Joypurhat/Dhaka, Bangladesh, and New Delhi/Kolkata, India – Below the gentle afternoon solar, 45-year-old Safiruddin sits exterior his incomplete brick-walled home in Baiguni village of Kalai Upazila in Bangladesh, nursing a boring ache in his aspect.
In the summertime of 2024, he bought his kidney in India for 3.5 lakh taka ($2,900), hoping to carry his household out of poverty and construct a home for his three kids – two daughters, aged 5 and 7, and an older 10-year-old son. That cash is lengthy gone, the home stays unfinished, and the ache in his physique is a continuing reminder of the value he paid.
He now toils as a every day labourer in a chilly storage facility, as his well being deteriorates – the fixed ache and fatigue make it arduous for him to hold out even routine duties.
“I gave my kidney so my household might have a greater life. I did the whole lot for my spouse and youngsters,” he mentioned.
On the time, it didn’t seem to be a harmful alternative. The brokers who approached him made it sound easy – a chance relatively than a threat. He was sceptical initially, however desperation finally received over his doubts.
The brokers took him to India on a medical visa, with all preparations – flights, paperwork, and hospital formalities – dealt with completely by them. As soon as in India, though he travelled on his authentic Bangladeshi passport, different paperwork, comparable to certificates falsely exhibiting a familial relationship with the meant recipient of his kidney, have been cast.
His identification was altered, and his kidney was transplanted into an unknown recipient whom he had by no means met. “I don’t know who received my kidney. They [the brokers] didn’t inform me something,” Safiruddin mentioned.
By regulation, organ donations in India are solely permitted between shut relations or with particular authorities approval, however traffickers manipulate the whole lot – household bushes, hospital information, even DNA exams – to bypass rules.
“Usually, the vendor’s title is modified, and a notary certificates – stamped by a lawyer – is produced to falsely set up a familial relationship with the recipient. Solid nationwide IDs help the declare, making it seem as if the donor is a relative, comparable to a sister, daughter, or one other member of the family, donating an organ out of compassion,” mentioned Monir Moniruzzaman, a Michigan State College professor and a member of the World Well being Group’s Job Pressure on Organ Transplantation, who’s researching organ trafficking in South Asia.
Safiruddin’s story isn’t distinctive. Kidney donations are so frequent in his village of Baiguni, that locals know the group of lower than 6,000 individuals because the “village of 1 kidney”. The Kalai Upazila area that Baiguni belongs to is the hotspot for the kidney commerce business: A 2023 research printed within the British Medical Journal World Well being publication estimated one in 35 adults within the area has bought a kidney.
Kalai Upazila is considered one of Bangladesh’s poorest areas. Most donors are males of their early 30s lured by the promise of fast cash. In line with the research, 83 % of these surveyed cited poverty as the primary purpose for promoting a kidney, whereas others pointed to mortgage repayments, drug habit or playing.
Safiruddin mentioned that the brokers – who had taken his passport – by no means returned it. He didn’t even get the medicines he had been prescribed after the surgical procedure. “They [the brokers] took the whole lot.”
Brokers usually confiscate passports and medical prescriptions after the surgical procedure, erasing any path of the transplant and leaving donors with out proof of the process or entry to follow-up care.
The kidneys are bought to rich recipients in Bangladesh or India, a lot of whom search to bypass lengthy wait instances and the strict rules of authorized transplants. In India, for instance, solely about 13,600 kidney transplants have been carried out in 2023 – in contrast with an estimated 200,000 sufferers who develop end-stage kidney illness yearly.
Al Jazeera spoke with greater than a dozen kidney donors in Bangladesh, all of whom shared related tales of being pushed to promote their kidneys because of monetary hardship. The commerce is pushed by a easy but brutal equation: Poverty creates the availability, whereas lengthy wait instances, an enormous scarcity of authorized donors, the willingness of rich sufferers to pay for fast transplants and a weak enforcement system make sure that the demand by no means ceases.
