Pakistan's victims of the 'kidney bazaar'

NASSEM Kausar has done it. So, she says, have her sister, six brothers, five sisters-in-law and two nephews.

Each has sold a kidney to a trade that has led some Pakistanis to dub the country a "kidney bazaar". It even undercuts the Chinese organ business.

"We do this because of our poverty," said Ms Kausar, who is in her 30s and lives with her family in Sultanpur Mor, a village in eastern Pakistan.

A kidney nets the donor 1,300, sometimes less than half that amount, while recipients - about 2,000 a year - pay 3,100 to 6,300, compared with 36,700 in China.

Critics blame an economic system that traps farmers in chronic debt, forcing them to sell their kidneys, and say the trade should be banned. The government says it is taking action.

But now the Belgium-based International Society of Nephrology has suggested expanding the pool of kidney donors by legalising payment of about 20,900 to donors.

At least 20 transplant clinics exist in Pakistan, and 10 per cent of the patients are foreigners, many from the Middle East and "one or two" from Europe, said Bakhsh Ali, a senior official at the Sindh Institute of Urology and Transplantation.

The institute, a free transplant clinic run jointly by the government and private organisations, has joined the call for banning the sale of kidneys.

The government has drafted legislation to "regulate" kidney transplants, monitor surgeries and "encourage family donors", said Health Ministry official Athar Saeed Dil, who has helped draft the proposed law.

He declined to say if an outright ban was planned, but Mukhtar Hamid Shah, a prominent surgeon who opened a transplant centre in 1979, said the government plans to outlaw donations for money by non-family members .

Dr Shah, a former army surgeon, opposes any ban. "We have no interest in whether or not a donor is a relative of the recipient. The patient should have life," he said at his hospital in Rawalpindi, near the capital, Islamabad.

Mr Ali said donors need constant follow-up checks to keep their blood pressure and sugar under control and protect the remaining kidney. But in Jandala, another eastern village, kidney donors said they received no follow-up care.

"I pant. I cannot run. I cannot pick up heavy things," said Allah Yar, a 50-year-old farmer who has suffered poor health for seven years since selling a kidney. The father of six said he needed to pay off a 180,000 rupees (about 1,500) loan to his landlord, but got only about 75,000 rupees (about 600) for his kidney, meaning he remains deep in debt.

Sitting nearby, Mohammed Akram, a 22-year-old brick kiln worker, said he sold his kidney to pay off his father's debt.

"I cannot work like I did before. I cannot walk. I cannot run," said Mr Akram. "I did this for my father but destroyed myself."

Dr Shah said the government and transplant clinics should form a joint trust to give money to donors and give them post-operative care.

Ahmed Jama, 47, a British national of Somali origin, was recuperating at Dr Shah's clinic after a transplant that cost him 5,200; Dr Shah charges Pakistanis half what foreigners pay.

Describing his meeting with his donor, Mr Jama, a father of six, said: "I thanked him many times. I told him 'you saved my life and starting from today I feel as if we are brothers'."