The Intersection of Organ Trafficking and Bonded Labor in Pakistan

Pakistan’s brick kiln industry in particular is known for the peshgi system, which leaves workers forever trapped in debt – and vulnerable to coerced organ donations.

In February 2026, Muhammad Rafiq reported that his cousin in Rawalpindi, Pakistan had been kidnapped by an organ trafficking ring. He named an entire team of operatives, from abductors to medical personnel, who force individuals to have one of their kidneys removed and sold internationally. This case is the latest embodiment of a wider phenomenon in Pakistan surrounding the illicit organ trafficking industry, which continues to flourish despite the country’s existing legislation intended to curb the practice.

Primarily operating in Pakistan’s Punjab region, brokers coercively obtain organs to sell in a variety of ways, but one method in particular appears to be the most prevalent. Targeted victims tend to include impoverished workers who are often in desperate need of a loan to cover immediate expenses, such as medical bills, weddings and dowries, or, in some cases, to repay previous loans. Pakistan’s brick kiln industry in particular is known for offering what is known as a peshgi system, where workers can take an advance on future wages if they agree to work until the debt is paid off. These are unofficial and usually undocumented deals, with many debtors unable to verify the terms due to illiteracy. Some have reported that even when they know that terms have been drawn up in bad faith, they lack the confidence to challenge their bosses.

The debtors begin work at the brick kiln to pay off their loan, but the repayment terms are designed to keep them trapped in a continuous cycle of debt. One labor rights report published in 2025 found that a family of four who made 1,000 bricks in a day in Pakistan would be paid between 75-88 rupees each, which amounts to less than a dollar per person. With high interest rates on brick kiln loans, even when debtors pay toward their owed sum, their debt continues to grow. One girl’s family owed 200,000 rupees when she became a brickmaker at the age of 10. By the time she was 50, this debt had grown to 3.5 million rupees, despite her family working continuously to pay it off.

As it becomes clear that no amount of work will be sufficient to reduce, let alone fully repay, their debts, brick kiln owners begin to apply increasing pressure for loan repayments. They often provide indebted workers space to build mud huts near the kiln, and while this may seem like an appealing offer, it effectively places the whole family within the owner’s reach. Female family members are known to be subjected to sexual violence by kiln owners to increase pressure on debtors, demonstrating how such living arrangements enable exploitation. These types of threats are gradually increased over time to ensure the debtor enters a state of desperation and is punished psychologically.

It is at this point that the brick kiln owner will contact an organ broker and invite them to deliver a well-rehearsed speech that frames organ selling in attractive and heroic terms, with no mention of the serious health risks associated with the surgery. These appeals to heroism are likely intended to exploit the workers’ perceived failure as providers, implying that selling their kidney could restore a sense of masculinity by lifting their family out of debt. As debt is transferred intergenerationally after the debtor’s death, many choose to accept this morbid offer for the sake of their family. 

Some people in this situation are so desperate they even consider selling the organs of their own children, as was the case with one man who was then convinced by a local activist to refrain from doing so. The motivation for considering this option was to ensure the children could live their lives debt-free in the future.

These debtors undergo highly dangerous surgeries in unlicensed locations and leave without rehabilitation in order to keep medical costs as low as possible. Donors are then expected to return to work with little to no recovery time. There are even cases of these individuals requiring an organ transplant themselves to manage health issues incurred from the operation. They also tend to be paid less money than was negotiated – and sometimes are not paid at all. Although their kidneys are sold for tens of thousands of dollars, donors are only paid between $1,000-$3,000 on average.

In one case, Pakistani police discovered a 14-year-old child in an underground lab who had his kidney removed. The boy said there was an Arab man on the stretcher next to him when he woke up, illustrating the trend of typically wealthy foreigners, often from Gulf nations, coming to Pakistan to receive these illicit transplants. The relevant investigation led to the unearthing of an organ trafficking ring that would offer victims $4,000 for their kidneys. 

