Brick kiln workers in Pakistan who are burdened with debt are selling their kidneys to repay ever-increasing liabilities. Although this practice has been banned since 2007, cases continue to be reported, indicating that the country’s informal labor system is linked to a widespread illegal organ trafficking network.

Pakistan is estimated to have 20,000 brick kilns employing 4–5 million workers. The vast majority of these workers are locked into a debt-bondage system, where kiln owners provide advance payments in exchange for creating debts. These debts are recorded informally, and interest and additional fees are frequently added, creating obligations that are difficult to escape. In some cases, these debts are passed on to children, who continue working at the same kilns, perpetuating an intergenerational cycle of indebtedness. These workers can also be “sold” along with their debts to other kiln owners, limiting their freedom to leave or change jobs.

With no other means of repaying what they owe, a growing number of these workers are resorting to selling their kidneys. This activity is part of a broader international market. Pakistan, along with several other Asian countries, has been identified as a key hub in the illegal global organ trade industry, which is estimated to be worth between US$840 million and US$1.7 billion annually.

Brick kiln workers are not the only victims of this trade in Pakistan. Agricultural workers (including those in citrus orchards) and informal rural laborers more generally have also sold their kidneys to pay off debts or cover medical expenses. Like kiln workers, these groups are poorly paid and have limited social protection, leaving them highly vulnerable to being drawn into the trade. By targeting multiple sectors of vulnerable workers, illegal networks maintain a steady supply of donors.

The demand for kidneys is sustained by patients seeking transplants outside legal frameworks. Reports indicate that many recipients are wealthy foreigners, so-called “transplant tourists” who travel to Pakistan to obtain organs through illicit channels. At the height of the trade, some estimates suggested that 50–75% of recipients were foreigners. While these recipients may pay tens of thousands of US dollars for a transplant, donors receive only a fraction of that amount, sometimes less than US$1,000.

Efforts to regulate organ transplantation in Pakistan are ongoing, but results have been inconsistent. In 2023, a bust involving kidney removals came to light, in which a doctor alleged to be the lead surgeon was said to have performed 328 kidney removal operations. While such cases show that authorities are taking action, they also reveal that organized networks continue to operate. These underground networks involve brokers, private clinics, and middlemen.

Overall, the persistence of this trade is driven by structural factors such as poverty, dependence on debt, and uneven law enforcement, which together sustain both the supply of vulnerable donors and the demand from recipients.

Learn more about workers and debt in Pakistan → “What is debt bondage?: Pakistan’s harsh reality”

Learn more about workers’ rights → “Workers’ rights and international reporting”

Brick kiln workers, Pakistan (Photo: ILO Asia-Pacific / Flickr [CC BY-NC-ND 2.0])