Manila - Nilda Reyes winced as she lifted a chair to give to a customer in her small neighbourhood store that is also her home in Manila's slum district of Tondo.
The widowed 36-year-old mother of two admitted that she still feels pain from her side, almost five months since she donated one of her kidneys to an unknown recipient.
But for Reyes, it was all worth it.
"I don't feel pain all the time,' she said as she showed her scar that stretches from her navel to her back. "And when I do, it's very tolerable anyway. The inconvenience is a small thing compared to what I got in return for donating my kidney."
For her donation, Reyes received a "package of gratuity" that included 100,000 pesos (2,270 dollars) in cash, livelihood assistance of up to 75,000 pesos, a life insurance worth 100,000 pesos and a 10-year health care plan that also covers her family.
Using the money she received, Reyes put up her neighbourhood store and was preparing to open an eatery in another location.
"Of course, I also wanted to help those who are sick,' she said. 'But money was the biggest factor in my donation."
With millions of Filipinos living on less than 1 dollar a day, the Philippines has become one of the world's 'hotspots' for organ harvesting with foreign recipients paying as much as 30,000 dollars for new kidneys.
Due to high demand, illegal brokers prey on poor Filipinos who are forced to sell their kidneys and other organs for fast cash.
In Tondo's Baseco area, where hundreds of male residents have already sold their kidneys in the black market, many more are willing to make the risky deal for the cash.
"My wife and I decided it's our only option now," said a 28-year-old house painter, who was waiting for word from a broker about the sale of one of his kidneys. "We really need the money, I don't have a stable job and my wife earns very little doing laundry."
The father of three admitted he feared the consequences to his health, adding, "We haven't told our children because they might object. But I will be assuring their future with this deal. I can give them a better future."
But not all donors get a happy ending like Reyes, who gave up her kidney under a government organ donation programme that aims to ensure that donors also get proper health care before and after the operation.
In a study by the Philippine Society of Nephrology (PSN) of a cluster of donors in a province southeast of Manila, many of those who sold their kidneys were found to be suffering from various medical problems, such as hypertension and above-normal creatinine levels.
In one case, a 50-year-old man died from a heart attack just a few months after he sold his kidney for 110,000 pesos.
The PSN noted that while foreign recipients pay a huge amount for new kidneys, most of the money is pocketed by brokers, including doctors, who find the donors and convince them to donate. Donors only receive about 3,000 dollars for a kidney.
In 2007, a total of 1,046 kidney transplants were conducted in the Philippines, up from 690 in 2006, according to the Philippine Renal Registry.
More than 50 per cent of the recipients were foreigners in 2007, violating a 10-per-cent cap on the number of transplants to foreign recipients that was imposed in 2003. More than 80 per cent of the donors were not related to the recipients.
In March, the Department of Health issued new guidelines banning all organ transplants to foreigners in a bid to curb the thriving black market in the trade of organs in the country.
Health Secretary Francisco Duque acknowledged that the ban could lead to more illegal organ sales, but expressed confidence that the move was a necessary step towards curbing the illicit trade.
"This should not be the only step we take," he said. "We need strict enforcement of law and I'm sure that will lessen if not stop the illegal peddling of human organs."
But just two months after the ban was imposed, the Department of Health came under fire when its National Transplant and Ethics Committee issued exemptions for nine Israeli patients to undergo kidney transplants in the Philippines.
Duque said the exemption was given for "humanitarian reasons."
The PSN warned the exemption was setting a bad precedent, while Social Welfare Secretary Esperanza Cabral chided health officials for allowing the foreigners to again prey on poor Filipinos.
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