BEYOND DISGUST #27: VERA'S KIDNEY, WALTER'S MONEY

DESPERATION, GREED 
AND THE GLOBAL ORGAN TRADE

She was a poor Russian immigrant in Israel; he was a well-off German businessman. The case of Vera and Walter reveals a thriving illegal trade in kidneys and other organs ~ and shows how it is fueled by desperation.

The article you are reading originally appeared in German in issue 31/2012 (July 30, 2012) of DER SPIEGEL.

By Arndt Ginzel, Martin Kraushaar and Steffen Winter

DER SPIEGEL ONLINE

August 12, 2012

The deal brought together two people who had nothing in common. They were from different cultures, spoke different languages and would never meet. The only thing they shared was desperation.

It was 2008 when a wealthy, 74-year-old businessman from the western German state of North Rhine-Westphalia decided to ignore the law and morality in order to save his own life. The businessman's first name is Walter, and he had suffered from high blood pressure since the age of 50. He had been forced to take strong drugs for 20 years, but now his kidney, responsible for sifting toxins out of the blood, were failing. Walter needed dialysis.

But he didn't tolerate dialysis very well. He suffered from cramps, pain and anxiety. He was also having trouble with his heart, so doctors inserted stents to improve blood flow. There were complications, and Walter had to be operated on again and again.

The doctors diagnosed two infarctions and Walter was taken to the hospital in an ambulance. His wife and his son looked on as his body began to fail. His immune system declined, as did his mental state.

Doctors told him he had just a few months left to live ~ and he knew that he was far down on the waiting list for a new kidney. It would likely be years before his name rose to the top. His family members became increasingly bitter. They no longer perceived the German doctors as helpers but, rather, as dialysis gangsters who were primarily interested in collecting the €70,000 ($88,000) they could bill annually for his regular dialysis treatments and medications.

But then the family saw a television documentary about the illegal organ trade. The journalist in the report sharply criticized organ traffickers and their shady operations. But with Walter's health declining from day to day, the villains in the program began to seem like potential saviors to his family. They tried to call one of the organ traffickers featured in the program, but he either didn't want to or couldn't deliver. Then, says the son, they called the TV reporter to ask about a second contact she had mentioned in the story.

LOOKING FOR A BETTER LIFE

In July 2008, Walter boarded a flight to Istanbul, where he was to meet with one of the middlemen the family had contacted. From there, he took a propeller plane to Kosovo.

Vera Shevdko, 50, a hotel maid from Israel, was on the same flight. She had emigrated from Moscow only a few months earlier, leaving her 10-year-old daughter behind with her ex-husband.

Shevdko had hoped to find a better life in Israel but, instead, she was now saddled with debt. Life in Tel Aviv is expensive, and she had rashly spent too much money on a party. And then there was Nastja, her daughter, who would always cry on the phone when she called.

As a hotel maid, Shevdko didn't make enough money to pay for flights, and she certainly couldn't afford to bring Nastja to Tel Aviv to live with her there.

In the spring, she had picked up a free Russian-language paper from the ground at the Tel Aviv bus terminal. There was an ad in the paper that read "Looking for Kidney Donors." It promised good pay and included a telephone number. She had kept the paper, and now she remembered it and called the number. The man who answered the phone promised her $10,000 (about €8,100). Shevdko agreed to sell her kidney.

She says that she saw Walter for the first time in Istanbul. It was only a brief encounter. He was standing in front of her in the customs line after the plane had landed in Priština. According to Shevdko, he was tall and was holding hands with his wife. Walter and Vera didn't speak to each other, but they were going to the same place: the Medicus Clinic on the city's outskirts, which was partially funded by a German doctor.

At first glance, the story of Walter and Vera would seem to be an account of two adults who wanted to improve their situations and, driven by both hope and hopelessness, made a deal with each other.

But a closer look at their story reveals the structure of international gangs that profit from the desperation of human beings.

