Reyna returned home with a tired expression after having spent a long day at the Philippines General Hospital with two potential organ donors.

The kidneys of these people can save someone's life. Reyna may also receive a small commission. Reyna is a "kidney hunter", searching the impoverished residential areas of the capital, Manila, in search of organ donors.

What she did was illegal. Under Philippine law, Reyna's actions constitute human trafficking of organs with a fine of up to 20 years in prison and very severe fines. However, poor life forced Reyna to engage, despite the risk of sitting behind bars.

Reyna works mainly to earn commissions. She sought potential donors, instructing them to undergo medical examinations on orders. Each time she was brought to a health examination, she received 500 pesos, equivalent to a dollar. Candidates must pass a series of examinations and screenings before performing any transplant. The process can take up to a year, giving Reyna abundant opportunities to make money.

The reward is compelling enough to entice Reyna into the world of illegal organ trafficking in the Philippines, which has been quietly developing over the past decades, where the termites are mostly poor, vulnerable people at the bottom of the ground. society.

"The government can't stop it," Reyna told Channel News Asia reporter inside her ramshackle home in one of Manila's most shabby slums.

Reyna's latest order came from a retired public official with progressive kidney damage. He lived on dialysis and was willing to pay 120,000 pesos ($ 2,300) for a healthy kidney from a living donor.

"It is not fair if I cannot help a fellow countryman who desperately needs an organ donor," she said.

The Philippines is famous as a global hotspot for organ trafficking. In 2007, they appeared on a World Health Organization (WHO) list, listing the notable human organ export countries, alongside India, Pakistan, China, Egypt and Colombia.

The Philippines later enacted a stricter anti-human trafficking law in 2009. The move contributes to a reduction in the rate of live organ transplants, according to WHO. The trend is also affected by stricter regulations in hospitals.

Although the Philippine government has made it more difficult for organ dealers to exploit the poor and vulnerable, they have not been able to completely eradicate organ trafficking in the underworld. Currently, illegal organ trafficking is overseen by the Justice Department's Interdisciplinary Committee (IACAT).

"In 2019, IACAT detected 51 organ trafficking," said IACAT Deputy Executive Director Yvette T Coronel. However, all of the new cases were only filed by none of the accused or perpetrators. "Law enforcement agencies are hindered by the fact that not many people complain about organ trafficking. Victims in organ trafficking lines are also not ready to come," she said.

Organ donation will be considered legal in the Philippines provided that the donor and the recipient must have a biological relationship, including parents, children, siblings, grandparents, nieces, nephews.

The Philippine government allows even organ donation among non-relatives. However, organ donors must prove they have a deep emotional relationship with the recipient and their actions stem from altruism. For example, a long-time boyfriend may donate kidneys to his girlfriend. Colleagues who have worked together for 10 years are also eligible for organ donation.

Without emotional, emotional, organ donation among non-relatives is illegal. Even so, such activities continue in hospitals in the Philippines when organ donation has become widely commercialized. Every transaction made on an underground market has long been a "well-known secret".

Based on online advertising, the cost of buying a kidney can be up to 500,000 pesos (US $ 9,700). Normal prices range from 200,000 pesos to 300,000 pesos ($ 3,900 - $ 5,800). The recipient of the organ will be responsible for the cost of meals and travel for the organ donor candidate and the broker during the medical examination.

Organ trafficking is an organized crime in the Philippines and involves many different parties. It is driven by widespread poverty and a rapid increase in the number of patients with kidney disease. In 2016, there were 21,535 Filipino patients receiving dialysis due to kidney failure, up from 9,716 in 2010.

People who need kidney transplants are mostly patients with chronic kidney failure and living on dialysis. According to Dr. Benita Padilla from the National Institute of Kidney and Organ Transplant in Manila, there are currently about 40,000 patients undergoing dialysis throughout the Philippines but only 500 are able to find the right kidney and afford it. Transplant. The cost of an organ transplant surgery ranges from 600,000 pesos to one million pesos ($ 11,650 - $ 19,400).

For wealthy patients, money is no problem. Their biggest worry is the long waiting list for legally donated kidneys and the heartbreaking fact that they may have to spend the rest of their lives on dialysis.

