The overcrowded municipal slums in Aynavaram, India, on the north side of Chennai form one of the nicer kidneyvakkams in the city. View Slideshow CHENNAI, India – Aadil Hospital in Lahore, Pakistan is one of the top medical facilities in the region, rated on par with any hospital in the West, according to the International Organization for Standardization.

Kidney-transplant candidates stuck on a 10-year waiting list in the United States might happily pay a consultant $35,000 or more to book an operation here. Or, they could arrange it themselves for less than half that price.

These days, Aadil openly advertises two packages for transplant patients at steep discounts to the brokered rate: $14,000 for the first transplant, $16,000 for people who need a second organ after the first has failed.

Surgeons, Slums and Money: Organ Trafficking in India Black-Market Scandal Shakes India's Ban on Organ Sales

Inside 'Kidneyville': Rani's Story

Why a Kidney (Street Value: $3,000) Sells for $85,000

The Case for Mandatory Organ Donation

Portrait: A Land Ravaged by Tsunami and Kidney Brokers

Infographic: Where in the World Can I Buy a Heart?

"You do not have to worry about the donor. We shall provide a live donor arranged through a humanitarian organization, which has hundreds," said Abdul Waheed Sheikh, CEO of Aadil Hospital in an e-mail interview with Wired News.

Scarcity has long been a key driver of the global kidney market, but in regions like India, Brazil, Pakistan and China, sellers are dealing with signs of a surplus. Operations that once set back patients tens of thousands of dollars on the black market can now be had for a fraction of the cost in some places.

The price of a kidney transplant at one of the best hospitals in the Philippines, where organ sales are legal, was recently just $6,316, according to a 2005 report by the Philippine Information Agency. That compares to prices as high as $85,000 charged by professional organ hunters who place Western patients with donors from the slums of Manila.

Yet, legalization has seemingly not worked to alleviate the supply shortage for the patient. Legal confusion, fear and an information gap have created a classic arbitrage scenario for connected vendors, and the vast profits available to the middlemen have entrenched market inequities and dented reform efforts, experts say.

Falling prices have hit the lowest end of the chain hardest. In South Asia, sellers work through organ brokers who on average pay only a few thousand dollars for a healthy kidney, assuming they pay at all. And that's despite booming demand. The World Health Organization in 2002 pegged the global number of people suffering from diabetes at 171 million. By 2030 the number will climb to more than 366 million.

"Each country and each region therein has completely different situations than the next one," explained a Los Angeles-based organ finder doing business online at the website liver4you.org, who asked to be identified only as Mitch. "Since most overseas transplants are doctor-controlled, like (from) private medical practice in the United States, there is a wide range in prices ... The donors are in such huge supply where it's legal, like the Philippines, so they have to accept the average of $3,000 (for selling their kidneys)."

Savings are rarely passed on to the buyer. Once the organs move from the streets into the medical supply chain, their value inflates quickly. Mitch said he typically charges between $35,000 and $85,000 for kidney transplants. Depending on where those operations take place, Mitch could clear $25,000 or more per transaction.

"When Iran legalized live donations, they bought the argument that the short supply of kidneys was really only a marketing problem," said Nancy Scheper-Hughes whose nonprofit Organs Watch monitors organ trade around the world. "But by making the government responsible for managing the black-market kidney trade, the so-called transplant coordinators were turned into brokers and kidney hunters – or more accurately into thugs who troll the streets and homeless shelters for people to donate on the cheap."

In Chennai, K. Karppiah is widely considered one of the most active players in the kidney trade, having been fingered by dozens of organ donors from the slums north of the city. He declined requests to be interviewed for this story.

When a reporter visited his house, a man outside was laying asphalt. "Everyone knows Karppiah," he said. "On this street, all the houses are his."

- - -

Scott Carney is an investigative journalist based in Chennai, India.

Comment on this story.

Indians Buy Organs With Impunity

Mystery of the One-Eyed Child

Medical Refugees Flee to India

Stripped for Parts

Homebrew Site Becomes India's Bone Marrow Registry