The market is worth billions, based as it is on the tens of thousands of seriously ill people like Walter around the world. In many cases, they don't have enough time to wait until their names move to the top of long waiting lists.

FURTHER UP THE WAITING LISTS

A recent scandal involving a transplant surgeon in the German city of Göttingen shows how easily matters of life and death can lead to criminal activity. Presumably to improve his patients' survival odds, but also to secure lucrative surgeries for the university hospital where he worked, the surgeon allegedly manipulated patient laboratory results so that they would be moved further up the waiting lists.

Criminal organ trafficking rings have an even easier time of it because there is a practically limitless supply of people like Vera Shevdko: poor, unknowledgeable and willing to sell parts of their bodies for a few thousand euros.

Of course, organ traffickers do their best to remain in the background when presenting their cynical business model to surgeons and middlemen.

Their illicit activities are rarely exposed, and convictions are even less common.

But, in the case of the Medicus Clinic in Priština, the criminal network is now well documented. Tall and lanky, with piercing eyes, Canadian prosecutor Jonathan Ratel came to Kosovo in 2010 to aid in the development of a constitutional system within the framework of the European Union Rule of Law (EULEX) mission. It wasn't long before Ratel had turned his attention to the illegal activities of organ traffickers at the Medicus Clinic.

Ratel, 51, is convinced that unscrupulous transplant surgeons removed kidneys from 20 to 30 people and implanted them into wealthy patients at the partially German-owned clinic.

The middleman was from Israel, the buyers of the organs were from all over the world and the surgeon, referred to in the press as "Dr. Frankenstein," was from Turkey.

The organ "donors" were from places like Istanbul and the Moldovan capital Chisinau, or they had recently immigrated to Israel. The system could only work, says Ratel, because Kosovar doctors and government officials helped cover it up.

SPIEGEL reporters spent months tracing the organ mafia from the Medicus Clinic, following a trail that led to Israel, Turkey, Belarus ~ and Germany. The results of Ratel's investigation and SPIEGEL's research now provide deep insights into the structures of the trade in human replacement parts.

The case of Walter, the German businessman, shows how deeply Germans are involved in the business dealings of international organ traffickers. It's a business, says Special Prosecutor Ratel, in which "obscene profits" can be made. And, as Europol warns, it's also a "rapidly growing" commerce involving criminal gangs.

GROWING DEMAND

Medical advances have opened up new opportunities to the traffickers, with doctors now able to take parts of the liver and lungs from living donors. But the kidney is still the most sought-after organ.

According to United Nations figures, some 10,000 kidneys are illegally transplanted each year, although some experts believe that the number could be as high as 20,000. And with both an expanding and aging global population, the demand for organs continues to grow.

In Europe alone, 40,000 seriously ill patients are waiting for a new kidney. That number includes 8,000 in Germany, of which only 2,850 received a replacement kidney through official channels last year. Three Germans who are on organ donor lists die every day, most of heart or liver disease.

The organ mafia thrives because people fear that their time will run out before they become eligible for a transplant. As they face the prospect of death, they are willing to ignore moral qualms and the law ~ and to brutally exploit another human being to extend their own lives. Some even choose this route because they would prefer to have a fresh organ from a living body than an old organ from someone who just died.

Organ brokers offer such customers "kidney packages" at prices of up to €160,000 ~ all-inclusive, meaning that expenses and bribes are covered.

The people who agree to have their body parts removed receive only a fraction of the money. In India and Bangladesh, organ traffickers offer €750 for an operation that will supposedly rescue a donor from poverty. And once a donor has agreed, there is no turning back.

Local overseers apply pressure to those who are plagued by doubts or become concerned about the effects on their health. Not uncommonly, the victims are even cheated out of their miserable pay after the organ removal.

PART 2: MEETING THE TRAFFICKERS

The world of organ trafficking revolves around a simple scheme. There are importing and exporting nations.

