MANAGUA // Luis Picado's mother remembers the day her son thought he had won the lottery. He came home to their tin-roofed cinder-block house in a slum in Managua, capital of the central American country of Nicaragua, and said he had 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 who worked as a construction labourer, a job and an apartment in New York if he'd donate one of his kidneys. He jumped at the deal, his mother said.
Three weeks later, in May 2009, Mr 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 in the recovery room and prayed.
"I told my boy not to worry, that I would take care of him," Mrs Tercero, 49, said. "But it was too late." Mr Picado bled to death as doctors tried to save him, according to a coroner's report. "He was always chasing the American dream, and finally, it cost him his life," she said.
Matthew Ryan, the American man, suffered a similar fate. Mr Ryan, a 68-year-old retired bus company supervisor in New York, died two months after receiving Mr 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 US, 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, Mr Delmonico said.
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 are performed - for fees - by accredited surgeons, some of whom have trained at the world's leading medical schools.
The global demand for organs far exceeds the available supply. In the US, 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, Mr Delmonico said.
"With all the anxiety in getting a transplant, they exploit the patient," said Mr Delmonico, who is president-elect of the Montreal-based Transplantation Society, which lobbies governments to crack down on trafficking. "It's big money."
The illegal organ trade is the ugly side of the otherwise legal medical tourism industry, in which people travel to other countries for cut-rate hip replacements, tummy tucks and gastric bypasses. The legitimate medical procedures generated about $100 billion (Dh367.2bn) in revenue in 2010, according to a report by Deloitte Touche Tohmatsu.
For decades, wealthy Brazilians, Mexicans and Saudis have gone to US and European hospitals for medical care they could not get at home. In the past decade, that pattern has changed. Hospitals from Puerto Vallarta, Mexico, to Medellin, Colombia, now lure middle-class Americans with promises of high-quality care at a fraction of what it would cost them at home.
The medical tourism company MedToGo, based in Tempe, Arizona, says it will offer kidney transplants in Mexico and Costa Rica for about $50,000, a fifth of the cost in the US.
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, criminal investigators say.
Nancy Scheper-Hughes, an anthopologist at University of California, Berkeley, who specialises in studying organ trafficking, said: "The poor have become a spare-parts bank for the well-to-do."
Because people with kidney failure are always in poor health, a transplant is never a guaranteed cure. Still, legal transplants have a high probability of success. More than 75 per cent of the recipients of kidney transplants in the US live for more than 10 years, according to the National Institutes of Health. Donors usually do fine; they can live a normal lifespan with just one of their two kidneys.
The illicit organ trade, however, is dangerous for the donor and patient because criminals take shortcuts, such as accepting organs from people who are sick and would not be approved by hospitals in the US, said Gabriel Danovitch, the medical director of the kidney and pancreas transplant programme at the University of California, Los Angeles.
"It's a filthy business in the same subcategory as the sex trade and child pornography," Mr Danovitch said. "That is why it has to be stopped."