Pervaiz Masih, 32, is taking particular care of his diet these days. "I try to eat some meat and drink at least one glass of fruit juice a day. I need to be healthy because then it is more likely someone will buy my kidney," he told IRIN.
Masih, a labourer, earns about Rs 4,000 (about US$50) a month. With three children to support, he says it is impossible to survive on his income (and that of his wife, who earns Rs 2,000 a month as a domestic helper).
The family has accumulated heavy debts, owed to neighbours, relatives and shopkeepers. "The only way I can pay off these debts of around Rs 100,000 [US$1,250] is if I sell a kidney. I have been in touch with some agents from a hospital in Lahore and have been told I could get Rs 200,000 [about $2,500] or even more if a wealthy Pakistani or foreigner buys my kidney."
Before September 2007, Pakistan was known as a major world centre for “renal tourism”. The lack of laws governing the donation and transplant of kidneys made it easy for people needing a new organ to visit Pakistan and buy one - usually from destitute people desperate for cash.
"My nephew - 24 years old at the time - sold a kidney in 2004, though all his family advised him against it. He had wanted to buy a motorbike," said Sumera Khatoon, 60, from a village near the central Punjab town of Sargodha.
"Now, four years later, he is still jobless and still impoverished. He has multiple health problems and cannot do heavy physical work," Khatoon said.
Such accounts are borne out by academic studies.
Writing in Transplant International, the official journal of the European Society for Organ Transplantation, researchers from the Karachi-based Sindh Institute of Urology and Transplantation (SIUT) noted in July 2007 that a survey of 239 kidney vendors from Punjab (90 percent of them illiterate) found 88 percent reported no economic improvement in their lives and 98 percent reported worsened health. Sixty-nine percent of vendors were bonded labourers; 93 percent of the vendors needed the money to repay debts.
|Selling one's kidney leaves behind a physical scar, poor health and no economic improvement, studies say|
The ushering in of the Human Organs and Tissues Transplant Ordinance in September 2007 offered hope this situation would change. The new law made it a criminal offence to buy or sell human organs and laid down tough conditions for the transplant of kidneys between unrelated persons.
However, the jury is still out on the law’s success. "I know colleagues who remain engaged in the kidney trade because it is so profitable, but after the passage of the law it has become harder to obtain a kidney. Some doctors that I know were engaged in such practices were threatened with police action," Jaffar Malik (not his real name), a Lahore-based urologist, said.
"Even now people from the Middle East or Europe buy kidneys here, although the costs are higher than before," he said.
There are now fears the gains made under the 2007 law may soon be reversed. Several members of Pakistan's parliament have proposed amendments that experts fear will pave the way for the kidney trade to flourish once more.
The director of SIUT, which had campaigned for the 2007 law to be brought in, Adibul Hasan Rizvi, said some parliamentarians wanted to see the terms “half brother” and “half sister” added to the definition of “close blood relatives”, thus creating loopholes enabling illegal sales to be more easily made.
The number of kidneys sold illegally each year in Pakistan is unknown. The World Health Organization (WHO) estimated annual sales to “kidney tourists” were about 1,500 before 2007. Others believe the figure was much higher.
Agents - linked to hospitals - scout rural areas for donors, earning their cut from any sales.
"Such middle-men come to our houses too. So far, none of our relatives have sold a kidney. But who knows - times are so hard we may eventually need to do so," said Abdul Rehman, 35, who lives in the Shahdra area of Lahore.
Oxfam, the UK-based charity, reported earlier this month that 17 million more Pakistanis had fallen into poverty as a result of food price hikes.