of suspicious transplants and are targeting the role of brokers.
It’s in the slums of Lima, the capital, where brokers have found most of their recruits. Brokers enlist people like Jose Levano, an unemployed medical laboratory technician, and his wife, Vilma Bramon. They live with one of their four children and Levano’s elderly mother in a derelict home in Ancon, a dusty coastal town on the northern edge of Lima. They have no running water.
In 2005, Levano, 45, placed an ad in a local newspaper offering to sell a kidney. Peraldo, the taxi driver, responded. Peraldo paid Levano $5,000, and surgeons at Clinica Internacional in Lima completed the transplant without any complications on Aug. 20, 2005, Levano says.
By late 2007, the couple was broke, after having cared for an ailing relative. Levano called Peraldo, saying his wife would sell a kidney so the family could get some money. Peraldo took Bramon, a housewife, to Laboratorio Clinico LAD SrL, a medical testing laboratory in Lima that’s co-owned by Peraldo’s friend Victor Salas, a pathologist, Bramon says.
‘Perfect Candidate’
A few days later, Peraldo brought Bramon to Christian Miranda, a nephrologist at Clinica El Golf hospital in Lima’s San Isidro neighborhood, where mansions and luxury apartments line the streets.
“He told me I was a perfect candidate to be a donor and nothing would happen to me,” Bramon says.
In early January 2008, Peraldo contacted Bramon with the news that he’d found a patient who needed her kidney, she says. On Jan. 20, Miranda had Bramon admitted to San Felipe Hospital, her medical records show. As she settled into a private room, Peraldo gave her $6,000 in cash, Bramon says.
The next day, on Jan. 21, 2008, Jose Arias, a transplant surgeon on the hospital’s staff, removed her kidney. The organ was transplanted into a Spanish man, hospital records from the criminal investigation say.
Constant Pain
Immediately after her surgery, Bramon was moved to an intensive care bed, suffering from high fever, nausea and a urinary tract blockage, she says.
“I thought I was going to die,” she says.
Bramon says she has been in pain ever since. At night, she can’t lie on her left side because it hurts too much. She’s visited four different doctors, had six abdominal scans and taken five different painkillers. She spent all the cash she got for her kidney on medication and doctors.
In January this year, Bramon allowed a reporter to accompany her on a visit to Wilfredo Luna, a cardiovascular surgeon in Lima. She told the doctor that her pain was overwhelming. Luna, 50, examined images of Bramon’s abdomen and shook his head. The malady was caused by a poorly made incision during the transplant, which slashed nerves, he said.
“It cannot be reversed,” he told her.
Arias says in his office at San Felipe that he’s been paid $4,000 to $5,000 for each of the four transplants he’s done. All of his donors, as required by law, said they hadn’t accepted money for their organ, he says.
‘What Can I Do?’
“If these people are up to something but have all the correct papers, what can I do?” Arias says. Bramon says she signed a sworn statement saying she wasn’t compensated for her kidney because Peraldo said that was the only way she’d get paid.
Miranda, the nephrologist, told investigators he didn’t know anything about organ trafficking in Peru.
“I don’t belong to or know of any illicit organization,” Miranda said in a Jan. 14, 2010, statement to police. He didn’t return telephone and written requests for comment.
Peruvian prosecutors started their criminal investigation of Peraldo and his associates in October 2009. Peraldo said he was a taxi driver who knew nothing about donors paying for kidneys. Salas, who says he screens patients for transplants, told investigators he didn’t know anything about organ trafficking. He didn’t respond to requests seeking comment.
Within a year after harvesting Bramon’s kidney, Peraldo and Miranda found someone else who was willing to sell an organ. In late 2008, a friend who had sold a kidney sent Eduardo Yataco, a construction laborer in Lima, to Peraldo.
‘Totally Safe’
“He promised about $12,000,” Yataco, 33, says. “He said it was totally safe.”
In February 2009, when Peraldo said it was time to donate his kidney, Yataco says he told his wife he was going to Trujillo, in northwestern Peru, on a construction job.
“I was embarrassed that I was doing this, so I lied,” says Yataco, a thin man with black hair and deep-set brown eyes. Yataco went to Lima’s Clinica Vesalio.
