Poverty, indebtedness, and vulnerability have for many years pushed poor people in several developing countries into selling their kidneys. In many developing countries, a vast cross-border organ-selling market thrives illegally. This piece aims to discuss these illegal organ markets and how they led to the creation of ‘Kidney villages’ in many South Asian countries.
Nepal, a landlocked country sandwiched by two giant neighbors, China and India, has a sordid history of illegal kidney sales. In Central Nepal, there is a district named Kavre which is infamously called ‘kidney valley’. Numerous men from nearby cash-trapped villages have either voluntarily travelled to India to sell their kidneys over the past 20 years or have been trafficked and lured into doing so. In late 2009, it was estimated that nearly 300 people in Kavre (Kavrepalankchowk) district were the victims of the illegal extraction of kidneys. As per a recent report in PBS, Nepal’s Human Rights Commission stated that over 150 people in a village in the Kavre district have sold their kidneys. One of the major reasons behind the ‘organ brokers’ targeting the Kavre district is poor education and high illiteracy rates.
Reportedly, every other home in Jamdi village, another “kidney village” of the infamous “kidney valley,” has at least one resident who has in the past sold their kidney out of necessity for money, as per a report in PBS.
Approximately 50 kilometres east of Nepal’s capital city Kathmandu, the Hokse village, dubbed as ‘Kidney village’, is where almost all the adult villagers both, men and women have sold their kidneys to organ traffickers or the so-called ‘organ brokers’. Reportedly, these organ brokers dupe uneducated, poor, and desperate villagers by taking advantage of their vulnerability.
According to a study published in 2015, more than 300 Hokse villagers had already sold their kidneys for as little as $200 USD, the majority of whom had been duped by brokers who had promised them a better future and sizeable financial rewards. As a result, the community has earned the nickname “kidney village,” offering the cheapest kidneys in the world.
In some cases, these brokers even tell the villagers that their organs will grow back. There are several ways that organ trafficking works. In some cases, victims are kidnapped and forced to sell their organs. In other cases, they agree to do so out of financial compulsion. In many cases, they are duped into believing they need surgery, at which point the organ is removed without their knowledge.
It is notable that under the Human Body Organ Transplantation (Regulation and Prohibition) Act, 1998 selling human organs for transplantation is a crime in Nepal. Moreover, under the Human Trafficking and Transportation (Control) Act (HTTCA), 2007, extraction of human organs, except as otherwise determined by law, is an act of human trafficking and transportation.
Apart from poverty and human trafficking, the drastic earthquake that hit Nepal in April 2015 also forced people into kidney selling in a bid to rebuild their lives.
Ganesh Gurung, a sociologist and founder of the Nepal Institute for Development Studies in a 2016 report by The Lancet was quoted as saying, “After the earthquake, everyone said that it didn’t discriminate against the rich, the poor, different religions and ethnicities. That statement is wrong. Yes, the earthquake didn’t discriminate against religion or sex or ethnicity but the earthquake hit the poorest of the poor.”
According to information on the official website of the Forum for the Protection of People’s Rights in Nepal, during PPR’s investigation, government officials in the legal and para-legal sectors were unwilling to accept the prevalence of trafficking based on formally filed cases. Since the country’s current legal framework forbids the sale of organs and both buyers and sellers are supposed to be under investigation, scammed kidney donors are reluctant to seek legal remedies. These scammed victims had left their home village.
‘One-kidney village’ in Afghanistan
Ever since the Taliban took over Afghanistan by overthrowing the democratically elected government in 2021. The country has been faced with multiple challenges on various fronts. The country is experiencing a multifaceted crisis including a crumbled economy, ratcheting up poverty, high unemployment, and deteriorating human rights.
A United Nations Development Programme (UNDP) report from October 2022 states that “the price of a basket of essentials needed to avoid food poverty has increased by 35%, forcing poorer households to take on more debt or sell off assets in order to survive.”
The Office for the Coordination of Humanitarian Affairs (OCHA) released a report in November last year that showed that the poverty rate increased dramatically from 47% in 2020 to 70% in 2021 and then to 97% in 2022. As a result, 97% of Afghans currently live below the poverty line, making Afghanistan the country with one of the worst humanitarian crises in the world.
Destitute Afghans have been compelled to sell their organs to survive. In a settlement near the Herat city, the practice of kidney selling has become so rampant that it is now called a “one kidney village”. In Afghanistan, buying and selling of organs remain unregulated.
In Herat’s Sayshanba Bazaar village populated by hundreds of people displaced during the years of conflict, the poverty-stricken villagers have resorted to selling their one kidney to wealthy recipients through organ brokers. These rich buyers pay donors as well as bear the expenses of the surgery. In a February 2022 report France 24, reported that dozens of people in Herat have sold their kidneys in exchange for money.
Nooruddin, a 32-year-old father who is one of the 575,000 unemployed people in Herat, is also without a choice due to his unemployment.
“I didn’t want to, but there was no other option for me. As he displays the prolonged, diagonal scar from the operation on the left side of his abdomen, he said sharing his ordeal to AFP, “I did it for my children.”
India’s ‘Kidney-vakkam’
The south of Chennai was the centre of the organ trade in the 1980s and 1990s, and the story of the city’s kidney trade caught the attention of even the international media to Villivakkam, also known as “Kidneyvakkam” or the land of kidney trade. Even though selling organs in India was outlawed in 1994 through The Transplantation of Human Organs and Tissues Act, 1994. The illegal kidney trade continued owing to the loopholes in the law. The commercial transaction (of the kidney) was done under the veil of altruism.
Even though it made them poorer by a kidney, the poor and indebted villagers believed they had secured a small fortune for their family. The primary donors then enrolled more of their kind to sell kidneys and served as collection agents for city brokers and physicians in renal transplant centres during that time.
A kidney-selling hub gradually formed in locations like Villivakkam in Chennai, the Tamil Nadu towns of Pallipalayam and Kumarapalayam, and Magadi close to Bangalore. During the late 1980s, Pallipalayam and Kumarapalayam became ‘virtual kidney farms’.
The kidney trade in Tamil Nadu was centred for eight years, from 1987 to 1995, in the slum of Bharathi Nagar in Villivakkam, Chennai. The slum was known as Kidney Nagar or Kidney-vakkam at its peak when foreigners were flocking to South India in quest of kidneys.
Reportedly, selling kidneys was said to be a woman’s way of earning money in some areas. In many cases, people also sold their kidneys to arrange money for a dowry. Besides, women who had lost their husbands were also forced by their circumstances to sell their kidneys.
‘When you are most desperate…the brokers come in’
In his book The Red Market, Journalist Scott Carney describes about a refugee camp for 2004 Tsunami survivors he visited where women selling their kidneys was common practice turning the place into Kindeyvakkam or Kidneyville. Taking advantage of the desperate situations people were in, the organ brokers took the opportunity to make quick money by convincing them to get their kidneys extracted in exchange for money.
Tamil Nadu, however, has come a long way from being a hub of organ trade to an organ donation hub. In 2015, during a Mann Ki Baat program Prime Minister Narendra Modi also lauded the state’s transformation.
