The lack of cadaver organs for transplantation motivates some Balkan patients to go to developing countries to buy a kidney. We have followed 36 patients who received kidney transplants in Lahore and Rawalpindi, Pakistan. The patients had not been cleared for transplantation with a standard pre-transplant work-up: 80% were hepatitis-C virus (HCV) or HBsAg positive. During follow-up, seven patients died. Sixteen patients experienced wound infections with post-operative hernias, and three patients developed peri-renal hematomas. Six abscesses and four lymphoceles occurred, and four urinary fistulas were surgically treated. Nephrectomy was performed in three patients because of renal artery thrombosis. Nine patients developed active hepatitis C, and four patients manifested cytomegalovirus disease. Three patients developed steroid diabetes, and three patients experienced acute myocardial infarction. Nine patients had one or more rejection episodes. Urinary tract infection with Pseudomonas or Escherichia occurred frequently. The one-yr patient and graft survival rates were 80% and 68%, respectively. Paid unregulated renal transplantation is not recommended for both ethical reasons and because of an association with excessive morbidity and mortality.