A village of one kidney : an ethnographic study of Nepalese community

Abstract

Kidney-selling is a global phenomenon with the higher-income countries functioning as the recipients and the lower-income countries as the donors. Over the years, an increasing number of residents in a Ramita Gau village near the capital city of Nepal have sold their kidneys. This study aims to explore the drivers of kidney-selling, and its consequences in a Ramita Gau village using the ethnographic methods and the multi-stakeholder consultations. This study was approved by Mahidol University Central Institutional Review Board (MU-CIRB 2020/217.1808) in September, 2020 and by the Nepal Health Research Council (NHRC 716/2020 PhD) in January, 2021. The fieldwork started in February, 2021. An ethnographic approach using the assistance along with the in-depth interviews and the key informant interviews were conducted among the residents and kidney sellers in the village. The relevant participants in the village were selected purposively using a snowball approach. In addition, the online interviews with the relevant stakeholders were conducted at various levels, such as the authorities within the village, outside, and the policymakers. All interviews were audio-recorded for transcription and subjected to a thematic analysis. The ethnographic study identifies various factors to drag the villagers into kidney-selling such as development, lack of employment opportunities, alcoholism, imitations, social inequalities, and lack of government support to them. The case study shows that the lack of employment led the villagers to travel to India for jobs, which opened new prospect to earn money, hence they were indulged in kidney-selling. The key informants’ interviews show that the villagers are dragged into kidney-selling due to lack of education, employment, huge demand of kidneys in the market, the role of brokerage, and trend of kidney selling from the village.