Selling kidneys to pay loans

The combination of rising kidney failure cases, and the lack of an organ donation system in the country, is leading to a thriving and growing black market in kidney trade. 

Bhutan Kidney Foundation (BKF) Founder and Executive Director, Tashi Namgay, said that there was one instance where a person was demanding Nu 10 million (mn) for the sale of his kidney. Tashi Namgay said BKF gets queries from donors asking if they will be paid money for the donation, and BKF, as a survey exercise, asks how much money they expect to be paid, after which they quote their different rates for their kidney.

The people selling their kidneys are the economically depressed ones driven to desperation.

As per BKF records, there are people asking for various rates. There are quite a few offering to sell their kidney to pay loans. The minimum is Nu 150,000 by a person working as a chef to help clear a loan. The next highest is Nu 500,000 by a private businessman donor wanting to help clear a loan. There is one more private businessman wanting Nu 700,000 for his kidney to clear a loan. Another is a homemaker willing to sell her kidney for Nu 800,000 to pay a loan. There is another one offering his kidney for Nu 1.3 million to clear a loan.

A former employee wants to sell his kidney for Nu 1.5 mn to clear the same amount to a former employer after crashing his vehicle.

A former travel agent is offering his kidney for Nu 900,000. Another donor wants Nu 1.2 mn. There is one more that needs Nu 1.7 mn as the person needs cash. There is one who is asking for Nu 2 mn.

There are three more donors who want money but are not sure about just how much to charge.

The above include cases of people unable to pay loans and about to be locked up, and so, selling kidneys is seen as the fastest way to get the cash to pay their loans. The above also includes those whose businesses have failed and want the money for a new start.

There are also cases of the unemployed desperate for some money to keep up the high cost of living in Thimphu, and at times, to even keep up with the lifestyle here.

There are even cases where a couple turned up to donate their kidney with either partner willing to donate if their blood group matches.

The above are only a fraction of what is happening on the ground as not all donors approach BKF with demands.

Tashi said these people are in great economic distress, and at times, in tears explaining their story and he even fears they may die by suicide if things get worse for them. Tashi tries and educates them that the selling of kidney is forbidden.

Section 152 of the Penal Code prohibits the buying and selling of organs and section 153 grades it as a misdemeanor.

In a bid to discourage the sale and buying of kidneys, the Health Ministry issued a circular to some media houses saying that advertisements requesting for a kidney donation can only be done after getting clearance from BKF.

Here, BKF Founder Tashi Namgay said that under this system, the patients who need a kidney, first have to try within the family to find a suitable donor, and if the patient cannot get a kidney within the family, then they have to come to BKF to register and bring a letter signed by family members proving this inability, and only after that, BKF can clear the patient’s advertisement in the media.

However, if a family member is willing and the blood group is not matching then they are put in swap cases where the family member’s kidney is given to another patient, and a family member of the other patient with a matching blood group gives a compatible kidney in exchange to the other patient. So far, BKF has facilitated two such cases.

Kidney donors have to be of the same blood group, should not have ailments like diabetes, blood pressure, heart issues, cancer, be below 18 or above 60, should not be pregnant, should not have given birth in the last one year.

Tashi said that in most cases of strangers donating kidneys, usually money is involved behind the scenes in internal agreements between them, but BKF or others cannot prove it as the donor comes as a voluntary donor, and BKF also has no jurisdiction on the issue. There are even cases that patients who get transplants let it slip that they paid for their kidney.

It is not just kidney donors giving their prices, but even patients sometimes ask BKF how much a kidney would cost.

The demand for kidneys is only on the rise. In 1998 there were only two recorded cases of people getting kidney dialysis, but now there are between 450 to 500 people, all of whom need kidney transplants.

Kidney issues are on the rise in recent times with 10 to 14 transplants done in a year, when it was 8 to 10 in the recent past. Just in December, around 5 kidney patients went with their donors for kidney transplant procedure.

Unfortunately, not all kidney patients are eligible for getting transplants. Those with serious comorbidities like cancer, heart issues, active tuberculosis, Hepatitis infection, Liver Alcohol Disease, those above 70 and others cannot get transplant, as the process requires taking strong immuno suppressants which is not for those of weak health.

Globally, the main cause of Kidney ailments is, firstly, prolonged or untreated diabetes, secondly, chronic glomerulonephritis which is when the immune system attacks the kidney after an infection and can even affects the young, and thirdly, hypertension or high blood pressure.

There has not been enough research in Bhutan, but doctors based on biopsy samples are coming across chronic glomerulonephritis, hyper tension and diabetes as causes of kidney ailments.

The rise of kidney issues corresponds with the rise of Non-Communicable Diseases (NCD), and here, the doctor’s advice is to eat a balanced diet, exercise regularly, drink plenty of water and avoid junk food.

The advice is also to go for regular kidney function test screening for those with blood pressure, diabetes, obesity, cancer, and those with kidney stones.

Tashi said a solution to the organ trading issue is an Organ Act that would cover all types of organ donations like kidneys, eyes, liver, etc. He said the Ministry of Health should bring forth such an Act.

Tashi said that Bill would help create and encourage a system of ethical organ donation without money involved. He said in other countries, people can sign up as organ donors and on their death their organs are taken and given to help other patients on the waitlist. He said the Bill could help promote that practice here in Bhutan too. He said this is the need of the hour, as more and more kidney failure cases are coming up.

On why family members are not donating kidneys, Tashi said the first reason is clinical, as the immediate family members may not be matching the blood type or be medically fit or of the right age. The second reason is a fear factor and ignorance that they may not be fine with one kidney or may not be able to work hard, and thirdly, it is a cultural issue where the belief is that donating a kidney may result in rebirth with only one kidney. The fourth reason is that the family member may be an unemployed or unproductive one and so others do not want to help. 

Tashi said that the Je Khenpo had issued a video message saying such cultural beliefs are not true.

One worry is the rise of possible third parties or even organ brokers. Tashi said there were instances where a third person called BKF saying they have a friend who wants to donate a kidney, and what would be the rate. Tashi said the issue has reached the red zone, and something needs to be done.