HERAT, Afghanistan – In the midst of the hustle and bustle of beggars and patients outside the crowded hospital, there are sellers and buyers looking at each other suspiciously: the poor looking for money for their vital organs, and the seriously ill or their surrogate mothers looking for something to buy.
The illegal kidney business is booming in the western city of Herat, fueled by sprawling slums, poverty and endless war in the surrounding country, an entrepreneurial hospital bidding as the country’s first kidney transplant center, and officials and doctors turning a blind eye to organ trafficking.
In Afghanistan, as in most countries, the sale and purchase of organs is illegal, as is the implantation of purchased organs by doctors. However, the practice remains a worldwide problem, particularly with respect to the kidneys, as most donors can live with just one.
“These people need the money,” said Ahmed Zain Faquiri, a teacher who is looking for a kidney for his seriously ill father in front of Loqman Hakim Hospital. Walim Ahmad, 21, who had heard of the kidney market and was about to sell after his harvest failed, eyed him uncomfortably.
The consequences will be dire for him. For the impoverished kidney vendors recovering in cold, unlit Herat apartments with peeling paint and concrete floors that have been temporarily freed from debt but are too weak to work, in pain and unable to afford medication, the deal is a portal for new misery. In one such apartment, half a sack of flour and a modest container of rice were the only food for a family with eight children last week.
Transplants are big business for Loqman Hakim Hospital. Officials boast more than 1,000 kidney transplants in five years, involving patients from across Afghanistan and the global Afghan diaspora. It offers them bargain deals at one-twentieth the cost of such procedures in the United States in a city with a seemingly endless supply of fresh organs.
When asked if the hospital made good money from the operations, Masood Ghafoori, a senior finance manager, said, “You could say that.”
The hospital takes care of the removal, transplant, and initial recovery for both patients without asking questions. Sellers say their hospital fees will be covered by the buyers and after a few days at the recovery center they will be sent home.
How the organ recipient gets the donor to agree to the procedure is not the hospital’s concern, the doctors say.
“It’s none of our business,” said Dr. Farid Ahmad Ejaz, a hospital doctor whose business card reads “Founder of Kidney Transplant in Afghanistan”.
Dr. Ejaz initially claimed that more than a dozen impoverished Herat residents lied when they told The Times that they had sold their kidneys for cash. He later admitted that “maybe” wasn’t the case. Interviews with other health officials here followed the same arc: initial denials, followed by reluctant appreciation.
“Everything has value in Afghanistan except human life,” said Dr. Mahdi Hadid, member of the Herat Provincial Council.
According to the United Nations, reports of organ sales in India date back to the 1980s, and today the practice accounts for around 10 percent of all global transplants. Iran, less than 80 miles from Herat, is the only country where kidney sales are not illegal as long as the parties are Iranian.
“There is always a gap between international guidelines and what governments do in practice,” said Asif Efrat, a faculty member at the Herzliya Interdisciplinary Center, a university in Israel, pointing out that Afghanistan compares to the countries in which it is located Organ trafficking is taking place, a new player is most productive: China, Pakistan and the Philippines. “The current international consensus is on the ban side, but governments have incentives not to follow it,” he said.
The moral scruples that keep business underground elsewhere are barely noticeable in Herat. Dr. Ejaz and health officials point out the hard logic of poverty. “The people in Afghanistan sell their sons and daughters for money. How does that compare to selling kidneys? “He asked. “We have to do this because someone is dying.”
Dr. Ejaz seemed unimpressed when he was shown the business card of a kidney broker: “In Afghanistan there are business cards with which people can murder others.”
On the fourth floor of the hospital, three in four recovering patients said they had bought their kidneys.
“I’m fine now,” said Gulabuddin, a 36-year-old imam, a kidney recipient from Kabul. “No pain at all.” He said he paid about $ 3,500 for his kidney that he bought from a “total stranger” with a $ 80 commission to the agent. He did a good deal: kidneys can cost up to $ 4,500.
“If there is approval, Islam has no problem with it,” said Gulabuddin.
Dr. Herat Province Public Health Director Abdul Hakim Tamanna acknowledged the rise of the kidney black market in Afghanistan but said there was little the government could do.
“Unfortunately, this is common in poor countries,” he said. “There is a lack of the rule of law and a lack of regulation related to this process.”
According to the World Bank, the poverty rate in Afghanistan is set to reach over 70 percent by 2020 and the country remains largely dependent on foreign aid. Domestic revenue only finances around half of the state budget. Without a substantial public safety net, healthcare is just another opportunity to take advantage of the most vulnerable people in the country.
Mir Gul Ataye, 28, regrets every second of his decision to sell his kidney deep in the maze of sandy streets in Herat’s slums. As a construction worker who made up to $ 5 a day prior to his surgery last November, he can now lift no more than 10 pounds, and hardly can.
“I am in pain and weak,” he said. “I’ve been sick and can’t control my piss.” Four children huddled in front of him on the concrete floor in the bare, unlit room. He said he supported a total of 13 family members and had around $ 4,000 in debt.
“It was difficult, but I had no choice. Nobody wants to give any part of their body to someone else, ”he said. “It was very embarrassing for me.”
Mr. Ataye received $ 3,800 for his kidney. That was almost three months ago. He’s still in debt and can’t pay his rent or electricity bill.
He said he felt “sadness, despair, anger and loneliness”. One night he was in such severe pain that he hit his head against the wall and fractured his skull.
Others around Herat gave similar reasons for selling a kidney: outstanding debts, sick parents, a marriage that would otherwise have been unaffordable.
“My father would have died if we hadn’t sold,” said Jamila Jamshidi, 25, who was sitting on the floor across from her brother Omid, 18, in a cold apartment on the outskirts of town. Both had sold their kidneys – she five years ago and he a year ago – and both were weak and in pain.
Mohammed Zaman, a tribal elder in a white turban, spoke of the irresistible attraction of Loqman Hakim’s kidney surgery in a mud-walled camp just outside Herat, a vortex of sun, wind and dust filled with war refugees from a neighboring province . More than 20 from his village who have now been evicted from their homes had sold their kidneys.
“My people are hungry. We have no land. We can’t be shopkeepers. We don’t have any money, ”he said. “I can’t stop it.”
In a local restaurant, five brothers talked about being driven from their land in Badghis province by constant attacks by the Taliban. In Herat everyone had sold their kidneys. The youngest was 18, the oldest 32 years old.
“We had no choice,” said Abdul Samir, one of the brothers. “We had to sell. Otherwise we wouldn’t have sold a fingernail. “
Asad Timory and Kiana Hayeri contributed to the coverage.