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"The crime was … the theft of life, defrauding the wretched of the earth of their spare kidneys, stealing from the poor to supplement the bodies of the well-insured and well advantaged.”

The Rosenbaum Kidney Trafficking Gang

by NANCY SCHEPER-HUGHES

A CounterPunch Exclusive

On October 27, 2011 Levy Itzhak Rosenbaum, 60, a portly, sometimes risqué, “self-described” kidney matchmaker, pleaded guilty in a Trenton, NJ federal courtroom to three counts of acquiring, brokering and transferring for “valuable consideration” organs from the bodies of poor Israelis trafficked into the US to service the transplant needs of New Jersey residents, and an additional count of conspiring to do the same.

The Rosenbaum case was the first prosecution of organs trafficking under NOTA , the 1984 National Organ Transplant Act that established altruism as the principle underlying organs sharing among US citizens, whether from living related or deceased donors. Rosenbaum admitted that his modus operandi was to recruit (through extensive networking) local kidney patients willing to pay $140,000 for whom he would arrange kidney sellers from among ethnic minority and new immigrants , mostly Eastern Europeans, to Israel who were paid $10,000 to undergo nephrectomy (kidney removal) in one of several hospitals from NYC to Baltimore willing to harvest and transplant the foreign kidney into the bodies of Rosenbaum’s clients.

The original complaint against Rosenbaum and his plea bargain concern only the illicit transfer of kidneys. There is no mention of the real crime hidden between the lines, the recruitment and trafficking of poor and minority Israelis into the United States for the sole purpose of procuring their organs. The US is not party to the 2000 UN Palermo Convention on human trafficking that includes human trafficking for organs. The Convention has been applied in successful prosecutions in Brazil, South Africa, India, Moldova and elsewhere to prevent human traffickers, some of whom are surgeons and doctors, from exploiting the bio-available bodies of immigrants, refugees, prisoners, the mentally deficient and others from being harvested while still alive.

Under NOTA the only object of concern is the detachable organ, that precious commodity exchanged for “valuable consideration for use in human 2 transplantation”. The person who is trafficked to provide the fresh commodity that is carried across borders is an invisible non-entity, less significant than the “mules” used in transnational drug trafficking. All that is known about two of Rosenbaum’s victims is their names. “They returned to Israel long before we began our investigation”, a federal prosecutor involved in the Rosenbaum case told me.

Transplant trafficking has been going on for many years in the US, as it has elsewhere in the world. The individual cases in my Organs Watch research files run to the hundreds. Some of the victims of US organs trafficking are bonded servants from Syria and Jordan brought into the US to provide kidneys to their patron royal families from the Gulf States. The Cleveland Clinic has a transplant wing that for many years has catered to these so-called “transplant tourists.” UCLA had its heyday with wealthy Japanese Yakuza crime “family members” who were given priority for liver transplants from the UNOS waiting list, livers that technically belonged to US citizens.

So, Rosenbaum’s network, though extensive, represents only one of many forms of transplant trafficking into and out of the United States. Transplant trafficking is a public secret within the transplant profession, something that everyone knows about but which within the corporatist culture of the transplant profession — as secretive as the Vatican — is never discussed. Rosenbaum plea bargained, admitting that he’d arranged three other illegal transplants for New Jersey patients. In fact, he had arranged more than a hundred such transplants in hospitals along the east coast corridor from Boston to Newark to NYC to Philadelphia to Baltimore since 1999.

I first heard about ‘Rosenbaum’ in Israel in the late 1990s among ‘transplant tourists’ who were looking for a safer, if more expensive option than India, a more familiar site than Istanbul, and less distant than Durban, South Africa among the many transplant destinations offered by commercial crime brokers for backdoor transplants abroad that were reimbursed (until 2008) by Israel’s universal health care system. Following my research informants I located Rosenbaum’s home office in Brooklyn, communicated with two of his brokers, and identified the US hospitals that welcomed Rosenbaum’s kidney -matchmaking skills. I also traveled to the communities in Israel and in the former Soviet States that were providing  the kidneys – mostly new immigrants and ethnic minorities in Israel, but also trafficked sellers from rural Moldova, Romania and Brazil where local kidney hunters worked for international networks of transplant traffickers.