Arias, Bramon’s surgeon, cut out Yataco’s left kidney on Feb. 12, 2009, hospital records show. The recipient of Yataco’s organ was a Lima woman, according to hospital records cited by police. Yataco, who says he signed a statement at Peraldo’s request before the procedure saying he wasn’t being compensated, says Peraldo paid him about $12,000.
‘She Was Horrified’
The for-pay organ trade cost Yataco his marriage and his health.
“When my wife saw this, she was horrified,” says Yataco, pulling up his work shirt to show a 4-inch (10-centimeter) scar where doctors removed a kidney. “She asked me what would have happened if I had died on the operating table, and she was right. My wife left me because of this.”
Yataco looks pale, and his eyes have a yellowish tint. He says he’s always tired and his side is in constant pain.
“Physically and emotionally, I am not the same man,” he says, shaking his head. “I’m alone, broke and humiliated.”
Seven months later, Miranda was contacted by a Mexican man who wanted to buy a kidney, according to police findings. Oscar Soberon, founder of Mexico City-based computer systems company S&C Constructores de Sistemas, had been suffering from kidney failure since December 2008.
He’d heard about the organ ring in Peru from a barber at his country club in Mexico City, his son, Oscar Soberon Jr., says.
In late September 2009, the senior Soberon called Miranda in Lima, and the doctor promised him a transplant with a donated kidney for $125,000, Soberon told police after the transplant.
‘Cover the Costs’
“He told me that would cover all the costs for me and the person who donated the kidney,” Soberon said.
Peraldo called Santiago Montero, a 34-year-old baker in Lima, according to a statement Montero gave police. When Montero was admitted to Santa Lucia hospital in Lima on Oct. 31, 2009, doctors listed kidney stones as the reason for removing his kidney, hospital records show.
“The idea was to hide what was happening,” Montero later told police as they were investigating the case. “The truth is, my kidney was never sick.”
Surgeons removed Montero’s left kidney on Nov. 1, 2009, and transplanted it into Soberon. As Montero recovered from the surgery, Peraldo stopped by.
“He gave me $7,000 in U.S. dollars,” Montero told investigators.
‘It’s All About Money’
Six weeks after the surgery, Soberon, 56, began complaining of severe pain. He went to San Felipe, the same Lima hospital where surgeons had removed Bramon’s kidney, according to police interviews.
Soberon’s body rejected the transplanted kidney, his medical records show. On Dec. 13, doctors removed it. Within 10 days, Soberon had developed a fever and pneumonia, a Dec. 23, 2009, investigation report shows. He died on Jan. 14, 2010, in Mexico City, and his body was cremated, his death certificate says.
“I don’t think this business has anything to do with medicine,” Oscar Soberon Jr. says. “It’s all about money.”
Fanny Fregueiros, an attorney for the Peruvian Health Ministry, says Soberon died because the transplant was poorly done.
“I investigated this thoroughly, and it’s clear there was criminal negligence,” she says. On Jan. 26, 2010, Fregueiros recommended the National Prosecutor’s Office charge those responsible with criminal organ trafficking. As of May 11, no one had been charged.
‘It’s False’
Miranda and Peraldo told investigators that they hadn’t paid Montero for a kidney.
“It’s false that I said there was a donor or spoke of economic figures,” Miranda told police.
These kinds of conflicting statements are typical of the organ transplant trade, making it hard to curb illegal behavior, Harvard’s Delmonico says. He’s spent the past six years traveling internationally to urge doctors and governments to stop organ trafficking.
“The problem is that you have so many people who are desperate for a transplant and willing to pay for one and so many poor people who need the money and can be exploited,” he says.
Back in Managua, Elizabeth Tercero weeps. In March this year, Tercero visited the prosecutor investigating her son’s death, and she says he told her that it may be too hard to prove anyone broke the law.
“This crackdown won’t bring back my son Luis,” she says. Her pain shows how putting a price tag on human organs isn’t just illegal; it’s also potentially deadly.
To contact the reporter on this story: Michael Smith in Santiago at Mssmith@bloomberg.net
To contact the editor responsible for this story: Jonathan Neumann at jneumann2@bloomberg.net
http://www.bloomberg.com/news/2011-05-12/desperate-americans-buy-kidneys-from-peru-poor-in-fatal-trade.html