Seven years ago, Nepalese farmer Madhab Parajuli faced an agonizing choice: lose his small plot of farmland to mounting debts or sell one of his kidneys to an organ trafficker.
In desperation, Parajuli accepted the trafficker’s offer of 100,000 rupees (US$1,400) and traveled to India to have the organ removed — a decision he now bitterly regrets.
“I didn’t get paid until we got back to Nepal, and then only around a third of what I’d been promised,” the 36-year-old said in his home village of Jyamdi, about 50km east of the capital, Kathmandu.
“I lost my farm anyway, and if I’d known then what I know now, there’s no way I would have sold my kidney,” he said.
Parajuli, whose family abandoned him after he lost all his property, looks frail and haggard. Now a day laborer, he said he finds heavy work difficult.
“I occasionally feel the pain on the side,” he said, pointing to the 15cm scar on his right side.
Under Nepalese law, kidney transplants are allowed only if the organ is donated by a blood relative or spouse.
However, India’s laws are more lax, allowing a non-relative to donate an organ “out of affection,” subject to the approval of a medical committee — a checking process which can often be circumvented.
Everyone knows someone who has given up a kidney in Jyamdi, one of a cluster of impoverished villages in Nepal that have become a center for the traders because of the proximity to Kathmandu and the Indian border.
Most of the villagers are subsistence farmers, but many cannot produce enough food for the whole year, and are forced to seek work in Kathmandu or neighboring India.
“The organ traffickers trawl the villages looking for poor donors like Madhab,” former village chief Krishna Bahadur Tamang said. “People here are poor and uneducated so it’s easy. However, in most cases they get only a tiny fraction of the money they were promised.”
Some are even lured into India with cover stories, and only told the true purpose of their journey once they are over the border.
That is what happened to Mohan Sapkota, who was initially told he would be paid to accompany a Nepalese kidney patient traveling to India for treatment.
He became suspicious when the trafficker told him he would have to undergo a blood test and a health check-up before traveling, but it was only after he arrived in the southern Indian city of Chennai that the true reason emerged.
“I had no money and no property and the trafficker promised to pay for my children’s education, so I agreed to give up a kidney,” said Sapkota, 43. “But in the end, all I got was 60,000 rupees.”
Sociologist Ganesh Gurung has conducted research into organ trafficking in the district of Kavre, where the villages are located.
He says that once they are in India, the victims are even more vulnerable to the traffickers’ demands.
“The donor is in a very weak position in India, where he often cannot understand the language and has little bargaining power,” he said. “And then when they get back to the village, many of them spend the money on alcohol.”
A survey conducted by a local non-government organization last year put the number of people in Kavre who have sold a kidney at 300. No official statistics are available, but many people believe the true figure is much higher.
Many organs rackets in India cater for foreigners dubbed “transplant tourists,” but most of the kidneys from Nepal are actually destined for Nepalese patients.