Israel, Saudi Arabia, the United States and Canada are examples of the former, while China, India, the Philippines, Egypt and Moldova are exporting nations.

You don't have to be a member of Attac, the international anti-globalization movement, to see the trade as a parable of the global imbalance of power, with organs being transplanted from the poor to the rich, from black and brown to white people, and from south to north.

Walter, the wealthy German businessman, had spent a lot of time in hospitals and operating rooms before he decided to travel to Kosovo. He doesn't want to talk about it, but his son, who also chooses to remain anonymous, explains the family's motives.

He attributes his father's history of suffering to a series of mistakes made by German doctors. According to the son, his father's heart disease was treated incorrectly, and doctors also failed to notice that his kidneys were in poor condition. That's why his father needed dialysis in the first place, Walter's son said.

When dialysis becomes necessary, a patient is usually placed on the waiting list for a donor kidney. But it wasn't done in Walter's case, and by the time the family noticed the oversight, valuable time had been lost, says the son.

Then, he continues, there were two incidents in which doctors made mistakes that resulted in unnecessary problems. In one case, a stent that was supposed to keep an artery open accidentally passed through the artery and disappeared. The doctors cut open the father's leg to search for the stent, but found nothing. In another operation, says the son, a doctor punctured an artery with a catheter, and the father almost died.

During one of the next treatments, the father received an infection at the hospital. The drugs he had to take to fight the infection further damaged his kidney.

AN ACT OF SELF-DEFENSE

The son is an inconspicuous, soft-spoken man. His account revolves around the shoddy work of the doctors and the wrongs inflicted on his father. The son sees Walter as a victim of malpractice and someone at the mercy of a relentless system.

Although he doesn't say so in as many words, it's clear that he considers the family's subsequent decision to help the father with other means to be an act of self-defense.

The son searched the Internet and found a Filipino hospital where, as he believed, a kidney transplant would be an easy procedure. But nothing came of it, and he continued his search.

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Vera Shevdko emigrated from Russia to Israel in 2008 in search of a better life. Soon, though, she became awash in debt and needed money. She decided to sell one of her kidneys to a shady network of organ traffickers. Her story reveals the degree to which desperation fuels the global illegal trade in human organs.

According to Ratel's investigators, Walter transferred €81,892.72 into an account held by the Israelis that the family eventually found. Neither Walter nor his son is willing to comment on the payment.

Vera Shevdko is sitting on the sofa in her small apartment in a low-income Tel Aviv neighborhood far from the sandy beaches where wealthy Russians like to spend their time. A fan pushes around the hot and humid air, and the shabby kitchenette is only three steps from the living room. Between the two is a supporting column covered with plastic ivy. Her dog Don, a pit bull, lies panting on the floor.

Vera talks about the pain she has in her right kidney, which now has to perform the work of two kidneys in filtering toxins out of her body. She likens it to a persistent toothache. She tries to drink a lot of fluids, she says. A large bottle of lemon soda is standing next to her. A 15-centimeter scar runs along the left side of her abdomen.

SHE SHOULD NEVER HAVE DONE IT, SHE SAYS.

She still remembers the day she picked the number out of the ad. The man who answered the phone had a pleasant voice, says Shevdko, and she met him a while later in a café at the Tel Aviv bus terminal. He looked to be in his early 30s, had blue eyes and spoke Russian. He asked her about her blood type and her general health. Finally, he promised her $10,000 and told her to tell absolutely no one.

NO SIDE EFFECTS?

There were two other women, also potential donors, at a second meeting, this time outside Tel Aviv. A young man showed them his scar, says Shevdko, and he told them that he was feeling well after donating his kidney, and that there were no side effects.

The blue-eyed Russian pointed out that many people, including his own grandmother, could grow as old as 80 with only one kidney.

The truth is that organ removal is very dangerous. The recipients return to hospitals in their native countries, where doctors don't ask a lot of questions and provide the best possible post-surgical care, especially to avert the risk of transmission of HIV or hepatitis through the new organs.