I won’t discuss here the damages to the bodies and the communities of the kidney sellers or the damages to the kidney buyers, not all of whom survive beyond the first year of their reckless gamble. Caveat emptor! But these ‘consequences’ of the kidney trade forced me to realize that what I was studying on the ground was not a problem in medical ethics, in morality, or even in medical malpractice. It was human trafficking, the recruitment of the wretched of the earth – to provide a so-called ‘spare’ kidney – to very sick and equally desperate buyers. But my attempts to get the attention of transplant societies, to alert health officials at US Health & Human Services, UNOS, Medicare, The New York Commissioner of Health, the media – The New Yorker Magazine , 60 Minutes, and, finally, ( at the suggestion of the NY Commissioner of Health) a NYC FBI agent in 2002… led nowhere.

Nobody, it seemed , cared about transplant trafficking. And, in the meantime, Rosenbaum’s organ trafficking business run out of his classic two story Brooklyn brownstone in Borough Park was growing, despite setbacks from restless sellers from abroad who would panic on arrival in NYC and sometimes had to strong-armed by “enforcers” ( “hey – a deal’s a deal, buddy”) to get them up on the operating table.

Mr. Rosenbaum’s downfall came with the infamous “Jersey Sting” of July 2009, when just about everybody who was anybody – 44 prominent people – were arrested , among them three mayors, a deputy mayor, 2 state legislators, 5 Orthodox Rabbis, a stripper or two, and Rabbi Rosenbaum, who as it turns out, was not a rabbi at all but an Israeli immigrant to the orthodox Jewish community in Borough Park, Brooklyn. He was caught red-handed, so to speak, when he accepted a cash deposit of $10,000 to arrange an illicit transplant at a NYC hospital for an undercover agent posing as a kidney buyer. The essential missing piece – the “fresh” commodity – would be trafficked into the hospital from Israel, where transplant tours usually went the other way – that is, with well-insured Israeli patients traveling into the US, South Africa, Turkey, Moldova, Azerbaijan and Medellin, Columbia and China for kidney and liver transplants, provided by desperate, indebted, disgraced , displaced sellers or 4 executed prisoners (in the case of China).

Caught in the dragnet Rosenbaum admitted that he charged a lot to set up these illegal transplants in some of the best hospitals on the east coast, including Mount Sinai in NYC , Albert Einstein in Philadelphia, and Johns Hopkins in Baltimore. Of course it was costly, Rosenbaum defended himself, because a lot of people had to be “schemered” (paid off). Just who had to be paid off to expedite Rosenbaum’s kidney express was never part of the legal case against him. It is nowhere in the court records. The prosecution assumed that the hospitals and transplant staff had been “deceived” by the broker and his clients who had agreed to lie. In his guilty plea Rosenbaum admitted to the minimum, to having arranged two other illegal transplants with purchased kidneys for residents of Deal, a Syrian-Jewish enclave in New Jersey. Presumably, Medicare paid for the surgeries of both the transplant patient and their counterfeit ‘kidney kin’, the foreigners described in their patient charts as ‘emotionally related, altruistic living ‘donors’.

Did I see the medical charts? No, but without that statement in the medical files a transplant cannot proceed. It is easy to become ‘emotionally related’ very quickly when a tower of crisp $100 bills ( cash only) is involved in the kidney exchange. One of the “Israeli sellers brokered by Rosenbaum was an African-American Israeli whose parents had immigrated some years ago to Israel, possibly joining the small enclave there of Black Hebrew Israelites founded by a steel worker from Chicago in the 1960s. The other kidney seller is only a name. The prosecution has not tried to find either one. However, we know that they were each paid “$10,000″, the going price in Israel for the kidneys of ethnic minorities, Arab-Israelis, and so-called “Russian” immigrants from the former Soviet countries.

