Twenty-six-year-old Mizanur Rahman was desperately looking for a way to settle debts he had incurred while buying a small piece of land in Bagoil, a village in Joypurhat district in the north of Bangladesh. It had been three years, and the loan sharks who had lent him 10,000 taka (USD 130) three years ago were now asking for more than three times as much, some USD 418. Mizanur is a farmer with a two-year-old son and a wife to take care of, and he wanted to get rid of his debts so that his family would not have to deal with them. He heard that his neighbour had earned some quick cash by donating one of his kidneys – a man named Golam was brokering kidney transplant in his village. ‘You will not even realise that you had a surgery,’ he had told Mizanur. So, on 3 August, Mizanur went to a Dhaka hospital and gave away one of his kidneys; in return, he was paid USD 1830.
In so doing, Mizanur also joined a group of at least 200 Joypurhat district villagers who have illegally sold their kidneys. Like Joypurhat, impoverished villagers from other parts of Bangladesh’s northern areas have been lured by hefty sums of money to give away their kidneys and other organs. In September, Bangladeshi law enforcement arrested six members of a network – thought to be the first of its kind in the country – that was illegally trading human organs inside Bangladesh and abroad.
The black market for human organs has recently been recognised as a growing problem across the world. Poorer countries are seen as particularly vulnerable, however, with Bangladesh and India having become particular countries of concern. In 2007, the World Health Organisation (WHO) estimated that organ trafficking was accounting for upwards of 10 percent of all kidney transplants worldwide; a 2004 WHO report suggests that organs can bring as much as USD 200,000 from wealthy patients. Donors, meanwhile, may receive as little as USD 1000 for a kidney.
Although many countries have banned the buying and selling of organs, some suggest that this has actually intensified the underground trade, creating a lucrative black market. In India, for instance, it was legal to trade in organs until a new legislation was passed in 1994, making it a crime to gain monetarily from organ transplantation; five years later, Bangladesh followed suit. According to information obtained by Bangladeshi law enforcement from arrested suspected organ traders, the black market in the country began to flourish around 2006, with increasing numbers of villagers having been convinced to sell off one of their kidneys.
On 8 September, police arrested Tareque Azim, who they say is the mastermind behind the organ-trading network. ‘The racket has been operating in different parts of Bangladesh for the last six years, mediating between donors and patients requiring organ implants,’ said Fazlul Karim, officer-in-charge of the Kalai police station in Joypurhat. He said the accused were actively growing donor pools in Joypurhat, Noakhali, Barisal, Madaripur, Kushtia, Jessore and Comilla districts. Azim said that he has been involved in the trade for six years, and that he had started when he first required a kidney for his cousin, in 2006. ‘I placed an advertisement in the newspaper and a lot of calls started coming in,’ he said in an interview with this writer.
Following this response, Azim started encouraging his fellow villagers in Joypurhat to sell their kidneys. In just two villages of Joypurhat, police have identified at least 42 individuals in financial hardship who took him up on the offer. According to Azim, he has procured kidneys for at least 32 donors since 2006. ‘I did this for humankind and to help save lives,’ he said, naming several prominent Dhaka hospitals where the patients were operated upon.
Nazma had been receiving kidney dialysis for 12 years before her husband decided she had to have a transplant. Unfortunately, none of her relatives were eligible to donate their kidneys, either because their blood types did not match or they had health complications. Increasingly desperate, she asked her physician in Dhaka to do her kidney transplant with a paid donor. When the physician refused, she found one herself and pretended that he was her uncle. They forged affidavits and police verification reports to fake their relationship but, during the interview, Nazma’s physician discovered that they were not related. Undeterred, she proceeded with the procedure, using the same donor, in Singapore in April 2011. The new kidney did not function well, however, and she was eventually forced to disclose the full story to her local physician.
Other than the ending, this has not become a common story. Bangladesh’s lax monitoring and verification system are thought to make it relatively easy for people to forge identities and legal papers, as Nazma had done. Similarly, many patients are seeking the actual transplantation to take place outside of the country, as Dhaka hospitals claim to be refraining from doing transplants using organs from paid donors. Dr Harun Ur Rashid, a senior nephrologist at Kidney Foundation Bangladesh, says that he believes the majority of organ trading is done for institutions outside of Bangladesh. In fact, while some medical facilities in the country do make notable strides to ensure that organs from paid donors are not used (as in Nazma’s case), there is plenty of evidence that Bangladeshi regulations are either not strong enough – or are being wilfully ignored.
Just grow another
In May, 23-year-old Mehdi Hassan was looking to earn some extra money so he could help to pay for his sister’s marriage. Being the eldest in a family in which the parents had died, it was his responsibility to take care of his two sisters as well as himself. Eventually, he says, three members of the organ-trafficking network met him with a proposition: selling one of his kidneys would give him enough money both for his sister’s wedding and to start a new business.
Mehdi hesitated at first, but eventually decided to do it. The brokers took him to a Dhaka hospital where his blood and tissue samples were tested to see whether there was compatibility with a particular patient. The results were negative. The brokers then talked Mehdi into selling his liver, offering him about USD 4000. Mehdi had little knowledge of the significance of his organs but, even so, he was reassured when the hospital doctors promised him that his liver would grow back. On 8 May, Mehdi underwent a 10-hour surgery at the hospital; three weeks later, his stitches were removed. Abdus Sattar, one of the brokers who mediated his transplant, was arrested on 29 August. Meanwhile, Mehdi was given only about USD 2000 from Sattar and his band; currently he suffers from severe gastric problems and cannot lift heavy items.
Meanwhile, all of this is taking place against the backdrop of a very serious international debate over the legalisation of the organ trade. In Bangladesh, about 15,000 patients die every year from renal failure. So why is trading in live organs considered unethical, and why has it been made illegal? ‘People who are desperate lay themselves open to exploitation and deceit, and organ sellers are exploited and deceived in today’s black markets. But the answer is to regulate the market, not to drive it underground,’ said Martin Wilkinson, an associate professor at the University of Auckland who has done extensive research on ethical issues pertaining to organ transplantation. He argues that selling an organ should not be a criminal offence, and that rescinding the ban in organ trading would do away with the ruthless exploitation of people in the black market.
Sabina Faiz Rashid, with the James P Grant School of Public Health at BRAC University in Dhaka, disagrees. ‘This is absolutely exploitation,’ she says. ‘Not everybody has the same level of knowledge, and therefore villagers are prone to be exploited given the lack of literacy. We do not know if they are informed about the consequences and the risks involved.’ Other countries seem to agree with her. In the United States, for instance, hospitals require a series of interviews with the donor and recipient as well as meetings with a social worker to make sure no money is exchanged. In Bangladesh, while regulations state that a health institution is supposed to verify the relationship to ensure that no trading occurs, very few are able – or willing – to do so. In a country with 40 percent of the population earning less than a dollar a day, says one doctor, such a lack of regulation has allowed for a situation in which people are being ‘driven to sell off their organs’.