The clandestine business is, of course, not entirely without risk for the buyers, either.

The suppliers of the organs, on the other hand, often can't expect to see a doctor at all when they return home. They face the risk of infection and postoperative hemorrhage, rising blood pressure and reopening wounds.

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Vera's kidney was bought by a 74-year-old German man named Walter, who had been given but a few months left to live. Desperate, he too turned to the black market. The two ultimately ended up in a small clinic in Kosovo for their operations.

American anthropologists and doctors have tracked down and interviewed dozens of organ sellers. Almost all donors reported that their health declined considerably after the risky procedure.

Vera Shevdko knew none of this when she boarded a flight for Istanbul on July 21, 2008. Nevertheless, she was so agitated that she couldn't eat, so she only drank some apple juice.

Another Russian and an Israeli woman were also on the flight. Upon arrival in Istanbul, Shevdko was met by men she had never seen before. The three women were told to hand over their passports, and when they were still in the hotel lobby, the men took a drop of blood from one of their fingers. That, at least, is Shevdko's account.

She flew to Priština four days later. The customs agents asked a lot of questions, she says. Why, they asked, would a woman from Israel be traveling to a urology clinic in Priština?

Shevdko told the customs agents what the organ traffickers had told her to say, namely that treatment was better in Priština. One of the agents wasn't convinced, says Shevdko, but after making a few phone calls he finally allowed her to enter the country.

THE MAN FROM THE AIRPORT

Two cars were waiting at the airport, one for the donors and one for the recipients. Shevdko remembers that it was a long drive, and that the road was no longer paved at the end. It reminded her of her childhood in the Soviet Union. "It felt as if we were driving to the dacha," she says.

The car eventually stopped in front of a modern, pink, two-story building with red roses in the front garden. A sign on the building reads "Klinika Gjermane." The private hospital is on the edge of an industrial zone, and the front windows are darkened. A German doctor is recorded as the owner of the clinic in the register of companies in Priština.

Although she was already afraid in Turkey, says Shevdko, things became worse "in the villa." She was forced to sign forms in English that she didn't understand.

Shevdko recalls that the overseers forbade them from talking to each other and told them that their organs would be going to an American. But, she adds, there was a passport on the table, and it wasn't blue like an American passport, but dark red like a German passport.

Shevdko saw the man from the airport again, next to his wife. They seemed like ordinary people to her, and they seemed nice. She imagined that they had scraped together their money to save the husband's life with a new kidney. She says that she "suddenly felt embarrassed to receive money for my organ."

The EULEX investigators have reconstructed who was at the clinic and when. They are convinced that Walter was the older man in the room.

"My whole body was shaking before the operation," says Shevdko. She wanted to run away, and yet she knew that "no one would have let me go. They had paid for my flights and had sent someone to greet me. They would have given me a shot and operated on me anyway. I realized that I had become involved with the mafia." And so she held out her arm when someone came to give her an injection.

PART 3: CONTEMPT OF HUMANKIND

When she woke up, there was a thin tube hanging down from her body with a bag at the end, and she was in great pain. Moshe Harel, an Israeli, had given her an envelope containing €8,100, which she placed under the pillow of her hospital bed.

Buying and selling organs is illegal all over the world, except in Iran, where so-called living donors can receive a monetary gift. But what exactly are the reasons for forbidding the trade in a human kidney, for example?

Don't women and men sell their bodies as prostitutes all over the world? Why shouldn't someone be allowed to sell a single organ?

These questions have been debated in the scientific world for more than 15 years.

If a living donor can manage without an organ, why shouldn't the recipient and medicine in general benefit, legal philosophers asked in a 1998 essay in the respected medical journal Lancet?

Indian legal expert R. R. Kishore argues that, for the recipients, it's a matter of surviving an illness. The donors, for their part, want to survive and escape their poverty. According to Kishore, it is "paternalistic" and "dogmatic" to try to bar poor donors from selling their body parts, since doing so could provide them with a new life.

