‘Village of one kidney’: India-Bangladesh organ traffickers rob poor donors

Joypurhat/Dhaka, Bangladesh, and New Delhi/Kolkata, India – Under the mild day sun, 45-year-old Safiruddin sits extracurricular his incomplete brick-walled location successful Baiguni colony of Kalai Upazila successful Bangladesh, nursing a dull ache successful his side.

In the summertime of 2024, helium sold his kidney successful India for 3.5 lakh taka ($2,900), hoping to assistance his household retired of poorness and physique a location for his 3 children – 2 daughters, aged 5 and seven, and an older 10-year-old son. That wealth is agelong gone, the location remains unfinished, and the symptom successful his assemblage is simply a changeless reminder of the terms helium paid.

He present toils arsenic a regular labourer successful a acold retention facility, arsenic his wellness deteriorates – the changeless symptom and fatigue marque it hard for him to transportation retired adjacent regular tasks.

“I gave my kidney truthful my household could person a amended life. I did everything for my woman and children,” helium said.

At the time, it didn’t look similar a unsafe choice. The brokers who approached him made it dependable elemental – an accidental alternatively than a risk. He was sceptical initially, but desperation yet won implicit his doubts.

The brokers took him to India connected a aesculapian visa, with each arrangements – flights, documents, and infirmary formalities – handled wholly by them. Once successful India, though helium travelled connected his archetypal Bangladeshi passport, different documents, specified arsenic certificates falsely showing a familial narration with the intended recipient of his kidney, were forged.

His individuality was altered, and his kidney was transplanted into an chartless recipient whom helium had ne'er met. “I don’t cognize who got my kidney. They [the brokers] didn’t archer maine anything,” Safiruddin said.

By law, organ donations successful India are lone permitted betwixt adjacent relatives oregon with peculiar authorities approval, but traffickers manipulate everything – household trees, infirmary records, adjacent DNA tests – to bypass regulations.

“Typically, the seller’s sanction is changed, and a notary certificate – stamped by a lawyer – is produced to falsely found a familial narration with the recipient. Forged nationalist IDs enactment the claim, making it look arsenic though the donor is simply a relative, specified arsenic a sister, daughter, oregon different household member, donating an organ retired of compassion,” said Monir Moniruzzaman, a Michigan State University prof and a subordinate of the World Health Organization’s Task Force connected Organ Transplantation, who is researching organ trafficking successful South Asia.

Safiruddin’s communicative isn’t unique. Kidney donations are truthful communal successful his colony of Baiguni, that locals cognize the assemblage of little than 6,000 radical arsenic the “village of 1 kidney”. The Kalai Upazila portion that Baiguni belongs to is the hotspot for the kidney commercialized industry: A 2023 study published successful the British Medical Journal Global Health work estimated 1 successful 35 adults successful the portion has sold a kidney.

Kalai Upazila is 1 of Bangladesh’s poorest regions. Most donors are men successful their aboriginal 30s lured by the committedness of speedy money. According to the study, 83 percent of those surveyed cited poorness arsenic the main crushed for selling a kidney, portion others pointed to indebtedness repayments, cause addiction oregon gambling.

Safiruddin said that the brokers – who had taken his passport – ne'er returned it. He didn’t adjacent get the medicines helium had been prescribed aft the surgery. “They [the brokers] took everything.”

Brokers often confiscate passports and aesculapian prescriptions aft the surgery, erasing immoderate way of the transplant and leaving donors without impervious of the process oregon entree to follow-up care.

The kidneys are sold to affluent recipients successful Bangladesh oregon India, galore of whom question to bypass agelong hold times and the strict regulations of ineligible transplants. In India, for example, lone astir 13,600 kidney transplants were performed successful 2023 – compared with an estimated 200,000 patients who make end-stage kidney illness annually.

Al Jazeera spoke with much than a twelve kidney donors successful Bangladesh, each of whom shared akin stories of being driven to merchantability their kidneys owed to fiscal hardship. The commercialized is driven by a elemental yet brutal equation: Poverty creates the supply, portion agelong hold times, a monolithic shortage of ineligible donors, the willingness of affluent patients to pay for speedy transplants and a anemic enforcement strategy guarantee that the request ne'er ceases.

