Kidney transplantation: cultural and legal challenges
Each organ in a human body deserves care and timely intervention to lessen the negative fallout of a disease.
The writer is a public policy analyst based in Lahore and can be reached at durdananajam1@gmail.com
Each organ in a human body deserves care and timely intervention to lessen the negative fallout of a disease. Fortunately, medical science has ventured deep into the thick and dark world of organ deterioration to defeat its purpose of failing a human life. Although many people die every day because of untreated kidney ailments, a lot more lead a quality life because of life-saving advances in kidney transplantation. Pakistan, unfortunately, in spite of acquiring the latest technologies in the medical field, lags far behind in making kidney transplant a transparent and accessible mode of treatment.
On this World Kidney Day, let’s put this predicament in context.
A 34-year-old woman died in Lahore, last month, because of a kidney transplant surgery that went wrong. The organ she received was arranged through illegal means, necessitating operation in a hospital away from the eyes of the government, in Azad Jammu and Kashmir (AJK). The finances used for this clandestine planning amounted to Rs3.4 million.
Not every illegal organ transplant gathers this kind of attention leading to a police operation and subsequent arrests. As the daughter of Pakistan’s famous comedian Umar Sharif, this patient’s story had the privilege to make headlines and unmask those involved for ages in this heinous trade of human organs. Dr Fawad Mumtaz, who did the transplant, has a history of arrests and jail sentences for misusing his professional services. Not only did he insist on committing the crime time and again, he had also been employed by leading hospitals both in the public and private sectors. The question is: why is organ transplantation done illegally when a legislative cover has been provided to the practice through the Transplantation of Human Organ and Tissue Act in 2010? The purpose of bringing this law was to put an end to the exploitative trade of human organs practiced openly in the country.
However, the devil is in the details. It is the rules of the law that make organ transplantation a tardy process — a process that lacks empathy and raises more barriers than lowering them.
There are two ways in which a kidney can be donated. One, from a live person. Two, from a cadaveric source. In case of organ transplant from a cadaver, the deceased person should have given in writing his/her approval for organ removal. This person could be anyone —blood relative or a complete stranger. However, in the case of an organ transplant from a live adult, the donor should be a close-blood relative. The law does give an alternative of having a volunteer donor if none of the blood-relatives’ blood group or tissues match with the patient’s, but to exercise this right a patient may have to wait years. And even when a volunteer is found, (s)he have to prove their willingness to donate before an evaluating committee set up by the Human Organ Transplant Authority in Pakistan.
This made for a perfect breeding ground for donors pretending to be ‘distant cousins’. But to avoid the hassle of forging documents and going through a tardy legal process, the easiest path was to use a makeshift healthcare facility and hire a doctor laced with greed.
The irony, isn’t it? Until the enactment of the organ transplantation law, all transplants were more or less done in proper hospitals and under the supervision of professional doctors. However, when the process was given legal attire, the operation for kidney transplant moved to improvised hospitals, endangering lives and creating a huge racket in the kidney trade.
It goes without saying that the racket’s success is entirely because of poverty, illiteracy and weak enforcement of laws. Hundreds and thousands of lives could be saved if someone could unencumber the practice of deceased organ donation, which will also render the racket ineffective.
There are two limiting factors to the success of the deceased donor programme: the infrastructure and the commitment of the people. While we do not have ICUs with enough ventilators in the public health sector to keep a person’s organs alive when (s)he is brain dead, we also lack acceptance of the concept of deceased organ donation.
In the context of Pakistan’s culture where religious diktat rather than logic influences decision-making and awareness is sparse, organ donation as an act of service to humanity is not a very popular practice. Relatives deny donation and the number of those willing to have their organs removed after death can be counted on fingertips. According to research, Pakistan only had five deceased organ donors in the last two decades.
According to a study conducted by the Pakistan Institute of Medical Sciences (PIMS), Pakistan ranks eighth in the list of countries with a high rate of kidney diseases. Seventeen million people have chronic kidney disease, which has a number of causes — most often diabetes and high blood pressure. A person with a failed kidney is treated either through dialysis or a kidney transplant. For a quality life, transplantation has been considered an ace option.
