In contrast to developed countries, where cadaveric donation is the main source of transplants, most of the world’s poor countries, including Pakistan, rely mainly on donations from unrelated live donors. It is claimed that these donations are voluntary, but in reality kidneys are often bought from poor people to be transplanted into affluent recipients. And where the donor is actually a relative, although on paper the donation may seem to be motivated by altruism, in a male dominated society such as Pakistan this is often not the case. Sadly the donors, almost all of whom are female, typically have no say in any affair connected to their lives. In my experience of surgery in Pakistan, 95% of donations from live relatives were from sisters, daughters, mothers, female cousins, or from one of several wives.

In the past few years “transplant tourism” has become a lucrative business in Lahore, Rawalpindi, and Islamabad. Private hospitals shamelessly advertise their services in newspapers and on the internet. Taxi drivers and touts …