They call it Isla Walang Bato, Tagalog for No-Kidney Island.

This is the impoverished port area of Baseco in Manila, where residents sell a kidney on the black market just to get by.

Across the Philippines, places such as Baseco are providing a ready supply of kidneys for the ailing wealthy. The seller is invariably male, in his 20s and desperately poor.

Like Reynaldo Yap, a pier hand who works on the docks. Broke and in need of money to pay off a loan, he decided to sell his only asset: a kidney.

A broker living in Baseco arranged the sale for 85,000 pesos (US$1,750), a miserable price, considering that the going rate for a kidney can be as much as $4,300.

A few days later Yap checked into a hospital, was screened for compatibility and went under the knife. The recipient was a Canadian with end-stage renal disease.

That was just over a year ago. Today, Yap said his health is good: "But when I am carrying heavy loads, I get tired quicker than before."

In the meantime, the police are struggling to put kidney bazaars such as Baseco out of business.

Baseco police chief Norbeto Murillo knows the identities of the brokers in his community of 6,000 families.

"But it is hard to make an arrest," he said resignedly. "A broker accompanying a donor to hospital will say he is only serving as a companion; it is a secret agreement."

Under the law, there is nothing to stop an organ donor coming to a private arrangement with a recipient. It is only the presence of a middleman brokering the sale — for a cut of $7000 — that makes the deal illegal.

Baseco’s nickname suggests that many residents have sold a kidney over the years. But arriving at a final figure is hard.

A University of the Philippines study from 2003 quoted Baseco’s most senior official as saying that around 3,000 had gone under the knife — a figure that meets with incredulity in the medical profession.

From 2000-05, there were 2,367 kidney transplants performed in the whole of the Philippines, according to National Kidney and Transplant Institute (NKTI) data.

The figure — accurate or otherwise — caught the attention of President Gloria Arroyo when it appeared in a Manila newspaper recently. She reportedly instructed the Department of Health to work with the medical profession to find ways of stopping the illegal trade in human organs.

As it happens, moves were already under way to set up a regulated system of compensated organ donations and a national procurement body.

This issue, nonetheless, is a complex one. For many, organ sales by living donors are morally questionable. The poor, too, are usually less healthy than the better-off, and studies have shown that live donors go on to suffer a decline in health.

But a regulated ‘ethical’ market could give poor donors a better deal — and remove the middleman.

In fact, a local non-governmental organisation — the Kidney Foundation of the Philippines — already offers a ‘package of gratuities’ worth $9,600 for people selling a kidney that includes cash, life insurance and free annual check-ups.

Unfortunately, word hasn’t got out to the slums yet.

Dr. Remedios de Belen-Uriarte, manager of the NKTI’s Renal Disease Control Programme, admitted the system is failing. "We have to concentrate on areas known for selling kidneys with education campaigns."

Those who have sold a kidney rarely go for the check-ups that doctors say must be done annually for at least a decade, because they can’t afford to.

"I was told to go back for a check-up, but I felt okay, so I did not," said Baseco resident Celedonio Piandiong, a roadside cigarette vendor who sold his kidney for $2,900.

At the other end of the transplant chain, regulating the market could help the authorities exercise some control over how donors spend their kidney windfalls.

Baseco senior community councillor Rey Campenera said that while some invest their money wisely — buying a house or starting a small business, for instance — too many squander their money on home appliances.