Aizaz Azam is a young police detective in Pakistan whose brief career has been devoted to busting minor prostitution and gambling rackets and sorting out street brawls.
Now, though, he's slogging away for up to 20 hours a day, working his first major case. It involves a crime so ruthless that Azam says he and his fellow cops feel "strangely unsettled in our souls."
They are pursuing a group of wealthy surgeons and their network of agents who lured impoverished and illiterate Pakistanis from the countryside and imprisoned them for weeks with the intention of removing one of their kidneys in order to sell these for huge profits.
"There's a lot of crime everywhere, no matter where you are. But taking away someone's kidneys? That's very disturbing," says Azam, 28.
The case burst open last month, when Azam and his colleagues raided an apartment block in the city of Rawalpindi, just outside Islamabad, the capital, and found 24 terrified people — 20 men and four women — who were to be operated on at a nearby clinic.
He says some of these prisoners told him they'd been held there for four months. The doors were locked; the windows had bars. Prowling the streets below were "look-outs" making sure no one escaped, says Azam.
Destitute Pakistanis have for years been selling their kidneys in an effort to pay off loan sharks or buy their way out of bonded labor, a form of slavery that has existed in South Asia for centuries.
These "donors" are usually paid at most several thousand dollars, a tiny fraction of the six-figure sums or more paid to the surgeons by the recipients, including rich, foreign "transplant tourists."
Numbers dropped substantially after 2010, when Pakistan's government passed a law criminalizing the buying and selling of kidneys for transplant. But, with a worldwide shortage of organs for donation, the "kidney mafias" appear to be flourishing anew.
"With the relaxation in enforcement, the wide boys, the fly-boys, the get-rich-quick boys, have got back in there and have continued to prey — particularly in Pakistan — on the indentured workers," says Dr. Jeremy Chapman, an Australian professor of renal medicine and prominent campaigner against organ trafficking.
Azam's case is unusual because, he says, most of the 24 prisoners in the apartment had no desire to sell a kidney, and no idea when they arrived in Rawalpindi that their captors planned to bamboozle them into doing so.
"This is the first time the police have got onto this," says Dr. Mirza Naqi Zafar of the Sindh Institute of Urology and Transplantation, which has won worldwide acclaim for offering free, "ethical" organ transplants.
"This is something new, that people have been kidnapped and forced to stay in a place like Rawalpindi, and made to give kidneys at a very small price."
The motive for the crime? "Money and riches," says the doctor.
Profits are huge.
There's a saying in medical circles in Pakistan: You want to know if a surgeon's involved in the illegal organ transplant trade? Just count the engines on his private jet.
A man 'with a very sweet tongue'
Saddi Ahmed spent four weeks locked in the Rawalpindi apartment. He says his fellow prisoners spent much of their time weeping.
Disoriented and far from home, they were too frightened to resist their captors, who told them the Taliban were outside and might attack if they made any noise.
Ahmed says they were also worried that they were somehow complicit in the crime and, being poor and powerless, would wind up being punished for illegally selling their kidneys if they complained.
There is a particular reason for this. "They implicated us," says Ahmed.
Ahmed, 39, is a casual laborer in the building trade. He has four kids between the ages of eight and 15. In a good week, he earns the equivalent of $27. Sometimes there's no work at all.
He says he was hanging around the railway station in the city of Lahore, feeling "helpless and jobless," when a fat, friendly man "with a very sweet tongue" accosted him.
Over a cup of tea, the man offered him a full-time job for $335 a month with a new company in Rawalpindi, 220 miles away.
The man, a covert recruiting agent for the kidney mafia, set one condition, Ahmed says. Ahmed must go with him to Lahore's law courts to sign some travel documents — a "passport" which, according to the man, would enable Ahmed to go by bus to Rawalpindi without being stopped at police checkpoints.
The following day, Ahmed says he met the man in the precincts of the courts, where hundreds of lawyers have desks, for what was in reality an entirely fake legal hearing.
The man insisted that Ahmed agree to be filmed, using a mobile phone — saying this was only to enable him to travel. He was ordered to state on-camera that he was going to Rawalpindi to donate a kidney to a relative. Ahmed did so.
"I asked him, 'What's a kidney got to do with getting a job?'" Ahmed recalls. "He said, 'We're just recording this statement so that you won't be stopped by the police. We won't actually take your kidney.'"
When he arrived in Rawalpindi, Ahmed says he was met by a gang member, driven to the apartment block and escorted to the upper floor, where he found several dozen other people.
As the door locked behind him, he realized he'd been duped: "That's when I got frightened. I said to myself, something's wrong. I've been cheated.
