The shock. That is perhaps the best place to start. The realization that time had run out. For her kidney and for life as she had known it. The letter arrived on May 23, 2022, and it marked the end of the almost 30 years she had lived with her first donor kidney. The envelope contained the results of a blood test. Her creatinine value was 3.6, far above the norm of around 1. She knew then that the organ wouldn’t last much longer.

Sabine Fischer-Kugler hung on for another year, as she recalls – drinking less and consuming less protein and potassium. Then, her doctor called with new test results. Her creatinine level was now over 6. The doctor told her to get ready and the taxi arrived half an hour later to take her to the place she had never wanted to return: the dialysis station. Three times a week, five hours each time. For several years, most likely – as long as it would take to slowly climb the long waiting list in Germany of thousands of people waiting for a new kidney, growing weaker all the while.

Perhaps that is the right way to start to understand just how far a person is willing to go to get a new kidney. All the way to Kenya. All the way to the outer limits of morality – and beyond. And how far a new kidney must travel such that Sabine Fischer-Kugler, 57 years old, can continue living as before. In her case, it was a kidney from the Caucasus in the body of a young man who flew to Kenya to have it removed so that he could then fly home presumably with a couple of thousand euros in his pocket.

"Why not look abroad? The main thing is I once again have a kidney and don’t have to go back on dialysis,” says Fischer-Kugler, back in her living room in northern Bavaria six weeks later. Her surgery took place on February 4, and everything has been great since then. Her creatinine value is back to 0.67. "It’s a young kidney, as you can immediately see in the ultrasound. It’s totally healthy.” And how is the donor doing, down to just one kidney, six weeks later? She doesn’t know. She doesn’t even know the donor’s name, nor does she want to.

That, too, is part of the story when a kidney becomes just another commodity, when supply and demand is dictated by desperation on both sides, when unscrupulous middlemen and doctors extract money from the global system of kidney capitalism. It is a business that is just as incompatible with too much knowledge as it is with too much conscience. One that operates because of the need, and because of the benefits and the profits it produces.

DER SPIEGEL, German public broadcaster ZDF and Deutsche Well teamed up over the course of several months to follow the organ trail. From Germany and Poland via Israel to the clinic in Eldoret, Kenya, that is currently in the center of an international and seemingly criminal kidney trade. The transactions and transplants link patients in Germany with donors in Caucasus nations like Azerbaijan. And it links prosperous Somalians with young Kenyans who are talked into earning a quick 2,000 to 5,000 euros for one of their kidneys, while patients in the West pay up to 200,000 euros to the organ traders – preferably in cash.

Kidneys from the Online Shop

It all sounds like a shadowy industry, well out of the public eye and so secret that one might think even the operating room lights have to be dimmed. But that is not the case. Kidneys from Kenya are offered openly on the internet – in German on a website registered in Germany. Beneath a photo of a man with graying hair in a white lab coat, a stethoscope around his neck, the company promises something that is – legally – virtually impossible anywhere in the world: a "kidney transplant within just four to six weeks.”

Site visitors are directed to "click on the following links” to learn what the service costs. Once they do so, they end up in a WhatsApp chat that ultimately leads to a man without a last name – because on the path to the shady world of the organ merchants, a first name has to be sufficient.

The location of the company’s headquarters – which claims to "focus on empathy and efficiency” – also remains concealed. The address provided in the imprint leads to a construction site in Warsaw. The high rise that once stood there was demolished in 2023. The "consulting and service agreement” that Fischer-Kugler signed with Medlead, meanwhile, indicates that the company is located at an address in Warsaw not far from the airport. But nobody there has ever heard of the company, neither in the ground-floor pizzeria nor on the two floors above it.

On YouTube and Facebook, though, the organ merchants are much easier to find. Under hashtags like #Nierentransplantation (kidney transplant) and #Erfolgsgeschichten (success stories), German patients gush about the medical wonderland of Kenya. Frank the real-estate salesman, Isabelle the business consultant and Ingo the heating engineer all look directly into the camera as they enthusiastically describe their path out of the "dialysis prison.” Some of them even provide a bit of dubious advice: "I can only urge anyone suffering from kidney failure in Germany: Don’t sit around waiting for some law you think will mean you’ll get a replacement organ more quickly.”

Not a single recipient speaks about the money they had to pay and what may have become of that cash. And only one of them sounds like he believes the story that Medlead would like people to believe: that the kidneys come from donors who provide their organs solely out of the goodness of their hearts for the desperate people who receive them. The narrative holds that there are selfless organ donors from poor countries who are lining up to have Medlead slice their kidneys out of their bodies – even as transplant centers in wealthy countries like Germany are unable to find enough people who are prepared to donate their kidneys even after death.