The price of desperation
Josna Begum, 45, a widow from Binai village in Kalai Upazila, was struggling to lift her two daughters, 18 and 20 years previous, after her husband died in 2012. She moved to Dhaka to work in a garment manufacturing facility, the place she met and married one other man named Belal.
After their marriage, each Belal and Josna have been lured by a dealer into promoting their kidneys in India in 2019.
“It was a mistake,” Josna mentioned. She defined that the brokers first promised her 5 lakh taka (about $4,100), then raised the provide to seven lakh (round $5,700) to persuade her. “However after the operation, all I received was three lakh [$2,500].”
Josna mentioned she and Belal have been taken to Rabindranath Tagore Worldwide Institute of Cardiac Sciences in Kolkata, the capital of India’s West Bengal state, the place they underwent surgical procedure. “We have been taken by a bus by way of the Benapole border into India, the place we have been housed in a rented house close to the hospital.”
To safe the transplant, the brokers fabricated paperwork claiming that she and the recipient have been blood relations. Like Safiruddin, she doesn’t know who acquired her kidney.
Regardless of repeated makes an attempt, officers at Rabindranath Tagore Worldwide Institute of Cardiac Sciences haven’t responded to Al Jazeera’s request to touch upon the case. Kolkata police have beforehand accused different brokers of facilitating unlawful kidney transplants on the identical hospital in 2017.
Josna mentioned her passport and identification paperwork have been dealt with completely by the brokers. “I used to be OK with them taking away the prescriptions. However I requested for my passport. They by no means gave it again,” she mentioned.
She stayed in India for practically two months earlier than returning to Bangladesh – escorted by the brokers who had her passport, and nonetheless held out the promise of paying her what they’d dedicated to.
The brokers had additionally promised help for her household and even jobs for her kids, however after the preliminary cost and some token funds on Eid, they reduce off contact.
Quickly after he was paid – additionally three lakh taka ($2,500) – for his transplant, Belal deserted Josna, later marrying one other lady. “My life was ruined,” she mentioned.
Josna now suffers from persistent ache and struggles to afford medicines. “I can’t do any heavy work,” she mentioned. “I’ve to outlive, however I would like drugs on a regular basis.”
‘In entrance of this gang’s gun’
In some instances, victims have grow to be perpetrators of the kidney rip-off, too.
Mohammad Sajal (title modified), was as soon as a businessman in Dhaka promoting home goods like stress cookers, plastic containers and blenders by way of Evaly, a flashy e-commerce platform that promised massive returns. However when Evaly collapsed following a 2021 rip-off, so did his financial savings – and his livelihood.
Drowning in debt and beneath immense stress to repay what he owed, he bought his kidney in 2022 at Venkateshwar Hospital in Delhi. However the promised 10 lakh taka ($8,200) by no means materialised. He acquired solely 3.5 lakh taka ($2,900).
“They [the brokers] cheated me,” Sajal mentioned. Venkateshwar Hospital has not responded to repeated requests from Al Jazeera for touch upon the case.
There was just one method he might earn what he had thought he would get for his kidney, Sajal concluded on the time: by becoming a member of the brokers to dupe others. For months, he labored as a dealer, arranging kidney transplants for a number of Bangladeshi donors in Indian hospitals. However after a monetary dispute along with his handlers, he left the commerce, fearing for his life.
“I’m now in entrance of this gang’s gun,” he mentioned. The community he left behind operates with impunity, he mentioned, stretching from Bangladeshi hospitals to the Indian medical system. “Everybody from the medical doctors to recipients to the brokers on each side of borders are concerned,” he mentioned.
Now, Sajal works as a ride-share driver in Dhaka, attempting to flee the previous. However the scars, each bodily and emotional, stay. “Nobody willingly provides a kidney out of pastime or need,” he mentioned. “It’s a easy calculation: desperation results in this.”
