July 27, 2025

Deep in debt, L. Manikandan*, a 36-year-old construction worker and father of three, took a desperate step to secure his family's financial future. Struggling with inadequate monthly earnings, he turned to a relative for assistance, leading him down a perilous path where he ultimately sold his kidney for ₹4.50 lakh through a dubious network. Manikandan's journey began in Samandur, Namakkal district, where mounting debts drove him to consider options that his father had taken years earlier. Despite the emotional weight of this decision, he could see no other way to manage his financial crisis. With only about ₹10,000 earned monthly from sporadic work, the pressure to repay loans from multiple microfinance companies became overwhelming. He owed ₹8 lakh, and in desperation, he followed in the footsteps of others in his community who had sold their organs. The following weeks saw Manikandan traversing several private hospitals in search of donors. He encountered brokers who instructed him on every detail, from medical tests to how to present his story to the Authorization Committee overseeing organ transplants. Throughout this process, he was compensated minimally for his efforts, with payments accruing from his hospital visits. Ultimately, he underwent surgery at a private hospital in Tiruchi. Despite his expectations, the financial return was less than promised. A broker withheld ₹50,000 from him under the pretense of commission fees. He returned home not only with diminished health but also faced the persistent demands of creditors seeking immediate repayment. His health deteriorated following the procedure, exacerbating the challenges he faced in providing for his family. The situation in Namakkal is not isolated but part of a broader investigation into an organized syndicate involved in illegal kidney trade, impacting many workers, especially in the powerloom sector. Recent probes by the Directorate of Medical and Rural Health Services (DMS) revealed the complicity of two hospitals, which have since had their kidney transplant licenses suspended. The region echoes a troubling history. A notable kidney racket in Tamil Nadu came to light after the 2004 tsunami when many impoverished individuals sold their kidneys to alleviate their financial burdens. This led to the establishment of Tamil Nadu's Cadaver Transplant Programme in 2008, aimed at promoting deceased organ donations, yet illegal organ trade persists. Previous studies have shown that factors like debt drive many, revealing that 96% of donors sold their kidneys to relieve financial strain. However, many continued to live below the poverty line post-operation, with little to no economic benefit from their decision. M. Ashokan, secretary of the Namakkal District Powerloom Workers Union, explains that this systematic exploitation of vulnerable workers has been ongoing. He highlights how microfinance lending practices have trapped them in cycles of debt, intensifying their susceptibility to brokers offering financial solutions for organ sales. The DMS has confirmed that fake documentation is rampant, allowing brokers and hospitals to sidestep regulations. Previous instances, such as unauthorized renal transplants at private facilities, illustrate the grave lengths to which these networks go to subvert regulations. Authority figures have noted that this issue is compounded by the lack of rigorous inspection of hospitals that perform such operations, allowing malpractice to thrive in secrecy. The concept of 'near relatives' in organ donation laws allows significant loopholes. While stringent measures are proposed, such as comprehensive interviews and documentation verification, the reality is that many unethical transactions occur under the guise of legality. Critics argue that existing laws offer insufficient protections for donors. A recent court ruling could exacerbate these issues by limiting the oversight capability of the Authorisation Committee, permitting claims of affection between donors and recipients to be accepted at face value. This decrease in regulatory scrutiny further emboldens criminal operations that exploit desperation and poverty. In response to growing concerns, the DMS has pledged to enhance surveillance and inspections of hospitals involved in transplants. Yet, the complexity of these illegal networks poses a significant challenge to rooting out corruption, with impoverished populations remaining their primary targets. For individuals like Manikandan, the decision to sell a kidney is not merely a temporary fix but often leads to further financial and health complications, reinforcing a cycle of exploitation within an already vulnerable community. Thus, as the plight of kidney donors is revealed, it underscores a deeper societal issue around poverty, desperation, and the urgent need for systemic reform in health regulations.

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Tags: Organ trade, Kidney donation, Tamil nadu, Poverty, Microfinance,