Why a textile town became the hub of illegal organ trade

A large scar ran from the middle of his stomach to the middle of his back, across his left. Walking past the bare-chested elderly man, I instantly recognised the scar as one left after a kidney transplant operation. I had seen similar marks on others the previous day.

Minutes before we had crossed paths with him near the Pallipalayam bus stop, Kannamma K had pointed in the direction of her village and asked me to follow her. “There are many such people,” she had said.

The village is located in Pallipalayam municipality, in Tamil Nadu's Namakkal district. When we reached it, we found that most houses' doors were locked. It was a cloudy November afternoon, and many residents had gone to work. And yet, among the first small group of women we encountered in the village was one who had sold a kidney.

As we continued walking through the village, nearly every second or third person told us they had sold a kidney – anywhere between five years ago and 30 years ago. Every single person knew someone who had sold a kidney.

“It is very common here,” said Jayamma M, an elderly woman who lives in the village and has herself sold a kidney. (All those mentioned in the story who went through the process have been identified by pseudonyms at their request.)

Kannamma, too, had sold a kidney, around 25 years ago, for Rs 50,000 – she had faced a financial crisis and needed to raise money.

In her family, she was not the only kidney-seller. Ten years after she had given up her kidney, her younger son, Prakash, found himself in debt and also decided to sell his kidney to clear his loans.

And theirs was not the only family with more than one seller.

One woman said that over the last decade, both her daughter and her daughter-in-law had sold their kidneys within five years of each other. A 37-year-old man, Rakesh M, and his wife had both sold their kidneys six years apart. “My neighbour had got it done and suggested it was a good way for me to make some money and pay off the loans,” Rakesh said. “So I agreed.”

I had travelled to Namakkal after coming across news reports about district authorities busting an illegal kidney sale racket.

The reports, which began to appear July 2025 onwards, said that authorities had learnt of brokers luring women into the kidney trade and had arrested one such broker. Police have made four arrests so far in the case and are continuing to investigate it.

But, reporting from the area, what became clearer was how commonplace organ sales were in some villages, particularly by distressed textile workers. Many of these workers were persuaded to undergo the procedures by brokers whose networks ran deep in the region.

Trade in organs is illegal in India. The donation of organs is regulated by the Transplantation of Human Organs Act, 1994. Under the law, an individual can donate a kidney or part of a liver to a living family member or friend. Those in need can also receive organs from donors who are deceased, known as cadaver donors.

The law states that an individual who participates in illegal organ trade – for instance, who “seeks to find person willing to supply for payment any human organ” – is liable to be punished with five years' imprisonment.

The act also prescribes punishment for anyone who “abets in the preparation or submission of false documents” to establish that the donation has been made to “a near relative or by reason of affection or attachment towards the recipient”.

The stories from Namakkal noted that in July this year, after receiving complaints from several victims in the region, the Tamil Nadu government suspended the licenses of two private hospitals in Chennai and Tiruchirappalli that were involved in the illegal trade. The sellers I spoke to said they had been taken from Namakkal to hospitals in different parts of the state for their surgeries, mainly to Chennai and Coimbatore.

A key factor in the widespread illegal sale of kidneys in the district, I learnt, was the broader decline of the textile sector in the state. In an interview earlier this year, B Kandavel, the secretary of the Tamil Nadu Federation of Powerloom Associations, noted that “Currently, about 30% of powerloom units in Tamil Nadu are closed due to lack of work, which affects the livelihood of workers.”

“Nobody is setting up new units either. So new jobs aren't being created,” Kandavel said when I met him.

Indeed, of around 15 sellers I spoke to, eight were former powerloom workers, while others relied on informal daily wage jobs, including construction and domestic work.

Mill workers I spoke to said that they find work at most three days a week and sometimes no days at all. “Sometimes, the mill owners will say they were not able to procure threads, or if the electricity goes off, we won't have work that day,” said one worker, Vijaya, who had sold a kidney. “So, we are forced to find other daily wage jobs.”

Dr J Amalorpavanathan, who helped set up the Tamil Nadu State Cadaver Transplantation Program, noted that Namakkal had been hit particularly hard by the sector's decline because it is not an economically robust district. “Namakkal is one of the driest districts, there are no big rivers and agriculture is very little, mostly only dry crops are grown,” he said. “The only source of revenue is eggs and chicken, and second is small powerslooms.”

