Bulgaria: Kidneys trafficked from impoverished E. Europeans to the wealthy, most from Israel Print E-mail

2006; 367:461

Bulgarian hospital admits role in illegal transplants

Bojan Pancevski

Managers at one of Bulgaria's top hospitals have admitted that their institution was involved in at least 20 illegal transplant operations. Authorities are now investigating whether eastern Europeans are being flown to Bulgaria to supply wealthy patients with kidneys. Bojan Pancevski reports.

Bulgarian prosecutors have confirmed they are investigating an accusation that one of the country's top hospitals participated in illegal organ trading by taking kidneys from eastern European donors that were then given to wealthy foreigners.

Under Bulgarian law, organ donations are only possible if the donor and recipient are related by blood or marriage, but investigators have found cases where both parties left the country after the operation, making it impossible to check the relationship.

In most countries around the world paying money for organ donations beyond expenses is considered unethical and in most cases illegal.

Since the claims first surfaced, management at the St Ekaterina University Hospital in the capital Sofia have done their own internal investigation, and the president of the hospital's board of directors, Krasimir Gigov, admitted that at least 20 illegal operations have taken place during the past 2 years.

Prosecutors are currently examining evidence suggesting that the transplants were from impoverished donors in countries like Russia and Georgia and mainly made to wealthy recipients from Israel.

Gigov, who is also a secretary in the Health Ministry and was appointed hospital board president after the controversies started, confirmed that the hospital charged over £10 000 per operation but that he had not yet been able to confirm allegations that the donors had received money for their organs.

Bulgaria recently tightened up its law on transplants to prevent such abuses, ruling that an organ can only be donated if the donor is a relative of the recipient. It also stated that all transplant surgery must be registered with the Executive Transplant Agency­a requirement ignored in all the St Ekaterina operations.

Gigov admitted that in cases of the illegal operations the law had been violated in at least one of three different ways. These included a lack of proper documents proving the donors and the recipients were related; no evidence of psychological or psychiatric counselling of either donor or recipient before surgery; and no notification of the operation to the Transplant Agency.

He said: “All of the transplants were made with live donors. I don't know whether the donors received money for the kidneys, but the hospital charged €15 000 per operation.”

Only recently Bulgarian police detained a Russian citizen at Sofia airport suspected of making an illegal kidney donation to an unnamed man he claimed was his uncle. He reportedly said that the surgery, for which he was given about £3400, was done in the St Ekaterina hospital.

Gigov admitted that the case was one of the 20 illegal operations he had uncovered that had taken place in the hospital.

Former hospital director Alexander Chirkov, who was sacked after the scandal broke, denied the allegations, claiming all the donors had provided their organs of their own free will and without “financial incentives”.

Chirkov, who also teaches at Freiburg University in Germany, was in charge of the hospital during the time of the controversial operations and has since been stripped of his role as executive director amid accusations of mismanagement. The director of the country's Transplant Agency, Yanko Nachkov, has also been dismissed following the scandal.

Bulgarian prosecutors are now probing the case and Chirkov's involvement in particular. He could face up to 8 years in prison and a fine, while the hospital could be fined up to 50 000 leva (£17 000), with every doctor that participated in the operations fined up to 30 000 leva (£10 000).

Insiders however admitted that it is unlikely prosecutors will be able to find solid evidence of illegal trading in organs that could lead to convictions.

Speaking in an interview with local press, Chirkov said that he and hospital management were not aware that they were supposed to inform the Transplant Agency about surgery involving organ transplants.

He said: “We did not know that they (the transplants) were supposed to be registered. But we did not stop anyone who carried them out from letting the agency know.

“We follow European norms, ­the donor and the recipient meet and sign legal declarations, clearly stating that they are related. It is not our job to go to Israel and check whether what they say is actually true.”