KALAI (Bangladesh) • After years of crippling debt, Bangladeshi villager Rawshan Ara decided to follow in her family's footsteps - and sell a kidney on the black market to raise cash.
Like many of her neighbours in the poor farming area, the 28-year-old easily found a local broker and became a victim of the thriving but illegal organ trade.
The mother-of-one insisted her relatives warned her against having the surgery in February, after suffering complications from their own operations two years ago.
"But I was tired of poverty," Ms Ara said in Kalai district, which has become a hot spot for the racket.
"My husband is perennially sick. My daughter's education became costly. I went to Dhaka to be a maid or garment worker. But the wages were abysmal," she said, declining to give the name of her broker.
The police, however, tell a different story. They suspect the relatives talked her into going ahead with the operation - part of a growing web in Kalai of donors who become brokers, taking a commission for anyone they successfully recruit. "This year alone, 40 people from Kalai have sold their kidneys," said local police chief Sirajul Islam, adding that the figure had been 200 villagers since 2005.
Another 12 villagers are currently missing, suspected to have travelled across the border to Indian hospitals to have the operation.
Almost every household in Kalai, 300km north-west of Dhaka, has someone with the telltale, foot-long scar from the operation.
"Those who have sold kidneys have themselves turned brokers and agents, and become part of this huge organ trade network," said the police chief.
Some eight million Bangladeshis suffer from kidney disease, and at least 2,000 a year need transplants. But kidney donation is legal only between living relatives, resulting in a chronic shortage. A lucrative black market has filled the void, with a steady stream of desperate buyers, and equally desperate and poor donors.
"A donor can easily convince a potential seller that he/she has nothing to lose," said Dr Moniruzzaman Monir of Michigan State University, who has done extensive research in Kalai.
Bangladesh nephrologist Mustafizur Rahman said: "This racket has a lot of influential people on their payrolls.
"They can easily prepare all papers, including fake passports and national identity cards, in order to facilitate unlawful transplants."
Last month, police cracked down on the trade, arresting a dozen people in Kalai and Dhaka.
They were spurred into action after a criminal gang cut out a six-year-old boy's kidney and dumped his body in a pond.
The local authorities have also launched campaigns warning of the dangers but many doubt much will change, saying previous efforts have failed, thanks to an inefficient criminal justice system.
Ms Ara was paid US$4,500 (S$6,300), which she spent on leasing farmland to grow potatoes and rice. She also hired tutors for her 13-year-old daughter.
But she can no longer lift heavy objects, tires easily and often struggles to breathe. "Selling the kidney was a big mistake. I need costly medicine to stay well," she said.
One of her neighbours got US$5,350 for selling his kidney in Sri Lanka. But the 21-year-old has been hospitalised three times in the last six months with complications. Said Ms Ara: "I am lucky the buyer of my kidney paid for the treatment. But I know many villagers who got only a pittance. They are facing a slow death."