MANAGUA, Nicaragua — Luis Picado's mother remembers the day her son thought he had won the lottery. He came home to their house in a Managua slum and said he'd found a way to escape poverty and start a new life in the United States.
An American man had promised to give Picado, a 23-year-old high school dropout, a job and an apartment in New York if he'd donate a kidney.
Three weeks later, in May 2009, Picado came out of surgery at Managua's Military Hospital, bleeding internally from the artery doctors had severed to remove his kidney, according to medical records. His mother, Elizabeth Tercero, got on her knees next to her son's bed and prayed.
"I told my boy not to worry, that I would take care of him," Tercero, 49, says. "But it was too late." Picado bled to death as doctors tried to save him, according to a coroner's report.
Matthew Ryan, the American man, suffered a similar fate. Ryan, a 68-year-old retiree in New York, died two months after receiving Picado's kidney in the same hospital.
Nicaraguan postmortem reports cited the transplant as a cause of death for both men. Prosecutors in Managua are now investigating whether anyone broke a Nicaraguan law that prohibits paying a donor for an organ.
The two men were participants in a growing and illicit market for organ transplants that spans the globe. Every year, about 5,000 gravely ill people from countries including the United States, Israel and Saudi Arabia pay others to donate an organ, said Francis Delmonico, a Harvard Medical School professor and surgeon. The practice is illegal in every country except Iran, Delmonico says.
Affluent, often desperately ill patients travel to countries such as Egypt, Peru and the Philippines, where poor people sell them their organs. In Latin America, the transplants are usually arranged by unlicensed brokers. They're performed — for fees — by accredited surgeons, some of whom have trained at leading medical schools.
The global demand for organs far exceeds the available supply. In the U.S., 110,693 people are on waiting lists for organs, and fewer than 15,000 donors are found annually.
Americans who go abroad for illicit transplants can contract infections or HIV from unhealthy donors, posing a public health threat when they return, Delmonico says.
In the illegal organ trade, brokers scour the world's slums, preying on the poor with promises of easy money and little risk in exchange for a kidney. Inside hospitals, people are injured or killed by botched surgery as doctors place money above ethics, investigators say.
Legal transplants have a high probability of success. More than 75 percent of recipients of kidney transplants in the U.S. live for more than 10 years, according to the National Institutes of Health. Donors usually do fine; they can live a normal life span with just one kidney.