News - May 6, 2024 | 03:08 pm PT

Brokers benefit, patients perish in illegal organ trade

On learning he was behind almost 5,000 other people in the queue to receive an organ transplant, the 40-year-old man lost hope in the system.

Thanh (name changed on request) searched the black market for organs twice in vain.

He had been diagnosed with final-stage kidney failure just a few months after the birth of his youngest son.

His two older children were about to go to school soon. His business, over which he had struggled for the last two decades, was in big trouble due to the Covid-19 pandemic. He also had a loan of VND3 billion (US$118,400) he had taken out to build his house.

Thanh only had two options: make three visits a week to a hospital for kidney dialysis or receive a kidney from a living or dead donor.

Since Vietnam made its first successful transplant in 1992, it has been the best option to improve the survival rates of patients with end-stage organ failures.

Thanh had sobbed to his doctor: "I wish to do the transplant. I can’t live like this."

He did not want to get tied to the hospital for the rest of his life.

To get an organ from a dead donor, he registered himself on the national organ transplant waiting list, but learned there were almost 5,000 people in it before him.

Every year there are only 10 around successful transplants from donors, according to Vietnam’s National Organ Transplant Coordinating Center. Vietnamese law currently only allows organ donation involving brain-dead donors.

"When will be my turn?" Thanh desperately asked every time he saw the long queue of patients getting dialysis at Thong Nhat Hospital in HCMC.

Losing hope in the centralized, government-controlled system, he thought about looking for organs from living donors.

In the history of organ transplantation in Vietnam, 96% of over 7,600 donations have been from living donors, with a meagre 4% coming from dead people.

With his strong desire to live, Thanh could manage to simply wait his turn and decided to embark on a journey to find a kidney.

Surreptitious kidney transactions

According to doctors, patients looking for a potential organ donor should start with family members due to the lower possibility of rejection.

Thanh’s father was the first to volunteer. He traveled from the northern Nam Dinh Province to HCMC, a 1,600-kilometer journey to check, but was unfortunately not a match.

Continuing his dialysis, Thanh kept looking for a donor since he "had so many uncompleted dreams and hopes."

He learned from a fellow patient about the black market for organs.

Thanh runs dialysis three times a week at the Thong Nhat Hospital in HCMC, March 2024. Photo by VnExpress/Phung Tien

According to the Law on Donation, Removal and Transplantation of Human Tissues and Organs and Donation and Recovery of Cadavers, any individual aged above 18 who is registered as an organ donor and is sufficiently healthy can legally donate organs without any other restrictions.

However, commercial transactions and brokerage related to organs are strictly prohibited.

Under the law, anyone involved in buying, selling or appropriating human tissues or body parts face imprisonment of three years to life, depending on the seriousness of the crime.

Despite being fully informed of the legal stipulations, Thanh decided to go ahead and buy a kidney on the black market regardless of the consequences.

He did not want to be one of thousands of patients desperately waiting for a transplant and dying before their turn came.

Through an acquaintance, Thanh met a broker named Van from Hue. While the supply of legal organs from dead donors is limited, Van claimed that the supply in the black market was "abundant."

After several months of discussions Thanh boarded a flight to Hue in mid-2022 and met him at a café. Van introduced him to a stranger, a man a few years younger than himself and ready to "donate" a kidney.

The deal was sealed at a price of VND400 million ($16,000) excluding other expenses.

He had to immediately make a down payment of VND100 million ($4,000). It was a transaction that involved no bargaining: The buyer fully knew it was a seller's market.

But the first two candidates' kidneys were not a match. The third, a 35-year-old man, was a match, which gave Thanh hope.

But he had many more hurdles to jump through.

The screening procedure for non-family donations typically has nine steps, the most difficult of which is the legal consultation between the donor and the receiver, specifically designed to uncover illegal transactions like the one Thanh was preparing for.

When Van told him that the legal consultation was complete and he should fly to Hue to sign the documents, Thanh was in seventh heaven.

Meeting Van at a café next to a hospital, he signed and sealed the contract. Van told him to transfer the remaining VND300 million ($12,000) later that day.

The contract, handwritten on a plain A4 paper, was the only evidence of the illegal transaction.

Thanh returned home, feeling hopeful about the day when he would meet the transplant committee.

One day Van just disappeared.

Thanh heard rumours that he had been caught in a drug-related bust by the local police.

