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Thursday, April 17, 2014
- Forty-year-old Sajja Bibi from Sukkur, 470 km from Pakistan’s port city of Karachi, has been camping on the pavement across from the Sindh Institute of Urology and Transplantation for over two years now.
Every other day, she walks up to the 750-bed institute for dialysis, offered free of charge. A few hours later, she’s back on the pavement.
With her is a whole community, patients and families of patients with late-stage renal failure, undergoing regular dialysis and waiting endlessly for a compatible kidney donor.
The dialysis ward at the Sindh Institute of Urology and Transplantation (SIUT) is perhaps the busiest in the country. Widely recognised as a centre of excellence in urology and nephrology in South Asia, the institute provides 160,000 dialysis sessions every year, which according to SIUT’s head Dr Adibul Hasan Rizvi, takes care of only 27 percent of the country’s needs.
And renal complications are only likely to grow, with the International Diabetes Federation estimating Pakistan to rank 10th by 2030 among countries with prevalence of diabetes. Diabetes mellitus is one of the leading causes of chronic kidney failure.
Yet, there are not enough organ donors in Pakistan. This, despite the country having passed the Transplantation of Human Organs and Tissues Act in 2010 which allowed not just relatives but also a living unrelated donor to donate organs, though under very stringent conditions.
People are just scared of donating a part of their body, according to Sabiha Mohammad Saleh, 36, who has been coming to SIUT for dialysis since 1995. “They don’t even donate blood, what to talk of kidneys,” she tells IPS.
Offering a rough estimate, Rizvi says 50,000 people in Pakistan die of organ failure every year. Of these, he adds, 20,000 die of kidney failure, 15,000 of liver complications, 8,000 from heart failure and the rest due to failure of the lungs and pancreas.
But SIUT has performed only just over 4,000 kidney transplants since it started operations in 1971 as an eight-bed unit in Karachi’s government-run Civil Hospital, says Rizvi, who is also the president of the Transplant Society of Pakistan.
There have been only two deceased organ donations in the country since 2010, he says. Many young and educated people pledge their organs, but their relatives refuse to honour their wish at the last minute, he adds. Dismembering the body, they feel, is tantamount to desecrating it and, therefore, goes against the tenets of Islam.
Twenty-six-year-old Shamim Meerajan, who has been coming to SIUT for dialysis for the past five years, cannot understand why this should be so. “A corpse is anyway eaten up by creatures after it’s buried,” she tells IPS. It’s the spirit that matters and it cannot be dismembered, she adds.
Many Muslim countries have a strong deceased donor programme, particularly Iran and Saudi Arabia.
Religion is just a smokescreen people hide behind, says Rizvi. The real reasons lie elsewhere. “We had been involved in organ sale for almost 20 years, which had become a sort of culture here,” he tells IPS. “There was a powerful group which benefited from this malpractice. They had money as well as contacts among the higher-ups, who they obliged with illegal transplantations.”
Pakistan had, in fact, become the hub of transplant tourism in the mid-2000s, with recipients from Australia, the Middle East, Europe and the U.S. constituting the bulk of the beneficiaries.
During this time, the country was hosting up to 1,500 transplant tourists every year, according to World Health Organisation estimates, second only to China. They would pay up to 40,000 dollars for a kidney, but only 1,000 to 2,000 dollars of this would reach the donor.
Given these firmly entrenched interests, it took Pakistan three years to enact the bill. Initially, there were objections that its provisions were contrary to the Islamic law of Sharia, but Pakistan’s Federal Shariat Court, which has the power to examine and determine whether the laws of the country comply with Sharia, gave the bill its approval in 2007.
The Act now prescribes a punishment of up to ten years and a fine of up to one million Pakistani rupees (roughly 9,700 dollars) for those found to be involved in human organ trafficking.
Sindh also became the first of Pakistan’s four provinces to ratify the law in its assembly after the 18th amendment to the constitution in 2010 devolved the country’s health sector to the provinces.
It still hasn’t helped the cause of deceased organ donation. This is because, says Dr Farhat Moazam, head of the Centre of Biomedical Ethics and Culture at SIUT, “no concerted effort has really been made to reach out to people, and make them understand what the deceased organ donation programme is.”
Rizvi holds civil society, media and “all those who matter in society” responsible for failing to encourage people to come forward and pledge their organs. Leading by example, he and his entire team have pledged their organs after death.
Another reason for the negligible levels of organ transplants in Pakistan, Rizvi points out, is the limited number of high-quality intensive care units (ICUs) in government hospitals where organ harvesting can take place.
“Most ICUs of international standards,” he tells IPS, “are in private sector hospitals. And they will never help advance the deceased donor programme.”
They will, for example, not bother with counselling or persuading families to donate the organs of their deceased kin. “We have converted the medical profession into an industry; in an industry, you work for profit, not for altruistic reasons,” says Rizvi. The country therefore needs more ICUs and trained personnel in its government hospitals, he adds.
Only then can the deceased donor programme become a success. “Not only will it arrest the trafficking of organs,” says Rizvi, it will also open up a new era in the science of transplantation in the country where every organ could be transplanted. “A deceased man could become a source of life for at least 17 others.”