Encounter with gang in the illegal buying of kidneys

In the final instalment of a two-part special report, ‘Nation’s’ senior health and science reporter Angela Oketch and our investigative team drive from Homa Bay County to Eldoret to come face-to-face with a vicious gang involved in the illegal organ trade, lifting a lid on the inner workings of such groups across the country

We left Oyugis in Homa Bay County for Eldoret in Uasin Gishu County around 3 pm, drove for four hours, and arrived around 7 pm. The following day was going to be dramatic.

After following the directions given to us by Mathew (not his real name), who we had spoken to in Homa Bay, we finally get to the house where we were told the top-secret illegal transactions involving the sale of kidneys are done.

Read: Kidneys for sale: Inside the sprawling underworld of human organs trade

The poorly-lit room with floral tiles is almost empty except for a table with a piece of leftover ugali, a mattress and a stool.

There are two men in the room— one seated scrolling his phone with a barely disguised weapon that looked like a gun tucked in his trousers and the other, looking ill at ease, lying on the mattress.

We later learn the uneasy man is waiting to be ferried for surgery to remove his kidney at a fee.

Moments earlier, one person in the Nation team had walked in confidently and enquired about the selling of kidneys while the rest of us waited at a distance. He posed as someone interested in selling a kidney.

 “You cannot just walk into someone’s house and ask about selling a kidney. Who brought you here and what do you want? Who is selling the kidney?”  asked the man who had been scrolling his phone.

We give the name of Mathew (not his real name) as the person who referred us—who said he had previously sold his kidney—and this seems to placate the man.

 He makes a call to a man he refers to as Jack or “the boss”. The phone is given to Jack, who has little time for niceties.

 “Where are you from and who gave you directions to that room? Don’t think we don’t know what you are trying to do, you better tell us the truth,” Jack says.

Mathew is contacted and told he had gone against protocol by not accompanying the potential seller.

The questioning then starts on age and health status from the medical records.

Age is the deal-breaker: nobody above 32 years should even think about offering the gang a kidney for sale. Our colleague is 44 years old.

“Bwana you are joking, we cannot operate anyone that age (more than 40 years old). When you were being referred were you not told our preferred ages? Take your things and vanish from that house before something bad happens to you,” Jack says.

We leave Eldoret and drive back to Oyugis to meet David Kirui, who is the officer-in-charge of the Directorate of Criminal Investigation in Rachuonyo South and East.

Given that our sources pointed out the area as a hotspot crawling with brokers seeking sellers to be recruited into the illegal organ trade and trafficking, we ask him if he was aware of this.

“When I arrived here in February, I found an ongoing case. There is a young man we summoned but on realising that the case was picking up, he disappeared to Nairobi never to return. He did not give us the particulars of the parents. He did not have a phone, the case never picked up,”  Mr Kirui says.

He explains that nobody has reported any recent cases even though people talk about the illegal trade in the area.

The officer says preliminary investigations point to a hospital in Eldoret where the procedure is being done. 

Mr Kirui adds that the initial leads they are pursuing indicate an intricate criminal network that they will soon crack.

 “The young men, who do this secretly, are being recruited for a small amount of money with the recruiter earning a lot from each transaction. We are yet to arrest any culprit but we will continue with the investigations and get them sooner rather than later,”  he says.

The stories of Mathew and Elijah (not their real names) are a representation of many that have come to light in recent weeks as part of the Nation’s investigation that is currently under scrutiny by authorities in the Director of Criminal Investigation.

Despite the two, and other young men in the area, selling their kidneys in the illegal trade to overcome urgent needs, they say their financial situation has not changed.

On the contrary, their health status has worsened since they had to use the money to buy drugs for post-surgery recovery. The money they were paid for taking part in the illegal organ trade was quickly spent.

To show the gravity of the situation, the Kenyatta National Hospital recently highlighted that tens of Kenyans were inquiring and willing to put on sale their kidneys in exchange for money.

Read: Organ transplant patients suffer even with law in place

However, the KNH management in a statement maintained that there is no law in the country that allows the purchase of organs from willing sellers.

“How much for my kidney?” is our most in-boxed question,” KNH revealed on June 20, adding that it has been receiving messages from people willing to sell their kidneys and also seeking to know the prices but the practice remains outlawed.

"Please note that organ sale is strictly prohibited and illegal. You can only donate out of the free will and not sell,” says KNH management.

Early this year, the Kenya Renal Association, which is a professional body for nephrologists and renal scientists, wrote to the regulator, the Kenya Medical Practitioners and Dentists Council, to investigate whether alleged claims that hospitals are dealing in unethical practice are true.

