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Human beings only need one of their two to survive, making the bean-shaped body parts the most trafficked organs in the world. Nigeria has made unwanted international headlines as former Deputy Senate President Ike Ekweremadu and his wife stand trial in London for alleged trafficking and illegal organ harvesting. The couple is accused of flying a teenage boy from Nigeria to donate a kidney to their daughter. Similar tales of desperation are common across the country.
When they got to India, the donor disappeared. Eventually my nephew returned home after we had been scammed. He died three weeks later
In an interview with The Africa Report, Joe Igbokwe, a Lagos engineer, recalled how his 50-year-old nephew died of kidney failure a few years ago despite the large sums of money his family raised to try and save his life. Igbokwe said his nephew, an only child, had been in contact with a donor that the family trusted because he was from their hometown and was recommended by a relative.
However, when the family flew to India for the transplant, things quickly unravelled. “We paid for return tickets to India, hospital bills, hotel, feeding and other [expenses]. We even paid the rent of the donor’s parents and he kept on demanding money for other things, but we paid,” Igbokwe said. “When they got to India, the donor disappeared. Eventually my nephew returned home after we had been scammed. He died three weeks later.”
Relatives tell The Africa Report that the family ended up paying nearly $20,000 for the elusive kidney. Even so, not all quests end so tragically.
Nigeria’s Nephrology Association says that as of 2020, at least 700 kidney transplants had been conducted within the country. Meanwhile, patients who can afford it prefer to go abroad, spending some $1bn a year on medical tourism.
With more and more Nigerian hospitals now carrying out kidney transplants, patients have less need to travel abroad for the operation.
“The procedure itself costs about 10m naira ($24,000) on the average,” Joshua Awobusuyi, a consultant nephrologist at Lagos State University Teaching Hospital, tells The Africa Report. Those who cannot afford it often turn to newspapers to appeal for funds from the public.
Interviews by The Africa Report reveal that in hospitals that perform kidney transplants, staff members introduce patients to agents who go about looking for donors far and wide. The patient then pays for potential donors to be transported and accommodated in the city where the hospital is located.
Donors then undergo tests that include screening for HIV, hepatitis and diabetes before the process of ‘matching’ with patients begins.
In some instances, a donor will end up matching with a different patient than initially planned. Once a match has been identified, agents for the donor and the patient begin negotiations on compensation. Patients usually end up paying between $10,000 and $15,000 to donors, most of them youths, if the surgery is performed in Nigeria. Agents make about $1,000.
These agents work in a closed network. They are the ones that locate the donors
A kidney patient who wished to remain anonymous tells The Africa Report that the only people who donate kidneys for free are relatives.
“When my kidneys failed last year, I asked my siblings to donate to me, but they couldn’t because they both have diabetes, so the hospital introduced me to an agent,” the patient says. “These agents work in a closed network. They are the ones that locate the donors.”
The patient says agents identified three agents, the first two of whom weren’t a match. They ended up pairing with other patients, however, “so, there are no losses in the business per se”.
“Currently, I’m trying to put the money together – about $10,000,” the patient says. “The testing takes place in the hospital, but the transactions take place outside, to give them deniability.”
A thriving business
The thriving business is in clear violation of the National Health Act. Section 53(1) of the Act makes it an offence for a person who has donated tissue, blood or a blood product to receive any form of financial or other rewards for such donation except for the reimbursement of reasonable costs incurred to carry out the donation. The law prescribes a jail term of not less than one year or a fine of about $2,400.
However, the law hasn’t stopped desperate Nigerians. With about 100 million people living below the poverty line and youth unemployment topping 30%, Nigeria’s minister of state for health, Olorunnimbe Mamora, tells The Africa Report that organ donation is an attractive option for many. Mamora adds that the secrecy of the illegal organ trade, and the fact that no one ever reports violations to the authorities, make it difficult to enforce the law.
“Poverty often deprives a man of all virtues. And when people are pushed to the wall on account of poverty, they will be willing to do virtually anything,” Mamora says. “Secondly is the lack of enforcement. No matter how beautiful a law has been crafted, if it is lacking in enforcement, then you are not likely to benefit from it as much.”
Poverty often deprives a man of all virtues.
The minister also blames the breakdown in citizenship. “The people who ply this trade are not spirits,” he says. “People know them, but what citizenship entails is that citizens assist the government by providing information that will lead to arrests and actions.”
No organ banks
Awobusuyi, the nephrologist, has performed several kidney transplants. He says the reason there’s less organ trafficking in developed countries is that they have robust organ donation programs.
“Most of the countries with established kidney transplantation programmes rely more on diseased organ donors,” he says. “These are people that die in hospitals, in intensive care units. The brain can die and a couple of minutes after, the other organs are still functioning. Then you harvest the organs based on prior permission. This needs to be encouraged in Nigeria, but many are of the belief that organs could be used for money rituals,” he says.
The president of the Nigerian Medical Association, Uche Ojinmah, also believes that voluntary organ donation should be promoted. He tells The Africa Report that Nigeria lacks organ banks where donated kidneys, lungs, and hearts can be stored.
“It is illegal for anyone to pay for any organ. Definitely, the best approach would be for people to donate their organs at the point of death, but the fundamental question is where will you store them? Which centre can store these organs? […] we should not put the cart before the horse,” he says.
“We need organ storage facilities. It is when we have this in place that you can then engage in enlightenment and encourage people to give out their organs,” Ojinmah says. “Currently, we have only blood banks.”
Former Minister of Health Isaac Adewole, who once headed Nigeria’s largest public hospital, adds that kidney disease is on the rise in Nigeria because of increasing diabetes and hypertension which are being triggered by the change in lifestyle and diet.
Adewole tells The Africa Report that the use of body creams that contain mercury is on the rise. This is not unexpected since the World Health Organisation says 77% of women in Nigeria use skin-lightening products, the highest percentage in the world.
With kidney diseases and failure steadily rising, Adewole believes Nigeria desperately needs to get its act together. “We desperately need organ banks and to encourage people to donate,” he says. “Unfortunately, the demand is growing every day. Dialysis is just a stop-gap and offers temporary relief.”
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