This may sound like a valid argument when it's posed as part of an academic theory. But it crumbles in the reality of the slums of India, Bangladesh, Egypt and the Philippines.

There have been studies that included surveys of people in these countries who had sold a kidney. Many of them complained of poor physical and emotional health, and the overwhelming majority had spent the money within only a few months.

Their lives did not improve. In fact, many were now worse off than before because they could no longer perform heavy labor or even work at all anymore.

Most had also failed to consider that the sale of about 160 grams of tissue would marginalize them even further, so that they would end up being relegated to the same level as prostitutes within the social structure of their countries.

Moldovan organ donors told researchers that they were berated as "one-kidneyers" and "half-men," and told that now they would never be able to find a wife.

'CAST ASIDE LIKE CHATTEL'

In many cases, the various surveys and investigative reports leave doubts as to whether a person selling a part of his or her body is truly making an independent decision.

In the case he is pursuing, says Special Prosecutor Ratel, gangs used the methods and techniques that are the signature or organized crime to recruit potential sellers of kidneys. The brokers lured them with false promises and later intimidated them.

"We see the limitation, the restriction of their movements…. In some cases, we have seen people being warehoused where they cannot move until the operation is complete," says Ratel. "The false promise of payment only comes about after the surgery, and these persons, in my opinion, are cast aside like so much chattel."

Kosovo is only a small hotbed of contempt for humankind.

In China, prisoners sentenced to death have been a source of organs for decades.

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European investigators have been pursuing the global organ black market for years. Here, police escort Turkish doctor Yusuf Sönmez to a local court in Istanbul in January 2011. He was suspected of carrying out illegal organ transplants in the clinic in Kosovo and is thought to have performed the operations on Vera and Walter. His nicknames are Dr. Frankenstein and Dr. Vulture and he has boasted of having transplanted some 2,200 kidneys.

In Egypt, the Coalition for Organ-Failure Solutions (COFS) questioned 57 Sudanese a year and a half ago. They said that gangs had smuggled some of the men, women and children into Egypt so that their kidneys could be removed there. According to COFS, there was a sharp rise in organ trafficking in the aftermath of the Arab Spring. There are also persistent but unconfirmed rumors that people have been murdered for their organs.

But there are also many urban myths surrounding the organ trade. According to one story, a business traveler was seduced by a prostitute while traveling abroad, only to wake up in a bathtub full of ice ~ with only one kidney left. There is another rumor that orphaned babies in Latin America are killed for their organs, and their butchered remains are left by the side of the road.

None of these stories has ever been proven, and yet the very existence of the myths has its own impact. "They distract from and obfuscate real organ trafficking," says Nancy Scheper-Hughes, an anthropologist at the University of California, Berkeley.

Scheper-Hughes has studied worldwide organ trafficking for more than 20 years. She has frequently tracked down trafficking rings and helped investigators.

Because of the hair-raising myths, she says, the public also mistrusts credible research on the organ trade. Besides, she adds, quite a few people believe the made-up stories and therefore tend to minimize the severity of the more mundane trafficking cases.

A LANGUAGE SHE COULDN'T UNDERSTAND

Occasionally, however, reality comes very close to the horror stories. On the morning of Nov. 4, 2008, Yilman Altun, a 23-year-old Turkish citizen, collapsed at the Priština airport. Blood was oozing through his shirt. He was taken to the airport doctor, who determined that someone had just cut out his kidney ~ at the Medicus Clinic, as Altun claimed. Police were deployed to the villa but, by the time they arrived, the only person there was the 74-year-old Israeli receptionist.

Altun later returned to Turkey, where neither domestic nor international authorities have been able to track him down since. Investigators believe he is dead. "We are very concerned about a number of our witnesses," says Special Prosecutor Ratel. Some of the donors have already died during the investigation, which has dragged on for years.