"But for his arrest, I think Van was an honest broker," Thanh says with a sigh, holding the handwritten contract.

His hands are darkening as his kidneys continue to weaken.

The scamming organ broker

After Van’s arrest, another broker approached Thanh. Hue, a former acquaintance, told him: "I’m helping you because I care about you."

The same procedures were carried out again with the new broker.

Every other day Hue would ask Thanh to transfer a small amount of money.

The money might not have been big, but the frequency kept increasing. There were more and more calls and messages for amounts as little as VND500,000 ($20) to VND22 million ($880), and the amounts stacked up.

Thanh’s wife kept telling him to be careful of scams. As a businessman himself, Thanh knew the risks, but decided to keep going.

He says in explanation: "We were already halfway, with many flights and a lot of money spent. I could not give up at that point."

This time Thanh went through six of the nine steps in the process. The broker told him that after the Lunar New Year in February 2024 his case would come up to the transplant committee.

Organ sale receipts between Thanh and Van. Photo by VnExpress/May Trinh

He was again excited since the transplant had come very close.

Thanh says from there "things went south pretty fast."

His fingers point at his phone screen that shows a large number of phone calls with Hue on Zalo, the popular Vietnamese messaging application.

The closer it got to D-day, the increasing demands the broker and the organ seller made.

As Lunar New Year (Tet) approached, the latter demanded that Thanh sent money in advance if he wanted the person to come to Hue and appear before the transplant committee.

Thanh mustered VND20 million ($800) and sent it to Hue's account as usual.

But the seller kept saying he had not received the money, while Hue remained silent.

Desperate as he was, Thanh borrowed VND30 million ($1,200) from a loan shark at a staggering 1% interest per day, to transfer to the seller "for him to celebrate Tet."

February arrived and the broker and seller continued to demand more money.

Meanwhile, the bank demanded the payment of unpaid debts warning it would otherwise seize the house he had pledged as collateral.

Thong Nhat Hospital, where Thanh was still getting dialysis done, demanded the VND12 million ($480) he owed.

Only then did Thanh understand that he could not be in a game where the rules were constantly changing based on the interests and whims of other players.

People line up for dialysis at the Thong Nhat Hospital in HCMC, April 2024. Photo by VnExpress/Phung Tien

The transplant black market

Thanh is a typical victim of the illegal organ trade, which is rampant not only in Vietnam but also globally.

The demand for organ transplants remains high and is increasing daily.

The enormous gap between supply and demand means there is a thriving black market for illegal organ transactions.

There are no statistics on the organ black market in Vietnam.

Globally, according to a report by the international database Global Observatory on Donation and Transplantation ("GODT"), there are 12,000 cases of illegal organ transplants annually.

Though this number accounts for only 10% of the total number of transplants, it fetches illegal brokers an income of $840 million-1.7 billion annually.

Of the organs, the kidney is the most traded, with over 8,000 sold annually due to the organ’s easy accessibility: An individual can lead a relatively healthy life with only one kidney, which means many people are ready to sell one of their two kidneys for money.

Organ Watch, an international non-governmental organization tracking human organ commercialization, estimates that over 10,000 kidneys are illegally transacted every year.

Vietnam, Costa Rica and Egypt are three hotspots of organ commercialization, according to a 2015 European Union report on human organ trafficking.

Vietnam’s Ministry of Public Security says that between 2018 and 2022 there had been 394 cases of organ commercialization with 837 individuals involved.

Organ sellers are typically individuals with financial difficulties; the main buyers are people with end-stage kidney failure who are typically willing to pay VND700 million to VND1 billion (US$28,000 to 40,000).

Brokers usually scour for potential buyers on social media or hang outside major hospitals.

They even hire rooms for potential sellers to stay near major hospitals after finding a buyer and wait for the transplant.

If a transplant goes through successfully, they earn VND 150-250 million ($6,000-10,000).

The parasitic brokers earn big money while the risks mostly devolve on the buyers and sellers.

Research by the World Health Organization found that over 70% of organ sellers no longer have the physical capacity to work like a normal person.

The relatively small amount they get in exchange for an organ typically runs out in around five months, and the sellers quickly return to financial deprivation.

Vietnam’s Ministry of Public Security estimated that organ sellers lose 45-70% of their health, and some die due to post-surgery complications.

