Fighting Kidney Tourism in Pakistan

By Zubeida Mustafa
Source: The WIP

A few years ago, Pakistan’s newspapers and magazines were awash with pictures of shirtless men displaying scars on their torsos indicating they were organ donors. There were villages where practically every male adult claimed to have sold a kidney to earn extra money to repay his debts.

• Dr. Rizvi with one of his young patients. Photograph courtesy of SIUT. •

Those were the days when the organ trade operated in a grey area in Pakistan. Repeated demands by the head of the leading medical institution in the country – the Sindh Institute of Urology and Transplantation (SIUT, Karachi) – failed to stir lawmakers into action. There was no law to regulate surgical procedures like kidney transplants, although nearly 2,000 were performed in the country annually. Of these, 1,500 involved foreigners suffering from end stage kidney failure who traveled from as far as the US to purchase an organ for $40,000USD to save themselves the discomfort and hassle of dialysis. Since the organ trade did not enjoy public approval, transplant surgery was always hastily and surreptitiously done. On their return home many of these patients suffered complications and landed back in the hospital.

For many, such as Dr. Adibul Hasan Rizvi, Director of SIUT, this practice was “shameful.” He strongly feels that healthcare is a basic human right.

“Why should only the rich, who can afford to pay, be entitled to live but not the poor?” he asks. Dr. Rizvi does not charge a single penny for his services. “I do not ask my patients to prove their poverty. Even costly transplantation surgery is free at my Institute.” His compassion has touched many – SIUT, a public sector facility, remains financially afloat with the help of donations from the community.

But his philosophy has not made Dr. Rizvi popular with some surgeons whose main concern has been the commercialization of the medical profession. At SIUT, Dr. Rizvi enforces the principle that only live, related or deceased donors can provide organs for transplantation.

Dr. Rizvi won his first battle when the highest court in the country directed the government to draw up a law to keep organ trafficking in check. In 2007, Pakistan adopted the Transplantation of Human Organs and Tissues Ordinance (THOTO) that bans the sale of human organs. Widely hailed as a victory for ethics in medical practice by the World Health Organization and the International Transplantation Society, transplantation from unrelated donors thus became permitted under stringent conditions and never for foreigners.

• The Sindh Institute of Urology and Transplantation in Karachi, Pakistan. Photograph courtesy of SIUT. •

But the story did not end there. As Levy Izhak Rosenbaum’s recent arrest in Brooklyn, New York, for arranging the sale of organs from donors in Israel indicates, avarice recognizes no boundaries. In Pakistan, THOTO did not deter some surgeons and touts from seeking a way around the law. One surgeon practicing in Rawalpindi even petitioned the court asking it to declare the ordinance “repugnant to Islam.” After a comprehensive hearing, the court dismissed his appeal.

And yet the organ trade continued to thrive in Pakistan. Just a few weeks ago, the court once again cracked down on offending hospitals. They first denied any wrongdoing, but as evidence surfaced, they appeared before the court and pledged to refrain from all transplantation surgery.

But can one assume that no more foreigners will visit the country in search of human organs? Many are skeptical because the debate on paid organ donation rages furiously all over the world. Some are of the opinion that the trade benefits both parties – an ill person gets an organ to save his life and a poor man gets the money he needs.

In actual fact it is not as simple as that. Once monetary considerations enter the transaction, it can never be ensured that the elements of exploitation, oppression and coercion will not determine the decisions of donors who are poor – especially when they have few alternatives. Many vendors have confirmed that they remained debt-ridden (with a large portion of the money going to the middlemen and hospitals) and worse still, their health suffers due to inadequate medical follow-up.

In Pakistan, more than a third of the population lives below the poverty line and only a fraction of patients suffering from kidney failure find a donor. Yet this equation has not led to the eradication of poverty. It has only enriched a handful of unethical elements.

The best approach is to step up the campaign for deceased organ donation and live related transplantation. For people like Dr. Rizvi, this strategy alone will ensure that the poor are not robbed of their dignity. Neither will it make healthcare the privilege of the rich.