How Did Organ Trafficking Scheme Stay Hidden?

by Emily Witt, www.ProPublica.com

The arrest of Levy Izhak Rosenbaum, the Brooklyn resident charged last month with acting as a "matchmaker" for buyers and sellers of human organs, spotlights the issue of live donor organ trafficking in the United States. It also raises a question: How could Rosenbaum ply his trade for as long as a decade, according to statements in the criminal complaint filed against him, without being caught?

The 1984 National Organ Transplantation Act states clearly that the buying and selling of organs is illegal: Violators face up to five years in prison and a $50,000 fine. The prohibition is intended to prevent exploitation of the poor or others who might be tempted to sell an organ out of desperation.

When it comes to enforcing the law, however, transplant centers are essentially left to police themselves. The law doesn’t offer guidelines about how transplant centers should proceed if they suspect a live donor has been paid.

"Other countries have mobilized the justice system around the traffic, and the U.S. has in my estimation turned a blind eye," said Nancy Scheper-Hughes, an anthropologist from the University of California, Berkeley, who has documented the international organ trafficking business for more than a decade. The Daily News in New York reported that Scheper-Hughes had informed the FBI about Rosenbaum’s business seven years before he was finally arrested.

Some who follow the donation process aren’t surprised by the lack of enforcement interest.

Alex Capron, a professor of health care law, policy and ethics at the University of Southern California, said reports of potentially illegal organ transactions are rare within the medical community because doctors feel bound by a confidential relationship with their patients.

"My guess is the doctor would simply drag his feet, and the patient would disappear rather than having the police swoop in," Capron said.

The United Network for Organ Sharing, a nonprofit organization under contract with the Department of Health and Human Services, has established guidelines for members of its Organ Procurement and Transplantation Network. To gain membership in the network, which is mandatory to receive Medicare payments, transplant centers must demonstrate that they make sure a recipient isn’t purchasing the organ. They also must have an independent donor advocate on staff and conduct psychosocial assessments prior to surgery. The organization conducts occasional audits to make sure members comply.

But the network’s guidelines don’t specify how rigorous an investigation must be. They state only that the center should get "confirmation of the voluntary nature of proceeding with the evaluation and the donation."

A network spokesman acknowledged that the burden of proof can vary from center to center. He also said that tips about suspicious activity have been passed on to federal authorities in the past.

Dr. Gabriel Danovitch, medical director of the kidney transplant program at University of California, Los Angeles, said that the process of live organ donation is effectively governed by trust, and that more regulation could deter legal donors. Doctors and hospitals know their reputations would be destroyed if they broke the law, he said.

"We are not police, and we are not the FBI, and we do not do, for instance, Social Security background checks or identification checks — and we haven’t found that necessary to do so because we use our best judgment," Danovitch said.

As an example, he recalled refusing a suspicious donation of a kidney by a gardener to his multimillionaire employer. "It didn’t smell right," he said.

The charges against Rosenbaum go beyond a single illegal exchange. According to the criminal complaint, he claimed to have been in the business of brokering live organ sales for 10 years. He allegedly charged the kidney recipient $150,000 to find a donor.

To justify the cost, the complaint says, Rosenbaum cited the expense of medical examinations in Israel, visa fees and the donor’s care in recovery. From the information available thus far in the case, it’s unclear who else was involved. The only other person cited in the complaint is a lab worker whom Rosenbaum paid in cash to verify recipients’ blood types.

Danovitch said there are three possible scenarios for how such a long-standing scheme could exist: The hospitals and the doctors were successfully hoodwinked into believing the emotional relationship between the donors and the recipients; they turned a blind eye to signs of impropriety; or they were complicit.

Danovitch said there’s no evidence that doctors or hospitals have been complicit in such schemes. If the Rosenbaum case or others end up revealing systemic wrongdoing, he said he would support stricter rules and greater oversight.

The criminal complaint alleges that Rosenbaum helped coach a donor and a recipient to fool doctors and create a fictitious relationship. He called it "the easy part," the complaint says.

Scheper-Hughes said investigations by her and by various news investigations indicate that the sale of live organs isn’t as widespread in the U.S. as it is in some other countries, but it does exist here.

"This has been known," Scheper-Hughes said. "It’s not a secret."

She expressed frustration that the transplant community worked to keep oversight "inside the fold."

"That’s just not the way justice works in the world," she said.

The Council made a pretty strong statement with its vote to ignore the warnings of the "big" power company (see front page).

An easement typically gives the rights to access, not exclusive ownership. City officials have the opinion that if at some point in time the skate park obstructs access for some reason, the apparatus can be removed from the concrete slab. When work is complete, the park can be restored.

Although this particular situation may not be of any real consequence to KAMO, the longer term effect of letting an easement be encroached upon may in fact be worth puttin’ up a fight.

There are some who predict an injunction to halt the skate park project. As of yesterday, a opening is still scheduled.

This is some fact, but mostly,

Just Jake Talkin’

artCentral

We are experiencing the "quiet before the storm" here at the Hyde House. Our kids are gone from the children’s artCamp, and though we enjoyed the 48 students that we signed up this year, the twelve days they were here were wild and crazy! I have dumped the trash, stacked the chairs and washed the porch, and will clean the floors and walls in preparation for the new show that begins in September, but in the meantime it is time to play catch-up with paperwork and letters to those who helped up both with artCamp, to thank my teachers, and to the students to thank them for coming. I will be leaving for a short while, but before I go I hope to see the work beginning on the new parking lot and drive scheduled to begin this week. We are also choosing to go ahead and remove the large tree that stands near the Pottery House. The old tree is a fixture, and will be missed. But like a beloved pet, we must let it go as it is dying, and would surely "take out" one of our two structures, or our neighbor’s structures, should it fall in a storm--- a distinct possibility to which we can all attest! So we will say goodbye to the old tree, and continue to plant the new ones. Our grounds look well due to the recent rain, but I am sure will get torn up when the trucks all move in, and will need time to recuperate. It is vacation time, for me and my board. We will begin meeting in September to discuss the special plans that we have for next year, 2010, our 25th Anniversary year, so stay tuned to see what those will be. I will not be submitting a column next week, so I hope in my absence you will enjoy whatever our publisher determines worthy of filling my space!