In times of financial difficulty, workers often rely on loans – but the lack of livelihood opportunities leaves them unable to pay back these loans. “Namakkal is a peculiar subsect of the population, the people are not absolutely poor but they are drowning in loans, and because of the pressure from loan sharks, they are forced to opt for organ donation,” Amalorpavanathan said.

Kandavel echoed this observation. “If the employees had work on all six or seven days, they would be able to repay the loans,” he said. “When there is no work, how will they repay?”

In some pockets, like Pallipalayam, such economic strife has led to an alarmingly high rate of organ sales.

Kannamma and her neighbours estimated, for instance, that their village had around 100 families, from which around 20 or 25 individuals had sold their kidneys – all of them to clear their debts.

“It is often said that if someone in Tamil Nadu was in need of an organ and is willing to try illegal means to get it, they will always have the chance of finding one in Namakkal,” a local journalist told me. “Particularly in the powerloom areas such as Pallipalayam and Komarapalayam.”

“This is not anything new,” said M Ashokan, the district executive committee member of the Communist Party of India (Marxist) and a leader of the textile mill workers union in Namakkal. “It has been happening for about 35 years.”

Ashokan noted that the price of the organ in the illegal trade had risen steadily. “People used to get only Rs 20,000 to Rs 30,000 a few decades ago,” he said. “Nowadays they get a few lakhs.”

Though people were often hesitant to speak about giving up their organs, he explained, in 2025, “One young woman submitted a complaint to the collector claiming she was given only half the amount she was promised.”

After the young woman filed her complaint, others also approached Ashokan for help – he compiled a list of 94 individuals who had sold their organs, mainly in Pallipalayam and Komarapalayam, who said they had been cheated or treated unfairly, or that they were suffering from medical problems after the surgery.

In October, many of these kidney sellers came together to submit petitions to the collector. Among the demands listed in the petitions, which Scroll has seen, are a monthly income, sought because those who had sold organs are no longer able to work after their surgeries, and free housing, because they are unable to pay rent. The petitioners have also sought education assistance for their children, loans from the government to help with their financial troubles, and the allocation of a kidney specialist in the government hospitals in Pallipalayam and Komarapalayam, who can provide treatment for their ailments post their surgeries.

Amalorpavanathan argued that thus far, authorities had treated the problem as one of law and order, but that they needed to also take into account the social conditions that were forcing people to sell their kidneys. “Due to the large number of donors from a single region, we must force our attention to other issues that could be driving so many individuals to donate their kidneys,” he said.

The woman that Ashokan was referring to, who filed the first complaint to the collector, is P Shanthi, a 37-year-old mother of two, and a powerloom worker from Pallipalayam.

I met Shanti at her small two-room house late one afternoon. There were many hand-drawn pictures on the walls – Shanthi said they were by her daughter, who is around 13.

Shanthi's story was indicative of how entrenched the illegal organ trade is in the region.

She explained that she had worked in powerlooms from the time she was 12 years old. She had always struggled financially – a few years ago, when she last worked in a powerloom, she earned around Rs 4,000 for about 15 days of work, barely enough for her family of four.

She was plunged even deeper into a crisis during the Covid-19 pandemic, when many powerlooms shut down. After even her small income dried up, Shanthi was forced to take loans. “My husband did not treat me well, he was an alcoholic and did not provide for the family,” she said. “I had to take care of two children so I borrowed money.”

Shanthi's account of how she met the broker who made the deal for her about two years ago was startling. She recounted that she was at a bus stop with another friend. “I was crying and telling her about my loan problems and suddenly a woman who was sitting close by approached me,” she said. “She asked me if I would consider giving my kidney in return for money, and said it would be a good way for me to clear my loans.”

Vijaya explained that this was not an uncommon occurrence, and that she too had been approached by a broker a few days after she had shared her financial woes with a neighbour. “These brokers have eyes and ears everywhere,” she said. “Women often tend to pour out their miseries in the open and somehow someone hears and tells someone else who tells someone else.”

She added, “And then the brokers magically appear in front of you and give you this offer.”

Shanthi initially refused. But the woman “convinced me that it was a good way to get out of my situation and I agreed”, she said.

The very next day, the woman met Shanthi to discuss the details – she recounted that she was made to rehearse a story about how she was related to the patient, and was willingly donating her kidney, free from any kind of pressure. “They also gave me an Aadhaar card where my name was changed,” she said.

As part of this process, Shanthi also had to pretend to be more well-off than she is. “She told me that I should wear a silk saree and new footwear. She said I should look like someone who had money,” she recalled.

She was soon taken to Chennai and booked into a lodge. During this time, she was made to take several medical tests. She was not allowed to have a phone with her, so she could not speak to her family.