"I told the people in the room, I've been brought here for work; the agents said they had a business. The people said, 'There's no such business. They take away your kidneys here.'"
He repeatedly begged his captors to set him free: "I would entreat them, saying I have small kids and that if my kidney is taken out, I will be useless for whole of my life."
For Ahmed, the police raid came just in time. The cops arrived at around 2 a.m. He says he was due to be taken to a clinic to have his kidney removed just a couple of hours later.
Powerful political connections
Four alleged gang members are now behind bars, accused of abduction and imprisoning people. Aizaz Azam, the detective, says prosecutors also plan to bring charges over the fake legal proceedings.
Police say they're searching for four medical doctors, believed to be key players.
The number of victims isn't clear. One of the accused estimates more than 400 people were imprisoned in the apartment at various times, says Azam.
Ahmed says the prisoners were told they'd be paid $2,800 for their organs; it's not clear if the victims ever received this.
Nor is clear for whom their kidneys were to be transplanted.
According to Global Financial Integrity, a U.S.-based research organization that analyzes illicit financial flows, organ trafficking is among the world's top 10 most profitable crimes, with an estimated annual worth of up to $1.2 billion.
Data on this clandestine international racket is sparse and unreliable. Before outlawing organ trafficking in 2010, Pakistan was believed to be the third most popular destination for "transplant tourists," according to local medics and media reports. Evidence suggests the largest number of patients came from Southeast Asia, but the U.S., U.K. and Saudi Arabia were high on the list.
Pressure is mounting in Pakistan to further tighten its laws.
Its Supreme Court has taken up the issue at the urging of the head of the Sindh Institute of Urology and Transplantation, where Dr Mirza Naqi Zafar works. "I think this raid we've seen in Rawalpindi is the follow-up from that," he says.
But Pakistan's kidney mafias are known to have powerful political connections and enormous financial resources that they're willing to use to bribe their way out of trouble.
This was recently made graphically clear to Babar Nawaz Khan, chairman of Pakistan's parliamentary committee on human rights.
Khan is lobbying for a list of reforms, including life imprisonment for illicit organ trading, health checks for foreigners seeking Pakistani visas and a nationwide organ donor program linked to ID cards.
He shows NPR texts on his mobile phone, saying they're from the kidney mafia urging him to halt his campaign. He keeps them in a file labeled "Offer."
"They offered me 100 million," says Khan. He was so disgusted he didn't bother to ask the currency. In dollars, that's nearly $1 million. He says while out shopping in the market, he was also accosted by a mysterious man making the same offer.
"I said to him, 'You're lucky you're talking to me in a public place, where I cannot hit you,'" Khan says.
At 30, Khan is Pakistan's youngest parliamentarian. He and his family know the dangers of public life in Pakistan. His father, a former government minister, was murdered in 2008.
Yet Khan says he intends to persevere until Pakistan's poor and uneducated are no longer vulnerable to human predators using power, money and deception to acquire their victims' only assets — their body parts.
STEVE INSKEEP, HOST:
Many of us have checked a little box on our driver's license applications. It says we agree to donate organs if we're in a crash. Some people volunteer to give up a kidney while they're still alive. The key there is they volunteer. In Pakistan, authorities say some poor people have been tricked into donating organs against their will while they are still alive. NPR's Philip Reeves has a story of illegal organ harvesting.
PHILIP REEVES, BYLINE: Hi.
INSKEEP: How has this even come to light?
REEVES: Steve, not long ago, the police here got a tipoff saying that some people were imprisoned inside an apartment block. So the cops raided the place in the middle of the night. And they found 24 people, including four women, locked up on the top floor. And some of them had been imprisoned there for months. And all of them were waiting to be taken to a nearby clinic to have a kidney removed.
INSKEEP: Imprisoned, like hostages? Who were they?
REEVES: Very, very poor and illiterate people who'd been lured there from the countryside by a criminal gang. Now, over the years, there have been many, many cases in Pakistan of impoverished people selling a kidney to try and clear debts, for example. But this is a little different. The police are convinced that most of the people in that apartment were tricked and had no intention of selling an organ when they arrived there.
INSKEEP: How were they tricked into that imprisonment, that apartment?
REEVES: Well, these gangs use extreme deception backed up by threats. And they have powerful connections and backed up, also, by money. Let's take, for example, the case of Saddi Ahmed, one of those imprisoned. I spent a long time talking with him. He's a casual laborer, aged 39. He has got four kids. And he makes less than 30 bucks a week, usually. He was hanging around the railway station in Lahore looking for work when he met a charming man who bought him tea and gave him a little money. The man, of course, was in fact a covert agent from the gang. And Ahmed says that the man said that he got a great job for him, except that it was 200-plus miles away in Rawalpindi, which is where that apartment is.
