A leading transplant surgeon has called on the government to license the sale of human organs in the UK.
Professor Nadey Hakim, a surgeon based at St Mary's Hospital, London, said a regulated market of organ donors would cut so-called "transplant tourism".
Senior doctors have complained of growing strains on the NHS from botched transplant operations conducted abroad, while doctors in India see poor donors dying after selling one of their kidneys.
Professor Hakim told BBC Radio 4's File On 4 programme: "As this trade is going on anyway, why not have a controlled trade where if someone wants to donate a kidney for a particular price, that would be acceptable.
"One in three of patients from our waiting lists who have gone overseas have either died or had the transplant fail "
Dr Robert Higgins, a transplant surgeon at Coventry Hospital, has logged the inherent dangers of transplant tourism.
"One in three of patients from our waiting lists who have gone overseas have either died or had the transplant fail. It compares to about one in 10 death or failure rate in this country."
The problem is particularly acute within the Asian community where people are at particular risk of kidney failure and disease.
Asians represent 4% of the population but 14% of the waiting list for kidneys.
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Heart attack
File On 4 spoke to a number of British Asian families with members who have gone to the sub-continent to pay for transplants.
In his mid-50s, the father of Jamal travelled to India where he had arranged with a surgeon to buy a kidney on the open market.
"The hospital got five donors in a room and he could choose which one to use," said Jamal.
The hospital declared the transplant a success, but they had apparently overlooked the risk from the man's high blood pressure, and 45 minutes later he died of a heart attack.
Police investigation
In the Punjabi capital, Amritsar, File On 4 tracked down the poor and homeless who are recruited as donors by agents for the transplant surgeons.
16-year-old Harjinder was whisked off to a safe house near a hospital and introduced to the woman patient he was being paid to help - but he did not know the truth of what she needed.
"Ultimately, the organ trade is like child prostitution"
"I'd been told I was donating blood but the doctor said he had removed a stone.
"It was when I left hospital I found out they had removed my kidney."
A police investigation into more than 2,000 questionable transplants in and around Amritsar found that 22 donors had died after giving their kidneys.
Some were secretly and illegally cremated, others dumped into canals. The leading doctor has been accused of culpable homicide.
In cases under investigation, scores of British transplant tourists are thought to be among those who have received organs.
This is an aspect of the trade which disturbs the lawyer for the Punjab Human Rights Organisation, Rajwinder Bains.
"Ultimately, the organ trade is like child prostitution. The developed world comes to South-East Asia for kidneys.
"The British legal system should take care of this."
The UK National Kidney Research Fund said it was important to find new ways to increase the supply of donor organs.
These could include the use of older donors, non-heart beating donors and living donors, and improved co-ordination and training of transplant co-ordinators
But a spokesperson said: "The fund does not believe that compensating people for donating an organ, over and above that of reasonable expenses, is necessarily the right answer."
File on 4 is broadcast at 2000 BST on Tuesday 20 May.
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