The only middle class Israeli seller in any of the several prosecutions in several countries, was a young man who needed $25,000 (in 2003) to save his restaurant business and was offered a ‘lifeline’ by Ilan Perry, an Israeli organs trafficking crime boss, who made an exception to allow an Ashkenazi to sell his kidney to another middle class Israeli in Durban, South Africa. The young man changed his mind just as he was being prepped for the kidney removal and he escaped down the back stairs of St Augustine’s Hospital in Durban. “It wasn’t  worth $25,000”, he said. “I’d rather go to jail than go through the surgery’, he told the airport police who picked him up before he could escape. Palestinians, Arab-Israelis, and Russian immigrants are the primary providers of ‘spare’ kidneys in Israel and to other locations arranged by Israeli organs brokers.

So, if the transplant surgeries of Rosenbaum’s clients and of their “altruistic” kidney donors are paid for by Medicare, as they are for all US citizens, regardless of age or the nationality of the donor, and $10,000 goes to the invisible kidney seller, who else gets paid? Some was paid to the “baby sitters” of the frightened transplant tourists and the foreign sellers who were kept in different accommodations according to their status. There was a safe house in Brooklyn and a minder to make sure the sellers wouldn’t flee. There were the airfares to be purchased, meals, visas, and passports, blood tests to assure that at least the blood type was compatible.

Were the surgeons, transplant coordinators, and nurses given a bonus for taking the risks they did, as happened in other linked Israeli-organized transplant tour schemes that were prosecuted? Rosenbaum’s lawyers argued at his plea bargain hearing and they will likely argue again at the sentencing that their client is a soft-hearted Robin Hood who was saving the lives of his desperately ill clients. The lawyers are also likely to pull at the heart strings of the judge by saying that thousands of people are stranded on the UNOS waiting list, and that every fifteen minutes someone dies waiting for an organ that could save their lives. They won’t say that the fastest growing demographic of patients on the organs queue are patients over 70 years old with multiple diseases who would not be  waitlisted for organ transplant in most European nations where reason rules over individual passions and desires to survive at any cost.

Rosenbaum’s clients include those who are too old or too sick to get a UNOS kidney and those who are impatient and those who refuse dialysis altogether. One of his New Jersey kidney recipients was close to 80 years old, not an ideal candidate for the UNOS waiting list. He could be waitlisted but it would be better to suggest that at his age dialysis is the best option. But US doctors, unlike doctors in other countries, do not want to appear ageist or supporting “death lists” even though  we are all on one of those lists.

What hasn’t been revealed in the indictment and guilty-plea in the Trenton courtroom was that Rosenbaum and his associates had been setting up illegal transplants in hospitals from Baltimore to NYC to Philadelphia to Minneapolis to Los Angeles since 1999. His Israeli transplant tourist clients described Rosenbaum as greedy but also as jovial, upbeat and a little bit off color. “He put you at ease; he made you relax”, one of his clients told me. Another said that he was a kibitzer, but also a no-nonsense guy. He didn’t like to hear that people were nervous or had reservations. “He had a lot of money riding on these deals, so naturally he kept his eye on us. I realized he was worried that one of us might lose our courage, might change our mind, and then what?”

One client said of Rosenbaum, “He looked very orthodox, dressed in black pants and coat, white shirt, black hat, but he wasn’t so worried about Halacha (Jewish Talmudic law), and that was fine with me because I am an atheist and the Doctor is God enough for me.” Neither was Rosenbaum very concerned about US laws, NOTA or US laws against smuggling illegal workers into this country, or laws against defrauding Medicare, all of which came into play. Asher A., a recovering kidney patient who was transplanted in a famous hospital in Philadelphia with a trafficked kidney seller via Rosenberg and his associates, told me in an interview in 2001 that quite naturally he was afraid of many things going into the transplant deal: his life was at stake; what they was doing was “not exactly legal”. What if he was questioned going in and out of the US? Would he say he was visiting relatives or that he was having medical treatments?

