The UK is supposed to have one of the best systems in the world for preventing vulnerable people being exploited for their organs. How then did one of its biggest hospitals become embroiled in the macabre trade of kidney harvesting?
The UK’s first trial organ trafficking trial has exposed alarming vulnerabilities to a illegal trade that makes up 10% of transplants worldwide. The case has highlighted how poverty can tempt some people to sell their body parts to those willing to exploit an acute global shortage of organs for donation.
The case heard that doctors at a private renal unit at London’s Royal Free hospital and the regulators, the Human Tissue Authority (HTA), were fooled by Dr Obinna Obeta, into approving his kidney transplant in July 2021.
Obeta paid a 27-year-old street trader from Lagos for his kidney – a practice that is almost universally outlawed. The operation was approved on the flimsy basis of a forged Nigerian court document falsely identifying the man as Obeta’s cousin and therefore an altruistic and legal donor. To help conceal the lie, Obeta also paid a medical secretary at the hospital, Evelyn Agbasonu, who acted as an Igbo translator between the donor and the clinicians.
The operation was a success, but it left Obeta £27,000 in debt. Unable to work in the UK on his medical visa, Obeta turned to a powerful and rich family headed by Ike Ekweremadu, a former president of the Nigerian senate and an ally of the former leader Goodluck Jonathan. Obeta knew that the senator’s daughter, Sonia Ekweremadu, suffered kidney failure.
For a fee, Obeta agreed to find Sonia a kidney donor. Through his own donor, he found another Lagos street trader as a suitable candidate.
At the time, the 21-year-old was making about £6 a day selling phone chargers and screen covers from a wheelbarrow. Incriminating WhatsApp message to Ike Ekweremadu revealed that Obeta’s bill included a “donor fee” of 3.5m naira (£6,280). It would take eight years to earn such money on Nigeria’s minimum wage, the court heard.
Ekweremadu agreed to pay and arrange the donor’s passport, visa and travel to London.
To get around the authorities, the Ekweremadus pretended the man was Sonia’s cousin and an altruistic donor. The address on his visa, which Ekweremadu sponsored, was listed as the politician’s home address. The man, who was controlled at all stages by Obeta and the Ekweremadus, was also made to pose for a staged photograph with Sonia at a west African restaurant on London’s Old Kent Road to help maintain the fictional family bond.
In February 2022 he was presented to the Royal Free’s private renal unit as Sonia’s cousin and a willing donor for the £80,000 private operation. Agbasonu again acted as an Igbo interpreter between the donor and the clinicians. She asked for £1,500 to “coach” the donor and offer “relevant interpretation”.
The transplant was declined by Dr Peter Dupont because the potential donor did not appear to understand the medical implications of the operation. The doctor also had his doubts that he was related to Sonia, but he and a colleague did not raise the alarm. Dupont told the court: “We’re clinicians; we’re not the FBI or the CIA. We have no means to investigate people.”
It was not until the man fled to the police in May 2022 that the plot was discovered.
As the prosecutor, Hugh Davies, said: “If there’s a lesson to be learned here – those clinicians need to set the index of suspicion for safeguarding somewhat lower.”
In what Davies said was a “sinister development”, the man only fled to the police over fears he was being lined up for another donation, after being measured up by Dr Chris Agbo, an NHS consultant kidney specialist who ran a health tourism business.
Dominique Martin, a professor of health ethics at Australia’s Deakin University who studies organ trafficking, said the case highlighted the need for robust vetting by hospitals and regulators.
She said: “There is a level of complacency, including in the UK, the US and Australia regarding the risks of organ trafficking happening within our borders. Screening programmes may not be as strong as we assume or as consistently implemented as we might expect.”
She added: “Organ trafficking is increasingly sophisticated, with prospective ‘donors’ and recipients often specifically trained in order to successfully pass psychosocial evaluation, rehearsing fake relationships and with carefully counterfeited documents. So even very good screening programmes might be duped.”
The interpreter highlights a common weakness in the vetting process, Martin added. She said: “Reliance of interpreters – whether corrupt or not – may not be able to facilitate effective evaluation.” Most reported cases of organ trafficking occur in the private sector, where there is a potential conflict of interest in decisions to approve transplants, Martin added.
She urged clinicians to report any suspicions about trafficking. “Reporting concerns may be an essential step to protect the prospective donor, someone at serious risk of harm.”
She also called on regulators to publish data on how many transplants were declined because of concerns about trafficking. “If you’re not detecting any potential cases, you’re probably missing some,” she said.
Justine Carter, a director at Unseen, which campaigns against modern slavery, agrees. She said: “This is one particular case that has come to the attention of the authorities; there could be so many others.”
Prof Peter Friend, a hospital consultant, professor of transplantation and a council member of the Royal College of Surgeons, said: “We need to ensure that the checks and balances in place in the UK are robust, so that living donor transplants do not go ahead where there has been any coercion or financial incentivisation. This case is a reminder of the essential requirement for diligence at the highest level to ensure that such cases do not get through the system. If this happens once, it is once too many.”
In a statement the Royal Free said: “National guidance for the clinical assessment of living donor transplantation, which applies to both our NHS and private patients, was followed in this case and a decision taken not to go ahead with the procedure.” It did not comment on Obeta’s transplant.
The Human Tissue Authority said its guidance required hospitals to inform it of any concerns that donors were being coerced or rewarded. Such cases would then be referred to the police.
A spokesperson said: “Our guidance to transplant teams and independent assessors is clear that translators must be independent. When the HTA was first made aware of this case we immediately took steps to look at all cases with potentially similar features that have been approved since 2017. We have increased the scrutiny we give to cases that involve overseas donors and cases taking place in the private sector.
“We continue to look at processes and systems to identify any areas that can be strengthened further.”