Half a year after the raid in Priština, Interpol contacted prosecutors in Germany about the case of Walter, the German businessman. Prosecutors initiated proceedings on charges of violation of the German Transplant Law, which permits the removal of a kidney from a living donor, but only "for the purpose of transplanting it into relatives of the first or second degrees, spouses, registered life partners, fiancés or other individuals who are clearly in a close personal relationship with the donor."

The donor must be "informed in a comprehensible manner." Walter was evidently not close to Vera Shevdko. And if she was informed, it was in a language she couldn't understand.

German investigators attempted to question Walter, but he refused to cooperate. In May 2010, the public prosecutor's office closed the proceedings in return for the payment of a fine. The public prosecutor's office is not even willing to disclose the amount of the fine, citing the "right to privacy" and "the assumption of minimal guilt on the part of the accused."

Meanwhile, the son says that Walter shouldn't have been questioned as a defendant in the first place. He insists that his father was a victim, not a perpetrator. The son prefers not to answer questions about Vera, the woman whose kidney is keeping his father alive.

A KIDNEY-FOR-MONEY DEAL

Hospitals in Europe and North America repeatedly see patients like Walter, who return from a trip abroad and suddenly have a new kidney. Four strange incidents involving presumed organ trafficking were brought to light in Germany in 2002.

In the first case, a kidney from a young Moldovan man was transplanted into a retiree from Israel at a hospital in the eastern German city of Jena in 2001. The donor was allegedly his nephew. Every transplant of this nature is examined by a so-called living donor commission in each of the German states. Its job is to determine whether the donor is truly motivated by altruism, or whether money is changing hands.

The commission in the western city of Essen, where the two alleged relatives were to undergo the surgeries, had voiced doubts ~ perhaps because it was the fourth such case in which an Israeli received an organ from a young Eastern European "relative."

The surgeon wasn't overly concerned about the Essen commission's qualms and agreed to perform the operation in Jena instead, where the local commission consented to the procedure.

Both the donor and the recipient confessed to SPIEGEL that it had indeed been a kidney-for-money deal, and yet prosecutors in Essen were unable to find evidence of organ trafficking.

The courts would probably have looked the other way in Kosovo if Ratel had not seized jurisdiction over the case of Turkish national Altun. Ratel assembled a team that traced worldwide connections to the Medicus Clinic. They ranged from Israel to South Africa, Turkey to Russia and the United States to Sri Lanka. For Ratel, the case has moved far beyond the clinic in Priština; it now involves global organ trafficking.

Ratel believes that a small group of transplant surgeons has repurposed the concept of the "flying doctors" and are now operating on all continents. The doctors fly to wherever they can remove and transplant organs without too much scrutiny.

If the authorities raid a hospital somewhere in South Africa or Brazil, the surgeons simply move on to the next country. Experts say that clinics in Cyprus and Kazakhstan are popular at the moment. To avert the possibility of customers, alerting the authorities, they are sometimes not told where their operation will take place until departure.

In Priština, a trial has been underway since October 2011 against four doctors and a former state secretary with ties to the Medicus Clinic. The charges include human trafficking, organized crime and practicing medicine without a license.

Another defendant is Lutfi Dervishi, a professor who, according to the register of companies, was the clinic's authorized agent. He also allegedly assisted in at least one kidney operation.

According to the indictment, Dervishi also had ties to senior members of the government in Kosovo. He allegedly met personally with the health minister and an adviser to the prime minister. Charges were also filed against a former state secretary in the Health Ministry, who allegedly issued the Medicus Clinic a permit for organ transplants, which, judging by the legal circumstances, it should never have received.

PART 4: TRACKING DOWN THE SUSPECTS

Accusations of organ trafficking quickly become a political issue in Kosovo. In recent years, Carla Del Ponte, the former chief prosecutor of the International Criminal Tribunal for the Former Yugoslavia (ICTY) in The Hague, and European Council Special Rapporteur Dick Marty have claimed that when the young country's prime minister, Hashim Thaçi, fought with the Kosovo Liberation Army in the late 1990s, he sanctioned the killing of Serbian prisoners of war for the removal of their organs.

