Peregraf- Ammar Aziz
Organized criminal gangs are searching for the poorest people across Iraq and the Kurdistan Region in order to buy their organs for cash. Under the guise of voluntary donation, these groups then sell them for a huge profit while putting the lives of their victims in danger. It is a clandestine practice that seeks to exploit the vulnerability of sellers and the desperation of buyers.
"Those who sell their kidneys do so because of poverty," one human organ trafficker bluntly told Peregraf.
An investigation by Peregraf found that the people who sell their organs, most commonly their kidneys, do so because of poverty or other difficult circumstances. The money the sellers receive will temporarily relieve some their problems, but does not solve them.
Buyers, on the other hand, often feel that they have no other option. They face terrible health problems and turn to the traffickers when no one close to them is willing or able to donate.
These transactions can cost anywhere between 6 million to 50 million Iraqi dinars (approximately $4,000 to $33,300) for one kidney. The person selling their kidney typically receives a third or less of the total. Surgery and expenses cost extra.
"Anyone who needs a kidney asks and the patient's relatives buy it. It is undeniable that there is this kind of trade," said Brigadier Nasraddin Sulaiman, head of Duhok’s Directorate for Combating Organized Crime.
Both are troubled, buyer and seller
Parwin Mazuri, who lives in Duhok, said her brother needed a kidney several years ago. Her family bought one for $10,000, which was then transplanted at a private hospital. "The total amount we spent reached more than $20,000," she said.
However, the new kidney did not work well and only lasted for three years. Fortunately, a sister-in-law proved to be a match and donated her kidney through legal channels.
"He's still not in good condition. He's abroad and living on medication," Mazuri told Peregraf.
Peregraf’s investigation found that at least fifteen people in Duhok governorate sold their kidneys in the first half of 2024. Most were motivated by extreme poverty. This reflects the area’s status as one of the poorest parts of Iraq.
One 40-year-old man sold his kidney after losing his shop and falling on hard times.
"He resorted to selling his kidney because of debt. He said would make good money," a person close to him told Peregraf on condition of anonymity.
"He disappeared for a while after the surgery, but was eventually arrested. He was released, but died two years later, leaving behind his family and five children without any income and in a rented house," they added.
According to the Law on Donation and Transplantation of Human Body Organs in Kurdistan, No. 1 of 2018, the transfer of any organ or part of an organ or cell from a living human body for transplant shall not be carried out except by donation. A donation must be done willingly and that consent must be made explicit in a written document.
The law further prohibits selling, purchasing, or exchanging a human body or any part of one. It is illegal for the relatives and heirs of a person to benefit from the sale of body parts. Intermediaries are subject to the same penalties as traffickers. However, they can be spared punishment under the law if they provide information about the crime to the authorities.
All donors must be more than 18-years-old, be free of mental and chronic illnesses, and have full legal autonomy. They can withdraw from the donation process at any time before the surgery.
If convicted under the law, traffickers and other involved parties can face up to seven years in prison and a fine of 10 million to 20 million Iraqi dinars. If the donor dies as a result of the procedure, the sentence is increased to ten years in prison and a fine of 30 million to 50 million Iraqi dinars.
Doctors who are authorized to perform transplants must only do them at the facilities indicated on their licenses. If they do a transplant elsewhere, which could indicate an illicit transaction, there is a penalty of up to 10 years in prison and a fine of up to 100 million Iraqi dinars.
Last year, six people were arrested in Duhok in cases related to kidney trafficking.
Halat Mazuri, a consultant lawyer, told Peregraf that he "had two cases in Duhok: one was sentenced to six months and the other to one year in prison because they had bought kidneys illegally."
The Kurdistan Regional Government (KRG) has set up special committees to regulate live organ transplants. They are made up of surgeons, psychiatrists, and specialized doctors, as well as representatives of the KRG Ministry of Interior, the prosecutor general, and the Directorate for Combating Organized Crime. Their primary purpose is to ensure that organs being used have not been trafficked.
Some people —both buyers and sellers—are desperate enough to ignore these rules and the severe penalties, and traffickers are the ones who facilitate the process.
A business in the dark
One trafficker operating in the Kurdistan Region explained that most of the kidneys that they purchase come from impoverished youth in Baghdad and Karbala. They are brought to cities in the Kurdistan Region or neighboring countries where the organs are removed.
