Furthermore, Cox writes, the records revealed “that hospital officials intentionally misled local media outlets about the full extent of the program’s breakdown. In a memo to Shands spokesman Dan Leveton about how to address the media, Steven Blumberg, vice president of planning and business development, said, ‘If asked, we will say that a program with low volumes is not economical to operate and that quality can be ensured with higher volumes.'” That statement, of course, makes no mention of looming federal intervention or a failure to meet basic quality standards.
Cox’s writeup should serve local reporters well as a sort of “anatomy of a failed transplant program,” as he delves into the regulatory process and exactly where the hospital went wrong.
For those of you who were, like myself, unfamiliar with the institution, Cox writes that “Shands is run by a private not-for-profit company, but it is widely seen as Northeast Florida’s safety-net hospital. The city of Jacksonville gives the facility about $23 million a year to care for the city’s poor, and it gets millions more from the state.”
The report alleges the organ trafficking was part of a broader web of organized criminal activity including assassinations and drug dealing. The “boss” of the criminal network, according to the report, was Hashim Thaci, Kosovo’s current prime minister and the former political director of the Kosovo Liberation Army.
The recent case of illegal transplants conducted at the Medicus clinic in Pristina is not an isolated episode. “We believe that there are sufficiently serious and substantial indications to demonstrate that this form of trafficking long pre-dates the Medicus case, and that certain KLA leaders and affiliates have been implicated in it previously,” the report states.
Last month, Salt Lake Tribune reporter Heather May was following a family as they waited for the liver donation that would ensure their 13-month-old daughter’s survival. The infant’s mother, Liz Badger, struggled with the unavoidable fact that the donor her daughter so desperately needed would likely be somebody else’s dead child.
At the same time her co-worker, Erin Alberty, was reporting on a 12-year-old girl, Ashley Maynard, on life support. That child’s mother hoped she would slip away in such a manner that her organs could go on to save as many other children as possible.
That’s when, as the reporters watched from the sidelines, the two stories came together. It’s a deep look at transplants, donors and ethics made possible by luck and thorough reporting. For an inside-the-newsroom look at how it all came together, I e-mailed May. Here’s her response:
After reading Liz Badger’s blog, I wanted to write a story about one family’s experience waiting for a transplant, never imagining the story we would get.
I started following the Badger family Jan. 5 — which happened to be the day that Ashley was struck by a car, though of course we didn’t know that until later. So I was with Liz as she spoke about waiting for another child to die as Ashley was in the hospital.
I was with the Badgers during their weekly doctor’s appointment while Ashley was literally down the hall on the same floor in the hospital, again, unknown to us.
On Jan. 14: Liz called me to say they were headed to the hospital for the transplant. Hours later, Ashley’s father called our newsroom to tell Erin Alberty that his daughter was going to be taken off life support and would become an organ donor. Erin had not been following the family, but the paper had written a brief about Ashley having been hit a week earlier while waiting for the bus. Her father called to update the paper about her condition.
At that point, the paper figured that Ashley was going to be LuLu’s donor, but we couldn’t ethically link the two families. I considered attending the funeral with Liz and James with their permission. But after consulting with an ethicist at Poynter, the paper decided I shouldn’t go: We couldn’t tell Ashley’s family that the reason we wanted to attend was because we thought Ashley was likely LuLu’s donor and that we wanted to watch as the families met.
Later, I got permission from Camie to talk to Ashley’s doctors about Ashley’s care. I recreated the hospital and funeral scenes from interviews. I was there when Camie met LuLu for the first time.
In a recent episode of HDNet’s Dan Rather reports, the journalist criss-crossed the globe alongside an academic/activist and others trying to trace the international black market for human kidneys (PDF transcript).
Rather and his crew pieced together the path a kidney would have taken, all the way from a tiny, desperate Moldovan village (where furious villagers once attempted to lynch the woman who’d lured about 40 young men to Turkey with promises of work, then sent them home minus a kidney) to brokers like Levy-Izhak Rosenbaum, the New Yorker arrested for his alleged role in matching live donors to ailing patients.
While hard numbers are difficult to pin down in the ‘kidney pirate’ universe, Rather says black-market transplants like these are a growing problem, citing anecdotal evidence and a 2005 WHO report that found that a tenth of kidney transplants were arranged through the black market. Another reason for the black-market organ boom, Rather finds, is the emergence of new anti-rejection drugs that make it possible for almost anyone to give a kidney to anyone else.
With more than 83,000 people waiting for kidneys in the United States alone, the potential benefit to patients is evident (though far from guaranteed, as Rather makes clear in the second half of the piece). The benefit to the donors is much more questionable.
While buyers spend up to $200,000 for a kidney, most of the money goes to a web of middlemen. Everyone from brokers to rogue surgeons, to bribed police and corrupt customs and border officials… all the average seller gets out of the deal, if he’s lucky, is about $3,000… and a tell-tale scar.”
For more on the price paid by the donors, Rather talked to well-known University of Pennsylvania bioethicist Arthur Caplan, Ph.D., who advocates criminal penalties for doctors who turn a blind eye to donors with dubious backgrounds as long as it saves their patient’s life.
If you say you are going to sell a kidney, coming from a poor village or a poor nation, nobody looks out for your health or your interest once that kidney’s out of your body. They toss you aside like an old piece of Kleenex. They don’t care. So you’re getting infections, you’re getting bleeds. You’ve got all kinds of problems going on, it’d be pretty easy to manage if you were getting followed post donation in an American or European hospital or in a developed country. You go back as a poor person who has sold their kidney, you’re in trouble.
The web of organized criminals matching donor to patient often centers in Istanbul, an international hub for illicit donations. The Turkish organ donation racket was pioneered by Yusuf Sonmez, a talented surgeon with questionable ethics and a knack for avoiding punishment. Somnez has recently been driven out of Turkey, but word on the street is that he’s still operating with impunity out of Azerbaijan.
There are signs in Istanbul that police are finally cracking down. … Turkish police rounded up more than 40 alleged kidney traffickers, but authorities here are still fighting an uphill battle against an insatiable global demand for kidneys. And it’s not just Turkish doctors. Rather even cites a recent incident in which a donor and patient hooked up through Craigslist, went to a Los Angeles hospital for the transplant, and apparently exchanged $25,000 in a restroom or hallway after the operation.
In the course of the story, Rather also visits Israel, another organ trafficking hotbed, and examines the toll the trade is taking up on patients as well as donors.
Josephine Marcotty of the Minneapolis Star Tribune recently wrote a series addressing the increasing demand for kidneys, a need spurred by an aging population, increases in diabetes, obesity and high-blood pressure. She found that it is a public health crisis that costs the nation $33.6 billion a year, and there is no end in sight.
Marcotty covered one woman’s search for a kidney, the ethics of paired donations and how the medical center decided who would get organs.
This month’s edition of Health Dialogues, part of KQED’s California Report, focuses on living with disease. In the report, KQED reporters talk to folks living with chronic disease, the effects of traumatic injury and other conditions that can have lasting effects on a person’s quality of life.