Although Marty and Del Ponte have so far been unable to furnish clear evidence, EULEX has been investigating the allegations since September 2011.

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Many of the organs on the kidney black market come from "donors" in poor countries like the Philippines, India or China. Here, a Pakistani man points to a scar resulting from the sale of one of his kidneys.

Ratel's investigation is much further along, but he also faces an uphill battle. It was only with difficulty that the special prosecutor managed to secure permission to interview foreign witnesses via video during the trial. One of the witnesses appearing on the courtroom monitor was Vera Shevdko, who described how she lost her kidney.

But while she was speaking, the scene in the courtroom was reminiscent of the waiting room at a train station. A defense attorney answered a call on his mobile phone and also made calls. Another attorney ranted that it would be better if Israel recognized Kosovo. The next one shouted "shalom," while a defendant gesticulated at the judge and left the courtroom. Another defendant was sleeping with his head on the table in front of him. It was a farce, and the presiding judge had no intention of intervening.

Ratel has become increasingly doubtful over whether his investigative zeal is even wanted. He has sent mutual-assistance requests halfway around the world, but even in the best cases, he says, they are only being "poorly" fulfilled. And Moscow, he adds, didn't react to his request at all, even though several victims, like Shevdko, are Russian-born.

The investigators have identified two men who they believed played a key role: the surgeon and the organ broker, a Turk and an Israeli. Both are at large.

EU special prosecutor Jonathan Ratel at an organ trafficking trial in Pristina, Kosovo in February 2012. In the case he is pursuing, says Special Prosecutor Ratel, gangs used the methods and techniques that are the signature or organized crime to recruit potential sellers of kidneys. "In some cases we have seen people being warehoused where they cannot move until the operation is complete," says Ratel. "The false promise of payment only comes about after the surgery and these persons in my opinion are cast aside like so much chattel."

A PIECE OF MEAT

The surgeon is believed to be Yusuf Sönmez, a gaunt, bald man with a neatly trimmed beard. He is known as both Dr. Frankenstein and Dr. Vulture. He even boasts of having transplanted 2,200 kidneys. By European standards, this certainly wasn't legal.

Vera Shevdko met Sönmez. She begins to tremble and cry when she talks about him. She says that when she saw him in Priština, he didn't respond to any of her questions, not in Russian and not in Hebrew. He simply ignored her, as if she were a piece of meat.

The 55-year-old doctor has been transplanting kidneys for about 20 years. He prides himself on the fact that he only uses living organs, not organs from dead bodies, and that he transplants them from one body to another within a short amount of time.

In 2005, the police raided his clinic in Istanbul and arrested him at the operating table. He was charged with having illegally harvested organs from Eastern Europeans and implanted them into rich Westerners. Sönmez was convicted, but he was released under an amnesty. He was sentenced to 10 years in prison two years later, but he appealed the conviction.

Special Prosecutor Ratel had Interpol issue a warrant for his arrest, but after being taken into custody in January 2011, Sönmez was released on bail. To this day, Turkey refuses to extradite him. He is now expected to face charges at home. Sönmez says that he did not break the law in Kosovo.

According to Ratel's investigation, Sönmez collaborated with Moshe Harel in Israel. The stocky 62-year-old has both Turkish and Israeli citizenship. According to Ratel, he was in charge of recruiting donors and managed the payments. Today, Harel lives less than 20 kilometers (9 miles) away from Shevdko, in the Israeli town of Ramla. He was arrested in Priština after the raid on the Medicus Clinic.

Four weeks later, the court allowed him to travel to Turkey for a month, where he had claimed that his mother was ill. Harel never returned to Kosovo. "Of course not," says Ratel.

