Safiruddin, 45, sits outside his bare brick home in Baiguni village of Kalai Upazila in Bangladesh, suffering from a dull ache in his side as a result of the mild afternoon sun in Joypurhat/Dhaka, Bangladesh and New Delhi/Kolkata, India.
In the summer of 2024, he sold his kidney in India for 3.5 lakh taka ($2, 900), hoping to lift his family out of poverty and build a house for his three children – two daughters, aged five and seven, and an older 10-year-old son. The pain in his body is a constant reminder of the price he paid, and that money has long since been passed. The house is still unfinished.
He now toils as a daily labourer in a cold storage facility, as his health deteriorates – the constant pain and fatigue make it hard for him to carry out even routine tasks.
“I gave my kidney so that my family could live better.” I did everything for my wife and children”, he said.
It didn’t seem like a risky choice at the time. The brokers who approached him made it sound simple – an opportunity rather than a risk. Initial skepticism eventually replaced him, but he learned to trust himself.
The brokers took him to India on a medical visa, with all arrangements – flights, documents, and hospital formalities – handled entirely by them. Other documents, such as documents that falsely depict a familial relationship with the intended recipient of his kidney, were forged once in India despite his original Bangladeshi passport.
His identity was altered, and his kidney was transplanted into an unknown recipient whom he had never met. I’m not sure who got my kidney, she said. They]the brokers] didn’t tell me anything”, Safiruddin said.
Organ donations are only permitted between close relatives in India or with special government approval, but traffickers evade the law by manipulating everything, including family histories, hospital records, even DNA tests, to break rules.
“Typically, the seller’s name is changed, and a notary certificate – stamped by a lawyer – is produced to falsely establish a familial relationship with the recipient. According to Monir Moniruzzaman, a professor at Michigan State University and a member of the World Health Organization’s Task Force on Organ Transplantation, “forged national IDs make it appear as though the donor is a relative, such as a sister, daughter, or another family member, donating an organ out of compassion.”
Safiruddin’s story isn’t unique. Locals refer to his village of Baiguni, which has less than 6, 000 residents as the “village of one kidney,” because kidney donations are so prevalent there. The Kalai Upazila region that Baiguni belongs to is the hotspot for the kidney trade industry: A 2023 study published in the British Medical Journal Global Health publication estimated one in 35 adults in the region has sold a kidney.
One of Bangladesh’s poorest regions is Kalai Upazila. Most donors are men in their early 30s lured by the promise of quick money. According to the study, 83 percent of those surveyed cited poor economic conditions as the main motivation for selling kidneys, while others cited loan repayments, drug use, or gambling.
Safiruddin said that the brokers – who had taken his passport – never returned it. After the operation, he was given the medications he had been prescribed. “They]the brokers] took everything”.
After the operation, brokers frequently seize passports and prescriptions for medical purposes, erasing any trace of the donor and allowing the donor to access follow-up care.
The kidneys are sold to wealthy recipients in Bangladesh or India, many of whom seek to bypass long wait times and the strict regulations of legal transplants. In India, for instance, only about 13,600 kidney transplants were performed in 2023, compared to an estimated 200 000 people who pass away each year from end-stage kidney disease.
Al Jazeera spoke with more than a dozen kidney donors in Bangladesh, all of whom shared similar stories of being driven to sell their kidneys due to financial hardship. Long wait times, a significant shortage of legal donors, the willingness of wealthy patients to pay for quick transplants, and a weak enforcement system serve as the driving forces behind the trade.
Desperation costs money.
Josna Begum, 45, a widow from Binai village in Kalai Upazila, was struggling to raise her two daughters, 18 and 20 years old, after her husband died in 2012. She relocated to Dhaka to start a garment factory, where she met and wed another man, named Belal.
After their marriage, both Belal and Josna were lured by a broker into selling their kidneys in India in 2019.
Josna remarked, “It was a mistake.” She explained that the brokers first promised her five lakh taka (about $4, 100), then raised the offer to seven lakh (around $5, 700) to convince her. However, all I received after the operation was three lakh [$2,500]$2.
Josna said she and Belal were taken to Rabindranath Tagore International Institute of Cardiac Sciences in Kolkata, the capital of India’s West Bengal state, where they underwent surgery. We were transported by bus from Benapole border to India, where we lived in rented apartments close to the hospital.
To secure the transplant, the brokers fabricated documents claiming that she and the recipient were blood relatives. She is unsure of the recipient of her kidney, just like Safiruddin.
Despite repeated attempts, officials at Rabindranath Tagore International Institute of Cardiac Sciences have not responded to Al Jazeera’s request to comment on the case. In 2017, police in Kolkata have previously accused other brokers of facilitating illegal kidney transplants at the same hospital.
