Organized Crime

Last April, A.A., a 21-year old from Kfar Manda, saw an intriguing ad in a popular Arab newspaper: "Wanted, kidney donor, any blood type. Reward paid throughout recuperation period." The ad suggested contacting "Dr. Mohammed" on the cellular phone number provided.

A.A. worked in a fowl slaughterhouse and had been depressed because of familial problems. He called and spoke to Mohammed Jit, who promised him $7,000 for harvesting one of his kidneys in a Ukrainian hospital for transplant into an Israeli patient.

At first A.A. was skeptical, but Jit - who wasn't a doctor as the ad purported - and his partner, Hassan Zahakla, were persuasive. Beyond the fortune promised, they said he would have a fun trip. They also claimed a person could live with only half, or even a quarter, of a kidney, and that the operation would leave a tiny scar; he then could resume his life as usual.

A.A. believed them. Jit took him to an Interior Ministry branch in Haifa for a passport, for his first trip abroad. He also accompanied A.A. to verify he was a match for the patient slated to get the kidney. On May 2, the two flew to Ukraine.

They were met at the hotel by Dr. Mikhail Ziss, an Israeli doctor whose medical license had been annulled for six months after being convicted of a criminal act in another affair. He drove them to the hospital.

A few days later, while recovering from the operation, A.A. was given an envelope with only half of the money he'd been promised. Upon returning to Israel, Jit took the envelope from him, saying he'd be paid in full later on. A few days later, Jit and Zahakla "settled" accounts with A.A. After calculating the costs of the trip, which included, for example, traveling for the medical tests, housing, getting a passport, food and clothing, the pair calculated that A.A. was owed just $500.

They then claimed there was a "problem with the money" and warned him not to come to Haifa looking for his money, because the police were lying in wait for him. A.A. was so cowed that he was afraid to go to the village Health Services clinic to have his stitches removed: He did so himself with a knife.

Three months after his kidney was removed, he's constantly tired and functions at a minimum. His body bears a conspicuous 30-cm scar and his mood is terrible. He says he's contemplated suicide.

This dreadful story is only one of five described in the charges the state filed this week at the Haifa District Court against Jit and Zahakla. They are charged with "selling A.A. to Dr. Ziss, exploiting and defrauding him under aggravated circumstances. The aggravated circumstances are reflected in the organization, the methodicalness, the cleverness and the scope of damage caused, and in illegally causing the kidney of A.A. to be removed, leaving him maimed for life." The charges against them included exploitation, obtaining organs by fraud under aggravated circumstances, and trafficking in humans for the sake of extracting organs. They were remanded to custody throughout the legal process.

Theirs is the first case in Israel of trafficking in human beings for their organs. It is based on an amendment from 2006, in which new articles were added to the Penal Code to block the practice. The penalty under the new law for trafficking in humans to extracts organs from their bodies is 16 years.

For his part in the deal, the indictment states, Ziss gave Jit tens of thousands of shekels. The two worked hand-in-hand, "in an organized, systematic and ongoing" fashion, the charges stated. All the kidney "donors" in the network were Arab and all the recipients were Jews, mostly hailing from central Israel, and many with private health coverage by Israeli insurers.

The prosecution against Ziss also marks the first time the state has leveled such charges against an Israeli doctor (no indictment has been served, but a warrant of arrest was issued). The defendants were accused of bringing their victims to Ziss in Ukraine, at his direction. While locating kidney "donors," he also located Israeli patients needing transplants. He charged between $125,000 to $135,000 per transplant.

Ziss emigrated to Israel from Russia in 1991. By 2002, he had worked for nine years at Assaf Harofe hospital, as a surgery intern, but he never completed his residency exams. At the start of this month, the Health Ministry revoked his medical license for half a year, after he was convicted of conduct not befitting a doctor following his conviction for abetting in money counterfeiting. Explaining its demand to revoke his license, the Health Ministry said that his actions in the affair were characterized by "moral and economic defects," and that "everything possible should be done to prevent criminal behavior from seeping into the medical profession." It added that his conduct "contravenes the definition of 'decent person' stated as the first and primary term in entitlement to engage in medicine."