Acknowledging the cross-border kidney trafficking commerce, Bangladesh police say they’re cracking down on these concerned. Assistant Inspector Normal Enamul Haque Sagor of Bangladesh Police mentioned that, along with uniformed officers, undercover investigators have been deployed to trace organ trafficking networks and collect intelligence.
“This concern is beneath our watch, and we’re taking motion as required,” he mentioned.
Sagor mentioned that police have arrested a number of people linked to organ trafficking syndicates, together with brokers. “Many individuals get drawn into kidney gross sales by way of these networks, and we’re working to catch them,” he added.
Throughout the border, Indian regulation enforcement businesses, too, have cracked down on some medical professionals accused of involvement in kidney trafficking. In July 2024, the Delhi Police arrested Dr Vijaya Rajakumari, a 50-year-old kidney transplant surgeon related to a Delhi hospital. Investigations revealed that between 2021 and 2023, Dr Rajakumari carried out roughly 15 transplant surgical procedures on Bangladeshi sufferers at a personal hospital, Indian officers mentioned.
However consultants say that these arrests are too sporadic to noticeably dent the enterprise mannequin that underpins the kidney commerce.
And consultants say Indian authorities face competing pressures – upholding the regulation, but in addition selling medical tourism, a sector that was price $7.6bn in 2024. “As an alternative of imposing moral requirements, the main target is on the financial benefits of the business, permitting unlawful transplants to proceed,” mentioned Moniruzzaman.
‘Extra transplants imply extra income’
In India, the Transplantation of Human Organs Act (THOA) of 1994 regulates organ donations, allowing kidney transplants primarily between shut relations comparable to dad and mom, siblings, kids and spouses to stop industrial exploitation. When the donor will not be a close to relative, the case should obtain approval from a government-appointed physique referred to as an authorisation committee to make sure the donation is altruistic and never financially motivated.
Nonetheless, brokers concerned in kidney trafficking circumvent these rules by forging paperwork to determine fictitious familial relationships between donors and recipients. These fraudulent paperwork are then submitted to authorisation committees, which – far too usually, say consultants – approve the transplants.
Specialists say the inspiration of this illicit system lies within the ease with which brokers manipulate authorized loopholes. “They fabricate nationwide IDs and notary certificates to create fictitious household ties between donors and recipients. These papers may be made rapidly and cheaply,” mentioned Moniruzzaman.
With these falsified identities, transplants are carried out beneath the pretence of authorized donations between relations.
In Dhaka, Shah Muhammad Tanvir Monsur, director basic (consular) at Bangladesh’s Ministry of Overseas Affairs, mentioned that the nation’s authorities officers had no position within the doc fraud, and that they “duly adopted” all authorized procedures. He additionally denied any alternate of data between India and Bangladesh on cracking down on cross-border kidney trafficking.
Over in India, Amit Goel, deputy commissioner of police in Delhi, who has investigated a number of instances of kidney trafficking within the metropolis, together with that of Rajakumari, the physician, mentioned that hospital authorities usually battle to detect cast paperwork, permitting unlawful transplants to proceed.
“Within the instances I investigated, I discovered that the authorisation board accepted these instances as a result of they couldn’t determine the faux paperwork,” he mentioned.
However Moniruzzaman identified that Indian hospitals even have a monetary incentive to miss discrepancies in paperwork.
“Hospitals flip a blind eye as a result of organ donation [in general] is authorized,” Moniruzzaman mentioned. “Extra transplants imply extra income. Even when instances of fraud floor, hospitals deny accountability, insisting that documentation seems legit. This sample permits the commerce to proceed unchecked,” he added.
Mizanur Rahman, a dealer who operates throughout a number of districts in Bangladesh, mentioned that traffickers usually goal particular person medical doctors or members of hospital evaluation committees, providing bribes to facilitate these transplants. “Normally, brokers in Bangladesh are in contact with their counterparts in India who arrange these medical doctors for them,” Rahman informed Al Jazeera. “These medical doctors usually take a serious chunk of the cash concerned.”
