The 1994 Transplantation of Human Organs Act (THOA) banned the commercial trade in organs in India — yet news channels in the country have literally survived on horror stories of poor laborers being relieved of one of their kidneys under the pretence of being taken in for a minor surgery. With no laws in place, by the 1980s India had became the great organ bazaar of the world, a trend now being replicated in most impoverished nations across the globe. The illegal narcotics trade routes along the Afghan-Tajik or Uzbek borders are now increasingly becoming the smuggling route for multiple actors — one of which is the illegal organs trade. Little children are the most gullible and common victims in the trade — sold off to middlemen for ridiculous sums of money only to be used either in the organ trade or as carriers. Pakistan and Bangladesh have had to deal with the same issue, leading to the enforcement of laws to prevent this exploitation of the vulnerable in each of these societies.

While the Indian government is contemplating amendments to the old Act to bolster it, the fact is that the old Act was abused for 15 years. Many victims later, the government seems to have awoken in the midst of "Dr. Horror's" web-like empire of deceit and material lust. With an Ayurveda degree, the doctor carried out kidney transplants with such impunity at makeshift "hospitals" and nursing homes — largely with the connivance of a plethora of government functionaries and officials, each enjoying their slice of the grand pie at the cost of poor, vulnerable human beings. Having developed into a veritable export industry, every year over a thousand organs from India go abroad – most of them to Arab countries – even though the domestic demand is far from met. With the support of newer medical technologies (like drugs controlling the body's rejection of foreign bodies), the huge transplant industry has actually survived on unwilling, poor donors for much too long.

To obliterate the black market, the law banned all transplants except those donated by relatives, which included the spouse, son, daughter, father, mother, brother or sister. Meanwhile, the illegal industry targets just about anyone vulnerable enough to part with or be fooled into parting with their kidney, but women constitute the lion's share of the willing or unwilling donors. Seventy one percent of those who sell kidneys in India are women. In a country where women struggle for space both in their marital and paternal homes and their status in the former is determined by their ability to bear a male child the statistics are far from shocking. With these women rarely having a say in most family matters – even with regard to the children they bear – the question of consent (which the law is so heavily hinged upon) is also rendered irrelevant. In most families where daughters are considered a burden to be gotten rid off via matrimony as early as possible, the daughter would be the first person from the family to be picked as a possible donor irrespective of her own medical conditions or ability.

Similarly, with the status and lives of women tied to their husbands, when a spouse is a donor it is usually the wife, and there are very rare instances of the reverse. Keeping these various cultural contexts in mind, it is just an extension of the same when it applies to a "donation" for sale — the woman would more often than not be the first to part with her organ in return for money. And this has been made easier with a clause in the Act, which allows unrelated donors to donate kidneys for reasons of ‘affection and attachment;' — opening doors for black marketeers to operate.

With most of these women themselves illiterate (like their spouses) not only are they cheated of the amounts originally promised, they also frequently do not receive the post-surgery care they need, nor are they educated about the post-surgery precautions further leading to medical complications. With limited or no access to medical facilities and due to the illegality of the transaction itself, the complications, more often than not, tend to be life threatening.

Stricter laws in the developed countries and an accompanying organ shortage in the West has spawned a new demand and supply equation across the world. In 2005, more than 16,000 kidney transplants were performed in the United States, an increase of nearly 50 percent in a decade. The potent mixture of the desperation of the waiting patients in these countries and the failure of laws in countries like India supports the unethical collusion between the medical practitioners and is abetted by the ready availability of the underprivileged victims and the incompetence of monitoring agencies. While scams and scandals do enough to shake a society out of its stupor the truth is that the sordid industry – like many times before – was unearthed when one of the male victims lodged a complaint. Who is the voice for the silent seventy one percent?