Josna said her passport and identification documents were handled entirely by the brokers. I consented to them removing the prescriptions. But I asked for my passport. She claimed that they never returned it.
She stayed in India for nearly two months before returning to Bangladesh – escorted by the brokers who had her passport, and still held out the promise of paying her what they had committed to.
After receiving initial payments and a few token payments on Eid, the brokers cut off communication and promised to support her family and possibly even offer jobs to her children.
Soon after he was paid – also three lakh taka ($2, 500) – for his transplant, Belal abandoned Josna, later marrying another woman. She claimed that “my life was destroyed.”
Josna now suffers from chronic pain and struggles to afford medicines. She said, “I can’t do any heavy work.” “I have to survive, but I need medicine all the time”.
‘ In front of this gang’s gun ‘
Victims of the kidney scam occasionally go on to get their hands on it.
Mohammad Sajal (name changed), was once a businessman in Dhaka selling household items like pressure cookers, plastic containers and blenders through Evaly, a flashy e-commerce platform that promised big returns. But his savings and livelihood were destroyed when Evaly collapsed as a result of a scam in 2021.
Drowning in debt and under immense pressure to repay what he owed, he sold his kidney in 2022 at Venkateshwar Hospital in Delhi. However, the 10-lakh taka ($8) that had been promised never materialized. He received only 3.5 lakh taka ($2, 900).
Sajal claimed that “the brokers] cheated on me. Venkateshwar Hospital has not responded to repeated requests from Al Jazeera for comment on the case.
Sajal came to the conclusion that there was only one way for him to make money off of others, Sajal said at the time. For months, he worked as a broker, arranging kidney transplants for several Bangladeshi donors in Indian hospitals. He left the trade, frightened of losing his life, after a financial dispute with his handlers.
“I am now in front of this gang’s gun”, he said. He claimed that the network that he left behind, which extends from Bangladeshi hospitals to the Indian medical system, is still in existence. “Everyone from the doctors to recipients to the brokers on both sides of borders are involved”, he said.
Sajal is currently attempting to flee the past by driving a ride-share in Dhaka. But the scars, both physical and emotional, remain. No one, he said, willfully donate a kidney out of a desire or a hobby. “It is a simple calculation: desperation leads to this”.
Bangladeshi police say they are cracking down on the illegal kidney trafficking across the international system. Assistant Inspector General Enamul Haque Sagor of Bangladesh Police said that, in addition to uniformed officers, undercover investigators have been deployed to track organ trafficking networks and gather intelligence.
He continued, “We are taking action as needed,” and this issue is under our watch.
Sagor said that police have arrested multiple individuals linked to organ trafficking syndicates, including brokers. We are working to catch kidney sales because “Many people get drawn into kidney sales through these networks,” he continued.
Across the border, Indian law enforcement agencies, too, have cracked down on some medical professionals accused of involvement in kidney trafficking. Dr. Vijaya Rajakumari, a 50-year-old kidney transplant surgeon affiliated with a Delhi hospital, was detained by the Delhi Police in July 2024. Investigations revealed that between 2021 and 2023, Dr Rajakumari performed approximately 15 transplant surgeries on Bangladeshi patients at a private hospital, Indian officials said.
However, experts contend that the business model that drives the kidney trade is seriously undermined by these arrests.
And experts say Indian authorities face competing pressures – upholding the law, but also promoting medical tourism, a sector that was worth $7.6bn in 2024. The emphasis is on the economic benefits of the industry, which will prevent illegal transplants, according to Moniruzzaman, rather than enforcing ethical standards.
‘ More transplants mean more revenue ‘
Organ donation laws in India are governed by the 1994 Transplantation of Human Organs Act (THOA), which permits kidney transplants between immediate family members, including parents, siblings, children, and spouses to prevent commercial exploitation. When the donor is not a near relative, the case must receive approval from a government-appointed body known as an authorisation committee to ensure the donation is altruistic and not financially motivated.
However, kidney trafficking brokers’ legal strategies for evade these laws by fabricating documents to establish fictitious familial connections between donors and recipients. These fraudulent documents are then submitted to authorisation committees, which – far too often, say experts – approve the transplants.
According to experts, the ease with which brokers exploit legal gaps is at the heart of this illicit system. “They fabricate national IDs and notary certificates to create fictitious family ties between donors and recipients. These papers can be produced quickly and affordably, Moniruzzaman said.
With these falsified identities, transplants are performed under the pretence of legal donations between relatives.
Director general (consular) at Bangladesh’s Ministry of Foreign Affairs Shah Muhammad Tanvir Monsur claimed that the government’s officials had no place in the document fraud and that they had “duly followed” all legal procedures in Dhaka. He also denied any exchange of information between India and Bangladesh on cracking down on cross-border kidney trafficking.