SADDI AHMED: (Through interpreter) He persuaded me in a very sweet and gentle way. He told me not to stress out. He said, don't worry, you'll get your money, a permanent job, and prosperity will come to your house.
REEVES: So, Steve, here's where the trickery really starts. The man arranged to meet Ahmed in the precincts of the local law courts the next day. He claimed this was just to get legal documents that Ahmed had to have to travel by bus to his new job without being stopped at the many checkpoints on the way. In fact, this was sort of a charade. Sitting outside the courts, apparently pretending to be some kind of lawyer, the man took Ahmed's thumb print - remember, he's illiterate. And he also ordered Ahmed to state that the reason he was traveling was to donate a kidney to a sick relative. And he filmed Ahmed on his mobile while he was saying that.
AHMED: (Through interpreter) I asked him, what's a kidney go to do with getting a job? He said, we're just recording this statement so you won't be stopped by the police. We won't actually take your kidney.
REEVES: So Ahmed set off, still full of hope. And when he arrived in Rawalpindi, an agent met him and drove him to the apartment, several dozen other victims already inside. And he was pushed in, and the door was locked behind him.
AHMED: (Through interpreter) That's when I got frightened. I said to myself, something's wrong. I've been cheated.
REEVES: Ahmed was a prisoner for 28 days. He says he didn't resist, for example, when he was taken to the clinic for pre-op tests because he was worried that mobile-phone movie somehow made him party to the crime.
AHMED: (Through interpreter) They implicated us and then imprisoned us. We were worried about being prosecuted.
REEVES: He and the other prisoners spent most of their time weeping, he says. Ahmed was lucky. He says the police raided just hours before his kidney was due to be taken out.
INSKEEP: Well, Philip, I'm sure that the people in that apartment are not the only people to whom this has ever happened. What are authorities doing now?
REEVES: They've arrested four people so far. And they've charged them with offenses, including abducting and imprisoning people. They say they're now searching for four doctors who are apparently the kingpins. Now, Steve, some of those imprisoned in the apartment told me that even though they were held there against their will and didn't know that they were expected to donate an organ when they arrived, they did, after a while, expect to be paid for their kidneys. That's what they were told. They expected about $2,700. So I went to see Aizaz Azam, a detective who's closely involved in this case and who took part in the raid, and asked him if these people really were prisoners.
AIZAZ AZAM: (Through interpreter) You didn't see what we saw. The doors were locked. People were sitting inside, too frightened even to go to the window. Some said they'd been there for three months, even four. No one who enters this slaughterhouse leaves until he's given up a kidney.
REEVES: Azam, by the way, is 28. And this is his first big case. He's finding it pretty distressing.
AZAM: (Through interpreter) I feel troubled, disturbed in my soul. It's the same for all the officers who went on the raid. When we sit down together, we're all troubled by this.
REEVES: These criminal gangs make huge profits. Some of these kidneys go to so-called medical tourists who come in from North America, from the Middle East. And tackling this issue is not easy. Babar Nawaz Khan is chair of the Human Rights Committee in Pakistan's Parliament. He's calling for tighter laws, including life imprisonment for organ trafficking. He also wants a nationwide organ donor program. And Khan says that when the criminals heard about his campaign, this is what happened.
BABAR NAWAZ KHAN: They tried to approach me. I had very good, good offers.
REEVES: What do you mean?
KHAN: Good offers mean money.
REEVES: Who offered you money?
KHAN: Parts of the mafia.
REEVES: They offered you money?
REEVES: So the mafia contact you. And they say, we'll give you a lot of money, to do what?
KHAN: To stop making the law, stop implementing it.
REEVES: How did they contact you? Did they call you by telephone?
KHAN: No. I was in the market. One of the guy come to me, and he said that we can do this for you.
REEVES: What? He just walks up to you while you were shopping?
KHAN: Yeah. Yeah, and I was alone.
REEVES: And Khan says he's also been getting similar messages on his mobile. And he's handed these over to law enforcement.
INSKEEP: That's NPR's Philip Reeves telling us about illegal organ harvesting of living people in Pakistan.
And, Philip, what does this practice say about Pakistani society?
REEVES: It says that the judicial system, the legal system and the police system is still extremely weak here. And it is also a reflection of how people are willing to use class, power, money, superior education in order to generate wealth from the most vulnerable people in this society. And that, I think for many Pakistanis, is a very uncomfortable reality.
INSKEEP: Philip, thanks very much.
REEVES: You're welcome.
INSKEEP: That's NPR's Philip Reeves, who's covered South Asia for many years. Transcript provided by NPR, Copyright NPR.