"I just wanted to own a house and pay off my debts — that's why I decided to sell my kidney," says Zeya, a farm worker in Myanmar. Prices had soared after a military coup in 2021 triggered civil war. He could barely feed his young family and was badly in debt. They all lived in his mother-in-law's house, in a village where thatched houses lined dirt roads, a few hours' drive from the country's largest city, Yangon. Zeya, whose name has been changed to conceal his identity, knew of local people who had sold one of their kidneys. "They looked healthy to me," he says. So he started asking around. He is one of eight people in the area who told BBC Burmese they had sold a kidney by traveling to India. Illegal organ trading is a problem across Asia, and Zeya's story gives an insight into how it takes place. Buying or selling human organs is illegal in both Myanmar and India, but Zeya says he soon found a man he describes as a "broker". He says the man arranged medical tests and, a few weeks later, told him a potential recipient — a Burmese woman — had been found, and that both of them could travel to India for the surgery. In India, if the donor and recipient are not close relatives, they must demonstrate that the motive is altruistic and explain the relationship between them. Zeya says the broker forged a document, which every household in Myanmar must have, listing the details of family members. "The broker put my name in the recipient's family tree," he explains. He says the broker made it appear as if he was donating to someone he was related to by marriage: "Someone who is not a blood relative, but a distant relative". Then, he says, the broker took him to meet the recipient in Yangon. There, he says a man who introduced himself as a doctor completed more paperwork and warned Zeya he would have to pay a substantial fee if he backed out. The BBC contacted this man afterward, who said his role was to check whether a patient was fit to undergo the procedure, not to check the relationship between donor and recipient. Zeya says he was told he would receive 7.5m Myanmar kyats. This has been worth somewhere between $1,700 and $2,700 over the past couple of years — the unofficial exchange rate has fluctuated since the coup. He says he flew to northern India for the operation and it took place in a large hospital. All transplants involving foreign nationals in India must be approved by a panel called an authorization committee, established either by the hospital or by local government. Zeya says he was interviewed, via a translator, by about four people. "They asked me if I was willingly donating my kidney to her, not by force," he says. He says he explained the recipient was a relative and the transplant was approved. Zeya remembers the doctors administering the anesthetic before he lost consciousness. "There were no big issues after the surgery, except that I couldn't move without pain," he says, adding that he stayed in hospital for a week afterward. Another donor, Myo Win — also not his real name — told the BBC he too had pretended to be related to a stranger. "The broker gave me a piece of paper, and I had to memorize what was written on it," he says, adding that he was told to say the recipient was married to one of his relatives. "The person assessing my case also called my mum, but the broker arranged a fake mum for the call," he says. He adds that the person who answered the call confirmed he was donating his kidney to a relative with her permission. Myo Win says he was offered the same amount of money as Zeya, but that it was described as a "charitable donation", and he had to pay the broker about 10% of the amount. Both men say they were given a third of the money up front. Myo Win says this was in his thoughts as he entered the operating theatre: "I made up my mind that I had to do it because I had already taken their money." He adds that he "chose this desperate way" as he was struggling with debt and medical bills for his wife. Unemployment rates have climbed in Myanmar since the coup — the war has ravaged the economy and sent foreign investors fleeing. In 2017, a quarter of the population were living in poverty — but by 2023, this had risen to half, according to the UN's development agency, UNDP. Myo Win says the broker did not tell him selling his kidney was illegal. "I wouldn't have done it if he did. I am afraid of ending up in prison," he says. The BBC is not naming any of the organizations or individuals involved in order to protect the anonymity and safety of the interviewees. However, another man in Myanmar, also speaking anonymously, told the BBC he had helped about 10 people buy or sell kidneys via surgery in India. He said he referred people to an "agency" in Mandalay in central Myanmar, which he said made arrangements. "But don't worry about donors," he said. "We have a list of donors who are queuing up to donate their kidneys." He too said documents were faked to label strangers as related by marriage. When asked whether he received money for his help, he did not answer. Organ transplants have increased by more than 50% worldwide since 2010, with about 150,000 carried out annually, according to the World Health Organization (WHO). But it says the supply of organs meets only about 10% of global need. Trading in human body parts is illegal in nearly all countries and is hard to measure. In 2007, the WHO estimated that 5-10% of transplanted organs came from the black market, but the figure may be higher. Illegal kidney sales driven by poverty have been documented in recent years across Asia, including in Nepal, Pakistan, Indonesia, Afghanistan, India and Bangladesh. India has long been a hub for medical tourism and concern there about kidney sales has been rising, following accounts in media reports and a recent police investigation. Last July, Indian police said they had arrested seven people in connection with an alleged kidney racket, including an Indian doctor and her assistant. Police allege the group arranged for poor Bangladeshis to sell their kidneys, using forged documents to secure approval for the transplants. Dr Vijaya Rajakumari, who had been working at the prestigious Indraprastha Apollo Hospital in Delhi, is alleged to have carried out the operations as a visiting consultant at a different hospital, Yatharth, a few kilometers away. Her lawyer told the BBC the allegations "are entirely baseless and without evidence", that she only carried out surgeries approved by authorisation committees and always acted in accordance with the law. According to her bail order, she is not accused of preparing forged documents. Yatharth Hospital told the BBC all its cases, including those managed by visiting consultants, "are subject to our robust protocols to ensure compliance with legal and ethical standards". "We have further enhanced our processes to prevent any such occurrences in the future," the hospital said. After her arrest, Apollo Hospitals said Dr Rajakumari was a freelance consultant engaged on a fee-for-service basis and it had discontinued all clinical engagements with her. Dr Rajakumari has not been charged in court. Last April, a senior health ministry official wrote to Indian states warning of a "surge" in transplants involving foreigners and calling for better monitoring. Under Indian law, foreign nationals who wish to donate or receive organs must have their documents, including those showing the relationship between donor and recipient, verified by their own country's embassy in India. The BBC contacted India's heath ministry and the National Organ and Tissue Transplant Organization, as well as Myanmar's military government for comment, but has received no response. A public health campaigner in Myanmar, Dr Thurein Hlaing Win, said: "Law enforcement is not effective." He added that potential donors need to be aware of the risks, including of bleeding during surgery and damage to other organs, adding that proper follow-up care is needed. The BBC last heard from Zeya several months after his surgery. "I was able to settle my debts and bought a plot of land," he said. But he said he couldn't afford to build a house and had not been able to construct one while recovering from the surgery. He said he had been suffering from back pain. "I have to restart working soon. If the side effects strike again, I have to deal with it. I have no regrets about it," he added. He said he stayed in touch with the recipient for a while, and she had told him she was in good health with his kidney. Speaking on condition of anonymity, she told the BBC she paid 100m kyats (between around $22,000 and $35,000 in recent years) in total. She denied that documents were forged, maintaining that Zeya was her relative. Six months after his surgery, Myo Win told the BBC he had paid off most of his debts, but not all. "I have no job and not even a penny left," he said, adding that he had been experiencing some stomach problems since the surgery. He said he had no regrets, but then added: "I am telling other people not to do this. It is not good." — BBC