Pakistan passed the Transplantation of Human Organs and Tissues Act in 2010 in an effort to limit the unethical selling of organs across the country, but the law criminalizes both the sellers and the buyers of organs. This has prevented coerced organ donors from coming forward as victims and giving crucial evidence in legal proceedings. Moreover, these organ trafficking cases often involve multiple jurisdictions, as the donor, buyer, and location of the transplant operation involve different countries. 

For example, there are reports of the financially vulnerable being lured from Pakistan to China to undergo transplant operations there. In 2020, Pakistan’s Federal Investigation Agency (FIA) discovered an international gang involved in the illegal organ trade with China. Seven suspects were arrested, and the subsequent investigation revealed that the group in question had sent approximately 30 such Pakistani donors to China for illegal transplant operations, having facilitated their travel to the country for that purpose. Against the background of the China-Pakistan Economic Corridor (CPEC), Islamabad remains hesitant to raise such concerns with Beijing, despite credible reports that these abuses extend beyond illegal organ sales to include the trafficking of Pakistani women as brides to China, alongside other forms of human exploitation.

Because there is no globally encompassing law on organ trafficking, each country sets its own rules and has different regulations. The level of interstate coordination required to prosecute a single case of organ trafficking is therefore substantial and has led to very few prosecutions under current legislation. Corruption and a lack of enforcement means that even the domestic laws that are in place are not effectively functioning as a deterrent against the practice. The prevalence of bribery, as well as a disregard for victims due to their refugee, minority, or socioeconomic status, has compounded efforts to bring perpetrators to justice.

As the key driver for the illegal organ trade in Pakistan is financial, discrimination regarding victim selection mainly relates to class. Such extreme levels of poverty inevitably create a persistent demand and market gap for this practice, as individuals driven by desperation are willing to accept significant risks in exchange for compensation, especially when the sums promised for organs are so high, relatively speaking. Without stronger external enforcement mechanisms and more robust international collaboration, this dark trade will continue. 

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In February 2026, Muhammad Rafiq reported that his cousin in Rawalpindi, Pakistan had been kidnapped by an organ trafficking ring. He named an entire team of operatives, from abductors to medical personnel, who force individuals to have one of their kidneys removed and sold internationally. This case is the latest embodiment of a wider phenomenon in Pakistan surrounding the illicit organ trafficking industry, which continues to flourish despite the country’s existing legislation intended to curb the practice.

Primarily operating in Pakistan’s Punjab region, brokers coercively obtain organs to sell in a variety of ways, but one method in particular appears to be the most prevalent. Targeted victims tend to include impoverished workers who are often in desperate need of a loan to cover immediate expenses, such as medical bills, weddings and dowries, or, in some cases, to repay previous loans. Pakistan’s brick kiln industry in particular is known for offering what is known as a peshgi system, where workers can take an advance on future wages if they agree to work until the debt is paid off. These are unofficial and usually undocumented deals, with many debtors unable to verify the terms due to illiteracy. Some have reported that even when they know that terms have been drawn up in bad faith, they lack the confidence to challenge their bosses.

The debtors begin work at the brick kiln to pay off their loan, but the repayment terms are designed to keep them trapped in a continuous cycle of debt. One labor rights report published in 2025 found that a family of four who made 1,000 bricks in a day in Pakistan would be paid between 75-88 rupees each, which amounts to less than a dollar per person. With high interest rates on brick kiln loans, even when debtors pay toward their owed sum, their debt continues to grow. One girl’s family owed 200,000 rupees when she became a brickmaker at the age of 10. By the time she was 50, this debt had grown to 3.5 million rupees, despite her family working continuously to pay it off.

As it becomes clear that no amount of work will be sufficient to reduce, let alone fully repay, their debts, brick kiln owners begin to apply increasing pressure for loan repayments. They often provide indebted workers space to build mud huts near the kiln, and while this may seem like an appealing offer, it effectively places the whole family within the owner’s reach. Female family members are known to be subjected to sexual violence by kiln owners to increase pressure on debtors, demonstrating how such living arrangements enable exploitation. These types of threats are gradually increased over time to ensure the debtor enters a state of desperation and is punished psychologically.