Bypassing the laws

Prof Dr Tran Ngoc Sinh, vice chairman of the Vietnam Transplant Association, says: "There are some institutions where leaders promote ethics related to organ transplantation while some employees find a way to bypass the laws and sneakily, sometimes openly, conspire with black-market dealers."

There are numerous instances of organ sellers being taken by foreign brokers to medical institutions near the country’s borders, where the laws are often flouted, to harvest organs, says Sinh, who has nearly 50 years experience in the organ transplant field.

But when there are medical complications, the organ sellers, now patients, are left to fend for themselves and have to travel back to urban hospitals to seek help, he says.

Medical personnel support the illegal brokers in operating these schemes, he laments.

Organ transactions, due to their illegal nature, typically do not involve the signing of contracts but carry significant risks.

A large part of the money falls into the hands of brokers.

As brokers become more organized, they increasingly take a larger cut, benefiting from the misery of organ sellers and receivers.

Nevertheless, a large number of patients still seek organs through illegal means, Dr Tran Thi Cam Thu, deputy director of the transplant center at Hue Central Hospital, said at a conference in 2021.

The Hue Central Hospital has been one of the main hubs for kidney transplants in the last decade.

At the end of 2016 doctors there discovered abnormalities in the documents furnished by some kidney donors.

The hospital swiftly established a department of transplant regulation to independently verify cases. Since 2018 the hospital has worked with the local police to examine the legality of organ donations. Some cases are rejected by the hospital because the documents are dubious, but the people involved just go elsewhere to get the procedure done, Thu says.

Assoc prof Dr Nguyen Bach, head of kidney and blood filtration at HCMC’s Thong Nhat Hospital, says if hospitals scrupulously follow procedures and thoroughly conduct all tests, many cases will be disqualified due to the risks of potential diseases.

Medically, kidney donors and recipients need to pass 71 tests, and over 50% fail to do so on average.

In many cases, despite the donor and receiver matching medically, doctors advise against the donation due to the risk of declining health for donors.

Cho Ray Hospital, southern Vietnam’s donation hub, only conducts around 100 transplants out of 300 cases that come to it every year.

Assoc Prof Dr Thai Minh Sam, head of the urology department, says the rest are rejected due to a medical mismatch or failure to prove the relationship between donors and receivers.

Besides their medical board, all hospitals have also established legal boards with independent legal personnel.

Organ donors and receivers need to submit documents proving their identity, such as birth and marriage certificates, and their relationship with each other.

The hospitals then verify the documents with local authorities.

Typically, kidney transplant patients are on dialysis, and the medical staff at hospitals typically have a clear understanding of each of them.

"If there is a new patient who was getting dialysis elsewhere and comes to the hospital for transplant, we find it very suspicious," Bach says.

"In such cases, the hospital has to be very careful with the legal procedures."

His department recently received two patients who had had illegal transplants and then post-surgery organ rejection, and had to return to the hospital for dialysis.

People on dialysis at the Thong Nhat Hospital in HCMC, April 2024. Photo by VnExpress/Phung Tien

Bach said if he had known that Thanh, who used to be one of his patients, had looked for a kidney in the black market, he would have intervened.

All Thanh had to show after two years of borrowing money for the organ transaction and flying back and forth between HCMC and Hue was a tired body.

Khoe, his wife, said one day: "So much money and travel went without any benefit. Can you check with the doctors if I can donate a kidney to you?"

Thanh was silent and looked at their three children, the oldest 15 years old and the youngest three. He began to contemplate his wife’s question.

The couple decided to see if it was possible. After two rounds of tests doctors found them to be a match medically. On hearing it, Khoe burst out crying and tightly squeezed her medical files.

For her, donating a kidney to her husband was a given. After marrying him, Khoe was a stay-at-home mother taking care of the children, and Thanh was the sole breadwinner.

She was not sure she could shoulder the responsibility if something happened to him.

She says in her strong Mekong Delta accent: "I love him and care about him. He is my husband."

After getting the green light from doctors for the donation, she walked for almost three hours every day to lose weight and improve the success rate of the surgery.

She needed to lose 10 kg, the doctors had told her.

After struggling for three years with kidney failure, Thanh had never thought he would take a kidney from his wife. He thought about their three children and that if he died she needed to be there, and healthy, to take care of them.

But after a long and arduous search for a kidney, his will weakened. Now getting a kidney from his wife is his best, and only, bet.

Story by May Trinh, Le Phuong, Le Nga

Photos by Phung Tien

Graphics by Dang Hieu