CHINA / JAPAN: With executed criminals among the 'donors', black market transplants are flourishing, writes David McNeill in Tokyo and Clifford Coonan in Beijing
When Kenichiro Hokamura's kidneys failed, he faced a choice: wait for a transplant or go online to check out rumours of organs for sale.
As a native of Japan, where just 40 human organs for transplant have been donated since 1997, the 62-year-old businessman says it was no contest. "There are 100 people waiting in this prefecture alone. I would have died before getting a donor."
Still, he was astonished by just how easy it was. Ten days after contacting a Japanese broker in China two months ago, he was lying on an operating table in a Shanghai hospital receiving a new kidney. "It was so fast I was scared," he says.
The "donor" was an executed man, the price 6.8 million yen (€48,000).
"It was cheap," a recovering Mr Hokamura, now back in Japan, says. "I can always earn more money."
Mr Hokamura is one of hundreds of well-off Japanese and other nationals who have made the trip to China for kidney, liver and other transplants, drawn by the availability of cheap, healthy organs and rapidly improving medical facilities along the Chinese east coast.
After paying a local broker, many arrive in Beijing or Shanghai to find gleaming, well equipped hospitals with world- class staff. Rumours of problems with follow-up care and patients dying within one to two years of returning home have failed to stem the tide.
Signs spray-painted on the walls outside clinics and hospitals in many parts of China are simple and direct: a mobile telephone number and the character for shen (kidney) written beside them.
Ads on numerous bulletin boards and other internet sites also offer kidneys for sale. Although the sale of organs for transplants is illegal in China, a black market is flourishing.
And it's not just the small private hospitals and clinics springing up all over China - bigger hospitals in the cities of Beijing and Shanghai have ads in toilet cubicles and on ward walls.
"We have to wipe off the notices again and again. They 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, told media.
"Such donations are surely organ trading, but 'organ donation' for money is strictly banned in China," said Ding.
The Chinese government issues regular bans on organ sales, but China is a huge country and, as the proverb goes: the mountains are high and the emperor is far away.
The bans may have an impact on the illegal organ trade in the big public hospitals but the private clinics and small hospitals are extremely difficult to regulate.
In Japan, a single broker has helped more than 100 Japanese people go to China for transplants since 2004 and the trade is growing. Official figures almost surely underestimate the number of people availing of the service, many of whom fly beneath the government radar.
Mr 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 centre in Shanghai. "Other people should know about this."
Sources say the cost of a kidney transplant runs to €55,000 and a liver up to €130,000. Mr Hokamura paid another €7,000 for transport costs.
There is little attempt to conceal the origins of the organs; many come from executed criminals. Although Beijing does not reveal how many people are executed annually, analysts reckon it is about 8,000. Executions in China are carried out by a bullet to the back of the head or lethal injection.
"My translator said my donor was a young executed prisoner," says Mr Hokamura, who claims this does not concern him. "The donor was able to provide a contribution to society, so what's wrong with that?"
After it was revealed that Japanese and Malaysians had died from botched Chinese organ transplants, the Beijing government insisted it had moved to regulate them.
"In respect to organ transplants, China has rigorous laws and regulations," said foreign ministry spokesman Qin Gang. "Donors, recipients and hospitals must all firmly follow laws and regulations in this area."
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 short plane hop to China.
As Mr Hokamura says: "I was on dialysis for four years. I was tired of waiting."