Walter Klak said this week that more than 100 patients have made it onto his waiting list for a spot for a transplant operation in a Shanghai hospital where car-accident victims are whisked in.

Mr. Klak told a Globe and Mail journalist posing as a dialysis patient that he and his Shanghai partner are using China for transplants because "we found that to be the largest supply of organs that are available." When asked if he uses kidneys from executed prisoners, he replied: "No, no, generally not, no."

Despite the newness of his venture, his waiting list is already 18 months long, and he stopped adding names in February.

He said he can't take any more patients "because right now it's getting out of hand. ... We're finding that we have far more requests than we have donors."

Canadians needing a kidney often face lengthy waits for a transplant: up to six years in Toronto, which has the longest queues of all. There were 2,923 patients waiting for kidneys across the country as of June 30, 2000.

Up to 50 Canadians each year travel abroad for kidneys, playing a form of medical roulette, not knowing exactly what they are getting, or from where.

In Toronto, a refugee who paid for a transplant in India ended up in Jeffrey Zaltzman's office with poor kidney function. Despite a six-inch scar on his abdomen, an ultrasound revealed there was no transplanted kidney and he was the victim of a con.

"There's no country where it's legally sanctioned, but it still happens," said Dr. Zaltzman, a Toronto transplant kidney specialist who is director of St. Michael's renal transplant program. "It happens like a black-market underground economy. We've had lots of patients who have gone. Some tell us and some don't tell us; they just come back with kidneys."

Buying and selling of organs is illegal in all provinces and territories in Canada, but it is a breach of a provincial regulation, not a criminal offence, and is subject to a maximum $1,000 fine and six months in jail.

Specifically, British Columbia's Human Tissue Act states: "A person must not buy, sell or otherwise deal in, directly or indirectly, for a valuable consideration, any tissue for a transplant, or any body or parts other than blood or a blood constituent, for therapeutic purposes, medical education or scientific research."

There is no specific law to cover Mr. Klak's activities: arranging for an operation outside the country. And there is no law preventing Canadians from going abroad to get organs, though some health officials have lobbied to have the Criminal Code changed to make it illegal.

Mr. Klak was so booked up, he said he could not add the Globe and Mail journalist's name to his waiting list. Still, he did offer to check with some Shanghai hospitals that "may have an organ that is readily available or someone close to passing away or something. And they may be able to put you in the bed next to him."

Approached Thursday at his business, located in an industrial mall of pastel greens and blues near cranberry farms in Richmond, B.C., Mr. Klak refused to divulge whether his patients were Canadians or Americans. However, he did say, leaning over his old, worn, wooden desk: "I'm only seeking to help people and nothing else."

Mr. Klak works in a tiny office that sits in front of a warehouse crammed with framing and canvas supplies. The self-described international businessman also runs Northwest Artists' Canvas, which specializes in art supplies in the Vancouver area and Asia.

Experts estimate 30 to 50 desperate Canadians each year make the sometimes hazardous journey to China, India or the Philippines for kidney transplants. They pay between $50,000 and $145,000 (U.S.) for transplants that have been condemned by the International Transplant Society and the World Health Organization.

Buying and selling organs is illegal in most countries, but soaring demand has opened a window for middlemen, such as Mr. Klak, who provide their services without breaking the law, linking those desperately in need of organs with private hospitals keen for revenues.

Mr. Klak, who stressed he is not a broker, was reluctant to talk on the record about his business when a reporter met him inside his office Thursday.

"It cost me a great deal of money to get into this business and I don't see what benefit I'll get by talking to you," he said. "I don't see what business it is of anybody else's. I'm not interested in getting attention."

Mr. Klak's entrepreneurial efforts seem to have surfaced in 1998 when he used his wife's Simon Fraser University e-mail address to place an ad on an Internet billboard in China. His wife works at the university.

The ad simply read: "Looking to buy turn key hospitals 100 beds and up with two or three specialty wards. We also require portable hospitals on trailers. No agents."

More than a year later, on Oct. 5, 1999, Mr. Klak made a cold call to Bill Barrable, chief executive officer of the British Columbia Transplant Society, looking for help.

"He was looking for a transplant surgeon to work at a transplant clinic in Shanghai," said Mr. Barrable, who is strongly against purchasing organs.

Though Mr. Barrable didn't quite catch his last name, he was disturbed enough to jot down the man's telephone number, and promptly called the Royal Canadian Mounted Police. He later wrote a letter to Justice Minister Anne McLellan, asking for some type of probe.

But no action was ever taken, he said, because no laws were apparently broken.

"We don't endorse the buying and selling of organs and the brokering of organs because it leads to the exploitation of the poor by the wealthy," said Mr. Barrable, who has been pushing for it to be made illegal for Canadians to buy organs overseas.

"It's a very slippery slope. It will lead to the broader exploitation of organs."

