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KARACHI, Dec 18 2007 (IPS) - More than two months after Pakistan passed a law to encourage cadaveric organ donations and do away with commercial transactions in live human organs, doctors are struggling to establish and popularise a deceased donor programme.
Insurmountable hurdles seem to be coming in their way, including low government spending on public health, poor infrastructure and religio-cultural issues such as permissibility in Islam to harvest organs from the dead.
Dr S.A. Jaffar Naqvi, a prominent nephrologist and chief executive of the ‘Kidney Foundation’, told IPS that he has not heard of a single case of cadaveric donation since the passage of the Transplantation of Human Organs and Tissues Ordinance on Sep. 2.
Naqvi, however, was optimistic that setting up a deceased donor programme was "really not an impossible task given the philanthropic nature of the people’’. ‘’But these programmes need the full backing and commitment from the government as well. It cannot be absolved of its duties just because of a few generous people around."
It took Pakistani doctors and activists 15 years to steer the law past powerful vested interests with stakes in a thriving ‘organ bazaar’ that dealt in live human kidneys transplanted to rich local people and foreigners.
For Dr Adibul Hasan Rizvi and Dr Anwar Naqvi, of the Sindh Institute of Urology and Transplantation (SIUT), Karachi, who put years of technical expertise into drafting the law, there is still reason to cheer despite the sluggish start.
However, Naqvi concedes that ‘’it is difficult to come to terms with the fact that your loved one is brain dead and is only alive because of life-supporting machines. For doctors, the task becomes doubly difficult convincing them (next of kin).’’
"We have the expertise, all that needs to be done is to get ourselves organised and set up centres", says Dr Sajjad Hussain, a Lahore-based renal transplant surgeon. He also believes that there is no more room for debate on the ethics of retrieving an organ from a dead person. "The issue has been settled on both the Islamic and ethical fronts. I don’t feel we will meet with any resistance due to that."
The ordinance stipulates that a dead person over 18 years may ‘donate’ any organ or tissue for transplantation. "The cases of unclaimed brain dead hospitalised patients shall be presented to an evaluation committee for transplantation after an intense search for their relatives within 24 hours,’’ states the law. The idea is borrowed from the Spanish model of cadaveric donation in which a person automatically becomes a donor if he or she does not carry a card forbidding organ removal in case of sudden death.
Pakistan has had a poor track record of cadaveric donations. Before the law was passed only two persons, Naveed Anwar, 24, in 1998, and Shamim Bano, 22, in 2005, were known to have ‘donated’ their kidneys and corneas. Both had met with accidents and were pronounced brain dead. There are also instances of men on death row having pledged their organs.
Besides creating awareness, there are practical issues. "With just a handful of intensive care units dotting Pakistan, a miniscule national health budget, almost non-existent private investment in healthcare in remote places, untrained human resources and absence of national transplant registry software," it is a gargantuan task, says Jaffar Naqvi.
Transportation is a problem in a country where road networks are not fully developed. And few can afford the charges involved in retrieval, storage, transport and transplant, even if organs are available. Doctors point out that lack of ready transport is one reason for high maternal mortality rates in Pakistan.
Naqvi suggests initiating the programme on a small scale from a metropolis like Karachi. "That will have an impact and convince people to donate." Instead of donor cards, which many people may not be carrying all the time, doctors suggest an indication of consent on the computerised national identity card. "Almost everyone carries that. That information can eventually be used to form a national registry,'' said Anwar Naqvi.
(*Reporting for this story was supported by the United Nations Development Programme through a UNDP Asia Pacific Human Development Media Fellowship)
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