Would the story that Rosenbaum had concocted to link Asher with an Arab-Israeli woman from Haifa be accepted at face value by the transplant staff. “I said that we were classmates as children”, Asher told me, and no one batted an eye. So, I guessed that everything was normal, out in the open…At least every few days Rosenbaum would pop his head in the special apartment they kept for us. I though that he was very worried that we weren’t taking care of the apartment he had rented for us, but I think he was making sure that we were OK”. Asher appreciated that Rosenbaum “didn’t try to get inside your head, or inside your soul, like some orthodox people. He made everything seem normal.”

In the 1990s Rosenbaum was the man to go to among Israeli ‘transplant tourists’ looking for a safer, if more expensive, option than India or Romania ,  more familiar than Istanbul, and less distant than Durban, South Africa, among the dozens of destinations offered by Israeli brokers arranging ‘back door’ transplants abroad. Rosenbaum and his gang, worked through an Israeli boss named “Tevye” (a name that was always whispered) who was the big shot who organized the Israeli patients and matched them to strangers who would pose as altruistic donors. “Tevye” employed kidney hunters, a lower strata of intermediaries, some of them previous sellers themselves, who were paid by the head to troll immigration offices, jails, unemployment offices, factories, Arab markets, and public housing on the urban periphery, looking for the bioavailable — the debtors, the displaced, the desperate and the cognitively disabled. Ads were placed in Hebrew, Russian, and Arabic in bold letters “as if they were yelling at you”, a new Ukraine immigrant kidney seller told me in 2009 in Jerusalem. “Here you are, like, alone, lonely, and sad, you don’t know anybody, you have a stigma like a black man in America. Everyone here hates Russians. They say, you [Russians] brought crime into Israel. Your people are all drunkards. You are not really Jews. And you have a strong accent that always betrays you. Then, suddenly you see this ad in the newspapers or posted on a wall or on the Internet that is saying “We want you! We need you!” and you feel like at least somebody cares about you. So, I called and I went through the medical exam and the blood matching tests, but I never got to meet the guy who would get my kidney, except in the airport. He was an old man, very sick, very feeble and in a wheelchair. He was being pushed into the first class section. I was stuck in the back of the plane in third class. Just before we got on the plane, the rabbi from [Bellinson Hospital] came and blessed him, the old man, the patient, but he didn’t come over to bless me. He didn’t say a prayer over my head.”

The transplant tourists paid $160,000-$180,000 for their transplant tour via Tevye and Rosenbaum. They came over in groups of four and five. Asher told me that “there were four other Israelis were in the transplant unit at Albert Einstein Hospital in Philadelphia at the same time. The money was raised through Israeli sick funds (insurance) and in part raised by campaigns run by Jewish charity foundations, some of which laundered the money and somehow cycled it back to Rosenbaum and his group. In the 1990s United LifeLine was the primary charity that opened an account for each transplant tourist.

Somewhere around 2002 or 2003 Rosenbaum changed his tactics and began operating more discreetly and with US citizens as his primary transplant clients. On one of my Organs Watch visits to hospitals in NYC, Philadelphia, and Baltimore, I met with transplant surgeons whom I knew to be involved in transplants arranged by Rosenbaum and I confronted them with the facts as I knew them. I also met with a New York Daily News reporter who published a front page and center piece based on a few comments I made to him about Brooklyn organs brokers trafficking displaced Eastern Europeans, and smuggling them into some of New York City’s finest hospitals, where they posed as the loved ones of affluent transplant tourists from Israel. The story, lacking any details, which I did not provide, interrupted a carefully orchestrated visit to the Rosenbaum headquarters accompanied by one of his associates from another east coast city. When I telephoned to confirm the visit I was told that Rosenbaum and his agency did not exist.

Then, in the fall of 2003, police stings in Recife, Brazil and in Durban, South Africa arrested two dozen brokers, surgeons, transplant coordinators, translators, blood lab workers, and private medical companies who were charged with human trafficking, organized crime, fraud, conspiracy, medical malpractice, and even in the case of Durban-Netcare, of trafficking minors as kidney providers. Perhaps Rosenbaum was becoming a bit desperate. I received a series of e-mails throughout the summer of 2002 from a man who identified himself with an alias “David Hamilton” asking for my help in extracting himself from an organization that he described as “the primary link between Israel and the United States in the illegal kidney trafficking business”.