After a week, however, doctors told Shanthi that she was not a match with the recipient.

She decided it was time to go home – but was in for a terrible shock. “The brokers said that since the surgery was not going to happen, I would have to pay them the money for all the tests they had done on me,” said Shanthi. “There was no way that I could afford that.”

What happened next was chilling. “They told me that they would take a part of my liver instead and then I would not have to pay for all the tests,” she said. “I had no choice but to agree.”

And so, Shanthi went through with the surgery. “The process was well coordinated,” she said. “Even the auto driver knew where to take me.”

Shanthi recounted that she felt that the doctors' conduct was odd too. “Some of the questions that they were asking, the broker answered on my behalf,” she said. The fact that doctors did not insist that she answer questions about her connection to the recipient, and her willingness to go through with the surgery made her suspicious, she said.

Amalorpavanathan noted that it was very unlikely that doctors were completely unaware of the illicit nature of these donations. “Usually, these patients are on dialysis for a long time,” he said. “Most of these are chronic patients, so they've been around long enough for the doctors to learn everything about them.” Thus, they would typically know about all potential donors in their family, he explained.

Shanthi was shocked when she was only given Rs 4.5 lakh as payment for giving up the portion of her liver – she said she had been promised Rs 8 lakh for a kidney. “Promptly after the surgery, the brokers turned off their phones,” Shanthi said. “I had no way of contacting them. That's what they do with everyone.”

B Sudha, a 50-year-old resident of Pallipalayam, recounted that in her case too, the family of the recipient shut off their phones after the surgery was completed.

Sudha, a former powerloom worker, burst into tears frequently through our conversation. She explained that she had always had a challenging life. Her father left their family when she was a teenager. She was forced into marriage with a relative who was an alcoholic and could not hold down a job. She had two children and as they grew up, she began to drown in debt.

In 2016, a textile trader that she frequently met told her about a family in Coimbatore that was looking for a kidney donor. “I got very scared and immediately said no to him,” she recounted.

But she was overwhelmed by her financial challenges. Her husband did not contribute any funds to the family, leaving her struggling to pay for her children's education and, later, their wedding expenses. So, she decided to accept the offer.

“The recipient's family said they would give me Rs 25 lakh and also take care of all the education expenses and wedding expenses,” she said. “It was a sacrifice I was making for the family after all.” The family said that she would have to do the surgery in Singapore.

Sudha had hardly stepped out of Tamil Nadu before this, let alone India. “I told them to give me some time because my daughter was pregnant and I wanted to wait until she gave birth,” she said. However, the family asked her to hasten her travel. “They told me I would only need to stay there for ten days and I could return to my family,” she said.

Sudha did not have a passport and was made to procure one. “The same day as the postman delivered it to me, a person known to the recipient's family came to the house and took it away,” she said.

Eventually, the day to travel arrived – Sudha, who was nervous and afraid, was escorted by a relative of the recipient on a flight to Singapore. “They put me in a hotel and told me I could not step outside,” she said. “When a Tamil-speaking maid arrived to clean the house, they would lock me inside a room, scared that I would tell her why I was there.”

At one point, she recounted, the recipient's daughter heard her speaking to her daughter and took away the phone. “She said she was scared I would change my mind about donating if I spoke to my family,” she said.

Sudha felt like she had been imprisoned. “Those were the worst days of my life. I was completely isolated, couldn't adjust to the food I got and never stepped outside,” she said.

The trip had initially been planned for ten days, but it stretched on – she was made to redo all the tests she had already undergone in India and was later told that the surgery was being postponed because the surgeon was busy. The trip turned into a three-month ordeal.

Finally, the day of the surgery arrived – it was the day Sudha felt the most isolated. “The minute they took my kidney, they didn't care anymore for me,” she recounted. “I was sitting in the hospital all by myself. I could not even raise my hands to tie my hair.”

She added, “I had to empty out my own urine bag even when I could barely move.”

Sudha was sent back to India with a friend of the recipient's family. She had not been paid any money yet. “They told me they would settle my dues ten days later,” she said through tears. “I didn't argue. At that point I just desperately wanted to somehow reach home.”

Ten days later, Sudha tried to call the daughter of the recipient, who had supervised the entire process, and had been the point of contact through the last several months. The call did not go through.

Sudha later found out that the family was a highly influential one, which owned big businesses in the neighbouring district of Salem. When repeated calls did not go through, she found a residential address associated with the family and visited it. “When I entered, they saw me and set the dogs on me,” she said.

