A Kuwaiti recipient, a Pakistani donor; an Israeli recipient, a Ukrainian donor; an American recipient, an Indian donor; and so on - the global dimensions of organ trafficking were exposed in shocking detail at an international summit on the subject at the Pontifical Academy of Sciences at the Vatican in February.

Every region, encompassing more than 50 countries, was represented; disturbing accounts emerged of organs being traded in every corner of the world, with medical professionals, police, middlemen ("agents"), immigration officials, et cetera, all playing a role.

There are two elements that underpin this transnational racket - greed and poverty.

There is no shortage of either in the sub-continent. A woman in Karachi looking for a liver donor for her father was horrified to find that a prospective candidate had already sold one of his kidneys.

In India, a labourer was persuaded to sell a kidney by three doctors at a private hospital who told him that it "was like donating blood". He went ahead with it and, over time, became an agent himself. In the Bangladeshi village of Tebaria, the body of a six-year-old boy was discovered some days after his kidnapping, with both his kidneys removed.

Yet all these countries have laws against organ trafficking.

The practice has been illegal since 1994 in India, and since 1999 in Bangladesh, where punishment for organ trade is between three to five years imprisonment and a fine of around US$3,850 (S$5,300).

Pakistan's legislative history on the issue began with an ordinance in 2007 that was legislated on by Parliament in 2010 as the Transplantation of Human Organs and Tissues Act 2010.

This law prescribes imprisonment of up to 10 years, and loss of licence for the medical personnel involved. The problem in all these countries, where the state does not expend itself in protecting the poor, is lack of implementation.

That has had a number of adverse consequences and the situation in Pakistan is a good illustration.

For one thing, pushing the racket underground has made it ever more lucrative. From US$5,000 earlier, transplants now cost between US$15,000 and US$20,000. And that is only for locals; those who come from outside Pakistan to buy an organ and undergo the procedure in the country - known as transplant tourists - can expect to pay up to US$100,000.

Not realising that he was speaking to an undercover journalist, a doctor at Rawalpindi's Kidney Centre, long notorious for organ trafficking, told Dawn: "Unrelated donors become a complicated issue; there are lots of legal aspects which we have to cover. Because of all this, the cost has gone up."

A number of creative solutions have been found to evade the law in Pakistan.

The transplants usually take place in the dead of night, in rented villas where rooms are prepared as operation theatres. Agents, who scour the countryside looking to lure people into selling their organs, change their mobile numbers frequently and smuggle people to the locations where their transplants are to be carried out.

At the same time, the clandestine nature of the business means that the quality of transplantation has deteriorated sharply.

In an e-mail exchange with Dawn, Dr Mustafa al-Mousawi, president of the transplantation society in Kuwait, said that most Kuwaiti patients who have undergone transplantation in Pakistan are sent home soon after surgery, "often with catheters and drains still in place".

Needless to say, such a modus operandi is extremely dangerous for transplant patients, whose immune systems are deliberately suppressed to reduce the chances of the body's natural response of rejecting the transplanted organ.

But the treatment given to the so-called donors is far worse.

These are desperately poor people, many of them bonded labourers trying to pay off crushing debts that keep them in servitude for generations.

The unscrupulous individuals in the organ trade consider them no more than mere commodities.

Unbeknown to her, a woman known as Halima was in her third month of pregnancy when she sold her kidney. No one bothered to give the young married woman a pregnancy test; if they had discovered that she was with child, they did not bother to inform her.

Also, donors are usually dispatched - by public transport - to their home village between 48 and 72 hours after their kidneys have been harvested, with no more than a few painkillers.

If their stitches become septic, or some other complications occur, they are on their own. Health facilities in most rural parts of Pakistan are substandard, if they exist at all. What better evidence can there be of the callousness of organ traffickers?

For urologists such as Dr Adib Rizvi, who heads the Sindh Institute of Urology and Transplantation in Karachi, which is at the forefront of the campaign for ethical transplantation practices in Pakistan, the donor is even more important than the recipient.

At the institute, donors are discharged after no less three days, that too only if they are healthy and have easy access to medical facilities. Nevertheless, the institute sees donors as a lifelong responsibility and continues to monitor their health through regular check-ups so that their remaining kidney continues to function properly.

Meanwhile, the impunity with which organ traffickers operate means that those who need a transplant often opt for purchasing an organ (sometimes at the suggestion of their own doctors), rather than testing for a compatible donor within the family, the legally permissible route.

The organ trade also undermines efforts by advocacy groups to promote deceased organ donation, which is the way forward to ensure that more organs become available for ethical transplantation. In fact, the shortage of organs is used by unscrupulous doctors to cloak their contempt for humanity in the garb of social service.

Objections to deceased organ donation on religious grounds are unfounded - many Muslim countries, including Saudi Arabia, allow the practice. There have been a number of fatwas by religious scholars stating that the medical procedure does not violate Islamic tenets.

Despite this, there have so far been fewer than 10 instances of deceased organ donation in Pakistan, where 150,000 people die of end-stage organ failure every year. In Bangladesh, there is no deceased organ donor programme yet.

India, which sees 500,000 people dying each year while waiting for transplants, is showing some results, even though the overall rate of 0.5 donor per one million people is far below that of many countries in the West.

In Pakistan, there have recently been some encouraging developments after the country's Federal Investigation Agency (FIA), less prone to being compromised than the local police, acquired the mandate to take action against this crime.

On April 29, an FIA team carried out a raid on a rented house in the city of Lahore while two transplants were in progress.

Two doctors and paramedics were arrested at the scene.

The two patients were Omani nationals and their donors were, not surprisingly, poverty-stricken Pakistanis - one a labourer and the other a 20-year-old woman, both of whom had sold their organs to pay off debt. The ruthless greed of the traffickers can be gauged from the fact that one of the doctors caught red-handed carrying out an operation was not even a kidney specialist: He was a plastic surgeon.

• The writer heads Dawn's investigation unit. This is a series of columns on global affairs written by top editors and columnists from members of the Asia News Network and published in newspapers and websites across the region.