Dr Anil Kumar, director of the Nationwide Organ and Tissue Transplant Organisation (NOTTO) – India’s central physique overseeing organ donation and transplant coordination – declined to touch upon allegations of systemic discrepancies which have enabled rising instances of organ trafficking.
Nonetheless, a former prime official from NOTTO identified that hospitals usually are up in opposition to not simply brokers and seemingly keen donors with what seem like legit paperwork, but in addition wealthier recipients. “If the hospital board will not be satisfied, recipients usually take the matter to greater authorities or problem the choice in court docket. In order that they [hospitals] additionally wish to keep away from authorized hassles and proceed with transplants,” this official mentioned, talking on situation of anonymity.
In the meantime, organ trafficking networks proceed to adapt their methods. When police or official scrutiny will increase in a single location, the commerce merely strikes elsewhere. “There isn’t any single fastened hospital; the places preserve altering,” Moniruzzaman mentioned. “When police conduct a raid, the hospital stops performing transplants.
“Brokers and their community – Bangladeshi and Indian brokers working collectively – coordinate to pick out new hospitals at totally different instances.”
Porous borders and the fallout
For brokers and hospitals which can be concerned, there may be massive cash at stake. Recipients usually pay between $22,000 and $26,000 for a kidney.
However donors get solely a tiny fraction of this cash. “The donors get three to 5 lakh taka [$2,500 to $4,000] often,” mentioned Mizanur Rahman, the dealer. “The remainder of the cash is shared with brokers, officers who forge paperwork, and medical doctors if they’re concerned. Some cash can be spent on donors whereas they stay in India.”
In some instances, the deception runs even deeper: traffickers lure Bangladeshi nationals with guarantees of well-paying jobs in India, solely to coerce them into kidney donations.
Victims, usually determined for work, are taken to hospitals beneath false pretences, the place they bear surgical procedure with out totally understanding the results. In September final yr, as an illustration, a community of traffickers in India held many Bangladeshi job seekers captive, both pressured or deceived them into organ transplants, and deserted them with minimal compensation. Final yr, police in Bangladesh arrested three traffickers in Dhaka who smuggled not less than 10 individuals to New Delhi beneath the guise of employment, solely to have them pressured into kidney transplants.
“Some individuals knowingly promote their kidneys because of excessive poverty, however a big quantity are deceived,” mentioned Shariful Hasan, affiliate director of the Migration Programme at BRAC, previously the Bangladesh Rural Development Committee, one of many world’s largest nongovernmental growth organisations. “A wealthy affected person in India wants a kidney, a intermediary both finds a poor Bangladeshi donor or lures somebody within the title of employment, and the cycle continues.”
Vasundhara Raghavan, CEO of the Kidney Warriors Basis, a help group in India for sufferers with kidney ailments, mentioned {that a} scarcity of authorized donors was a “main problem” that drove the demand for trafficked organs.
“Determined sufferers flip to illicit means, fuelling a system that preys on the poor.”
She acknowledged that India’s authorized framework was aimed toward stopping organ transplants from turning into an exploitative business. However in actuality, she mentioned, the regulation had solely pushed organ commerce underground.
“If organ commerce can’t be completely eradicated, a extra systematic and controlled method must be thought of. This might contain making certain that donors bear necessary well being screenings, obtain postoperative medical help for a hard and fast interval, and are supplied with monetary safety for his or her future wellbeing,” Raghavan mentioned.
Again in Kalai Upazila, Safiruddin these days spends most of his time at residence, his actions slower, his power visibly diminished. “I’m not in a position to work correctly,” he mentioned.
He says there are nights when he lies awake, pondering of the guarantees the brokers made, and the goals they shattered. He doesn’t know when, and if, he’ll have the ability to full the development of his home. He thought the surgical procedure would carry his household a pot of money to construct a future. As an alternative, his kids have been left with an ailing father – and he with a way of betrayal that Safiruddin can’t shake off. “They took my kidney and vanished,” he mentioned.
Reporting for this story was supported by a grant from Journalists for Transparency.