Safiruddin shows his scar pursuing the kidney transplant [Aminul Islam Mithu/Al Jazeera]

The outgo of desperation

Josna Begum, 45, a widow from Binai colony successful Kalai Upazila, was struggling to rise her 2 daughters, 18 and 20 years old, aft her hubby died successful 2012. She moved to Dhaka to enactment successful a garment factory, wherever she met and joined different antheral named Belal.

After their marriage, some Belal and Josna were lured by a broker into selling their kidneys successful India successful 2019.

“It was a mistake,” Josna said. She explained that the brokers archetypal promised her 5 lakh taka (about $4,100), past raised the connection to 7 lakh (around $5,700) to person her. “But aft the operation, each I got was 3 lakh [$2,500].”

Josna said she and Belal were taken to Rabindranath Tagore International Institute of Cardiac Sciences successful Kolkata, the superior of India’s West Bengal state, wherever they underwent surgery. “We were taken by a autobus done the Benapole borderline into India, wherever we were housed successful a rented flat adjacent the hospital.”

To unafraid the transplant, the brokers fabricated documents claiming that she and the recipient were humor relatives. Like Safiruddin, she doesn’t cognize who received her kidney.

Despite repeated attempts, officials astatine Rabindranath Tagore International Institute of Cardiac Sciences person not responded to Al Jazeera’s petition to remark connected the case. Kolkata constabulary person antecedently accused different brokers of facilitating amerciable kidney transplants astatine the aforesaid hospital successful 2017.

Josna said her passport and recognition documents were handled wholly by the brokers. “I was OK with them taking distant the prescriptions. But I asked for my passport. They ne'er gave it back,” she said.

She stayed successful India for astir 2 months earlier returning to Bangladesh – escorted by the brokers who had her passport, and inactive held retired the committedness of paying her what they had committed to.

The brokers had besides promised enactment for her household and adjacent jobs for her children, but aft the archetypal outgo and a fewer token payments connected Eid, they chopped disconnected contact.

Soon aft helium was paid – besides 3 lakh taka ($2,500) – for his transplant, Belal abandoned Josna, aboriginal marrying different woman. “My beingness was ruined,” she said.

Josna present suffers from chronic symptom and struggles to spend medicines. “I can’t bash immoderate dense work,” she said. “I person to survive, but I request medicine each the time.”

Josna Begum sitting extracurricular her tiny cattle shed [Aminul Islam Mithu/ Al Jazeera]

‘In beforehand of this gang’s gun’

In immoderate cases, victims person go perpetrators of the kidney scam, too.

Mohammad Sajal (name changed), was erstwhile a businessman successful Dhaka selling household items similar unit cookers, integrative containers and blenders done Evaly, a flashy e-commerce level that promised large returns. But erstwhile Evaly collapsed pursuing a 2021 scam, truthful did his savings – and his livelihood.

Drowning successful indebtedness and nether immense unit to repay what helium owed, helium sold his kidney successful 2022 astatine Venkateshwar Hospital successful Delhi. But the promised 10 lakh taka ($8,200) ne'er materialised. He received lone 3.5 lakh taka ($2,900).

“They [the brokers] cheated me,” Sajal said. Venkateshwar Hospital has not responded to repeated requests from Al Jazeera for remark connected the case.

There was lone 1 mode helium could gain what helium had thought helium would get for his kidney, Sajal concluded astatine the time: by joining the brokers to dupe others. For months, helium worked arsenic a broker, arranging kidney transplants for respective Bangladeshi donors successful Indian hospitals. But aft a fiscal quality with his handlers, helium near the trade, fearing for his life.

“I americium present successful beforehand of this gang’s gun,” helium said. The web helium near down operates with impunity, helium said, stretching from Bangladeshi hospitals to the Indian aesculapian system. “Everyone from the doctors to recipients to the brokers connected some sides of borders are involved,” helium said.

Now, Sajal works arsenic a ride-share operator successful Dhaka, trying to flight the past. But the scars, some carnal and emotional, remain. “No 1 willingly gives a kidney retired of hobby oregon desire,” helium said. “It is simply a elemental calculation: desperation leads to this.”

Acknowledging the cross-border kidney trafficking trade, Bangladesh constabulary accidental they are cracking down connected those involved. Assistant Inspector General Enamul Haque Sagor of Bangladesh Police said that, successful summation to uniformed officers, undercover investigators person been deployed to way organ trafficking networks and stitchery intelligence.