Unknown Doctors and a Dubious Company

Fischer-Kugler also isn’t particularly eager to talk about money. Just a few months after her transplant, the AOK administrator is sitting in her kitchen, decorated in warm brown tones, with a paneled ceiling and a flower-patterned cloth on the table. The windowsill is weighed down by knick-knacks. "When light appears, the darkness recedes,” reads the motto printed on the flower vase.

It all looks like the setting for a rather unspectacular lifestyle. And she says that’s all she has ever wanted: a normal life. Just that her illness – diagnosed when she was just 16 years old – meant that such a life was impossible. An examination at the time determined that something wasn’t right with her kidneys. Her creatinine values were rising and, by the time she was 20, thrice weekly dialysis sessions were her only hope. Including the drive to Ansbach and back home, each trip took six-and-a-half hours.

Five years passed like that until she finally received a donor organ and, with the new kidney, got her life back. She became a mother, took over leadership of a brass ensemble at the local church, conducting at New Year and church consecrations, birthdays and weddings. It was a life that couldn’t be any further away from Kenya and the risks inherent in depending on unknown doctors and a dubious company for a new kidney. In the local paper, she even promoted the legal pathway to procuring a new kidney, encouraging people to get their organ donor cards and all that goes along with it.

But when the replacement kidney began showing signs of failure and she had to go back to dialysis, normality vanished for Fischer-Kugler. "It’s rather scary,” she says. Her partner was willing to donate a kidney, but the risk that it would be rejected was too great. And her son, who was 22 years old at the time? Too young, the doctors said. It was impossible to know if he could live a normal life with just one kidney.

So they looked on the internet and came across Medlead, filled out a contact form and sent it off. A short time later, Alexander got in touch. Just Alexander. No last name, no indication as to where he was. Alexander presented Medlead’s offerings, including the normal package with flight, hotel stay, hospital and transplant. Or perhaps she might be interested in the security package, only about 25 percent more expensive? That package includes a second kidney in case the first one doesn’t work.

Up to Five Years in Prison

A second one? Just to be sure? It was enough to make even the desperate think twice. But Alexander was good at his job. He gave Fischer-Kugler the telephone numbers of patients from Germany who had already completed their transplants in Kenya. She called them and listened to their stories of successful operations. Afterwards, she only had one question: How could she be sure that it wasn’t part of an organ trafficking ring. "I don’t want to have to go to jail when I get home.”

Paragraph 18 of the German Transplantation Act doesn’t just ban the trafficking of organs, it also prohibits patients from receiving an organ they have purchased. Location plays no role. Sentences range between one and five years behind bars, though in individual cases, recipients and donors may not be punished.

Alexander knew how to reassure Fischer-Kugler. She would only be paying Medlead and the clinic; she wouldn’t be sending any money to a donor. Plus, the contract that DER SPIEGEL and ZDF were able to see includes the sentence: "It is made clear that there is an absolute prohibition on paying the donor compensation for their organ.” Fischer-Kugler read that as: "I don’t have to worry about it.”

Later, she used Google Earth to search for the Polish address of Medlead that was listed in her contract, but she didn’t find anything that looked like an office building. She began to suspect, she says, that it wasn’t "completely clean.” If she had just dug a bit deeper and searched for the name of the man who is listed in the Medlead imprint as "chairman of the supervisory board,” her suspicions would likely have grown deeper.

A Man with a Past

On the internet, Medlead boss Robert Shpolansky presents himself in a manner that doesn’t exactly fit with the graying "doctor” pictured on the company’s webpage. A bodybuilder, a half-naked and oiled up Shpolansky shows off his muscles like the bouncer at a smalltown brothel.

There exists an indictment that makes clear that this man isn’t just problematic from an aesthetic point of view. The 40-page document produced by prosecutors in Tel Aviv in 2016 describes the business of an organ trafficking network that is alleged to have performed "a large number of illegal kidney transplants” for sums between $140,000 and $180,000 in Sri Lanka, the Philippines, Thailand and Turkey. The head of the network is identified in the indictment as Boris Wolfman, who was already suspected of being the godfather of a transplant mafia in Latin America, Ukraine and Kosovo. The indictment identified his most important accomplice as Robert Shpolansky.

The current head of Medlead is thought to have ensured that both donors and recipients provided false information to give the illegal transactions the appearance of legality. Prosecutors alleged that payments for the illegal transplants were processed through the account of a company owned by Shpolansky in Albania. Prosecutors in Tirana said that Shpolansky and Wolfman also used the company to launder money earned in the cocaine trade.

