As the limelight shone brightly on the fallout from Bulgaria’s then Foreign Minister Roumyana Zheleva’s grilling during her European Commission confirmation hearings, the allegations about a possible conflict of interest involving another minister in Prime Minister Boiko Borissov’s Cabinet quickly disappeared in the cloud of dust raised by Zheleva’s fall.

Health Minister Bozhidar Nanev has maintained a low profile since taking office, despite the simmering debate on the direction of health care reform in Bulgaria. Were it not for his fellow minister’s ordeal, his name would likely have been the subject of more headlines in January.

The subject of the controversy is Nanev’s visit to the United States in November 2009, a trip on which he was accompanied by the chairperson of Parliament’s health care committee Luchezar Ivanov and the head of the Transplants Agency Teodora Djaleva.

The trip was paid for by two non-government organisations, the Americans of Bulgarian Descent Federation and the Euro Atlantic Fund. Both NGOs are chaired by Roumen Hichev, who was identified in the English-language official correspondence preceding the visit as Roman Hitchev.

Hichev is the vice president for international activities at Osteotech Inc, a US firm that describes itself as a "global leader in the processing of human bone and connective tissue for transplantation", and the managing director of Osteotech’s Bulgarian subsidiary, Osteocentre tissue bank.

The goal of the visit was meetings "with leaders and experts from the US medical community", according to paperwork made public by Osteocentre. The meetings schedule, published by Osteocentre, featured US health department assistant secretary for planning Donald Moulds and John Monahan, director of the health department office of global health affairs, as the highest-ranking government officials. A roundtable with representatives of medical equipment makers was also scheduled.

History of controversy
Osteocentre is no stranger to controversy in Bulgaria. As one of the biggest tissue banks in Bulgaria, it was among the main beneficiaries of the Transplants Act, approved by Parliament in 2002.

The act, controversially, allows harvesting of human tissue from dead people by silent consent. Unless the person explicitly denied permission by filing a form with his or her general practitioner – people who have no medical insurance or general practitioner in Bulgaria can file the form at their municipality – their tissue can be harvested. Immediate family can prevent the harvesting if, in "reasonable time", they do so in writing.

The tissue, usually ligament or bone, is later treated and used as allograft transplants. Osteocentre’s first tissue harvesting contract in Bulgaria was with the Transplants Agency in 2002, then called the National Centre for Transplantation, which, critics said, created a conflict of interest for the agency because it is also the government body overseeing all transplant-related activities.

Osteocentre now has a contract with the Euro Atlantic Transplant Alliance, a Bulgarian non-profit foundation, according to a statement Osteotech filed in April 2008, when the contract was renewed for four years.

Critics claim that the foundation is only a front for Osteocentre, an allegation that Hichev rejected in 2008. The foundation had renowned doctors and hospital heads on its board, Hichev said at the time, as quoted by Dnevnik daily. He did not give names, nor does the foundation have a website.

Nanev’s visit is now being investigated for a possible conflict of interest by the State Agency for National Security (SANS). Nanev, who denies all allegations, said that he would resign if SANS found any wrongdoing by him.

He said that the reason that he had accepted the invitation was that he had been told in advance that there were no legal issues with the trip. He said that the trip would yield benefits. If Bulgarian authorities had paid the bills, he would have been criticised for spending taxpayers’ money, he said.