by Zubeida Mustafa
Source: The WIP
A version of the following article was originally published August 12, 2009. In light of recent reports of illegal kidney transplants in Pakistan, the author has updated the article. – Ed. has updated the article. – Ed.
A version of the following article was originally published August 12, 2009. In light of recent reports of illegal kidney transplants in Pakistan, the author has updated the article. – Ed.
Several 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.
Those were the days when the organ trade operated in a grey area in Pakistan. 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 USA to purchase an organ for $40,000 USD. 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.
Repeated demands by the head of the leading medical institution in the country, the Sindh Institute of Urology and Transplantation (SIUT), failed to stir lawmakers into action. For 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 was permitted under stringent conditions and never for foreigners.
But the story did not end there. In Pakistan, THOTO did not deter some 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.
When the court once again cracked down on offending hospitals, they were forced to respond to the long arm of the law. They first denied any wrongdoing, but as evidence surfaced, they appeared before the court and pledged to refrain from all transplant surgery. One of them switched to cosmetic surgery.
There followed a brief era of transplant surgery done ethically and professionally. Dr Rizvi could hold his head high in the international medical circles where he is very popular. Pakistan was basking in a period of democracy and the restoration of a free judiciary. The newly elected Assembly adopted a law to give constitutional validity to the 2007 ordinance (THOTO). The illegal organ trade virtually disappeared.
To the intense disappointment of many, lately there have been reports of kidney tourism being revived. The unscrupulous elements are back in business, though they have tried to keep the racket concealed from public eye. But when a foreigner returns home with a transplant from Pakistan and falls ill and dies, it becomes difficult to keep matters undercover.
It seems the skeptics have won. They never believed that foreigners would stop visiting Pakistan in search of human organs. But Dr Rizvi is not one to give up. He has mobilized support from colleagues in his profession, human rights advocates, and media persons to file a petition before the court to get the Transplantation of Human Organs and Tissues Act 2010 implemented. The provocation came when a surgeon in the UAE reported the case of a patient who had visited Pakistan for an illegal transplant in May 2011. He paid $60,000 USD for it.
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, the matter is complex. Once monetary considerations enter the transaction it is difficult to ensure that the elements of exploitation, oppression, and coercion will not determine the decisions of donors who are poor – especially when they have few alternatives.
In April 2011, Mahnoor Sherazee reported in The Express Tribune the story of a man from rural Punjab in debt to his landlord. “Over time, the landlord raped his wife in order to settle part of the debt. Following this incident, the poor man was left with no choice but to sell his kidney. ‘I was promised Rs120,000 but all I received was Rs70,000…I have just one kidney and the landlord has taken away my son,” he said as tears streamed down his face. His son is kept in a field in which he works all day, surrounded by rabid dogs in case he tries to escape.”
Many Pakistanis who have sold a kidney remain debt-ridden with a large portion of the money going to middlemen and hospitals. And worse still, their health suffers due to inadequate medical follow-up.
The root of the problem lies in poverty, which combined with the shortage of organs, creates conditions for organ trafficking. In Pakistan more than two-fifths of the population live below the poverty line and only a fraction of patients suffering from kidney failure find a donor. Yet the sale of kidneys 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, it is only this strategy that will ensure the poor are not robbed of their dignity. Neither will it make healthcare the privilege of the rich.