When Kenichiro Hokamura’s kidneys failed, he spent four years on dialysis before going online to check out rumors of organs for sale.

With less than 10 kidney transplants performed in Japan a year, the 62-year-old businessman was desperate. “There are 100 people waiting in my prefecture alone. I would have died before getting a donor.”

Still, he was astonished by how easy it was. Ten days after contacting a Japanese broker in China in February, he was lying on an operating table in a Shanghai hospital receiving a new kidney. A doctor had only examined him that morning. “It was so fast I was scared,” he says. The “donor” was an executed man, the price 6.8 million yen. “It was cheap (in comparison to the cost of my life),” says a recovering Hokamura, now back in Kyushu in southern Japan where he runs a construction-related business. “I can always earn more money.”

Hokamura is one of hundreds of well-off Japanese who have recently made the trip to China for transplants. The so-called “transplant tourism” trade is also attracting a growing number of Koreans, Americans and other wealthy nationals. There is no attempt to conceal the origins of the organs, the bulk of which come from prison morgues. “My translator told me my donor was a young executed prisoner,” says Hokamura, who claims he is unconcerned at the possibility that prisoners were being executed to supply organ brokers. “The donor was able to provide a contribution to society, so what’s wrong?”

After paying a local broker, many patients arrive in Shanghai and other cities to find gleaming, well-equipped hospitals. Rumors of problems with follow-up care and patients dying within one to two years of returning home have failed to stem the tide.

Spray-painted signs on walls outside clinics and hospitals around China are simple and direct: a mobile telephone number and the character for “shen” (kidney) written alongside. Advertisements on bulletin boards and other Internet sites also offer kidneys for sale.

The sale of organs for transplants is illegal in China but a black market is flourishing in small private hospitals and clinics springing up all over the country but also bigger hospitals in Beijing and Shanghai where ads have appeared in toilet cubicles and walls. “We have to wipe off the notices again and again. They [brokers] even visit doctors, make numerous calls or write letters again and again,” Prof Ding Qiang, head of urology at Huashan Hospital in Shanghai’s Fudan University, recently told the media.

There is little confirmed information about how the organs are harvested but doctors have given accounts of driving to execution grounds with specially equipped ambulances carrying nurses and containers for body parts. The body is brought to a hospital where the organs are stripped. Although Beijing does not reveal how many people are executed annually, Amnesty International put the figure at 3,400 in a 2004 survey — the highest in the world — but some analysts say it may be as high as 8,000.

Executions are generally carried out by a bullet to the back of the head, or in the heart. The introduction of the lethal injection in the last decade means that more organs are left intact, and advances in immunosuppressant drugs have reduced the need for exact genetic matches. Beijing says that all condemned prisoners donate their organs of their own will but many are skeptical of such claims.

Human rights organizations accuse authorities in China of scheduling executions to coincide with transplant operations and some families have sued the authorities for using the organs of executed relatives without consent.

In March this year, Beijing announced new transplant regulations following highly critical reports in foreign newspapers and the deaths of several foreign donor recipients.

There is much mystery about the organ route from prison morgue to operating theater but little doubt that money helps lubricate the way in a country where foreign patients jump to the head of the queue despite a local transplant waiting list of more than two million people.

The ethics of paying for human organs are often trumped by the prospect of a few more years of life. Hokamura says his family is so pleased his daughter has put his experience on the Internet. In her blog she says she feels sorry for others to have to wait years for transplants and provides a link to a support center in Shenyang.

Many patients in Japan are bitter about the underdeveloped state of transplant health in a country with 12,000 people waiting for matching donors and just 50 cases of donated organs since the revised 1997 Organ Transplant Law.

“Doctors in Japan are happy with their patients being on dialysis because it is profitable,” claims Hokamura. “They get 5.1 million yen a year to treat people like me.”

With medical facilities improving in urban pockets of the Third World, wealthy, ill people have a powerful incentive to board a plane to India, the Philippines, Peru and China, where a kidney transplant can be had for $66,500 and a liver for up to $157,000. A Taiwanese broker recently told the Japan Times that a heart transplant in Shanghai can be had for as little as $119,000, a fraction of the $860,000 it reportedly costs in North America.

A single broker has helped more than 100 Japanese make the trip to China for transplants since 2004 and the trade is growing. Official figures almost surely underestimate the number.

Hokamura negotiated the deal through a Japanese broker in Shenyang called the International Transplantation Network Assistance Center. Calls to the center were answered by a Japanese-speaking Chinese secretary who transferred to a Dr. Mitamura.

“We cannot talk to the press because media attention last year caused a lot of problems,” he said. Dr. Mitamura said he would discuss money only after a return address and telephone number in Japan was provided. The hospital maintains a professional Web site with detailed information about services for donors in English, Japanese, Korean and Russian ( en.zoukiishoku.com/list/link.htm )

Several other Japanese groups have traveled to China to investigate the trade, including the Japan Transplant Recipients Organization, an NPO that lobbies for legal changes to increase the number of donors. “We do not approve of receiving organs from executed prisoners but personally I can’t simply disapprove of it,” says chairman, Masanori Suzuki. “There are just too few donors in Japan.”

Last May, Suzuki visited a Chinese hospital in a “major city” and learned that 95 per cent of its transplant patients had received organs from executed prisoners. The hospital had conducted 2,000 organ transplants last year alone, Suzuki said. Some 30 or 40 were Japanese and 200 were Korean.

“For many patients, this is their last chance.”

The Japanese health ministry has begun a joint research project with transport authorities in an effort to get a handle on the trade. But the government is likely to find it difficult to stop desperate people who have money from making the trip to China.

As Hokamura says: “I was on dialysis for four years. I was tired of waiting.”

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