He was employed, he said, by the NYC office that handled all the medical arrangements. He handled the medical files, the insurance claims, and the blood work files. He explained that while there was a totally legal aspect to the organization which was established to help Israelis get the medical care they needed anywhere in the world, that when “kidneys’ got into the mix it became a criminal outfit, and he, a young Jewish seminarian, wanted no part in it. He had complained to the ‘management’ and they had docked his wages. He began to dislike the people he worked for. They presented themselves as religious people and humanitarians when in fact they were motivated, he wrote, by one thing only, greed for the money they could make from the kidneys of people who sometimes arrived frightened to death and trying to back out of the deals. Whenever that happened, David wrote, his employer would push them against a wall, and stick a finger to their head screaming at them that this was a serious deal and there was no backing out after all the money had been spent in setting up the transplant and bringing the donor and the recipient together.

It didn’t help, said David, that two of the employees carried guns, registered, but guns all the same. He asked me to identify a safe way to alert the appropriate officials. I told him that I knew the organization he was with and that we could meet and see if anyone from the office of the Health Commissioner or US Health and Human Services could assist us. He wrote a final email in the fall saying that he was backing out altogether, that he and his fiancé were moving to another state. When I learned on a documentary film trip to Moldova that some young men recruited from economically demolished rural villages there ended up supplying kidneys to hospitals in New York City I reported this information (verified by officials at the US Embassy in Chisinau) to US Visa Control in Arlington, Virginia, to UNOS, to HHS, to The New York Commissioner of Health, the American Transplant Association and, finally, to a NYC FBI agent — to no avail.

Nobody cared about, or even believed in, human trafficking for organs. I went to the media, to CBS, to 60 Minutes and then to 48 Hours which did send an investigative reporter, Avi Cohan, to meet me in Israel where we spoke to patients who had had “undercover” transplants at hospitals in NYC Philadelphia, the Bay Area, and Los Angeles. CBS decided not to do the exposé. I was stumped. No one wanted to accuse surgeons, or prevent a suffering patient from getting a transplant, even with an illegally procured kidney from a displaced person from abroad. The Israeli origins of the trafficking network did not help either. It smacked of bias, blood libel, or worse. “Don’t Indians and Pakistanis broker more kidneys than Israelis”, I was asked? Why pick on Israel?

Thus, it took seven more years for New Jersey FBI to arrest Rosenbaum in 2009 as part of a much larger organized crime sting. One of the fish they caught in their dragnet was a ‘kidney broker’, a job most people had never heard of. And even the prosecutors did not seem to understand that the crime was not simply corruption, greed, and organized crime but rather the theft of life , defrauding the wretched of the earth of their spare kidneys, stealing from the poor to supplement the bodies of the well-insured and well advantaged. Whatever else he is, Isaac Rosenbaum is no Robin Hood. The reluctance to investigate the international dimensions of the crime, to make visible the suffering of the sick, while obscuring the suffering of the manipulated and sometimes coerced kidney sellers, to ignore the defrauding of Medicare which covers US transplant patients with “false” donors on the grounds that everyone was lying and the hospitals and surgeons were all deceived is preposterous.

Kidney trafficking is indeed the perfect crime. Empathy is displaced. Unless the complicit hospital records are subpoenaed we will never know how many illegal transplants were performed through the Rosenbaum gang. A surgeon at one of the major hospitals who wishes to remain anonymous suggests that it would be in the range of one hundred or more during Rosenbaum’s heyday. At $140,000 (low) to $180,000 (high) paid for each of 100 transplants (even with lots of people to bribe along the way), that’s a lot of money to launder, at least 150 million dollars, a profitable business for Mr Rosenbaum.

