In November 2008, a Turkish man named Yilmaz Altun crashed to the floor of the airport in Pristina, the capital of Kosovo. The 23-year-old had been waiting for a flight home when he collapsed. In checking on the ailing young man, authorities discovered a large fresh wound snaking down his abdomen. His left kidney was gone.

Altun told police he had donated the organ at a clinic called Medicus on the city’s outskirts. A broker in Istanbul had offered Altun a generous sum for the kidney. He would later recount lying in the same room as the man — a  74-year-old Israeli — who had paid about $145,000 for his organ, the Guardian reported in 2010. The two men, donor and recipient, locked eyes before the anesthetic kicked in.

The young man’s collapse was the first domino to go in a complex investigation into an international organ black market operating out of the Balkan country. Desperate donors, mostly from Turkey and the former Soviet Union, provided the organs. Buyers, many from Israel, paid between 80,000 and 100,000 euros ($96,000 and $120,000) for the kidneys. International prosecutors would later determine at least 23 people had their organs removed at Medicus in an eight-month run in 2008.

“The sole and driving motive for this exploitation of the poor and indigent was the opportunity for obscene profit and human greed,” Jonathan Ratel, the prosecutor with the European Union’s rule-of-law mission in Kosovo, told the Irish Times in 2013. “This was a cruel harvest of the poor.”

Despite the investigation, the main players behind the Medicus operation have continued to slip from justice — until last week. On Friday, authorities in Pristina announced Moshe Harel, an Israeli national, had been arrested in Cyprus, Reuters reported. Accused of being the fixer who found donors, Harel has been wanted by Interpol since 2010 on charges of human trafficking and intentional infliction of grave injuries. He is also wanted on a warrant for the same crimes in Russia.

Organ harvesting is a particularly sensitive topic in the region due to Kosovo’s war-scarred recent history. An international court was set up after a 2010 report from the Council of Europe accused guerrilla fighters of harvesting organs from Serbs in the 1998-1999 Kosovo War, Reuters has reported. The charges have yet to be substantiated, although the rumors remain part of the conflict’s haunting legacy.

Local authorities raided Medicus within hours of Altun’s 2008 airport fall. Inside the clinic, investigators discovered records detailing numerous kidney exchanges, with many clients traveling from across the world, including Canada, Germany and Poland, for the illegally harvested organs.

According to the Guardian, Medicus was allegedly run by Lutfi Dervishi, a prominent Kosovo urologist, and his son, Arban. The procedures at the clinic were allegedly performed by Yusuf Ercin Sonmez, a Turkish surgeon know as “Doctor Vulture” in his homeland after he was banned from practicing medicine in the country for his role in the illegal organ trade. Harel was “a key figure in the trafficking and organized crime aspect of this case, as the prominent facilitator or ‘fixer,'” judges later determined, the Irish Times reported.

“Medicus was one of a constellation of clinics operated by Sonmez, Harel and others,” lead prosecutor Ratel told the Times in 2013. “We found clinics in Azerbaijan and other places and we believe there may be one in South Africa.”

Harel was arrested in 2008 in connection with the Medicus investigation. He was later released and disappeared. Sonmez also could not be located. In 2010, both men were indicted by European Union prosecutors, according to Haaretz; Dervishi and his son were also indicted and both pleaded not guilty. In 2013, judges found both Dervishis guilty of organized crime and human trafficking. In their ruling, the judges noted the men behind Medicus purposely lured poor individuals into the operation.

“They were promised modest sums of money, usually in the range of $10,000 … in return for their kidney. Most were deceived into thinking that kidney transplantation was legal in Kosovo, when in fact it is not,” the judges said in their verdict, according to the Irish Times. “Several donors were not paid as much as they had been promised, and at least two were cheated out of the entire amount and went home with no money and only one kidney. Some have encountered ongoing health problems.”

Following the verdicts, Dervishi and his son Arban were sentenced to eight and seven years in prison, respectively. They ran. In 2016, Dervishi was rearrested. His son remains missing, as does the Turkish surgeon, Sonmez. In a twist last year, the Kosovo Supreme Court overturned the 2013 convictions due to “procedural irregularities.” Prosecutors are retrying Dervishi, and he could soon be joined by the alleged fixer, Harel.

Last Friday, Kosovo authorities confirmed to Reuters an official request for Harel’s extradition has been filed with Cyprus. Harel’s has not commented or entered a plea.

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