A Pound Of Flesh

The arrest of Muhammed Najeeb, an alleged organ trade kingpin, has put hospitals, oversight bodies and the exploitation of poor donors squarely back under the lens

On May 7, the inspector of Vadakkekara police station Biju KR knocked on the door of a 43-year-old woman in Chittattukara in Paravur, Ernakulam.

Accompanied by a woman officer and two constables, Biju had received confidential information linking her to Muhammed Najeeb—a man police suspected was running an organ trade and forgery racket.

Inside the house, officers opened an almirah and found a plastic packet. It contained a hospital discharge summary from a prominent city hospital.

The department of urology. A patient name. Admission date: Oct 6, 2025. Discharge date: Oct 13. Under diagnosis, three words: Voluntary Kidney Donor.

A second plastic cover deepened the puzzle. The documents inside showed that the state-level organ transplantation authorisation committee had rejected her application in June 2025. Yet the woman told police she had donated her kidney on Oct 8.

The transplant, she said, had been arranged by Najeeb.
Three days later, on May 10, police arrested him.

Questioning and raids revealed that Najeeb had facilitated at least 35 such transplants, collecting commissions that ran into several lakhs per transaction. Over half a dozen associates were arrested.

An SIT was formed.

The case has once again drawn attention to the shadowy world of illegal organ transplants in Kerala, where kidneys are allegedly sold for up to Rs 25 lakh while donors receive only a small share of the money.

For many donors, the payment is enough only to settle immediate debts before they return to lives marked by financial insecurity and health risks.

By law, organ donations in India are only permitted between close relatives or with special govt approval. When the donor is unrelated to the recipient, the case must be approved by a govt-appointed authorisation committee, which is required to verify that the donation is altruistic and not financially motivated.

The demand that fuels organ trade is real. Kerala currently has over 3,400 patients waiting for organ transplants. The shortage of legal donors is severe: Family members of brain-dead patients frequently hesitate to consent to donation, held back by unawareness or deeply held fears. Into this gap, illegal networks have inserted themselves with devastating efficiency.

By forging documents that establish fictitious family relationships between donors and recipients, they present authorisation committees with cases that appear legitimate on paper.

“In many cases, the donor and recipient have no connection at all,” says Dr Noble Gracious, executive director of the Kerala State Organ and Tissue Transplant Organisation (K-SOTTO). “The donor might be from a coastal village in Alappuzha while the recipient is in Kasaragod. The story is usually that the donor worked for the recipient’s family and felt moved by their condition. Many of these donors are women, from economically backward areas. The recipients are almost always affluent.”

District police chief (Ernakulam Rural) K S Sudarshan said investigating organ trade cases is tricky because both donors and recipients are reluctant to cooperate. “There are legal consequences for both parties, so they often remain silent,” he said.

He said donors were allegedly paid between Rs 5 lakh and Rs 10 lakh, while recipients spent anywhere between Rs 20 lakh and Rs 25 lakh for a transplant.

What the donor is left with, beyond a depleted bank balance, is a body missing one kidney and no guaranteed medical support if complications arise later. There is no one to take care of them if a health issue arises later. The transaction is over. They are on their own, says Dr Gracious.

One of the most uncomfortable questions raised by the SIT investigation is how 35 illegal transplants were conducted without detection, and whether hospitals were truly unaware.

Dr S Ganapathy, a longtime crusader against malpractices in organ transplants, puts it plainly. “The agent is only a middleman, the person who recruits donors. An agent cannot survive without the support of a hospital or a transplant surgeon. In hospitals where there is a high rate of donations between unrelated donors and recipients, such transplants are unlikely to have happened without the knowledge of the hospital concerned.”

The sequence, as Ganapathy describes it, is methodical: An agent identifies a potential donor, conducts preliminary compatibility tests at a hospital, forges the necessary documents, and then approaches the authorisation committee. The forgery gives bureaucratic cover; the hospital provides clinical infrastructure. Without both, the racket cannot function.

Police, in announcing the SIT, acknowledged as much. “The SIT will take urgent and effective measures to identify the international criminals involved in the organ trade racket, as well as the hospitals, individuals, agents and accomplices behind it,” read the official statement. Hospitals have denied any connivance, citing the absence of proof.

Donors, meanwhile, are recruited through informal networks. Some are identified by agents who loiter around hospitals, profiling patients and visitors. Others learn of the scheme from someone who has already sold a kidney and passed the word along.

Most come from areas of economic deprivation where the promise of even Rs 5 lakh represents relief that seems otherwise unattainable. Legally, however, donors are not absolved—the law makes commercial donation an offence for both parties.

Experts argue that the solution must be structural. Cadaver donation must be normalised and the donation process made more transparent and accessible. Dr. Ganapathy goes further, advocating for the legalisation of compensated donation along the lines of Iran’s regulated model, where donors register, recipients are matched through a govt system, and compensation is fixed and fair. “It is already illegally commercial,” he says.

“Legalise it. Cut out the middleman. Give donors long-term insurance and proper medical support.

Whether or not that proposal finds traction, the Najeeb case has made one thing impossible to ignore: The organ trade in Kerala is not a fringe phenomenon. It is organised, it is widespread, and it is preying on the most vulnerable.

While illegal rackets thrive on the desperation of the poor, their exposure creates a cloud of suspicion that threatens to stall legitimate donations. For the thousands of people waiting for transplants, the true cost of these forged documents may be measured in lives lost — unless effective intervention ensures that public trust in the ‘gift of life’ does not waver.