In Nepal’s ‘Kidney Valley,’ Poverty Drives an Illegal Market for Human Organs

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2022 is the year 19-year-old Santosh will never forget. Santosh had dreams of improving his life for the better, seeking work outside his rural village in Nepal as a migrant worker. His life did change, but only for the worse. Santosh is now half the man he used to be after losing one of his two kidneys to an organ trafficking ring in Nepal, a South Asian country of 29 million people and one of the poorest in the world.

“I never thought my life would come to this. I can barely walk, I faint easily and can no longer lift heavy objects,” he said.

Santosh, who asked to be quoted by just his first name due to fear of being shamed, is one of around half a million migrant workers who left rural Nepal to chase a better life. In June last year, he was lured by two men who came to his native village in central Nepal with the promise of a new job in New Delhi, the northwestern capital city of neighboring India. Over the next few weeks, he was illegally trafficked to India through the porous land border the two countries share and was then taken to a hospital in the eastern city of Kolkata, where doctors conducted an illegal surgery, removing one of his two kidneys.

“They stole my kidney, handed me a bunch of money and sent me back to Nepal. I never knew what was being done to me,” he said.

Nepali police’s anti-human trafficking wing has arrested nine people since July 2022 accused of running organ trafficking operations in the capital city, Kathmandu. Santosh is believed to be among dozens of victims this year.

Santosh was the only member of his family of six who earned an income of any kind. The work he did at a small farm of less than 13 acres in Nuwakot District in central Nepal made him barely enough to get by. “I have four sisters and a mother back home, six mouths to feed and no money. I was desperate for this new job,” he said.

That desperation made him an easy target for traffickers. Upon arriving in New Delhi, he said he was told that he needed to get a blood test as part of the new job requirement. He said he had no idea of what was being done to him at the hospital. “They asked me to say yes to whatever the doctor asks, so I did. The doctor didn’t probe further,” he said. Santosh woke up after the surgery with an acute pain in his stomach and was horrified to see the scar that is now a lifelong reminder of what was stolen from him.

Santosh told the NewsHour that after the surgery the traffickers handed him $4,500 for his stolen kidney, a kidney most likely to be sold to a rich buyer willing to pay to jump the line for an organ transplant. He was given medicine and sent back to Nepal. When he was back home, he was once again jobless, still poor, but now also with a chronic deficiency. For several weeks, Santosh was bedridden. He could no longer work at his farm, so he now works at a small tea-shop in Kathmandu, earning less than $2 a day. His stomach still hurts every time he bends. He’s no longer the healthy young man he once was.

19-year-old Santosh now has a scar as a lifelong reminder of his stolen kidney. Photo credit: Zeba Warsi

“The donor could die and no one would care,” said Dr. Francis Delmonico, a transplant professional. Delmonico is a transplant surgeon and the former President of United Network for Organ Sharing which oversees the organ transplant system in the United States to ensure equity. He said all kidney donors need prolonged care and must be monitored. But, in cases of illegal organ trafficking, donors like Santosh face serious health risks without that medical oversight.

It’s not just the traffickers who should be blamed and punished for illegal selling and buying of organs like kidneys. Dr. Delmonico said the blame also rests on the government, hospitals and medical professionals who can be negligent or even complicit in the trafficking.

“If a doctor is violating the law that prohibits the buying and selling of organs, the doctor should not be able to continue with that practice,” Dr. Delmonico said.

There are internationally accepted norms for kidney transplant surgeries that most countries including India and Nepal follow, enforced by domestic laws. In those norms, written consent is sought from the donor, in most cases the donor is related to the recipient – close family or relative, it must be ascertained that the donor is not under any pressure, or is not obliged by any monetary compensation for donating their kidney. “So the government has a responsibility, the professionals have a responsibility, the hospitals have a responsibility to know of this information,” Dr. Delmonico said.

“Who’s the donor that’s now providing either a kidney for this particular recipient? Where are they coming from? What is the relationship of that individual, the donor to the recipient? Those are facts that are, in my view, essential to having a transplant performed with ethical propriety,” he said.