In a telephone conversation with Haaretz from somewhere in Europe this week, Ziss said: "I didn't break the law anywhere. There is no law in Israel against organ trafficking. I am sure that nothing was done [with the kidney donors] by force or through lies. If any of them [the defendants]) deceived the donors, let them go to jail. I support punishing anybody who lied. It was all legal. Every patient has the right to undergo surgery abroad and every person has the right to do what he likes with his own body. If I want to donate a kidney, nobody can tell me not to."

Ziss also claims he never lied to anybody in his life. "I asked each donor before surgery whether he was doing it out of free will. None said he had been threatened. They do it for their own reasons, which I don't look into, nor do I care to," he said. "I didn't look for donors and don't know them."

Are you arguing that what you did was legal and medically ethical?

"Yes. Say that, heaven forbid, your son needs a kidney. What would you do? Study [medical] ethics, or enter the waiting list for transplants at Beilinson? There's no chance of getting a kidney there. People seek solutions. They look for a donor and reach an agreement with him. That's all."

If the procedure would disable the donor or impair his health, kidney transplants wouldn't have become a norm, he adds. "Medical literature on monitoring donors shows there's no difference between people with one or two kidneys," Ziss says.

Two years ago, a donor who sold a kidney died following the operation. "That was because of medical negligence. He bled to death. No patient today should die in a hospital in Israel. They didn't check him, which was a bad mistake. If they had, they would have seen that his blood pressure was falling and would have taken him back to the operating room." A Health Ministry committee indeed found flaws in the medical team's conduct.

Ziss also claims that what he does abroad is now common practice at Beilinson. "Everything there is done for money and the doctors know it. They take a Jewish patient and an Arab donor, and say he's donating a kidney for altruistic reasons. But check whether any of these altruistic donors are journalists, doctors or lawyers. Here, at least, I'm not lying, and it's less criminal than the way things are done in Israel."

In recent years, more and more stories have been heard about Israelis buying kidneys from other Israelis, sometimes through mediation. In most cases, surgery is done abroad, in South Africa, for example. But some claim that kidneys have been traded for transplant in Israel, including at Beilinson, where most of the kidney transplants here take place.

Such transactions are possible in Israel because of Health Ministry directives, which depart from Western norms; a kidney donation can be approved even if the donor isn't the patient's family member. All the donor has to do is convince a special committee that his motives are altruistic, and he isn't getting paid. When the ministry published the directives in 2000, some officials warned it opened the door to government-sanctioned trade in human organs. Indeed, some of the "altruistic" donations turned out to have been motivated purely by money.

In Israel, trade in organs for transplant here or abroad is common, and some of the top people in the health administration know all about it: Until last week, the prevailing opinion at the ministry, police and prosecution had been that Israel had no law explicitly prohibiting trade in organs. Nor does it. The charges filed last week were based on the law against trafficking in humans for the purpose of extracting their organs.

According to the National Transplants Center, Israel has 560 patients waiting for kidneys. Only 75 got one this year, 43 from dead and 32 from living donors.

Attorney Shaadi Srouji, representing Jit, said that the charges were unprecedented. "When the defendant was active, the law [against trafficking in humans for the purpose of extracting organs] hadn't been in force. The defendant denies any connection to the crimes and claims that he was a victim, because of his emotional and financial condition. He is now under observation at a psychiatric hospital."

Public defender Alon Nesher said, in Zahakla's name, that the crime of trafficking in humans is a new one. "The indictment shows that the defendant was a completely marginal character in the case, and in three of the cases he wasn't involved at all. He was a tool in the hands of the central defendant [Jit]."

Beilinson rejects Ziss' allegations. "Any transplant of a kidney from a donor who isn't a first-degree relation is checked, discussed and approved only by the Health Ministry, which is the only body empowered to decide whether the donor's consent was based on free will and not on financial gain. Only after the Health Ministry provides consent in writing does the hospital perform the transplant."

The Health Ministry said the task of the national committee that evaluates donors, is to assure that live donations are not based on commerce in organs, or economic or other pressures. "Based on its accrued experience, as it worked, the committee became skilled at filtering out cases suspected of being tainted by other than altruistic motives. Note the high incidence of rejected donors, where their motives are suspect." The ministry added that if a donor was proved to have fooled the committee, the case would be handed over to the police.