From recruitment to regret: a crime script analysis of illegal kidney donation in Pakistan

Organ transplantation is regarded as a lifesaving procedure, and a worldwide organ shortage has catalysed the market of illegal organ trade, especially for kidneys, due to high demand and need in low and middle-income countries like Pakistan. This process is often facilitated by sophisticated, organised crime networks acting within or parallel with licit healthcare systems, exploiting the vulnerable communities. Therefore, this study aims to explore the lived experiences of individuals who illegally donate their kidneys in Pakistan, with special focus on the whole process to map the findings on the crime script framework. The present study employs a qualitative, exploratory design using a semi-structured interview guide. Detailed in-depth interviews were conducted with five kidney donors using the snowball sampling technique. A thematic analysis approach was employed to interpret data, aided by crime script analysis to analyse the systemic organisation of the illegal kidney trade. Findings were divided into three major themes: Before Donation, During Donation, and After Donation. Participants explained that they were deceived by brokers, blindfolded, taken to hidden sites, and subjected to coercive surgery. Most suffered from health decline, psychological trauma, and economic instability after donation, with no long-term benefits. The crime script framework identified the sequential pattern of exploitation by brokers and collusive medical staff. Pakistan's illegal kidney trade is operated through an intricate yet predictable cycle based on poverty and poor regulation. Targeted policy change, institutional responsibility, and donor-focused protective measures are desperately needed to end exploitation.