It is at this point that the brick kiln owner will contact an organ broker and invite them to deliver a well-rehearsed speech that frames organ selling in attractive and heroic terms, with no mention of the serious health risks associated with the surgery. These appeals to heroism are likely intended to exploit the workers’ perceived failure as providers, implying that selling their kidney could restore a sense of masculinity by lifting their family out of debt. As debt is transferred intergenerationally after the debtor’s death, many choose to accept this morbid offer for the sake of their family. 

Some people in this situation are so desperate they even consider selling the organs of their own children, as was the case with one man who was then convinced by a local activist to refrain from doing so. The motivation for considering this option was to ensure the children could live their lives debt-free in the future.

These debtors undergo highly dangerous surgeries in unlicensed locations and leave without rehabilitation in order to keep medical costs as low as possible. Donors are then expected to return to work with little to no recovery time. There are even cases of these individuals requiring an organ transplant themselves to manage health issues incurred from the operation. They also tend to be paid less money than was negotiated – and sometimes are not paid at all. Although their kidneys are sold for tens of thousands of dollars, donors are only paid between $1,000-$3,000 on average.

In one case, Pakistani police discovered a 14-year-old child in an underground lab who had his kidney removed. The boy said there was an Arab man on the stretcher next to him when he woke up, illustrating the trend of typically wealthy foreigners, often from Gulf nations, coming to Pakistan to receive these illicit transplants. The relevant investigation led to the unearthing of an organ trafficking ring that would offer victims $4,000 for their kidneys. 

Pakistan passed the Transplantation of Human Organs and Tissues Act in 2010 in an effort to limit the unethical selling of organs across the country, but the law criminalizes both the sellers and the buyers of organs. This has prevented coerced organ donors from coming forward as victims and giving crucial evidence in legal proceedings. Moreover, these organ trafficking cases often involve multiple jurisdictions, as the donor, buyer, and location of the transplant operation involve different countries. 

For example, there are reports of the financially vulnerable being lured from Pakistan to China to undergo transplant operations there. In 2020, Pakistan’s Federal Investigation Agency (FIA) discovered an international gang involved in the illegal organ trade with China. Seven suspects were arrested, and the subsequent investigation revealed that the group in question had sent approximately 30 such Pakistani donors to China for illegal transplant operations, having facilitated their travel to the country for that purpose. Against the background of the China-Pakistan Economic Corridor (CPEC), Islamabad remains hesitant to raise such concerns with Beijing, despite credible reports that these abuses extend beyond illegal organ sales to include the trafficking of Pakistani women as brides to China, alongside other forms of human exploitation.

Because there is no globally encompassing law on organ trafficking, each country sets its own rules and has different regulations. The level of interstate coordination required to prosecute a single case of organ trafficking is therefore substantial and has led to very few prosecutions under current legislation. Corruption and a lack of enforcement means that even the domestic laws that are in place are not effectively functioning as a deterrent against the practice. The prevalence of bribery, as well as a disregard for victims due to their refugee, minority, or socioeconomic status, has compounded efforts to bring perpetrators to justice.

As the key driver for the illegal organ trade in Pakistan is financial, discrimination regarding victim selection mainly relates to class. Such extreme levels of poverty inevitably create a persistent demand and market gap for this practice, as individuals driven by desperation are willing to accept significant risks in exchange for compensation, especially when the sums promised for organs are so high, relatively speaking. Without stronger external enforcement mechanisms and more robust international collaboration, this dark trade will continue. 

Victoria Jones is a senior research fellow at the Asia-Pacific Foundation and a Ph.D. candidate in International History at the London School of Economics and Political Science. Additionally, she is the chief editor of INTERZINE, a digital media platform that uses history to contextualize current global issues. 

Eve Register is a research fellow at the Asia-Pacific Foundation and a member of NATO DEEP’s Global Threats Advisory Group.

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