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Thursday, July 31, 2014
- Already on dialysis, Sukhil Johal was told by her doctors in the United States that she needed a kidney transplant. But they also told her that it would probably take 10 years before a suitable one could be found for her.
Unwilling to wait that long, Johal headed for what was then known as the world’s kidney bazaar: Pakistan.
That was in 2008. Johal, now 47 and working as a beautician in Britain, is healthy. But non-Pakistanis who may be in need of an organ transplant as she once did may now find it harder to replicate her medical experience here.
At least that is what many doctors and government officials are saying more than a month after President Ali Zardari signed the historic human organ and tissue transplant bill into law.
But others worry that the new law would just drive the trade in human organs underground and put more lives at risk. They add that Pakistanis are not ready to donate organs of recently deceased loved ones, as the law’s proponents apparently hope to see happening.
“Performing (organ transplant) surgeries will now be in the hands of quacks,” predicts Ahsan M Khan of Masood Hospital in Lahore.
Aimed at stopping commercial transactions involving human organs and tissues, the law stipulates punishment of up to 10 years in prison, along with a maximum fine of one million rupees (11,668 dollars), for violators.
While it prohibits Pakistanis from donating an organ to a foreign national, the law allows voluntary organ or tissue donation by a person not less than 18 years of age to any other “genetically and legally related” person.
If no such donor is available, the law allows a voluntary donation from a “non-close blood relative”.
The law also allows the donation of organs and tissues from an individual 18 years and above who had passed away but had previously indicated his or her willingness to do so, or whose relatives permit such to be performed.
Likewise, evaluation and monitoring committees would be set up to give approvals before any donation and transplant can take place.
The law’s proponents had made no secret of their aims to stop the exploitation of the poor by those desperate for organs, especially kidneys. Up until recently, Pakistan was notorious for being a human-organ market, attracting patients from the United States, Europe and the Middle East.
As late as 2006, nearly 2,000 kidney transplants took place in Pakistan, of which half were carried out on foreigners. Only a quarter involved organ donations from relatives.
Ironically, Adibul Hassan Rizvi, chief of the Sindh Institute of Urology and Technology (SIUT) in Karachi, has noted that 50,000 patients die each year in Pakistan “for want of organ transplantation”.
In 2007, then president Pervez Musharraf had signed a version of the organ transplant bill into law. But when he was ousted the next year, that ordinance went into legal limbo. Last November, a fresh version gained the National Assembly’s approval. The bill was passed by the Senate before President Zardari signed it into law on Mar. 18.
Anwar Naqvi, also of SIUT, says it took this long for Pakistan to have such a law in part because in 2007, the commercial lobby, “realising that their nefarious businesses may be closed down… challenged the legislation in court, terming it un-Islamic”.
Eventually, he recounts, “it was revisited by Islamic scholars who declared the law was in keeping with the shariah (Islamic law). It was then taken to the National Assembly where some parliamentarians wanted the sale of organs to be permitted. After convincing them that it did not negate the ethical dimension of the law, the legislators withdrew their objections.”
Addressing fears that the new law may create a black market in human organs, along with surgeries done in the shadows, Rizvi argues that it is now for civil society and media to spread awareness of the law and the deceased donor programme, and of government agencies to ensure that the law is implemented.
But Khan says the law poses practical challenges as well. He says, “For the cadaver donation progamme, you need to create a complete infrastructure starting with a centralised database of willing donors, a string of intensive care units across Pakistan, urologists, transplant surgeons, a transport network, and even air ambulances.”
Keeping a dead body on a ventilator costs 10,000 rupees (116.7 dollars) a day, says Khan. “We don’t have funds to provide basic health to the living, where is the money going to come to keep the dead fresh (for organ- harvesting)?”
He says doctors may find it hard to counsel “say, parents of a young man, to think about donating the organs when they have not even accepted that he is dead”. The Kidney Foundation’s Jaffar Naqvi agrees that “the nation is not yet mature” to part with the organs of the dead.
As for intensive care units, he says they are available but “what needs to be done is to improve the units operating in government hospitals.”
Anwar Naqvi suggests that setting up a national donor database is not an impossible task either. “Consent can be on the computerised national identity card, which everyone carries.”