A GERMAN DOCTOR

Interpol still lists Harel as a wanted criminal. The statements by Shevdko and other donors convinced Israeli authorities to join Ratel's investigation. Harel was arrested and charged with human trafficking, money laundering, organ trafficking, and tax evasion. The Israeli authorities released him on parole. He has not commented on the charges.

And then there is the financier: a German doctor. Until a few years ago, the doctor was performing kidney transplants at a German hospital.

The attorney of Lutfi Dervishi, the Medicus representative, claims that the German doctor invested €3 million in the hospital. The doctor, he says, also helped find doctors who could rent operating rooms at the clinic.

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A live donor kidney transplant being performed in Birmingham. Most countries allow live kidney donations only in cases where the donor is related to or in a close personal relationship with the recipient.

Could the German doctor have been unwittingly dragged into a criminal operation by Dervishi?

Is it possible that he only learned that transplantation was being performed at the clinic after it was closed, as the doctor claims today?

Emails that Ratel's investigators found on an American server suggest otherwise.

In a 2007 email, the doctor wanted to know what had happened to the money he had earned and requested that it be transferred to his bank account. In March 2008, Dervishi wrote an email to his partner under the subject line "cardio surgery."

In somewhat broken German, he told the German doctor that he was in negotiations with people in Kosovo and Turkey. "We have begun with transplantation of the kidney. First case is finished. One more we do on 28 of this month."

The German doctor has refused to comment on the outrageous suspicions, but, through his lawyers with a Berlin law firm, he denies any knowledge of what was happening in Kosovo. The doctor claims to have no recollection of Dervishi's email and that he invested exclusively in the clinic's cardiac surgery department, an investment of less than €600,000.

The German doctor's lawyers also say that he reserves the right to take legal action against reporting of any nature, and that there is "no reason whatsoever to report on the matter."

EMPTY WITHIN THREE MONTHS

The German doctor clearly fears public exposure after it seemed like he had weathered the accusations last year. The Berlin public prosecutor's office had launched a preliminary investigation against the German doctor in 2011. But it dropped the investigation after Walter, the transplant patient, refused to talk.

The investigators did not question the German doctor. They were unaware of the emails that Ratel had secured.

Half a decade after the transaction between Vera and Walter, both backers and participants are either at large or are not being punished. The garden is overgrown at the Medicus Clinic, where guards question anyone who approaches the building.

Dervishi has opened the Uro Medica Hospital only steps away from the old Medicus Clinic. He performs surgeries there, unless he happens to be in court.

Walter, the German businessman, now has skin cancer. With Shevdko's kidney, he has already lived five years longer than the doctors had given him. His son says that the family had considered the option of having him donate a kidney to his father, which would have been legally unproblematic. But, of course, the family also knew that it's dangerous to donate a kidney, especially for someone who is still relatively young.

Then the son says that the family finally wants to put the matter behind it, and that they've already thrown out the last folder of documents relating to the case.

Shevdko used the money from the sale of her kidney to bring her daughter Nastja from Russia to Tel Aviv. Nastja is now old enough to understand what her mother did. "She gave me half a life," says Nastja. Now, she adds, she constantly does her best not to upset her mother, although she isn't always successful. The 15-year-old, who wears her long brown hair down, is happy in her new life. She wants to be a doctor, she says, so that she can take care of her mother later on.

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Vera and her daughter Nastja in Israel. Vera originally sold her kidney in part to be able to pay for her daughter ~ who was 10 and the time, now 15 ~ to join her in Israel. Vera says that she is still racked with pain, and that she often feels powerless. The €8,100 she received for her kidney are long gone.

Shevdko says that she is still racked with pain, and that she often feels powerless.

The organ traffickers had told her that she merely had to go to the hospital for post-surgical care. She didn't do it, she says, because it would have been too costly. The €8,100 are long gone. Shevdko spent the money on Nastja, to pay off debts and to buy a few articles of clothing from China. The envelope was empty within three months.

Translated from the German by Christopher Sultan