I interviewed several of the surgeons involved in the criminal dealings and if they did not know it was because they chose not to know. One of the hospitals I confronted acknowledged as much. The prosecutions of the Israeli- Brazil- South Africa transplant business involved many surgeons who, according to one of the convicted brokers, were paid bonuses by the scheme in cash each month for the number of illegal transplants they performed. In Brazil, a retired military doctor pocketed several hundred dollars from the Israeli scheme for each blood matching test he did to enable poor men from the slums of Recife to sell a kidney to an Israeli transplant tourist in Durban, South Africa. The donor’s blood was tested for matching the recipients by Dr. Silvio Bourdeaux, but the donors’ weight and height, blood composition and nutritional status were not measured. Some were severely anemic, most were poorly nourished. Were they willing to sell? For $8,000 or $6,000, yes they were.

But there are some contracts that are null and void when the power differential between the buyer and the seller (of labor) is too great. Kidney sellers are easily exploited and have no form of collective bargaining or even of their well-being (or not) represented in the court transcripts. They are the invisible global men ( and some women). What I imagine is that the complicit surgeons loved the Rosenbaum option because they didn’t have to go through UNOS, the United Network for Organ Sharing, which until 2007, had nothing to do with living donors, related or unrelated. Hospital administrators loved it because foreign patients paid cash so there was no waiting for Medicare or insurance premiums. And there was minimal responsibility for the aftercare of the recipients or their kidney providers. Both were speedily returned to their respective communities and countries. Should they ever get caught red-handed, surgeons can cite patient confidentiality (their privacy oath), the hospitals could pretend they had been duped, the transplant coordinators could say that they followed the transplant protocols for living donors, but they are not, after all, detectives. Everybody wins. Lives were ‘saved’, transplant surgeons got to do what they do best, poor people got a ‘bonus’ for being charitable with their ‘spare’ kidneys, and everybody was happy.

Or were they? It was a nice mythology. Who would begrudge a kidney patient saving or improving his life at any cost, even breaking the law, or (for the American recipients of trafficked kidneys via Rosenbaum’s scheme), defrauding Medicare which covers the cost of kidney transplant no matter the age of the patient or identity of the living donor. Medicare was happy because transplants got US kidney patients off expensive 3x weekly dialysis machines. Everyone knew what was going on, of course, but nobody wanted to spill the beans. As for the kidney sellers, I don’t have to imagine. I know how they fare in Moldova, in Israel, in Brazil, in Romania, in the Philippines and in Egypt. The kidney providers are neither healthy, nor happy nor wealthy as a result of their ‘free’ choice. Today, some want revenge. All want restitution for having been swindled in one way or another.

Meanwhile, complicit transplant doctors collude and protect each other, while the best ones tried to fix the problem from inside the profession without the help of the DOJ or the courts getting involved. Bioethicists argue endlessly about the “ethics” of what is in fact a crime and a medical human rights abuse. Economists and moral philosophers launch arguments based on rational choice theory for regulation rather than prosecution, as if prosecutions were going on every day. In fact, as the Rosenbaum history shows so well, human trafficking for organs is a protected crime. It is protected by the charisma and awe-inspiring ‘ miracle’ of transplant. The Rosenbaum guilty plea is the first prosecution in the United States for organs trafficking. On February 2nd Rosenbaum could be sentenced to five to 12 years in prison and a fine for illegally brokering organs in New Jersey. But the larger and deeper story of his international kidney dealings, his hired traffickers, kidney hunters, ‘enforcers’, money laundering operations, false charity organizations, Medicare fraud is yet to be told. And in the meantime, “life saving” for some at the cost of diminishing the lives of others ,the invisible kidney sellers of Chernobyl, Kiev, Nazareth, or the Negev desert, will continue undeterred.

NANCY SCHEPER-HUGHES is the author of several books on poverty and health, including Death Without Weeping: the Violence of Everyday Life in Brazil – listed by CounterPunch in its top 100 non-fiction books published in English in the 20th Century. Since 1996, she has been involved in active field research on the global traffic in human organs. She is a co-founder of Organs Watch, an independent, medical human rights, research and documentation center at UC Berkeley. Last year CounterPunch published her  investigation, “The Body of the Terrorist: Body Parts, Bio-Piracy and the Spoils of War at Israel’s National Forensic Institute.”  She can be reached at:  nsh@berkeley.edu