KEY POINTS:
Paul Lee got his liver from an executed Chinese prisoner; Karam in Egypt bought a kidney for his sister for US$5300 ($6940); in Istanbul Hakan is holding out for US$30,700 for one of his kidneys.
They are not so unusual: a dire shortage of donated organs in rich countries is sending foreigners with end-stage illnesses to poorer places like China, Pakistan, Turkey, Egypt, Colombia and the Philippines to buy a new lease of life.
Lee, a 53-year-old subway technician in Hong Kong, was diagnosed with liver cancer in January 2005 but doctors denied him a transplant because they feared the tumour would spread.
A friend told him about a transplant hospital in China's Tianjin city and he signed up for a place. That April, he paid 260,000 yuan ($45,000) for a transplant, which saved his life.
"The hospital has connections with a lot of prisons," said Lee. "Mine came from an executed prisoner. I thank the donor deeply."
The World Health Organisation estimates 21,000 liver transplants are carried out annually, but medical experts put annual worldwide demand at at least 90,000. Demand for kidneys also exceeds supply, and that has given rise to organ trafficking and a black market for rich people and "transplant tourists" who travel to poor countries to buy body parts from people with few other routes to a better living.
A donor in South Africa receives US$700 for a kidney compared with US$30,000 in the United States.
A lack of transparency and little protection for donors has spurred calls by international bodies to crack down on, or at least regulate, the trade.
But even where the trade is banned, laws are often muddled or laced with loopholes, which are sometimes defended by vested interests.
And the unregulated route is much less complicated for the recipient. Any transplant procedure involving a living donor carries risks for the donor - especially for liver transplants which involve removing part of the donor's liver.
The complications can include bleeding, infection, even death.
In the transplant trade, the recipient need not worry about, for example, exposing a living relative to that risk.
"It is cheaper and your next of kin is not taking the risk and you don't have to care for someone you don't know. Once you pay, it is discarded in a way, it is dispensable," said Luc Noel, a co-ordinator for Clinical Procedures at the World Health Organisation in Geneva.
China recently banned the sale of human organs and restricted transplants for foreigners, saying it must first meet demand at home for two million organs a year.
Only 20,000 transplants are carried out in China each year. Of these, 3000 are liver transplants and 95 per cent of them use livers from dead donors.
China defended its use of organs from executed prisoners, saying consent was obtained from convicts or their families. A transplant operation using the liver of a dead donor costs around $33,000 in China.
"What is important is the transparency, it has to be open to scrutiny ... if China makes its current system open to scrutiny and very transparent, that would do good," said Noel.
In Asia, a cultural obsession with keeping the body of the deceased intact has stymied public organ donation programmes.
Excluding China, Asia has fewer than 200 livers donated by people before they die each year, said Lo Chung-man, professor of hepatobiliary and pancreatic surgery at the University of Hong Kong.
Pakistan, where trade in human organs is not illegal, is turning into a "kidney bazaar", said the chief executive of Pakistan's Kidney Foundation, Jaffar Naqvi.
There are no confirmed figures for the number of foreigners coming to the country for new kidneys but Naqvi said 13 centres in Lahore alone reported more than 2000 transplants last year from bought kidneys.
Patients, mostly from Europe, Saudi Arabia and India, pay about 500,000 rupees ($11,330) for a new kidney, he said. Donors are paid US$300 to US$1000 and often get no medical care after the surgery.
There is no consent in some cases. In May police arrested nine people, four of them doctors, for abducting people, drugging them and stealing their kidneys for transplant operations.
In the pipeline is a draft law aimed at banning the trade, but a powerful lobby bent on preserving it is trying to ensure it allows kidney donations for a non-relative, with no payment.
Stories of people selling their organs, especially kidneys, are not uncommon in Egypt, where more than 30 per cent of a population of more than 73 million people live below the poverty line.
Karam, who asked to be identified only by his first name because organ trading is illegal, said it took him only 15 days to secure a kidney for his sister who had kidney failure.
He said a doctor found him a man willing to sell his kidney for 30,000 Egyptian pounds ($7065).
"The fees of the doctor were 5000 pounds. His money and the fees of the hospital were deducted from the money the 'donor' received."
Karam said doctors usually help in finding people willing to sell their organs from their patients' lists.
Abdel-Kader Hegazy, head of the disciplinary committee at the Doctors' Union, said Egyptian law lacks clear punishment for those involved in illegal transplants, making it easy for doctors to repeat the offence.
"The law says it is illegal to trade in organs but does not specify the punishment. We at the union suspended many doctors and closed their practices, but they have appealed before courts and won their licences back."
Hakan, a 27-year-old security guard in Istanbul with two young children, said he received five or six offers from Turkey and Germany, offering 10,000 to 15,000 lira, but he's holding out for 40,000 lira.
"Of course it's frightening but there's nothing else to be done. I'm doing it because of my family, if I was alone it wouldn't matter. I've got two children ... there's nothing else I can do for them."
- Reuters
