Amidst the commotion of beggars and patients outside the crowded hospital, sellers and buyers scrutinize each other: the poor, in search of money for their vital organs, and the critically ill or their loved ones, who looking to buy.
The illegal kidney trade is booming in the city of Herat in eastern Afghanistan, fueled by sprawling slums, surrounding poverty, endless warfare, a business hospital that bills itself as the country’s leading kidney transplant center. And by authorities and doctors who turn a blind eye to organ trafficking.
In Afghanistan, as in most countries, the sale and purchase of organs is illegal, as is the implantation performed by doctors of purchased organs. But this practice remains a global problem, especially when it comes to the kidneys, as most donors can live with just one.
“These people need the money,” said Ahmed Zain Faqiri, a professor looking for a kidney for his critically ill father outside Loqman Hakim Hospital.
It was examined with suspicion by a heavy farmer, Haleem Ahmad, 21, who heard about the kidney market and intended to sell one after his harvest failed.
The consequences will be harsh for him. For the poor kidney sellers recovering in Herat, in cold, dark apartments with peeling paint and cement floors, temporarily free from crushing debt but too weak to work, in pain and unable to pay drugs, the agreement is the gateway to more misery. In one of these places, recently, half a bag of flour and a modest container of rice were the only food for a family of eight children.
For Loqman Hakim Hospital, transplants are a big deal. Authorities boast that the unit has performed more than 1,000 kidney transplants in five years, attracting patients from all over Afghanistan and the global Afghan diaspora. He offers operations for one-twentieth the cost in the United States, in a city with a seemingly endless supply of fresh organs.
When asked if the hospital is making a lot of money from operations, Masood Ghafoori, the CFO, replied: “Can you say yes”.
The hospital takes care of the removal, transplant and initial recovery of both patients, no questions asked. The sellers say their hospital costs are covered by the buyers and after a few days in the recovery lodge they are sent home.
How the organ recipient gets the donor to accept the procedure is not a hospital concern, doctors say.
“It’s not our job,” said Dr Farid Ahmad Ejaz, whose business card says in English “Founder of kidney transplantation in Afghanistan”.
Ejaz first claimed that more than a dozen poor Herat residents were lying when they told the New York Times that they had sold their kidneys. He later admitted that “maybe” they weren’t. Interviews with other health officials followed the same path: initial refusals, followed by reluctant admissions.
“In Afghanistan everything has value except human life,” said Dr Mahdi Hadid, member of the Herat Provincial Council.
Reports of organ sales date back to the 1980s in India, according to the UN, and today the practice accounts for around 10% of all transplants worldwide. Iran, within 130 km of Herat, is the only country where the sale of kidneys is 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, professor at the Herzliya Interdisciplinary Center, a university in Israel, stressing that Afghanistan is a new player compared to countries where organ trade is concerned. most prolific: China, Pakistan and the Philippines. “The current international consensus is in favor of the ban, but governments are urged not to follow it.”
The moral scruples which keep the matter hidden elsewhere are not evident in Herat. Ejaz and health officials emphasize the harsh logic of poverty.
“Afghans sell their sons and daughters for money. How does that compare to selling kidneys?” He asked. “We have to do it because someone is dying.”
Ejaz looked calm when I showed him a kidney “broker” card. He said: “In Afghanistan you find maps for people who murder others.”
On the fourth floor of the hospital, three out of four recovering patients say they bought their kidneys. “I feel good now,” said Gulabuddin, an imam [sacerdote muçulmano] 36-year-old from Kabul, who received a kidney. “No pain.”
He said he paid around $ 3,500 (R $ 18,900) for the organ, bought from a “totally unknown” person, with a commission of $ 80 (R $ 432) for the middleman. He got a good deal: a kidney can cost up to $ 4,500.
“If there is consent, Islam has no problem with it,” Gulabuddin said.
Dr Abdul Hakim Tamanna, director of public health for Herat province, admitted the growth of the parallel kidney 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 rule of law and a lack of regulation around this process.”
Afghanistan’s poverty rate is expected to reach 70 percent by 2020, according to the World Bank, and the country remains heavily dependent on foreign aid; domestic revenues only finance half of the state budget. Without a substantial public safety net, healthcare is just another opportunity to explore the country’s most vulnerable.
In the labyrinth of sandy streets of the Herat slums, Mir Gul Ataye, 28, regrets every second his decision to sell one of his kidneys. A construction worker who earned up to US $ 5 (R $ 27) a day before the operation in November, he can now barely lift 5 kilos.
“I feel pain, weakness,” he says. “I am sick and cannot control my urine.”
Four children were gathered in front of him on the cement floor in a dimly lit room. He said he supported 13 members of his family and had accumulated about $ 4,000 in debt.
“It was difficult, but I had no choice. No one wants to give another person a part of their body,” he said. “It was very shameful for me.”
For his kidney, Ataye received US $ 3,800 (R $ 20,500). It was barely three months ago. He remains in debt, unable to pay his rent or his electricity bill. He says he feels “sadness, despair, anger and loneliness”. One night, he felt a lot of pain, banged his head against the wall and broke his skull.
Others in Herat mentioned similar reasons for selling a kidney: overdue debts, sick parents, an impossible marriage. “My father would have died if we hadn’t sold,” said Jamila Jamshidi, 25, sitting on the floor next to her brother Omid, 18, in a frozen apartment on the outskirts of town.
They had both sold kidneys – her five years ago and he a year ago – and both were weak and painful.
In a mud-walled camp near Herat, a swirl of sun, wind and dust full of war refugees from other provinces, Mohammed Zaman, an elderly man in a white turban, spoke of the overwhelming allure of the city. kidney operation in Loqman Hakim. More than 20 people from his village, now evicted from their homes, had sold their kidneys.
“My people are hungry. We have no land. We cannot have stores. We have no money,” he said. “I can’t stop this.”
At a local restaurant, five brothers said they would be forced to sell land in Badghis province due to constant Taliban attacks. Everyone had sold kidneys to Herat. 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 wouldn’t even have sold a nail.”