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The biggest health care provider in South Africa has been involved in illegal kidney transplant operations.
After seven years of obfuscation and denial, South Africa's largest private healthcare group, Netcare, finally confessed to its role in a cash-for-kidneys scheme and to benefiting from associated international trafficking of living donors.

Immediately after Netcare admitted to having illegally profited from the scheme, Richard Friedland, Netcare's chief executive, publicly apportioned blame to St Augustine's hospital management and transplant coordinators acting in cahoots with surgeons and others -- basically every­one involved in the scheme, except Netcare itself.

See here for graphic describing the scheme.

Netcare's conviction in the Durban commercial crimes court is said to be a world first -- no other hospital group has been found guilty of supporting an organised trafficking scheme dealing in organs.

The scheme, dubbed the Israeli Transplant Programme, recruited living kidney "donors". They were flown to South Africa for harvesting and transplant operations at Netcare's facilities in Johannesburg, Cape Town and Durban.

The recipients were Israelis who paid on average $120 000 to an international organ broker, Ilan Perry, and his agents to organise the transplants.

Ininitally donors were paid up to $20 000 for a kidney, but this dropped when it was discovered that some poor Brazilians and Romanians were willing to accept as little as $5 000 and $6 000.

"Organ transplant capital of the world"

At the height of the programme, between 2001 and 2003, Netcare dubbed itself the "organ transplant capital of the world", performing kidney operations, involving unrelated, living donors, almost weekly.

While more than 300 such operations took place at Netcare's transplant clinics in the three cities, the criminal investigations targeted only 109 illegal operations that took place at Durban's St Augustine's hospital.

Friedland previously said that the JSE-listed hospital group never knew that it was party to an illegal scheme, but the group pleaded guilty to receiving money from Perry to arrange illegal kidney harvesting and transplant operations.

Netcare was fined R4-million for its role in 92 illegal operations at St Augustine's involving non-related donors and recipients. Five of these operations involved minors, which is also illegal, even with parental consent. Netcare also forfeited R3,8-million to the Assets Forfeiture Unit.

That, said prosecutor Robin Palmer, was more than the estimated profit that Netcare had made out of the scheme.

In terms of the plea agreement finalised in court, criminal charges were withdrawn against Friedland as Netcare's chief executive.

The charges

Netcare's guilty plea has implicated all remaining eight accused -- two former transplant coordinators, Lindsay Dixon and Melanie Azor, a Hebrew interpreter, Samuel Ziegler, and five doctors -- professor John Robbs and Dr Neil Christopher, who allegedly performed the kidney-harvesting operations, and the transplant specialists, professor Ariff Haffajee, Dr Jeff Kallmeyer and Dr Mahadev Naidoo.

They face charges of fraud, forgery, uttering, assault and contraventions of the Human Tissues Act, which prohibits kidney transplants involving unrelated, living donors.

Palmer said two key state witnesses -- Netcare's former national transplant coordinator, Belinda Rossi, and Perry, the international organ broker and syndicate boss -- had made statements that firmly implicated Netcare as a group, Friedland as the chief executive, and the other eight accused.

But whether Rossi, Perry and others will ever testify is now a moot point. The prosecution looks set to engage in further plea discussions before the next court sitting on November 23.

"We have achieved what we set out to do," said Palmer, referring to the conviction of Netcare for profiteering through its deals with Perry.

He hinted that a compromise would now be sought in dealing with the accused doctors, who could be barred from medical practice if they are convicted as charged. "We do not want to denude this province of all its top kidney experts. How will that help anyone?" asked Palmer.

Programme and negotiations

From the outset of the case the accused doctors and their lawyers argued that they had nothing to do with setting up the programme or any negotiations with Perry -- they had simply been called in to perform harvesting and transplant operations at Netcare's request.

Attorney Altus van Rensburg also said that the doctors were shown documentation that the patients were family members. "It was not for them to question or dispute this," Van Rensburg said.

The false documentation led to charges of forgery and uttering against Netcare, although these have now been withdrawn as a result of the plea agreement.

In a statement on the Netcare website states that Friedland has acceded to a request from Netcare's board of trustees not to seek legal redress against those allegedly responsible for having wrongfully instituted criminal proceedings against him.

Roving Reporters