The kidneys are then sold for between 25 million and 30 million Iraqi dinars. The donors receive between 7 million and 12 million Iraqi dinars.
Earlier this year, the Iraqi Parliament’s Security Committee published a report that looked in part at the organ trade. It revealed that the federal Ministry of Interior and the security forces had dismantled six trafficking networks that specialized in kidneys.
"I don't know how many kidneys we have sold, but we will find them for anyone who calls," the trafficker told Peregraf, who declined to be named for fear of legal prosecution. "Kidneys are always available. According to the agreement with the buyer and according to the blood type, we will determine the price of the kidney."
"The security agencies only intervene and take legal action if we cheat someone or spend their money, but we do this in an honest way," they added. "We used to buy kidneys in the Kurdistan Region. But after 2018, the security forces did not allow this, although I have information that kidneys are being sold in one of its governorates."
It is hard to come by accurate and up-to-date statistics about organ trafficking given its clandestine nature. The KRG registered 33 cases across a three-year period from 2019 to 2021, though the total is likely higher. Worldwide, the World Health Organization estimates that there are at least 10,000 cases per year of illegal kidney trafficking.
In its 2021 report, the Independent Commission for Human Rights in the Kurdistan Region clearly acknowledges that organ trafficking exists, particularly the buying and selling of kidneys, and that measures to combat it have not proved entirely effective.
Yousef Khalid, a former organ trafficker, told Peregraf that he bought and sold more than 100 kidneys during his career, before stopping two years ago.
"The kidneys I bought were mostly in Baghdad," Khalid said. "We would buy them for 10 million to 12 million Iraqi dinars. Then we would sell them and make a profit of 5 million to 7 million Iraqi dinars per kidney."
That profit excludes the cost of necessary kidney tests, which can cost more than 2 million Iraqi dinars.
"No one has ever died and they are in good health," Khalid claimed, but added that he became uncomfortable with the business so he quit. "I quit only for God's sake, for no other reason."
The Kurdistan Region is still going through a severe financial crisis where public sector salaries are not paid on time and there is persistent unemployment. Khalid alleged that people in the Kurdistan Region’s armed forces were forced to sell their kidneys years ago because of poverty. This embarrassment led to intensified efforts by the authorities to eliminate this trade.
"I know there are people in Kurdistan who sell kidneys, but I don't know if the number is high or low," he said.
Deficiencies of law amid increasing disease
While the primary motivation for people to sell their kidneys is poverty, increasing rates of disease means that demand for kidney transplants is rising. Kidney disease has become more common and the queue for kidney transplants has become very long. The cause stems from two major changes in life in the Kurdistan Region.
"First, the overall number of people has increased, and second, the way people eat, drink, and everything else has changed compared with the past," Dr. Abdul Ghani Rashid, a specialist in kidney diseases and kidney transplants in Duhok, told Peregraf.
"There are no problems with kidney transplants. They are 85 percent good. We have hundreds of people who have had kidney transplants. They are now married, have children, and have no problems", said Abdul Ghani. He explained that transplant failures typically happen when patients do not take their prescribed medication or do not control their blood sugar or blood pressure.
In the Kurdistan Region, there are six teams at public hospitals that perform kidney transplants, with a further six working at private hospitals. According to the law and regulations, the KRG can cover the cost of organ transplant surgeries free of charge in public medical institutions.
Brigadier Sulaiman, the head of Duhok’s Directorate for Combating Organized Crime, told Peregraf that the law on organ donation passed by the Kurdistan Parliament is deficient and does not reflect what is actually happening.
What exists is about donation, and donation is mostly about relatives, but what is being done now is not donation." said Sulaiman. "They don't give it, they sell it."
In many other countries, citizens sign up for organ donation programs in case they die in accidents. Sulaiman suggested that such a program could be instituted in the Kurdistan Region to increase the supply of legal organs and depress demand for illicit ones.
Shahab Botani is a journalist and son of someone who suffered from kidney disease who has written about public health problems in some of the poorest areas of Duhok. He said that the system relies on the desperation of buyers and sellers, the greed of traffickers, and doctors and government officials who look the other way.
"Most of those who sell their kidneys are Arabs, but there are Kurds who have sold their kidneys. I have information that three people sold their kidneys in Bardarash district several years ago and were not arrested," he said
"The traders know people who sell their kidneys because of poverty, and they are cheated."