The Best American Science and Nature Writing 2011 Read Online Free PDF Page A

the late 1980s, Kumar (then using his birth name, Santosh Raut) had become well aware of medical tourists streaming in from the Middle East. "He knew at once that if he could tap this market, he would hit the jackpot," Maria said. To do so, he reached out to cab drivers at the city's international airport, paying them a commission to find clients.
    There was no shortage of potential donors to Kumar's makeshift hospital in Mumbai. He targeted homeless beggars, handcart pullers, sweepers. He hired two men to scout the slums and offer anywhere from a paltry $300 to just over $1,000 for a kidney. Later he began paying the agents a fixed amount of a few thousand dollars per donor. To boost their cut, the agents started paying donors less and less.
    Through the early 1990s, the business flourished, and the dozens of transplants performed at the hospital (many of them by a Mumbai Hospital surgeon named Yogesh Kothari) provided Kumar with the equivalent of a surgical residency. He attended conferences, read up on nephrology, and learned about different kinds of sutures and immunosuppressant drugs. In 1994 he performed his first transplant under Kothari's watch. But after a shortchanged donor filed a complaint, police raided Kumar's hospital that August, arresting eleven people on charges of cheating and criminal conspiracy. Kumar himself was charged with conducting illegal foreign-exchange transactions through two frontmen—a grocer and a silversmith—who had helped him receive payments from overseas clients to the tune of $60,000.
    After four months in a Mumbai prison, Kumar was freed on bail. In 1995, after Maharashtra (the state that contains the city of Mumbai) banned organ selling, he was busted again and charged with conducting illegal transplants. Finally he fled to Jaipur, 800 miles to the north. There he assumed his new name and conducted thirteen illegal transplants before being arrested yet again, in 1996.
    Released on bail, he disappeared from view and did not resurface until 1999, in Gurgaon. There Kumar built an empire bigger and more organized than ever as the Indian legal system churned sluggishly on.
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    While Kumar was setting up business in Gurgaon, Scheper-Hughes, Cohen, and two other academics were launching Organs Watch, a program to document exploitative organ transplantation worldwide. As Kumar's business boomed, the researchers visited Brazil, Turkey, the Philippines, and elsewhere to interview hundreds of kidney sellers (including victims of coercion and fraud) along with buyers, doctors, and police.
    As a result of new regulations, the climate for kidney dealers has gotten tougher. China implemented regulations in 2007 to stop the organ trade. Pakistan's last president, Pervez Musharraf, issued an ordinance that same year to outlaw organ trafficking, which in April 2009 survived a legal challenge by a petitioner who called it un-Islamic. And in May 2008, the Philippines, which for years had promoted transplant tourism, followed suit. Yet, like a multiheaded Hydra, the industry seems to be surviving legal onslaughts in countries like India and branching into newer, more vulnerable places such as Iraq and sub-Saharan Africa. "It gets snuffed out in one place and crops up in another," Scheper-Hughes says.
    The trade is adapting to the changing legal climate. One shift has been venue: transplant surgeries seem to have moved out of large hospitals to small clinics away from the public eye. "We even have anecdotal reports of surgery being transferred to private homes," WHO's Noël says.
    Another change is in marketing. Gone are the blatant online advertisements for transplant tours. Instead, dealers posing as private sellers post personal ads on Facebook. When the social networking site Orkut outlawed transplant-related communities, it saw a proliferation of user names containing the word
kidney,
such as "kid-ney4u." The Orkut pages of these users are typically blank and presumably exist only as a