Skint, depressed and with moneylenders banging on his door, Muhammad Iqbal decided four months ago to transform his fortunes by selling his last valuable possession — a kidney. The labourer went to the motorway that runs past his one-room house and took a bus to Rawalpindi, the home of Pakistan’s powerful military. He checked into a hospital, took a series of tests and, after two days, went under the scalpel.
Six hours later, he woke to find his kidney had been transplanted into the body of an ailing Arab man in a nearby ward and he was $1 340 richer.
”His name was Mehdi. We talked briefly through a doctor, and he took some pictures. Then he was gone,” said Iqbal, lifting his baggy shirt to reveal a long, red scar above his hip.
Most adults in the village of Sultan Pur More, northern Punjab, have donated a kidney. Poverty-stricken labourers such as Iqbal earn as little as $1 a day. Many people in the hamlet surrounded by orange groves and wheat fields are in bondage to feudal-style landlords.
It is one of dozens of villages that provide the human stock for Pakistan’s burgeoning cash-for-kidneys trade.
It all started with one local who worked in Rawalpindi, explained Sikander Hayad, who says 39 relatives have made the kidney pilgrimage. ”The man had the operation and came home to spread the word,” said the 33-year-old bicycle repair man. ”Then everybody went.”
The organ sales business, outlawed in all but a handful of countries, is legal and booming in Pakistan. The gold standard is the kidney. Frustrated by years-long waiting lists at home and fearful of an early death, ”transplant tourists” from Europe, the United States and the Middle East are flocking to private Pakistani hospitals for operations which can be arranged in days at a fraction of the cost back home.
Since India imposed a ban on the controversial trade 10 years ago, a thriving industry has sprung up around Rawalpindi and Lahore. Private hospitals advertise their services on the internet, and leading surgeons can make thousands of pounds for a few hours’ work. Newspapers carry small ads looking for new donors; even airport taxi drivers know the addresses of the busiest kidney hospitals. Middlemen scour the countryside, looking for fresh peasant labourers to entice with the promise of riches.
The trade has sparked passionate debate in Pakistan and abroad. Two years ago, a London-based property developer, Thor Andersen, admitted to buying a kidney from a 22-year-old Pakistani woman for £3 000.
Andersen said he could not bear to queue with the NHS for a cadaver donation that might never come. A spokesperson for UK Transplant, the government health authority specialising in organ donations, said more than 5 200 Britons were currently on the list, waiting an average of 506 days. However, it can be as long as nine years, and about 400 patients die every year. In these conditions, it is reasonable to buy a kidney, say some British academics. The rich get a kidney, the poor get money, and the medical procedure that satisfies both is relatively safe.
Opponents counter that the practice is exploitative, fails to alleviate poverty and leaves impoverished donors medically vulnerable and even exposed to death.
Professor Adibul Hasan Rizvi, a surgeon at the state-run Sindh institute of urology and transplantation, is Pakistan’s leading critic.
”We have no law governing transplants, so everyone just makes their own. That suits the rich, but the poor are coerced — by the feudal-type societies they live in, or their own poverty — into selling their kidney. It’s just wrong. Where will it stop? With eye, lung or heart transplants?”
Andersen had his transplant at Masood hospital in Lahore, a smart private facility which advertises its services on the internet and has Visa and MasterCard stickers on the front door. Business is brisk. Surgeons perform an average of 10 kidney transplants at $13 959 each every month, according to the management. Out front, builders are at work on a new nine-storey extension.
The kidney business is not a trade but a form of cooperation, said the hospital’s chief executive, Amir Masood Nasir. ”It is not buying or selling. One family is dying of hunger. The other family is on dialysis three or four times a week. If they decide to cooperate, they can help save each other.” Donors come from villages such as Mandia Wala, a settlement clustered around 25 brick kilns near the Indian border. The tall red chimneys bring to mind Victorian England, as do the working conditions. Labourers earn $3,35 for every 1 000 bricks they make, and many are heavily in debt to their employers. This makes them ideal kidney donors.
One kiln owner, Mian Maqsood, said he had asked the Masood hospital to stop recruiting his workers.
”We don’t want our labour involved in that business,” he said. ”The people who give their kidneys spend all the money at once. Then afterwards they cannot work properly.”
His observation is supported by a study published in the Journal of the American Medical Association in 2002. Researchers found that, of 305 Indians who had sold their kidneys an average of six years earlier, 96% had done so to pay off debts, but three-quarters remained in debt. Also, 86% said their health had declined since the operation.
Despite such qualms, relentless demand keeps the trade alive. One source in the medical industry said he was expecting a South African ”transplant tourist” later this month; another said three Bulgarians recently passed through.
Most of Pakistan’s clients come from the Middle East, many with the blessing of their own governments. Although paid-for transplants are illegal in Saudi Arabia, the Islamabad embassy actively assists citizens who seek one in Pakistan.
The embassy doctor, Eissa al-Harthi, said he visited patients in hospital and helped to iron out any difficulties, and sometimes his government footed part of the bill.
Pakistan’s government has spoken for years of legislating to regulate kidney transplants, but the idea remains little more than a vague proposal.
In the meantime, a handful of doctors are getting very wealthy. Dr Riaz Tasneem, a public-health kidney specialist in Lahore, estimates there are 30 cash-for-kidney transplants in the city every month, earning surgeons about $4 839 for each operation.
Retired army surgeons run two busy transplant centres in Rawalpindi. ”Another six people were being operated on at the same time as me,” said the donor, Muhammad Iqbal. He is ambivalent about his experience. The $1 340 was invaluable for getting the debt collectors off his back, he said. But he had no money left over. Now his children still have no shoes, his health has deteriorated and he has taken out a new £45 loan.
”The scar didn’t heal well, and I feel tired easily so I can’t do hard work now. But I was tired of all those people coming looking for money,” he said. ”What else was I going to do?” – Guardian Unlimited Â