While many patients return to Canada with healthy kidneys, others have died of complications. One British Columbia man, Roger Kinnee, suffered a devastating stroke on the journey home from India after purchasing an organ from a 17-year-old Madras construction worker. The 55-year-old is now in a nursing home.

Sometimes the best chance of obtaining a kidney is from a living donor, where the operation, while major, has few complications if the person providing the organ is healthy.

Of the 1,010 single-kidney transplants performed in Canadian hospitals in 1999, 379 of those were from living donors, according to the Canadian Organ Replacement Register. Spouses, family members and long-time friends are the best candidates, provided no money changes hands and they are properly screened.

But for many Canadians, a live donor isn't an option. Either relatives don't want to provide organs, or can't, because of complications in tissue matching, so these patients languish on waiting lists.

They are willing to make the desperate overseas journey knowing their trip may be risky, but also fearing they could die in Canada on a waiting list.

Indeed, 536 Canadians died waiting for all types of organ transplants from 1997 to 1999, according to the Canadian Organ Replacement Register. Though there are no separate figures for those who died waiting for kidneys, they make up about 80 per cent of those awaiting organs.

An aging population and an increase in hepatitis, diabetes and other ailments has Canadians clamouring for healthy kidneys.

However, doctors say only only one-quarter of those receiving dialysis are eligible for kidney transplants, largely because of other medical problems that make such an operation too risky.

David Landsberg, medical director of the British Columbia Transplant Society, said he tells patients who talk of wanting to venture into the world of transplant tourism of all the pitfalls.

"I'm very judgmental beforehand; I do my best to talk them out of it," said Dr. Landsberg, a transplant kidney specialist. "I warn them they may not be getting good treatment. I ask them to think about the ethical dilemma; I tell them personally I don't approve of it and I tell them about the donors being used."

But not everyone listens.

Kidney specialists and transplant doctors interviewed for this article had more than 50 patients among them who went overseas organ-shopping over the past decade.

One Chinese-Canadian woman recently paid $50,000 (U.S.) for an organ in mainland China and arrived with a six-inch scar at her belt line, knowing nothing about the new kidney filtering the blood and excreting waste products inside of her.

"She had nothing, not even a scrap of paper," Dr. Landsberg said in a telephone interview from Vancouver. "She had absolutely nothing. We had no idea what treatment she had received up until that point."

Another patient returned from the Philippines with a complete medical chart, including all the details about his donor.

(With kidney transplants, the new kidney is usually placed in front of the old one so the patient ends up with three kidneys.)

"They didn't make any pretence that it was anything but a bought kidney. I was quite amazed at how up-front they were," Dr. Landsberg said. "When they come back, they get the same care as everybody else. I never make it personal. I honestly do my best to forget about it."

Dr. Landsberg does find himself sometimes wondering who sold the kidneys and what has become of them. But like the vast majority of doctors, he always treats patients when they return from their surgical holidays.

"It seems that the donor is the No.1 loser, but then again, I'm not desperately in need of an organ," he said. "When you see the donor is just a commodity and is being totally used then it becomes more difficult to swallow."

Nancy Scheper-Hughes is a professor at the University of California at Berkeley and director of Organs Watch, a centre that investigates trafficking in body parts. She says there's a huge worldwide market in organs, and the cheapest place is Iraq.

"What we're having now is people travelling all over, grabbing construction workers, domestics, illegal undocumented workers," she said in a telephone interview. "Those people go off into the blue; they wind up living in situations of desperation and poverty without medical coverage and a higher risk of getting sick themselves."

In the Philippines, in the seaside slum district of Bagong Lupa, 100 men have sold their kidneys since 1992. But they have little to show for their loss except for the jagged, diagonal scars that mark the sides of their bodies.

Donors in these shantytowns often part with their organs for paltry sums: $800 to $2,500 (U.S.), a deal often negotiated with a broker who travels the areas, then arranges the surgery in some of the 13 transplant hospitals in the Philippines.

"A lot of it is being paid for by people through medical insurance," Ms. Scheper-Hughes said, pointing out the cost of an organ transplant is much lower than that to keep a patient on dialysis.

But there are worries about the organs themselves. Doctors question whether they are properly screened for HIV, hepatitis and other diseases.

Most of the doctors interviewed for this article said most of the transplants were successful, though they were not as well done as in Canada.

As for Mr. Klak, he faces competition from a number of international middlemen trying to make their mark in the emerging body-parts business.

Californian James Cohan, who describes himself as an international transplant co-ordinator, said he has arranged for four Canadians to go overseas, three of them to the Philippines. His all-inclusive price for a kidney transplant is $125,000 (U.S.), which can be arranged within weeks, after a $10,000 down payment.

"Usually people have the money or don't have it," he said in a telephone interview from Los Angeles. "Sometimes it takes a bit of doing for people to get it together. I guess loans. How they get it, I really don't pay much attention to that."

With a report from Rick Cash

Copyright © 2001 Globe Interactive

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