The Kavre District in Nepal is infamously known as ‘kidney valley’ because it is home to villages where dozens of people either voluntarily sold their kidney for money or were trafficked and duped into it. Photo credit: Zeba Warsi

Nepali officials told the NewsHour that each victim they spoke to led them to the same hospital in India – Rabindranath Tagore International Institute for Cardiac Sciences, a hospital that’s been in the headlines for illegal kidney transplants in the past. And yet, has never been prosecuted by Indian authorities.

“We wrote to the local authorities at that time and we have still not heard from them. And when a single hospital is being repeatedly in the news, clearly there seems to be a problem,” Dr. Sanjay Nagral, transplant professional, Mumbai, said.

Dr. Sanjay Nagral is the co-chair of the Declaration of Istanbul Custodian Group, an association of global experts from more than 100 countries on organ trafficking that sets international norms for transplant procedure. He said that a majority of kidney trafficking cases in Nepal lead to hospitals in India. And there’s big money riding on the illegal buying and selling of organs.

“A lot of transplantation in South Asia, including India, is done in the private sector and there’s huge money involved. So the rules of market medicine apply even more acutely or severely to transplantation. There’s big money riding on it and then there are individuals who need kidneys who are rich and willing to pay whatever is needed for a healthy kidney,” Dr. Nagral said. As of the time of publication, the NewsHour’s calls and emails to the hospital authorities and health officials in India went unanswered.

For several years, poverty and desperation drove people to sell their kidneys to traffickers who make money in the kidney black-market in India. This is part of the larger problem of human trafficking in Nepal: an estimated 35,000 Nepalese men, women and children are ‘sold’ into some form of modern slavery and sex trade each year, as per the latest government report.

When there’s a high demand for kidneys in India, its poorer neighbor Nepal becomes the hunting ground for traffickers who either convince young people in Nepal to sell their kidneys for quick money, or deceive them into doing so, as they did with Santosh.

Nepal has a troubled history with illegal ‘sale’ of kidneys. Kavre District in Central Nepal is infamously known as a ‘kidney valley.’ Over the last two decades, dozens of men from villages there have either voluntarily gone to India to sell their kidneys, or were trafficked and duped into it.

Nepal’s National Human Rights Commission told the NewsHour that at least 150 people sold their kidneys from a single village in the Kavre District, but only three cases were officially reported.

Murari Kharel, Nepal’s National Human Rights Commissioner said this vulnerability comes as the result of years of isolation. And the governments of India and Nepal and humanitarian agencies are falling short. “The government needs to pay more attention to this. Even humanitarian agencies have failed to create awareness and provide support in those villages. For too long, they’ve been neglected” and citizens are then more vulnerable to falling victim to illegal schemes, Kharel said.

69-year-old Kaali worries for her son who sold his kidney because of poverty. Photo credit: Zeba Warsi

In Jamdi village, also situated in the so-called ‘kidney valley,’ every other home has at least one person who has sold their kidney in the past due to financial need. “My older son gave his kidney a few years back. He used to work as a construction worker. Now he struggles with life, he’s weaker and gets sick easily,” said 69- year- old Kaali, who asked to be identified by just her first name over fear of being shamed. She said her son received less than $500 for his kidney.

Just next door, another family is in desperate need. “I know that my uncle’s kidney was sold when I was young. Whenever he changed clothes, we could see the surgery mark and grandma said his kidney was sold,” 13- year- old Shuddhata said.

Shuddhata, who also asked to just be identified by her first name over fear of shaming, studies in the local school, supported by her sister who works in Kathmandu. She likes to sing, likes languages and aspires to rewrite her family’s poor fate. Her uncle sold his kidney for only $300.

Only last month, Shuddhata stopped her father from selling his kidney out of desperation. He needed money to start a new business. His little girl talked him out of it.

“I cried and cried and we all in the family urged him not to do so. He is both – our mother and father because we don’t have a mother. After a lot of pleas, he finally agreed to not sell his kidney,” she said.

Shuddhata, said she is aware of how her district is perceived: poor and desperate people who sell their organs for money. She wants to break free from that tradition and she believes education is the key.

“I hear about kidney sale in our village and I know it is because of poverty. No one does such a thing if not in dire need,” she said. “I think what we need is education. Please help us with education, build schools for us, create jobs for us. So no one has to be so helpless that they sell their kidney.”

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