Despair mentality has pushed many kidney patients into the path of organ trafficking. It is estimated that at least 10,000 kidneys are sold worldwide each year, according to Organ Watch, a US-based organization that tracks global human organ trafficking.

In the Philippines, buyers include both Filipinos and foreigners with end-stage renal disease. They often hire clues to help find donors, forge relationships and related documents to deceive law enforcement agencies and health professionals.

The clues then contacted "kidney hunters" like Reyna, who are originally Filipinos living in impoverished communities with many social connections. Their goal is that the weak are in financial difficulties. They are easily pulled into selling organs.

"No wealthy people or ordinary minds are willing to donate organs and clues know this. That's why they are always looking for potential donors in poor areas," Reyna said. "The main motivation for people to agree to donate organs lies in their dreams. They want to buy a house, a car or a tricycle to carry passengers, to earn a stable livelihood."

This is the situation that Danilo knows best. On July 3, 2002, the father of two walked into the operating room at St Luke's Hospital in Manila to get a kidney donated to a recipient from Canada. Both are not related by blood and do not know each other.

"I'm not afraid because I only think about my children. I want to give my wife and children a home. Everything I think of is family," Danilo said.

The surgery lasted 6 hours. Danilo sold kidneys for 115,000 pesos (US $ 2,200) but eventually received only 85,000 pesos (US $ 1,650) after the commission deduction. He used all of his money to buy a house in a slum in Manila. 9 months later, a fire destroyed the home of Danilo.

"I was depressed ... but could do nothing but accept fate," he said.

17 years after organ transplant surgery, Danilo has not changed much. He is still poor and still lives in the slums with his wife and 5 children. Danilo's dwelling does not look like a home, it is dark, stuffy and cramped, symbolizing the difficulties and misery that Danilo has experienced throughout his life.

"I know it's illegal to sell kidneys, but the only thing that matters to us donors is that we can save others and save ourselves. The money I get is really helpful, especially. when we don't have a stable job, "Danilo said. "Life is great when we have money. Money to buy food and toys for the children."

Like many donors around, Danilo sacrifices his health to save others. With only one kidney, Danilo was easily tired. Previously, he used to work many days in a row but now, his body can not endure longer than two days. He could not skip meals, otherwise Danilo would suffer terrible pain. Heavy objects now became a great challenge for him.

Danilo said if he could return to the past, he would not sell kidneys. "I'd rather work tirelessly than to get tired as I am now," he said.

Many people are unaware of the side effects of organ donation. According to Nancy Scheper-Hughes from Organs Watch, some of the Manila slum youths have even been instructed by brokers to forge identity and age to donate organs.

Reyna started a kidney job from a living organ donor after her husband sold one of his kidneys. She has spent years building contacts with potential middlemen, buyers and sellers throughout the metropolitan Manila area. Sometimes desperate people come to her by themselves. They want to sell kidneys.

"I often go to residential areas, asking people if they want to donate at a fair price. Some people were initially scared. But I told them that my husband used to sell kidneys and he was healthy after each one." That year, at that time, they will be less worried, "Reyna said.

To prevent the commercialization of organ transplants, the Philippine government in 2002 established the National Organ Transplant Ethics Committee. Their job is to make sure the transplants at 18 accredited facilities across the country take place legally and without any commercial transactions.

The committee is responsible for interviewing organ donor candidates and recipients to confirm their relationship. If in doubt, they will refuse a transplant request. But even thorough evaluations don't always work.

"Is the Ethics Committee 100% successful? I'm not sure," said Dr. Padilla. "Organ brokers know what we're looking for. They know we want answers like," I don't sell. I just want to donate kidneys out of compassion. ' Therefore, they will guide potential donors how to respond correctly ".

Authorities hope stricter regulations will help end organ trafficking and prevent traffickers from taking advantage of kidney and poor Philippines patients. But in the meantime, kidney hunters like Reyna continue to hunt potential donors in vulnerable communities. Candidates without a biological relationship continue to tell stories to the Ethics Council, that they are long-term family members, friends of the recipient.

"After a series of examinations, they have to go through several interviews with pastors, doctors, social workers and psychologists. They can say that they really want to help patients. But if they decided not to donate kidneys, no one forced them, "Reyna emphasized. "For the donor, this is the only option that helps them make money."