“This contented is nether our watch, and we are taking enactment arsenic required,” helium said.

Sagor said that constabulary person arrested aggregate individuals linked to organ trafficking syndicates, including brokers. “Many radical get drawn into kidney income done these networks, and we are moving to drawback them,” helium added.

Across the border, Indian instrumentality enforcement agencies, too, person cracked down connected immoderate aesculapian professionals accused of engagement successful kidney trafficking. In July 2024, the Delhi Police arrested Dr Vijaya Rajakumari, a 50-year-old kidney transplant surgeon associated with a Delhi hospital. Investigations revealed that betwixt 2021 and 2023, Dr Rajakumari performed astir 15 transplant surgeries connected Bangladeshi patients astatine a backstage hospital, Indian officials said.

But experts accidental that these arrests are excessively sporadic to earnestly dent the concern exemplary that underpins the kidney trade.

And experts accidental Indian authorities look competing pressures – upholding the law, but besides promoting aesculapian tourism, a assemblage that was worth $7.6bn successful 2024. “Instead of enforcing ethical standards, the absorption is connected the economical advantages of the industry, allowing amerciable transplants to continue,” said Moniruzzaman.

The kidney transplant concern has agelong been lucrative successful India. In 2008, Nepal’s constabulary arrested Amit Kumar, a 40-year-old Indian antheral suspected of being the mastermind of an amerciable kidney transplant racket successful India [Gopal Chitrakar/Reuters]

‘More transplants mean much revenue’

In India, the Transplantation of Human Organs Act (THOA) of 1994 regulates organ donations, permitting kidney transplants chiefly betwixt adjacent relatives specified arsenic parents, siblings, children and spouses to forestall commercialized exploitation. When the donor is not a adjacent relative, the lawsuit indispensable person support from a government-appointed assemblage known arsenic an authorisation committee to guarantee the donation is altruistic and not financially motivated.

However, brokers progressive successful kidney trafficking circumvent these regulations by forging documents to found fictitious familial relationships betwixt donors and recipients. These fraudulent documents are past submitted to authorisation committees, which – acold excessively often, accidental experts – o.k. the transplants.

Experts accidental the instauration of this illicit strategy lies successful the easiness with which brokers manipulate ineligible loopholes. “They fabricate nationalist IDs and notary certificates to make fictitious household ties betwixt donors and recipients. These papers tin beryllium made rapidly and cheaply,” said Moniruzzaman.

With these falsified identities, transplants are performed nether the pretence of ineligible donations betwixt relatives.

In Dhaka, Shah Muhammad Tanvir Monsur, manager wide (consular) astatine Bangladesh’s Ministry of Foreign Affairs, said that the country’s authorities officials had nary relation successful the papers fraud, and that they “duly followed” each ineligible procedures. He besides denied immoderate speech of accusation betwixt India and Bangladesh connected cracking down connected cross-border kidney trafficking.

Over successful India, Amit Goel, lawman commissioner of constabulary successful Delhi, who has investigated respective cases of kidney trafficking successful the city, including that of Rajakumari, the doctor, said that infirmary authorities often conflict to observe forged documents, allowing amerciable transplants to proceed.

“In the cases I investigated, I recovered that the authorisation committee approved those cases due to the fact that they couldn’t place the fake documents,” helium said.

But Moniruzzaman pointed retired that Indian hospitals besides person a fiscal inducement to place discrepancies successful documents.

“Hospitals crook a unsighted oculus due to the fact that organ donation [in general] is legal,” Moniruzzaman said. “More transplants mean much revenue. Even erstwhile cases of fraud surface, hospitals contradict responsibility, insisting that documentation appears legitimate. This signifier allows the commercialized to proceed unchecked,” helium added.

Mizanur Rahman, a broker who operates crossed aggregate districts successful Bangladesh, said that traffickers often people idiosyncratic doctors oregon members of infirmary reappraisal committees, offering bribes to facilitate these transplants.​ “Usually, brokers successful Bangladesh are successful interaction with their counterparts successful India who acceptable up these doctors for them,” Rahman told Al Jazeera. “These doctors often instrumentality a large chunk of the wealth involved.”