There are several indications that the two still work together. Internet addresses for both Wolfman and for Medlead, for example, were registered by a certain "mike.k,” who is reachable through "fly-medical.com,” the domain with which the German Medlead website is also linked. Furthermore, a telephone number used by Wolfman and his wife is linked to a Skype profile called "Med-Lead SP.ZO.O” – with Warsaw given as its location.

Shpolansky did not respond to questions about the allegations leveled by the investigators. He only said that he has nothing to do with Wolfman and his companies. Wolfman could not be reached despite several attempts to do so.

It is not known where Shpolansky is currently. He disappeared from Israel in 2013. Investigators located him in Thailand, and then in Turkey. What is clear, however, is that his company Medlead has been in operation for more than three years in the Kenyan town of Eldoret, population 500,000. It is a top destination for organ traffickers and has been the focus of criticism in the Kenyan media since 2020 as being a stronghold of the organ trade. The Mediheal clinic in the center of town is often named as a frequent destination of the kidney mafia.

Dream Destination for Organ Tourists

Once Medlead entered the market, the erstwhile purely African business – which had involved local intermediaries targeting poor Kenyan donors and rich Somalian recipients – received an international arm. And not just on the recipient side. Medlead customers began receiving kidneys from donors from former Soviet republics like Kazakhstan and Azerbaijan, who would be flown in for the purpose.

The Israeli team that investigated the present-day Medlead head and his suspected accomplice Wolfman learned that Shpolansky had found perfect conditions and new business partners in Kenya. "We informed the Kenyan delegation at conferences of the international Transplant Society,” says one investigator. "They were shocked and promised to take action. But nothing has happened.”

The Transplant Society did send a warning letter to Nairobi in summer 2023 describing suspicions that an "organized syndicate” was operating out of the Mediheal clinic, "which circumvents regulations in Kenya, as is the case with organ trafficking.” The local business had turned into an international problem – and one that the government could no longer ignore.

Nairobi assembled a team of experts which spent several days inspecting the clinic in December 2023. "We were received with open arms and allowed to examine files,” says a member of the team. "The management and doctors didn’t even try to hide anything. They were proud of what was going on there.”

But the inspectors quickly stumbled across inconsistencies. The fact, for example, that the donors for foreign patients were almost exclusively young men from former Soviet countries. Furthermore, one name continually cropped up as the "next of kin” for both donors and recipients in case something went awry: Yusuf Idi. In Eldoret, he is thought to be a Medlead employee, but he denies the association, saying he is just a simple cab driver.

"Suspicious Activities”

The report compiled by the inspectors was never published. But DER SPIEGEL, ZDF and Deutsche Welle have obtained a copy. It speaks of "suspicious activities that are indicative of organ trafficking” and of "highly risky transplants” for cancer patients and the elderly. The fact that operations on foreigners were paid for in cash, the report notes, also hints at questionable practices. Nevertheless, the inspectors concluded in the report, there was "insufficient evidence” and recommended that the Health Ministry in Nairobi initiate a police investigation and that a follow-up inspection of the hospital be undertaken.

More than a year has passed since then and nothing has happened – despite the fact that Kenya is among the signatories to the 2008 Declaration of Istanbul, which has been recognized by more than 135 medical societies and government agencies. Initiated by the International Society of Nephrology together with the Transplant Society, the goal of the declaration is to "provide ethical guidance and support for medical professionals and policymakers” to ensure that "everyone in need should benefit from transplant, regardless of where they live, without relying on unethical and exploitative practices.”

Thomas Müller, the former head of the Transplantation Center in Zürich, is chair of the Declaration of Istanbul Custodian Group (DICG), a body established to monitor the standards laid out in the Declaration of Istanbul. "Kenya is currently our greatest concern,” says Müller. "There are many respectable and committed colleagues in the country, but they can do little to combat the criminal structures in the industry.”

Müller says there are three factors at work that provide an ideal climate for the dubious trade. First, the country is home to well-equipped clinics with modern devices. Second, much of the population is so poor that the sale of a kidney appears attractive. Third, corruption is widespread in politics and in state agencies, making the organ trade a risk-free proposition.

Backing from Politicians

Swarup Ranjan Mishra, for example, the founder and chairman of the Mediheal Group of Hospitals, is a man with the best possible connections. His motto is: "It is better to be the head of a cat than to be a tail of a tiger.” An Indian-born gynecologist, Mishra moved to Kenya in the late 1990s, where he became a multi-millionaire in the medical business. He became a member of parliament in 2017, and in November 2024, Kenyan President William Ruto appointed him head of the Kenya BioVax Institute, meaning he now rubs shoulders with leading figures from the World Health Organization (WHO) and foreign government representatives.

