In Nepal’s ‘Kidney Valley,’ poverty drives an illegal market for human organs

2022 is a year that 19-year-old Santosh will never forget. Santosh had dreams of improving his life for the better, looking for a job outside his rural village in Nepal as a migrant worker. His life changed, but only for the worse. Santosh is now half of his ex-husband after losing one of his two kidneys to an organ-trafficking network in Nepal, a South Asian country of 29 million people that is one of the world’s poorest.

“I never thought my life would turn out like this. I can barely walk, I faint easily and I can no longer lift heavy things,” he said.

Santosh, who asked to be identified only by his first name for fear of embarrassment, is one of half a million migrant workers who have left rural Nepal in search of a better life. In June last year, he was lured by two men who came to his village in central Nepal with the promise of a new job in New Delhi, the northwestern capital of neighboring India. Over the next few weeks, he was smuggled across the two countries’ porous land border into India and then taken to a hospital in the eastern city of Kolkata, where doctors performed an illegal operation to remove one of his two kidneys.

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

The anti-trafficking wing of the Nepali police has arrested nine people since July 2022 for allegedly running organ trafficking operations in the capital Kathmandu. Santosh is believed to be among dozens of victims this year.

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

This desperation made them an easy target for traffickers. After arriving in New Delhi, he said he was told he needed to undergo a blood test as part of the new job requirement. He said he did not know what was being done to him in the hospital. “They asked me to say yes to everything the doctor asked, so I did. The doctor didn’t investigate further,” he said. Santosh woke up with a sharp pain in his stomach after the surgery and was horrified to see the scar that is now a reminder of the life that was stolen from him.

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Santosh told the NewsHour that after the surgery, dealers offered him $4,500 for his stolen kidney, a kidney that will most likely be sold to a wealthy buyer willing to pay to go through the organ transplant line. He was given medicine and sent to Nepal. When he returned home, he was once again unemployed, still poor, but now with a chronic disability. For several weeks, Santosh was bedridden. He could no longer work on his farm, so he now works in a small teahouse in Kathmandu, earning less than $2 a day. Every time he bends down, his stomach still hurts. He is no longer the healthy young man he once was.

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

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

Dr. “The donor could die and no one cares,” said Francis Delmonico, a transplant specialist. Delmonico is a transplant physician and past president of the United Network for Organ Sharing, which oversees the organ transplant system in the United States to ensure equity. He said that all kidney donors need long-term care and should be monitored. But, in cases of illegal organ trafficking, donors like Santosh face serious health risks without that medical supervision.

Not only traders should be blamed and punished for the illegal sale and purchase of organs like kidneys. Dr. Delmonico said the blame also falls on the government, hospitals and medical professionals who may be negligent or complicit in the trafficking.


There are internationally accepted norms for kidney transplant surgeries that most countries follow, including India and Nepal, enforced by domestic laws. In those norms, written consent is required from the donor, in most cases the donor is related to the recipient – close family or relatives, it must be determined that the donor is not under any pressure, or is not obliged to pay money. . they donate their kidney. “Therefore the government has the responsibility, the experts have the responsibility, the hospitals have the responsibility to know about this information,” said Dr. Delmonico said.

“Who is the donor who is currently providing a kidney for this particular recipient? Where do they come from? What is the relationship between that person, the donor, and the recipient? Those are the facts that, in my opinion, are fundamental to making the transplant ethically correct. , “he said.

Kavre district in Nepal is famously known as the 'kidney valley' because dozens of people in the villages voluntarily sold their kidneys for money or were sold and cheated.  Photo credit: Zeba Warsi

Kavre district in Nepal is famously known as the ‘kidney valley’ because dozens of people in the villages voluntarily sold their kidneys for money or were sold and cheated. Photo credit: Zeba Warsi

Nepali officials told the NewsHour that every victim they spoke to was taken to the same hospital in India — the Rabindranath Tagore International Institute for Cardiac Sciences, a hospital that used to be primarily used for illegal kidney transplants. However, he has never been prosecuted by the Indian authorities.

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“We wrote to the regional authorities at that time and until now we have not received any information from them. And when a hospital is repeatedly in the news, it seems clear that there is a problem,” said Dr. Sanjay Nagral, a transplant specialist, Mumbai.

Dr. Sanjay Nagral is the co-chairman of the Istanbul Declaration Group, a global association of experts from more than 100 countries on organ trafficking that sets international norms for the transplant procedure. He said most cases of kidney trafficking in Nepal end up in hospitals in India. And there is big money to be made in the illegal buying and selling of organs.

“A lot of transfers in South Asia, including India, are done in the private sector and involve a lot of money. So the market drug rules apply to transfers even more strictly or aggressively. The big money is in ride on that and then there are people who need rich kidneys and are willing to pay whatever it takes for a healthy kidney,” Dr. Nagral said. At press time, NewsHour’s calls and emails to hospital officials and health officials in India went unanswered.

For years, poverty and desperation have forced people to sell their kidneys to dealers who make money on the kidney black market in India. This is part of the larger problem of human trafficking in Nepal: According to the latest government report, 35,000 Nepali men, women and children are ‘sold’ into a form of modern slavery and sex trafficking every year.

While there is a huge demand for kidneys in India, its poor neighbor Nepal is prey to traffickers who either convince young people in Nepal to sell their kidneys for a quick buck, or trick them into doing so, as they did with Santosh.

Nepal has a troubled history with the illegal ‘sale’ of kidneys. Kavre district in Central Nepal is known as the ‘kidney valley’. In the last two decades, dozens of men from villages there have either voluntarily gone to India to sell their kidneys, or have been trafficked and cheated.

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

Murari Kharel, Nepal’s National Human Rights Commissioner, said the damage was a result of years of isolation. And the governments of India and Nepal and humanitarian agencies are declining. “The government should pay more attention to this. Even human institutions could not warn those villages and support them. For a long time, they have been neglected” and citizens are more vulnerable to becoming victims of illegal schemes, Kharel said.

69 year old Kaaliya is worried about her son who sold his kidney due to poverty.  Photo credit: Zeba Warsi

69 year old Kaaliya is worried about her son who sold his kidney due to poverty. Photo credit: Zeba Warsi

In the village of Cemdi, which is known as the ‘valley of kidneys’, every other household has at least one person who has already sold his kidney due to financial need. “My eldest son donated his kidney a few years ago. He used to do construction work. Now he is struggling with life, weaker and gets sick easily,” said Kaali, 69, who asked to be identified only by her first name for fear of embarrassment. 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. “Every time he changed his clothes, we could see the operation mark and the grandmother said his kidney had sold,” said 13-year-old Shuddhata.

Shuddhata, who also asked to be identified only by her first name for fear of embarrassment, attends a local school, supported by her sister who works in Kathmandu. He loves singing, loves languages ​​and wants to rewrite the poor fate of his family. Her uncle sold his kidney for only $300.

Just last month, Shuddhata stopped selling her kidney out of desperation. He needed money to start a new business. His little daughter told him about it.

“I cried and cried and all of us in the family asked him not to do that. He is both our mother and father because we don’t have a mother. After many pleas, he finally agreed not to 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. He wants to break free from that tradition and he believes that education is the key.

“I am talking about the sale of kidneys in our village and I know it is because of poverty. Nobody would do something like that if it’s not necessary,” she said. “I think what we need is education. Please help us with education, build us schools, create jobs for us. Therefore, no one should be so desperate to sell their kidney.”


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