In 2024, Sudha filed a criminal case against the wife and daughter of the recipient at the Komarapalayam district court.

The accused filed a petition in the Madras High Court, asking it to quash Sudha's case. They claimed that Sudha had indeed donated her kidney at a hospital in Singapore, but that she had done so of her own will. Further, they stated in their petition that the recipient died in 2021 and that Sudha subsequently filed a false complaint “in order to extract money from the petitioners”. In January, the court ordered an interim stay in the matter for a period of four weeks.

Sudha has tried to approach activists and political leaders for help, to no avail so far. “Even when it seems like something is working out for me, that family somehow manages to make things go their way,” she said. “They are saying that I am lying and are claiming the story they made me tell the doctors there about my relation to them is true.”

She explained her health had been poor after the surgery, and that she had walked with a limp since. “I can't work anymore at the mill either because my health doesn't permit it,” she said.

Vijaya said that she, too, frequently suffers from pain on the left side of her torso, the area of the surgery. “I also cannot hold my bladder for even a few minutes. I need to urinate the minute I have the urge, if not my stomach swells up,” she said. “And if I delay the urination, I'm in excruciating pain.”

Amalorpavanathan explained that while for a typical kidney donor, recovering from a donor surgery is a fairly smooth process, in cases of illegal donations, donors can face complications. This is because they are often not properly screened for suitability, he explained. “Due to the lack of nutritious diet, anemia and the highly stressful conditions they live in, there are chances that some patients suffer lifelong impact,” the doctor explained.

A common complaint among many sellers I spoke to was that after their surgeries, their bodies had changed: they tired more easily, struggled to lift heavy weights or had developed other health troubles, including urinary problems and high blood sugar. As a result, many said they were struggling to find work and had to give up on the jobs they relied on before the surgeries.

Conversations with activists and those who had sold organs made clear that it was largely women who were targeted for illegal donations. Amalorpavanathan noted that this mirrored the patterns of even legal donations, in which “donors are mostly always women and the recipients are almost always men”.

But the pattern seemed amplified by the deep economic strife that families faced. “In Namakkal, women take on more responsibility and take it upon themselves to save the family's honour,” Amalorpavanathan said. “It is to save the family's honour and pride that many borrow money from loan sharks.”

Ashokan said he had heard similar accounts from women too. “The women said that the men may not be able to work after the surgery and so it was a risk for them to get the surgery,” he said. “So women would end up getting it done.”

Women also said that they did not feel supported by their husbands and thus were forced to sell their kidneys. “It becomes the woman's responsibility to save the dignity of the family,” Vijaya said. “If my husband had been a good provider, was not an alcoholic and treated me well, I would not have had to do this.”

Other women I spoke to echoed this assertion, even noting that while the decline of the power loom sector in the region was a key factor in their decision, if their husbands had been more financially and emotionally supportive or not addicted to alcohol, they would have been able to avoid undergoing surgery.

“If my husband had been supportive I would have never said yes,” Sudha said.

One 50-year-old woman said she was tricked by her husband into giving up her kidney. “He told me that he was in need of money and that he was giving his kidney,” she said. “He asked me to accompany him to the doctor to take care of him.”

When they arrived at the hospital, however, her husband insisted that they both donate their kidneys. The woman recounted that she tried to protest but was coerced into the surgery.

This was not the end of her horrors. “When I woke up from the surgery I found that my husband had not donated his kidney and instead had taken the money I was to receive for my kidney,” she said. “He disappeared. I never saw him again.”

Even warnings from those who have suffered after surgeries do little to dissuade women in dire financial straits. Vijaya recounted that around two years after her surgery, another woman approached her, asking for her advice on donating her kidney. “I told her that it doesn't matter how much debt she has and how much the loan sharks are harassing her, she just should not give her kidney,” Vijaya said. “But I later heard that the woman went in for the surgery despite my advice.”

Vijaya understood the desperation – it was also what had driven her to sell her own kidney. “The humiliation and harassment is unbearable,” she said.

But the surgeries do not usually mean the end of the families' financial woes – Vijaya and Sudha, for instance, still have debts to repay. “Despite my poor health, I try to do whatever small jobs I can because I'm determined to not leave my children in debt,” Vijaya said. “I just desperately need to stay alive until then.”

Sudha said the knocks on her door by loan sharks had left her in anguish, and sometimes even suicidal. Even complaints to police of their harassment did not help, she explained. “We are advised to just pack our bags and run away,” she said. “But where will we go?”

Source: Scroll
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