A public official who says he has gained insight into just how far the arm of the Kenyan organ industry seems to reach, is only willing to meet with DER SPIEGEL in secrecy. Well hidden behind a hedge in an outdoor restaurant in Eldoret, he has arrived in jeans and a button-down shirt, shunning his uniform. Even as he orders samosas, he glances around, scanning the people at the surrounding tables. He has to be extremely careful or his life could be in danger, he says, almost whispering.

The man is a police officer. He has investigated the organ trade on several occasions – and has always felt as though hurdles were being put in his path, despite having produced results, including victims, witnesses and clues as to the perpetrators in various clinics in Eldoret. He says it was made clear to him that he shouldn’t look too closely. "These people have friends in the system, powerful friends.” In the government? The man nods. Mishra is also extremely influential, he says.

The hospital chain executive declined to respond to an extensive list of questions pertaining to his business operations, connections and procedures in his clinics.

Among the cases gathering dust in the file cabinets of the police in Eldoret is that of Amon Kipruto Mely. The 22-year-old lives just a few kilometers from Mishra’s glass-fronted hospital – and in a completely different world. The streets are unpaved and the houses made of mud. Mely sold one of his kidneys late last year because he wanted to build a future. Now, he is struggling to come to terms with that decision – "the biggest mistake of my life,” as he describes it as he shows the scar left behind as a souvenir.

It all started when an acquaintance approached him, he says, saying that kidneys were in great demand in the city and asked him if he wanted to sell one of his. He would be paid the equivalent of 6,000 euros, the acquaintance told him, says Mely. "At first, I said no, but he kept asking, and in the end, I went along with it.” After all, 6,000 euros is quite a lot of money for a poor Kenyan. Average wages in the country are 500 euros per month.

In the Mediheal clinic, Mely says, a doctor told him that he was actually too young to donate a kidney, but he removed Mely’s kidney anyway. He claims he was paid just 4,000 euros instead of the promised 6,000. He used the money to buy a car to start up a taxi business. The car broke down and he had no money to fix it up again. Mely’s hopes for a better life were gone – as was his health.

"Before the operation, the doctors told me that all donors were doing great. Now, I am constantly in pain.” Once, he says, he even fainted, after which his mother brought him to the hospital, paying for the visit herself. The recruiter who had initially connected him with Mediheal, Mely says, told him he just had to drink more water and he would start feeling better.

Stories like Mely’s can be heard in many towns and cities in western Kenya. Oyugis, a city of 50,000 three hours by car from Eldoret is considered a donor hotspot. Willis Okumu grew up here and conducted research into organ trafficking on behalf of an investigative platform sponsored by Interpol. In Oyugis alone, he found, more than 100 people have sold a kidney. Many donors, Okumu learned, now work as recruiters and agents for Mediheal, paid on a commission basis. The result has been the emergence of exploitative networks providing opportunities to the poorest of the poor.

Okumu also believes that those behind the industry have excellent contacts within the government. "Everyone actually knows what is going on here. It’s not even being particularly well hidden. And yet it continues, as if those behind it were untouchable.”

"A Little Bit Fishy"

Medlead puts up its transplant tourists in Eka Hotel Eldoret, a four-star accommodation with a rooftop terrace, pool and fitness studio. A young man in the lobby says that his mother is set to receive a new kidney in the coming days. He assumes that the donors are paid for their organs. "It’s not totally clean, but I don’t care. It’s about my mother’s life.” In the breakfast room, a Russian couple uses a translation app to say what they consider to be patently obvious: "Nobody just hands over a kidney.”

Usually, it is family members of patients who talk about the kidney business. Many recipients spend their time ahead of the operation on the fourth floor, with access strictly regulated and requiring a special key card – in part, no doubt, to limit the risk of infection. The guests must leave the hotel only for dialysis. In the nearby dialysis center, they seem remarkably relaxed, likely fully aware that the eldorado of Eldoret makes things possible that are not permitted by law.

Of course it’s "a little bit fishy,” says a gray-haired Israeli who is hooking up a tube to a dialysis machine. "You’re not supposed to pay, but you pay.” You sign a document claiming "that it’s all kosher. It’s not. The story is that an old cousin is somehow in East Africa at the same time. You don’t have any other options?”

A long-time clinic employee says that false declarations of kinship are standard at Mediheal. Donors also have to declare that they are donating their kidneys free of charge and out of charity. Which could later create problems for them. "The legal situation in Kenya isn’t straightforward,” says Okumu. "In the end, it’s an open question whether those involved are victims or accomplices. After all, they have profited themselves.”