“In the country, the only persons who are allowed to donate kidneys are the relatives of the donor. I am wondering how they are being ferried to other parts of the country to donate. Who are they donating to even without the knowledge of their relatives?” Dr John Ngigi, the President of the Kenya Renal Association (KRA) and kidney specialist and consultant physician said.

He said they have received calls from people saying they have donated a kidney with others asking whether they could donate with claims that they know people who have donated their kidney.

“If such a thing is happening then it should be a disaster. It is unethical and illegal. As an association, what we must do is uphold the ethics of our practice. This is against the social ethics of the society and what we are trying to say by selling the organs is that the rich should live with the poor suffering,” he said

“What we must do as a society is to identify the hot points and close them as fast as possible. Paying for the organ is illegal and there is no market for it,” Dr Ngigi added.

In July 2019, the Ministry of Health formed the National Blood Transfusion Services, and Human Organs Transplantation to lead the implementation of the 2017 Health Act that was to set up regulations on organ donations.

This mandate was given to the Kenya National Blood Transfusion Services (KNBTS) and Human Organs Transplantation.

If enacted, the law would allow people who wish to donate their organs to make a will or oral statement before witnesses and donate their body or specific organs to be used after their death either to save another person’s life or in medical institutions for learning.

Dr Nduku Kilonzo, the director of the Kenya National Blood Transfusion Services and Human Organs Transplantation, said that the service has been working on a support framework for organ transplantation and looking to see to it that the Universal Health Coverage will have benefits and packages on transfusion and organ transplantation.

There is an array of organs that can be transplanted, such as liver, kidney,  heart, cornea and even skin, but Kenya is not fully equipped to conduct some of these transplants.

Last year, the United Nations raised concern over the increased illegal trade in human organs.

In Kenya, the business of human organ selling is illegal and punishable by law though difficult to enforce.

What Elijah and Mathew did violates the law that forbids the selling or purchase of live organs. However, the two caved into a pressing need for money and did not care about the law.

A draft law that deals with the issue have been lying in the Senate for years.

“The proposed law is stuck at the Senate hence no regulations on the organ trafficking, no storage and transportation guidelines. Right now, if a doctor forcefully harvests an organ, there are no charges that will be pressed against them. We need a law to protect Kenyans,” says Dr Gilchrist Lokoel, a practising physician.

He says that in the absence of laws and regulations, the poor and desperate people will always be exploited by gangs involved in the illegal trade.

“What this means is that there is no guidance on organ donor and organ culture in the country. Without the law, it opens a floodgate for the black market to thrive. It is like abortion, if you don’t offer a solution, then definitely thousands of people will be doing it unprofessionally hence the likely hood of more dying is high,” he says.

According to the World Health Organisation, the kidney is one of the most commonly trafficked organs due to its high demand and the fact that a donor can survive with only one. It states that about 10,000 organs are trafficked annually.

Dr Luc Noel, a consultant for patient security with the Initiative for Medical Products with Human Origins at WHO in Geneva said that the trade is increasing again.

He has appealed to countries to maximise the supply of organs from deceased and living donors and encourage healthy lifestyles to stop people from getting conditions such as diabetes in the first place to defeat the exploitation.

The rising cases of diabetes, high blood pressure and heart problems are making kidneys one of the most outsourced organs. It makes up 75 per cent of the global illicit trade of organs.

WHO opposes the sale of organs, arguing that it exploits downtrodden people mainly from poor countries,  and contributes to human trafficking and organised crime.

“There is a growing need for transplants and big profits to be made.  It's ever-growing,  it's a constant struggle. The stakes are so big, the profit that can be made so huge,  that the temptation is out there,” Dr Noel said in a statement.

He adds: “Lack of law enforcement in some countries, and lack of laws in others, mean that those offering financial incentives to poor people to part with a kidney have it too.”

Read: Knowledge gap hindering kidney care in Kenya

Prof John Feehally, a professor of renal medicine at University Hospitals of Leicester NHS Trust, said in a paper: “Many donors are being exploited because they are very poor and you are giving them a very small amount of money and no doctor is caring for them afterwards, which is what happens.”

"The people who gain are the rich transplant patients who can afford to buy a kidney, the doctors and hospital administrators, and the middlemen, the traffickers. It's absolutely wrong, morally wrong."

A study done to determine the economic and health effects of selling a kidney by Madhav Goyal, Assistant Professor, Johns Hopkins Medicine in India and colleagues revealed that the sale of kidneys by poor people does not lead to a tangible benefit for the seller.

