In Nepal’s Hokse, Kavrepalanchok district, the scars on villagers tell a story of survival: kidneys sacrificed to escape debt. In recent decades, nearly a third of the villagers have travelled to India to sell a kidney. Hokse, now known as “Kidney Village”, is defined by such profound poverty that residents’ resort to selling their organs.
The kidney trade began in the early 1990s. Brokers lured men to India with promises of quick money and risk-free labour. “You have two kidneys; you only need one.” Desperation made the pitch convincing.
As farming declined, a new highway severed the village from its trade routes. Debt and desperation grew. When the first few villagers returned with money, others followed. Brokers, many of whom were former sellers, forged documents and convinced illiterate villagers to sign away organs they barely understood.
The lure was simple: around 150,000 rupees, barely $1,200. For families with nothing, it seemed life-changing. Yet the money rarely lasted. Debts consumed it, new crises emerged, and villagers were left weaker, unable to labour as before. Many kidney sellers later became brokers themselves, both as a means of income and to rationalise their own decisions.
While the economic condition was the driving force, it was not the only factor. Education played a crucial role. Many people in the village have little schooling, making them easy targets for deception. Alcoholism and social imitation normalised kidney selling, pressuring younger villagers to participate. Migration, too, accelerated the trade. Away from home, surrounded by other struggling Nepalis, many fell into networks where brokers circulated freely.
The cultural burden runs deep. In Hokse, the shame of selling a kidney lingers long after the scars heal. Some hide their wounds beneath clothing, while others face quiet whispers in the community. Women who sold kidneys report marital strain, sometimes even rejection. Men who are unable to labour face ridicule. The body, once a source of livelihood, becomes both a stigma and a wound.
Nepal enacted the Human Body Organ Transplantation Act in 1998 to regulate donations, allowing transplants only between close relatives. Despite the law criminalising organ trade, forged documents and bribery enable its continued black market operation. The contrast between law and reality became stark when former Prime Minister KP Sharma Oli received two kidney transplants, one abroad and another in Kathmandu. Villagers often wait years for kidney transplant approval, even from related donors. The law protects those who can afford it, not those who have nothing left to sell.
For most sellers, the trade never delivered escape. Many now live with chronic pain, fatigue, and an inability to perform hard labour. Medical care is expensive, and insurance is nonexistent. The psychological toll is equally deep: guilt, depression, and fractured family relations are common. Social workers characterise Hokse as a community grappling with “collective trauma”, where desperate survival choices have redefined its social structure.
There have been attempts to intervene. Many NGOs have launched campaigns, and journalists have repeatedly exposed the village’s plight. Law enforcement occasionally cracks down on trafficking rings, but prosecutions remain limited compared to the scale of the problem. The government has promised alternative livelihoods and development aid, but lasting change remains slow.
Across South Asia, in parts of India, Bangladesh, and Pakistan, kidney trafficking flourishes in similar ways. The Philippines has seen entire communities caught in the trade. The global demand for organs remains high, and black markets thrive where laws are weak and inequality is sharp. This is not merely a tragic anomaly but a warning.
It’s about the human cost of systemic failure. Until structural poverty is addressed and organ transplant laws are enforced with integrity, more villages like Hokse will emerge, where survival leaves scars that never heal.
Pratikshya Bhatta is a junior editor with Nepal Connect.