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Monday, September 1, 2014
- Few in Pakistan believe that a presidential ordinance, passed earlier this month, regulating organ transplantation will stop a flourishing but gruesome trade in human kidneys. ''The trade will go on as long as there are poor and healthy donors around as well as rich patients needing a kidney and ready to pay the price. It will only go underground,’’ Shahzad Rizwan, 30, told IPS. Rizwan should know. He sold one of his kidneys four years ago to pay off a loan of Rupees 22,000 (366 US dollars) that he took when his wife underwent a caesarean section.
''Nobody had any objection (to the trade) till the agents became too greedy and stopped paying the promised amounts to donors…this is the real issue," Rizwan said. After attempts at legislation over several years failed, the Supreme Court, in July, took suo moto notice of complaints that poor people were being coerced into selling kidneys cheap, and ordered the government to bring in regulations.
But there are many loopholes in the ordinance promulgated on Sep. 3. For a start, it does not completely ban 'unrelated' donations. A clause allows kidney donations to be made by people not related to the recipient, provided they are "voluntary, genuinely motivated and without duress or coercion."
"Any law is only as good or as bad as society makes it to be," commented Prof. Anwar Naqvi of the Sindh Institute of Urology and Technology (SIUT) in Karachi. ‘’Now at least action can be taken to curb a nefarious activity that enjoyed complete legal impunity,’’ Naqvi, a campaigner for regulatory laws, told IPS.
In May, when Lahore police busted ten hospitals the impunity was all too apparent. ‘’There was no law that said that trade of this kind was illegal," explained Sajjad Hassan Khan Manj, superintendent police in the Kot Lakhpat area where the hospitals are located. "The hospitals showed us consent forms duly signed or stamped by so-called consenting donors."
As patients, suffering from end-stage renal diseases, began flocking in from the United States and Europe, and the oil-rich Arab countries of the Middle East, Pakistan had acquired the unsavoury reputation of being one of the world’s ‘kidney bazaars.’
"In 2006, some 2,000 kidney transplants took place in Pakistan. Of these 500 were donations from family, 500 were Pakistanis who had a family match but bought kidneys as either the donors were reluctant or the recipient thought that it would jeopardise the life of the donor. A further 1,000 transplants were carried out on foreigners, a vast majority of whom were from Saudi Arabia," says Naqvi.
While Saudi Arabia has a cadaver-based donation programme, many Saudis are reluctant to gift their organs after death because of religious and cultural beliefs.
Dr Ahsan M. Khan, executive director of the Masood Hospital in Lahore, a leading institution for kidney transplants and among the ten hospitals which were raided for alleged involvement in the trade, said he doubted whether the ordinance will curb the trade.
''Like (illegal) abortions, this will go on. Instead of expert teams of surgeons performing in well-reputed institutions, the transplants will be carried out by non-qualified hands," says Ahsan. He cited the example of India which banned commercial transplants more than a decade ago, but where the practice has gone underground.
The new transplant law stipulates the setting up of evaluation committees in each institution where a minimum of 25 transplants are carried out annually. These committees will include two notables from civil society to ensure no foul play or exploitation of the poor to benefit the rich takes place.
The law also instructs creation of a monitoring authority at the federal level that will include senior members from the medical fraternity. An important function of this body will be to frame rules and eligibility for certification of transplant centres and professionals and carry out inspections.
"There may still be some areas that need to be revised to purge it of misuse," acknowledges Naqvi. ‘’The ordinance may not be perfect, there is always room for improvement."
The new law also calls for urgent efforts on two fronts. ‘’We must improve our dialysis service and begin work on promoting a cadaveric donation programme,’’ says Sajjad Hussain, a Lahore-based urologist and transplant surgeon. At the moment there are an estimated 7,500 people on dialysis with only 140 centres in the public and private sector – some of them having just one or two dialysis machines.
Dr Sanaullah, a consulting urologist at Lahore General Hospital, says unrelated donations cannot be done away with completely. "Often diseases run in families, including those leading to kidney failure. That makes it difficult to find healthy relatives who are able to donate a kidney.’’
He is also concerned that apart from not having enough dialysis centres, even the quality was not up to the mark. "The machines we use are obsolete and outdated, technicians not properly qualified, and there is a very small pool of good nephrologists – our dialysis services need to be completely overhauled.’’
A better alternative, he said, would have been to make the state responsible for legalising and regulating 'donations'. "This will ensure that donors are adequately compensated and provided health insurance. It will also help eliminate the black market in organs and making transplantation safe for both donors and recipients.’’
(*Reporting for this story was supported by the United Nations Development Programme through its Asia Pacific Human Development Media Fellowship)