[Widespread
poverty and an ambitious private hospital are helping to fuel an illegal market
— a portal to new misery for the country’s most vulnerable.]
By Adam Nossiter and Najim
Rahim
The
illegal kidney business is booming in the western city of Herat, fueled by
sprawling slums, the surrounding land’s poverty and unending war, an
entrepreneurial hospital that advertises itself as the country’s first kidney
transplantation center, and officials and doctors who turn a blind eye to organ
trafficking.
In
Afghanistan, as in most countries, the sale and purchase of organs is illegal,
and so is the implanting of purchased organs by physicians. But the practice
remains a worldwide problem, particularly when it comes to kidneys, since most
donors can live with just one.
“These
people, they need the money,” said Ahmed Zain Faqiri, a teacher seeking a
kidney for his gravely ill father outside Loqman Hakim Hospital. He was eyed
uneasily by a strapping young farmer, Haleem Ahmad, 21, who had heard of the
kidney market and was looking to sell after his harvest had failed.
The
consequences will be grim for him. For the impoverished kidney sellers who
recover in frigid, unlit Herat apartments of peeling paint and concrete floors,
temporarily delivered from crushing debt but too weak to work, in pain and
unable to afford medication, the deal is a portal to new misery. In one such
dwelling, a half-sack of flour and a modest container of rice was the only food
last week for a family with eight children.
For
Loqman Hakim Hospital, transplants are big business. Officials boast it has
performed more than 1,000 kidney transplants in five years, drawing in patients
from all over Afghanistan and the global Afghan diaspora. It offers them
bargain-basement operations at one-twentieth the cost of such procedures in the
United States, in a city with a seemingly unending supply of fresh organs.
Asked
if the hospital made good money from the operations, Masood Ghafoori, a senior
finance manager, said: “You could say that.”
The
hospital handles the removal, transplant and initial recovery of both patients,
without asking questions. Sellers say their hospital fees are covered by the
buyers, and after a few days in the recovery ward, they are 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
not our business,” said Dr. Farid Ahmad Ejaz, a hospital physician whose
business card reads “Founder of Kidney Transplantation in Afghanistan” in
English.
Dr.
Ejaz at first contended that more than a dozen impoverished Herat residents
were lying when they told The Times of selling their kidneys for cash. Later,
he conceded that “maybe” they were not. Interviews with other health officials
here followed the same arc: initial denials, followed by grudging
acknowledgment.
“In
Afghanistan everything has a value, except human life,” said Dr. Mahdi Hadid, a
member of Herat’s provincial council.
Accounts
of organ selling date back to the 1980s in India, according to the United Nations, and today the practice
accounts for roughly 10 percent of all global transplants. Iran, less than 80
miles from Herat, is the only country where selling kidneys is not illegal, as
long as the parties are Iranian.
“There’s
always a gap between international guidelines and what governments do in
practice,” said Asif Efrat, a faculty member at the Interdisciplinary Center
Herzliya, a university in Israel, pointing out that Afghanistan is a new player
compared to the countries where the organ trade is most prolific: China,
Pakistan, and the Philippines. “The current international consensus is on the
side of prohibiting, but governments have incentives not to follow it,” he
said.
The
moral scruples that keep the business underground elsewhere are hardly evident
in Herat. Dr. Ejaz and health officials point to poverty’s harsh logic. “The
people of Afghanistan sell their sons and daughters for money. How can you
compare that to selling kidneys?” he asked. “We have to do this because someone
is dying.”
Dr.
Ejaz seemed unfazed when shown the business card of a kidney “broker,” saying,
“In Afghanistan you find business cards for people to assassinate others.”
On
the fourth floor of the hospital, three out of four patients in recovery said
they had bought their kidneys.
“I
feel fine now,” said Gulabuddin, a 36-year-old imam an kidney recipient from
Kabul. “No pain at all.” He said he had paid about $3,500 for his kidney,
bought from a “complete stranger,” with an $80 commission to the broker. He got
a good deal: Kidneys can cost as much as $4,500.
“If
there is consent, Islam has no problem with it,” Gulabuddin said.
Dr.
Abdul Hakim Tamanna, Herat Province’s public health director, 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’s a lack of rule of law, and
a lack of regulation surrounding this process.”
Afghanistan’s
poverty rate was expected to reach over 70 percent in 2020, according to the
World Bank, and the country remains largely dependent on foreign aid; domestic
revenues finance only about half the government budget. Without any substantive
public safety net, health care is just another opportunity to exploit the
country’s most vulnerable.
Deep
inside the warren of sandy streets in Herat’s slums, Mir Gul Ataye, 28, regrets
every second of his decision to sell his kidney. A construction worker who had
earned up to $5 a day before his operation last November, he is now unable to
lift more than 10 pounds, and barely that.
“I’m
in pain, and weak,” he said. “I’ve been sick, and I can’t control my pee.” Four
children huddled in front of him on the concrete floor in the bare unlit room.
He said he supports 13 family members in all, and had accumulated some $4,000
of debt.
“It
was difficult, but I had no choice. Nobody wants to give up a part of his body
to someone else,” he said. “It was very shameful for me.”
For
his kidney, Mr. Ataye received $3,800. That was barely three months ago. He is
still in debt, unable to pay his rent or his electricity bill.
He
said he feels “sadness, desperation, anger and loneliness.” One night he was in
such severe pain, he banged his head against the wall and fractured his skull.
Others
around Herat cited similar reasons for selling a kidney: outstanding debt, sick
parents, a marriage that would otherwise have been unaffordable.
“My
father would have died if we had not sold,” said Jamila Jamshidi, 25, sitting
on the floor across from her brother, Omid, 18, in a frigid apartment near the
city’s edge. Both had sold their kidneys — she, five years ago, and he, one
year ago — and both were weak and in pain.
At
a mud-walled camp just outside Herat, a vortex of sun, wind and dust filled
with war refugees from other provinces, Mohammed Zaman, a tribal elder in a
white turban, spoke of the irresistible attraction of Loqman Hakim’s kidney
operation. More than 20 from his village, now chased from their homes, had sold
their kidneys.
“My
people are hungry. We don’t have land. We can’t be shopkeepers. We’ve got no
money,” he said. “I can’t stop it.”
At
a local restaurant, five brothers spoke of being forced off their land in
Badghis Province by constant Taliban attacks. In Herat, all had sold their
kidneys. The youngest was 18, the oldest 32.
“We
had no choice,” said Abdul Samir, one of the brothers. “We were forced to sell.
Otherwise, we would not have sold a fingernail.”
Asad
Timory and Kiana Hayeri contributed reporting.
