Temporizing on transplant law

By Zubeida Mustafa
Source: Dawn

LAT Sunday, the newspapers carried the picture of a Bangladeshi woman who has offered to sell one of her eyes to earn some cash. Her husband has abandoned her and she is desperate for money. Shefali, that is the name of the unfortunate woman, is perhaps the first one to offer an eye.

Otherwise, the sale of human kidneys for transplantation has become, in recent years, quite common in many Third World countries. But as this unethical practice has assumed alarming proportions, governments have moved to ban the trade in organs and regulate transplantation.

India, which was at one time called the kidney bazaar of Asia, now has a law banning the sale of organs and recognizing cadaveric donation of organs. Sri Lanka and Bangladesh also have similar laws. (Shefali could get into trouble were she to go through with a deal, and one only hopes that some kind hearted philanthropist will bail her out without demanding the eye).

What is strange is that as other countries crack down on this unethical practice, Pakistan is fast emerging as the new centre of unauthorized sale of organs with 2,000 “cash for transplantation” surgeries taking place every year. This is only bringing a bad name to the country as President Musharraf’s endeavours to build up a “soft image” of Pakistan seem to be ending in disaster.

In the last few months, two major media in the West have carried damaging stories about the organ racket in the country. The CNN’s website posted an article titled Pakistan’s lucrative kidney trade and a few weeks later the Guardian of London reported “Transplant tourists flock to Pakistan, where poverty and lack of regulation fuel trade in human organs.”

Specially identified are two hospitals in Islamabad run by retired army surgeons and two others in Lahore. With the truth so widely known one cannot really hit out at the western media for distorting facts. The scandal has now been reported by the local press as well. The argument put forward by those who are involved in the trade and the individuals, who have benefited from the organ they have acquired from a donor after the payment of a hefty sum, are not very convincing. They have described this as a cooperative transaction the rich paying the poor who is in need of the money and the poor donating an organ as a quid pro quo to the rich who needs it.

But is it actually so? First of all only a fraction of the amount spent by the patient goes to the donor who is monetarily in desperate straits – generally heavily indebted and his family bonded to a feudal landowner or kiln brick manufacturer. Since the whole trade is clandestine, exact figures are difficult to obtain.

One report says the donor may earn barely Rs 100,000 from which he is required to foot his hospital bills too. But another person claims that the donor was paid Rs 400,000 in the case of his relative but he didn’t know how much went to the middleman who scours the countryside looking for potential donors. But this is clear that the bulk of the money goes to the hospital, the surgeon and his team and the middlemen. Surveys have shown that the donors very often end up in debt again and this time in poor health too since no one feels responsible for his health care.

As for the recipients of the graft not much can be said about their post-operative health because quite a few of them come from abroad and return home within a few weeks. One Pakistani who had a transplant had to pay Rs 800,000 and is now suffering from some complications. The foreigners are the ones who keep this trade going since they are required to pay as much as $40,000 out of which 40 per cent goes to the surgeon. Many of the patients coming here are from the Middle East — notably, Saudi Arabia. They come to Pakistan to get an organ because such commercial transactions are banned in their own country.

So far Dr Adibul Hasan Rizvi, the director of the Sindh Institute of Urology and Transplantation (SIUT) in Karachi, has been the most vocal critic of this unethical practice. He calls it exploitative because it amounts to taking undue advantage of the poverty of the poor. A staunch believer in the basic human right of every human being to health care he does not charge a penny from his patients who flock to SIUT. Even the costly transplantation operation is done free of charge.

“In the absence of a law regulating transplantation, we have self-made laws which suit the rich and coerce the poor. This is wrong. If this is not stopped will the poor be required to sell their eye, lung or even liver?” he asks. How prophetic his words have proved to be in the case of Shefali, the Bangladeshi woman.

For many years Dr Rizvi has pleaded for a transplantation law. A bill was presented to the Senate in 1992 and again in 1994 but it was never taken up because the government didn’t seem to be interested. The general impression was that given the orthodoxy in our society and the hold of the ulema over the people, a bill recognizing brain stem death and providing for cadaveric donation of organs would meet with resistance from the religious quarters. But to the surprise of many this has not been the case.

The SIUT’s Newsletter lists at least 14 fatwas issued by various Islamic jurists bodies sanctioning transplantation, legalizing cadaveric organ donation and recognizing brain stem death. That public acceptance can be easily gained for these concepts is apparent from two cases in Karachi when the families of two persons, who had been pronounced clinically dead, authorized the removal of their organs for transplantation. This was a moral victory for the transplant surgeons demanding a regulatory law. Society is moving ahead of the government and that too without a sustained public campaign.

Once again the law on transplantation of human organs and tissue, which the government had promised to move in the National Assembly, appears to have been shelved. One wonders what is stopping the government from moving ahead with the transplantation bill. It prescribes rigorous conditions and procedures for determining brain stem death and preempting the sale of organs. Amongst other provisions, it allows a living donor to voluntarily donate his organ to a person genetically and legally related to him.

To prevent abuse, the bill provides for an evaluation committee to determine brain stem death and the fitness of the organ to be removed for transplantation. A monitoring authority to be set up by the government would monitor the standards of the institutions authorized to conduct transplantations. The punishment for the violation of the law is quite stringent: three years rigorous punishment, a fine of Rs 300,000 and the suspension for three years of the surgeon’s license found involved in the violation of the law.

Even a fool can see that those who are minting money from the organ sale racket would not be interested in this law being adopted. Their self interest lies in stalling the bill. But why should the government be dragging its feet? This is a million dollar question.