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Man Dhoj Tamang cuts a forlorn figure as he stands in front of his house in central Nepal, overlooking a valley full of lush green rice fields.
The scenic beauty of the area hides an ugly reality symbolised by an eight inch (20 cm) scar near Tamang's abdomen.
The gaunt 42-year-old, who looks a decade older, sold a kidney in 2000 to raise money to pay off a family debt and buy a piece of land in the village of Shikharpur, 60 km (40 miles) east of Kathmandu, capital of the Himalayan kingdom.
Tamang, who is unemployed, received 70,000 Nepali rupees ($930) for his kidney, cleared his family's debt and gave the remainder to a broker to buy his dream plot of land for farming. The broker disappeared with the money.
"I'm finished. I lost a kidney and I don't have the land I paid for," Tamang, wearing a brown cotton vest and a pair of faded shorts, told Reuters in front of his thatched-roof house with its mud and stone walls.
Tamang is far from the only person to have sold a kidney in Nepal, one of the world's 10 poorest countries.
There are 33 others in the village of some 3,000 people who have sold their kidneys to either rich Nepalis or Indians who are ready to pay up to 180,000 Nepali rupees to brokers to buy a kidney for themselves or for their relatives.
In Nepal and more economically developed India - where demand for healthy kidneys is high and medical facilities are available for kidney transplants - it is illegal to sell or buy the organs.
The offence is punishable by fines and jail sentences of up to five years, although in Nepal one can legally donate a kidney to a relative who urgently needs the organ to save his or her life.
But with hundreds of people in the region in desperate need of kidney transplants, many choose the illegal route and deals are done in secrecy in both countries, with middlemen scouring villages looking for donors.
"There are no complaints in any court of law involving the sale of kidneys," said Shambhu Koirala, chief administrator in Dhulikhel, the district in which Shikharpur lies.
Poverty in Nepal - which drives thousands of young Nepalis to seek jobs in India as private guards, maids and army soldiers - also propels the kidney trade.
Most of Nepal's 25 million people live on an income of less than a dollar a day and nearly half of them have no access to basic healthcare, primary education or safe drinking water, making it a fertile hunting ground for kidney middlemen.
Most of the population depends on agriculture, seasonal work, which leaves many unemployed or underemployed for much of the year.
"Villagers, mired in deep-rooted poverty, are lured by local middlemen into selling kidneys for money," said Badri Prasad Dhungana, a teacher at the Shikharpur's only high school, who has tracked the sale of kidneys in the village for many years.
Locals say one reason why so many people have sold their kidneys in Shikharpur is its high level of unemployment, backwardness and yet, at the same time, its relative proximity to Kathmandu, which makes the rural hamlet attractive to brokers.
There is no electricity or piped water in the village, and buffaloes roam freely on the dusty trails between the houses.
Operations to remove and transplant kidneys are done in India and involve the seller travelling to Indian cities where medical facilities are better.
Pratap Lama said he grabbed the chance to sell his kidney.
"If you can live with one kidney, why not sell the other and make some money," said the 27-year-old, a farm labourer.
"What else can you do when you have nothing to support your family?" asked Lama, who started a tea stall and bar in the village from the money he received for selling his kidney to an Indian woman in the southern city of Madras four years ago.
But his business venture shut down as many impoverished villagers drank tea and liquor on credit and could not pay up.
"He (Pratap Lama) does not have any income to support two wives and eight children. Earlier, he could work as a physical labourer but now he is too weak for any hard work," said Maili Tamang, a local villager, standing nearby.
Others are critical of the kidney trade.
"We must take care of the body parts that are gifted to us by god," said Jit Bahadur Bishwokarma, who makes agricultural tools for villagers.

Copyright Reuters, 2004

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