Dr Anil Kumar, manager of the National Organ and Tissue Transplant Organisation (NOTTO) – India’s cardinal assemblage overseeing organ donation and transplant coordination – declined to remark connected allegations of systemic discrepancies that person enabled rising cases of organ trafficking.

However, a erstwhile apical authoritative from NOTTO pointed retired that hospitals often are up against not conscionable brokers and seemingly consenting donors with what look to beryllium morganatic documents, but besides wealthier recipients. “If the infirmary committee is not convinced, recipients often instrumentality the substance to higher authorities oregon situation the determination successful court. So they [hospitals] besides privation to debar ineligible hassles and proceed with transplants,” this authoritative said, speaking connected information of anonymity.

Meanwhile, organ trafficking networks proceed to accommodate their strategies. When constabulary oregon authoritative scrutiny increases successful 1 location, the commercialized simply moves elsewhere. “There is nary azygous fixed hospital; the locations support changing,” Moniruzzaman said. “When constabulary behaviour a raid, the infirmary stops performing transplants.

“Brokers and their web – Bangladeshi and Indian brokers moving unneurotic – coordinate to prime caller hospitals astatine antithetic times.”

Fields successful Joypurhat, a portion of Bangladesh that is turning into a hub of kidney trafficking [Aminul Islam Mithu/Al Jazeera]

Porous borders and the fallout

For brokers and hospitals that are involved, determination is large wealth astatine stake. Recipients often pay betwixt $22,000 and $26,000 for a kidney.

But donors get lone a tiny fraction of this money. “The donors get 3 to 5 lakh taka [$2,500 to $4,000] usually,” said Mizanur Rahman, the broker. “The remainder of the wealth is shared with brokers, officials who forge documents, and doctors if they are involved. Some wealth is besides spent connected donors portion they unrecorded successful India.”

In immoderate cases, the deception runs adjacent deeper: traffickers lure Bangladeshi nationals with promises of well-paying jobs successful India, lone to coerce them into kidney donations.

Victims, often hopeless for work, are taken to hospitals nether mendacious pretences, wherever they acquisition country without afloat knowing the consequences. In September past year, for instance, a web of traffickers successful India held galore Bangladeshi occupation seekers captive, either forced oregon deceived them into organ transplants, and abandoned them with minimal compensation. Last year, constabulary successful Bangladesh arrested 3 traffickers successful Dhaka who smuggled astatine slightest 10 radical to New Delhi nether the guise of employment, lone to person them forced into kidney transplants.

“Some radical knowingly merchantability their kidneys owed to utmost poverty, but a important fig are deceived,” said Shariful Hasan, subordinate manager of the Migration Programme astatine BRAC, formerly the Bangladesh Rural Advancement Committee, 1 of the world’s largest nongovernmental improvement organisations. “A affluent diligent successful India needs a kidney, a middleman either finds a mediocre Bangladeshi donor oregon lures idiosyncratic successful the sanction of employment, and the rhythm continues.”

Vasundhara Raghavan, CEO of the Kidney Warriors Foundation, a enactment radical successful India for patients with kidney diseases, said that a shortage of ineligible donors was a “major challenge” that drove the request for trafficked organs.

“Desperate patients crook to illicit means, fuelling a strategy that preys connected the poor.”

She acknowledged that India’s ineligible model was aimed astatine preventing organ transplants from turning into an exploitative industry. But successful reality, she said, the instrumentality had lone pushed organ commercialized underground.

“If organ commercialized cannot beryllium wholly eliminated, a much systematic and regulated attack should beryllium considered. This could impact ensuring that donors acquisition mandatory wellness screenings, person postoperative aesculapian enactment for a fixed period, and are provided with fiscal information for their aboriginal wellbeing,” Raghavan said.

Back successful Kalai Upazila, Safiruddin nowadays spends astir of his clip astatine home, his movements slower, his spot visibly diminished. “I americium not capable to enactment properly,” helium said.

He says determination are nights erstwhile helium lies awake, reasoning of the promises the brokers made, and the dreams they shattered. He doesn’t cognize when, and if, helium volition beryllium capable to implicit the operation of his house. He thought the country would bring his household a cookware of currency to physique a future. Instead, his children person been near with an ailing begetter – and helium with a consciousness of betrayal that Safiruddin can’t shingle off. “They took my kidney and vanished,” helium said.

Reporting for this communicative was supported by a assistance from Journalists for Transparency.