Kavre province in Nepal has been dubbed “Kidney valley”: there’s hardly a household in which a family member hasn’t sold his or her kidney on the black market. There is no legal way for patients to obtain donor organs other than from a relative. In the absence of a suitable familial match, the patient’s only chance of survival is to turn to the underground organ trade.

Sitamaya Tamang from Hokse village sold her kidney for $1,500 to build a house. A devastating earthquake in 2015 reduced her newly-built home to rubble.

Related: Childless couples hire surrogate mothers in India

Grim dealers exploit the region’s extreme poverty and the people’s lack of education about health and medicine. Many victims have been told that the process would have no impact on their health and even that a kidney would grow back. Desperate to escape debt and support their families, impoverished villagers have agreed to the irreversible surgery, only to be hugely underpaid and left with their health irreparably damaged.

Organ donors often deal with serious health complications.

Related: A whole village succumbed to a mysterious sleeping disease

While Nepal’s transplant patients often have no way to obtain life-saving organs, other than the black market, naïve and underprivileged villagers are easy prey for organ dealers who turn a tidy profit from the devastating trade. Ironically many of them started in the business by selling one of their own organs. RT Doc meets people from all sides of the illegal organ market to ask how and why it has reached today’s appalling levels.