The study published in the Journal of the American Medical Association (JAMA) wanted to find out the reasons for selling kidneys, the amount received from the sale, how money was spent, change in economic status, change in health status and advice for others contemplating selling a kidney.

It revealed that 96 per cent of participants sold their kidneys to pay off debts.

“The average amount received was $1,070 (Sh127, 000) and most of the money received was spent on debts, food, and clothing. Average family income declined by one-third after nephrectomy and the number of participants living below the poverty line increased,” says the study published in 2019.

From the findings, participants rated their health status before and after nephrectomy.

Forty participants (13 per cent) reported no decline in their health after nephrectomy, 117 (38 per cent) reported a 1- to 2 points decline, and 147 (48 per cent) reported a 3 to 4 points decline.

Of all participants, 50 per cent complained of persistent pain at the nephrectomy site with 33 per cent complaining of long-term back pain.

It also found that three-quarters of participants were still in debt at the time of the survey.

About 86per cent of participants reported a deterioration in their health status after nephrectomy.

Seventy-nine per cent would not recommend that others sell a kidney.

It concluded that selling a kidney does not lead to a long-term economic benefit and may be associated with a decline in health.

“Physicians and policymakers should re-examine the value of using financial incentives to increase the supply of organs for transplantation,” recommends the study.

The study also recommends that countries re-examine the value of paying for donations in light of these findings. “Although patients with kidney failure deserve access to optimal treatment, such treatment should not be based on the exploitation of poor people,” It states.

Dr Vidya Acharya, first lady nephrologist of India who died in 2014, discussed in a book how most donors who are paid to remove their kidneys come from a stratum of society where their health and nutrition are already compromised due to economic stringency, removal of organs from them further impairs their health and functional integrity.

Additionally, studies have shown that when the motive of donation is purely self-sacrificing, the physical and psychological recovery of the patient is much better as the donor makes an informed decision with a clear understanding of the risks and benefits while receiving post-operative care.

However, when the donation is purely commercial, the donors are more prone to ill-health in the post-operative period. They are not given post-surgery care hence complicating their recovery journey.

Taking the Nation through the process of donating a kidney, Dr Mburugu Gitobu, a urologist, said that only living donor transplant is performed in the country, where a relative donates to the patient.

“The advantage of living kidney donation is that living organs are in better condition, and the kidney will only be without blood for a very short time after it is removed from the donor, which increases the chances of a successful transplant,” he says

On who is viable and suitable to donate, Dr Gitobu said that generally, a close relative or someone who has a close emotional relationship with the person with kidney failure can donate.

In Kenya, the potential donor and recipient had to be blood group compatible, the ‘crossmatch’ between recipient and donor had to be negative and the donor must be in excellent health and have normal and healthy kidney function to donate one.

A donor with blood group O can donate to the recipient with the same blood group.

Recipients with blood type A can receive blood from either O or A blood type. Those with B blood type receive from O or B while those with AB receive from donors with blood type O or A or B or AB.

Before surgery is conducted, 11 major transplant teams including a living donor coordinator, consultant kidney specialist (nephrologist),  consultant transplant surgeon, consultant anaesthetist, theatre nurse, physiotherapist, counsellor, pharmacist, laboratory team and radiology each with a specific role to walk the donor through the transplant journey.

“This is why I tend to believe that those selling their kidneys and taking like two weeks and the surgery is done are not taken through the rigorous process, I am afraid they may develop complications in future,” Dr Gitobu said

“It is illegal to exchange money or gifts for organs for transplant. It is important that any living kidney donor consents freely and is not under any pressure to donate. In order to safeguard the interest of the donor, all donors and recipients must see an independent assessor (the counsellor or social worker) who is independent of their health care teams before the transplant operation can go ahead,” he said.

For a potential donor, he said, tests to ensure compatibility should be done to make sure that the donor is in good physical health and that the kidney is a suitable organ for transplantation, this takes quite a long period of time between three to six months.

A full medical history, physical examination, and laboratory and radiological investigations will be performed to assess this.

Blood tests will also be performed to check that the donor is not carrying any potentially harmful viruses that could be passed on with the transplanted kidney.

A potential donor’s blood will be examined for the presence of antibodies to certain blood-borne viruses, such as hepatitis B and C, human immunodeficiency virus (HIV) the virus that leads to acquired immune deficiency syndrome (Aids), cytomegalovirus (CMV) and Epstein-Barr virus (EBV).

On the risks, Dr Gitobu highlighted that after the surgery, a donor may experience chest infection, which occurs in approximately one in three donors, bleeding that requires blood transfusion or blood clots with some resulting in death as a result of pulmonary embolisms (blood clot in the lung) or heart attack.