Amit Goel, deputy commissioner of police in Delhi, who has investigated a number of instances of kidney trafficking in the city, including that involving Rajakumari, the doctor, claimed that hospital authorities frequently struggle to find forged documents, which enables illegal transplants to continue.
“In the cases I investigated, I found that the authorisation board approved those cases because they couldn’t identify the fake documents”, he said.
However, Moniruzzaman made the point that Indian hospitals also have a financial incentive to ignore errors in records.
“Hospitals turn a blind eye because organ donation]in general] is legal”, Moniruzzaman said. More transplants result in more money. Even when cases of fraud surface, hospitals deny responsibility, insisting that documentation appears legitimate. He continued, “This pattern allows the trade to continue unchecked.”
Mizanur Rahman, a broker who operates across multiple districts in Bangladesh, said that traffickers often target individual doctors or members of hospital review committees, offering bribes to facilitate these transplants. According to Rahman, “brokers in Bangladesh typically get in touch with their Indian counterparts who have these doctors for them.” “These doctors often take a major chunk of the money involved”.
The National Organ and Tissue Transplant Organization (NOTTO), India’s top organization overseeing organ donation and transplant coordination, Dr. Anil Kumar, declined to comment on claims of systemic irregularities that have led to an increase in cases of organ trafficking.
However, a former top official from NOTTO pointed out that hospitals often are up against not just brokers and seemingly willing donors with what appear to be legitimate documents, but also wealthier recipients. Patients frequently take the matter to higher authorities or bring a legal challenge to the decision if the hospital board is not convinced. So they]hospitals] also want to avoid legal hassles and proceed with transplants”, this official said, speaking on condition of anonymity.
Organ trafficking organizations are adapting their tactics in the interim. When police or official scrutiny increases in one location, the trade simply moves elsewhere. No single hospital has a fixed location, according to Moniruzzaman, who said it constantly changes. “When police conduct a raid, the hospital stops performing transplants.
Working together, Bangladeshi and Indian brokers coordinate the selection of new hospitals at various times.
fallout and porous borders
For brokers and hospitals that are involved, there is big money at stake. A kidney is typically valued between $22,000 and $26,000.
But donors get only a tiny fraction of this money”. The broker Mizanur Rahman said, “The donors typically receive three to five lakh taka [$2, 500 to $4, 000]]. The rest of the money is shared with brokers, officials who forge documents, and doctors if they are involved. While donors reside in India, some funds are also used for their needs.
In some cases, the deception runs even deeper: traffickers lure Bangladeshi nationals with promises of well-paying jobs in India, only to coerce them into kidney donations.
Victims are taken to hospitals under false pretenses, where they undergo surgery without fully understanding the consequences, because they are frequently desperate for work. In September last year, for instance, a network of traffickers in India held many Bangladeshi job seekers captive, either forced or deceived them into organ transplants, and abandoned them with minimal compensation. Three traffickers were detained by Bangladeshi police last year who were forced to undergo kidney transplants after bringing at least 10 people into New Delhi under the pretense of employment.
” Some people knowingly sell their kidneys due to extreme poverty, but a significant number are deceived, “said Shariful Hasan, associate director of the Migration Programme at BRAC, formerly the Bangladesh Rural Advancement Committee, one of the world’s largest nongovernmental development organisations”. A middleman either finds a poor Bangladeshi donor or entices a wealthy patient in India to get a kidney, and the cycle continues.
Vasundhara Raghavan, CEO of the Kidney Warriors Foundation, a support group in India for patients with kidney diseases, said that a shortage of legal donors was a” major challenge “that drove the demand for trafficked organs.
“Desperate patients turn to illicit means, causing a system that targets the poor.”
She acknowledged that India’s legal framework was aimed at preventing organ transplants from turning into an exploitative industry. She claimed that the law had only led to the underground movement of organs.
” If organ trade cannot be entirely eliminated, a more systematic and regulated approach should be considered. According to Raghavan, this could involve ensuring that donors are given pre-requisite health screenings, receive fixed-term postoperative medical care, and have financial security for their future well-being, “Raghavan said.
Back in Kalai Upazila, Safiruddin nowadays spends most of his time at home, his movements slower, his strength visibly diminished”. He claimed that I am unable to function properly.
He says there are nights when he lies awake, thinking of the promises the brokers made, and the dreams they shattered. He is unsure of when and when he will be able to finish building his home. He thought the surgery would bring his family a pot of cash to build a future. Instead, Safiruddin can’t shake off his children because he has left his ailing father with his children. They took my kidney and vanished, “he said.
Source: Aljazeera
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