"Outsourcing" in Pakistan

Transplant tourists flock to Pakistan, where poverty and lack of regulation fuel trade in human organs

Declan Walsh
Thursday February 10, 2005
The Guardian

Skint, depressed and with moneylenders banging on his door, Muhammad Iqbal decided four months ago to transform his fortunes by selling his last valuable possession - a kidney. The labourer went to the motorway that runs past his one-room house and took a bus to Rawalpindi, the home of Pakistan's powerful military. He checked into a hospital, took a series of tests and, after two days, went under the scalpel.

Six hours later, he woke to find his kidney had been transplanted into the body of an ailing Arab man in a nearby ward and he was £720 richer.

"His name was Mehdi. We talked briefly through a doctor, and he took some pictures. Then he was gone," said Mr Iqbal, lifting his baggy shirt to reveal a long, red scar above his hip.

Most adults in the village of Sultan Pur More, northern Punjab, have donated a kidney. Poverty-stricken labourers such as Mr Iqbal earn as little as 50p a day. Many people in the hamlet surrounded by orange groves and wheat fields are in bondage to feudal-style landlords.

It is one of dozens of villages that provide the human stock for Pakistan's burgeoning cash-for-kidneys trade.

It all started with one local who worked in Rawalpindi, explained Sikander Hayad, who says 39 relatives have made the kidney pilgrimage. "The man had the operation and came home to spread the word," said the 33-year-old bicycle repair man. "Then everybody went."

The organ sales business, outlawed in all but a handful of countries, is legal and booming in Pakistan. The gold standard is the kidney. Frustrated by years-long waiting lists at home and fearful of an early death, "transplant tourists" from Europe, the US and the Middle East are flocking to private Pakistani hospitals for operations which can be arranged in days at a fraction of the cost back home.

Since India imposed a ban on the controversial trade 10 years ago, a thriving industry has sprung up around Rawalpindi and Lahore. Private hospitals advertise their services on the internet, and leading surgeons can make thousands of pounds for a few hours' work. Newspapers carry small ads looking for new donors; even airport taxi drivers know the addresses of the busiest kidney hospitals. Middlemen scour the countryside, looking for fresh peasant labourers to entice with the promise of riches.

The trade has sparked passionate debate in Pakistan and abroad. Two years ago, a London-based property developer, Thor Andersen, admitted to buying a kidney from a 22-year-old Pakistani woman for £3,000.

Mr Andersen said he could not bear to queue with the NHS for a cadaver donation that might never come. A spokesman for UK Transplant, the government health authority specialising in organ donations, said more than 5,200 Britons were currently on the list, waiting an average of 506 days. However, it can be as long as nine years, and about 400 patients die every year. In these conditions, it is reasonable to buy a kidney, say some British academics. The rich get a kidney, the poor get money, and the medical procedure that satisfies both is relatively safe.

Opponents counter that the practice is exploitative, fails to alleviate poverty and leaves impoverished donors medically vulnerable and even exposed to death.

Retired army surgeons run two busy transplant centres in Rawalpindi. "Another six people were being operated on at the same time as me," said the donor, Muhammad Iqbal. He is ambivalent about his experience. The £720 was invaluable for getting the debt collectors off his back, he said. But he had no money left over. Now his children still have no shoes, his health has deteriorated and he has taken out a new £45 loan.

"The scar didn't heal well, and I feel tired easily so I can't do hard work now. But I was tired of all those people coming looking for money," he said. "What else was I going to do?"