A small group of impoverished villages not far from the Nepalese capital, Kathmandu, have recently become an epicentre for the selling of kidneys.
A fifth of the people in some villages have sold a kidney
Kidney donation in Nepal is illegal, except from a close relative. But middlemen have persuaded impoverished villagers to sell a kidney for cash or land.
I met one such donor, Ram Thakuri, at his family's two-storey mud hut in the village of Shikharpur, less than two hours drive east of Kathmandu.
Many people here are subsistence farmers and life is very basic, with the cattle living inside the house.
Ram is only 22 but has to support his parents and two brothers from his factory job in the capital.
Nowadays, he told me, he finds heavy work like that difficult. He believes his health has suffered because he's given up a kidney.
"I'd heard so many people talking about the middlemen who sell the villagers' kidneys," he said.
Two brokers, who Ram says were local tailors, arranged for him to travel to Madras in India, where he was operated on.
Later, secretly, his father followed suit.
"The brokers promised me 160,000 rupees [$2,100]. But I only got 75,000 [$1,000], and the brokers disappeared," said Ram. "The money has done nothing at all to change my life."
Villagers gathered under a tree told me about the problem. Perhaps a fifth of the people here, desperate for cash, have sold a kidney, without proper screening to ensure they're fit enough to do it.
Udab Bajgai had the operation in Punjab three years ago aged just 19. He had no land or money and was desperate for cash.
But, he said, he'd received not a single rupee of the promised money - part of what seems to be a clear pattern of brokers cheating villagers.
Badri Prasad Dhungana, a local schoolteacher, has been trying to publicise the issue since becoming aware of it five years ago.
Teachers are trying to publicise the issue
"The brokers promise them between 80,000 and 180,000 rupees, depending on the blood group," he said.
He has never met the brokers personally, but believes many live in Kathmandu, a convenient distance away.
Unlike kidney rackets in other countries, most of these transplanted kidneys come back to Kathmandu, even if the villagers go all the way to India for their operations.
Although Nepal still lacks the technology to transplant kidneys, there is a growing demand for such transplants among Nepalis who suffer kidney failure - especially when those patients are more prosperous and educated.
In the dialysis ward at the National Kidney Centre, patients have to come three times a week for costly treatment. A new kidney offers them a way out of this ordeal.
The centre's director, Dr Rishi Kumar Kafle, says the brokers are cunningly taking advantage of this - a neat case of supply and demand.
But he admits that there is an ethical dilemma here.
"Ethically, the people should not buy any kidneys from anybody," he says.
On the other hand, people often ask him for a way out of the punishing dialysis routine.
"Being a doctor, taking into consideration these people, how can I say - you go and die, or come to my centre for dialysis all the time? This also seems to be illogical."
Udab Bajgai had a kidney removed when he was just 19 years old
He believes commercialisation of kidney transplants should stop and that willing donors should get government support such as regular check-ups.
Less than two hours away, in Shikharpur, past kidney donor Udab is bitter about what he went through.
"I'd advise other people, never do this, because I've been through it and I don't want anyone else to go through what I did. I feel extremely angry but also helpless," he says.
This kind of trade in organs will continue in the shadows, here as in many other poor countries. The more the demand, the more people will step in to make money out of it.
But these are villages where there is no chance of education about the need for extra protection of the kidney that remains, and regular health checks are unaffordable.
So each new recipient can mean one more endangered life in the village.