Therefore, the awareness for organ donation from the cadaveric source is of paramount importance in Pakistan.
A major source of deceased kidney transplants could be road fatalities. Hundreds of people die in road accidents every year; and if their families allow, their kidneys can be used to save twice as many lives.
According to Dr Ramesh Kumar, the author of Kidney Transplants and Scams, India’s Troublesome Legacy, “Two kidneys save not just two lives but four, for this also renders free two dialysis machines.”
Published in The Express Tribune, March 12th, 2020.
On this World Kidney Day, let’s put this predicament in context.
A 34-year-old woman died in Lahore, last month, because of a kidney transplant surgery that went wrong. The organ she received was arranged through illegal means, necessitating operation in a hospital away from the eyes of the government, in Azad Jammu and Kashmir (AJK). The finances used for this clandestine planning amounted to Rs3.4 million.
Not every illegal organ transplant gathers this kind of attention leading to a police operation and subsequent arrests. As the daughter of Pakistan’s famous comedian Umar Sharif, this patient’s story had the privilege to make headlines and unmask those involved for ages in this heinous trade of human organs. Dr Fawad Mumtaz, who did the transplant, has a history of arrests and jail sentences for misusing his professional services. Not only did he insist on committing the crime time and again, he had also been employed by leading hospitals both in the public and private sectors. The question is: why is organ transplantation done illegally when a legislative cover has been provided to the practice through the Transplantation of Human Organ and Tissue Act in 2010? The purpose of bringing this law was to put an end to the exploitative trade of human organs practiced openly in the country.
However, the devil is in the details. It is the rules of the law that make organ transplantation a tardy process — a process that lacks empathy and raises more barriers than lowering them.
There are two ways in which a kidney can be donated. One, from a live person. Two, from a cadaveric source. In case of organ transplant from a cadaver, the deceased person should have given in writing his/her approval for organ removal. This person could be anyone —blood relative or a complete stranger. However, in the case of an organ transplant from a live adult, the donor should be a close-blood relative. The law does give an alternative of having a volunteer donor if none of the blood-relatives’ blood group or tissues match with the patient’s, but to exercise this right a patient may have to wait years. And even when a volunteer is found, (s)he have to prove their willingness to donate before an evaluating committee set up by the Human Organ Transplant Authority in Pakistan.
This made for a perfect breeding ground for donors pretending to be ‘distant cousins’. But to avoid the hassle of forging documents and going through a tardy legal process, the easiest path was to use a makeshift healthcare facility and hire a doctor laced with greed.
The irony, isn’t it? Until the enactment of the organ transplantation law, all transplants were more or less done in proper hospitals and under the supervision of professional doctors. However, when the process was given legal attire, the operation for kidney transplant moved to improvised hospitals, endangering lives and creating a huge racket in the kidney trade.
It goes without saying that the racket’s success is entirely because of poverty, illiteracy and weak enforcement of laws. Hundreds and thousands of lives could be saved if someone could unencumber the practice of deceased organ donation, which will also render the racket ineffective.
There are two limiting factors to the success of the deceased donor programme: the infrastructure and the commitment of the people. While we do not have ICUs with enough ventilators in the public health sector to keep a person’s organs alive when (s)he is brain dead, we also lack acceptance of the concept of deceased organ donation.
In the context of Pakistan’s culture where religious diktat rather than logic influences decision-making and awareness is sparse, organ donation as an act of service to humanity is not a very popular practice. Relatives deny donation and the number of those willing to have their organs removed after death can be counted on fingertips. According to research, Pakistan only had five deceased organ donors in the last two decades.
According to a study conducted by the Pakistan Institute of Medical Sciences (PIMS), Pakistan ranks eighth in the list of countries with a high rate of kidney diseases. Seventeen million people have chronic kidney disease, which has a number of causes — most often diabetes and high blood pressure. A person with a failed kidney is treated either through dialysis or a kidney transplant. For a quality life, transplantation has been considered an ace option.
Therefore, the awareness for organ donation from the cadaveric source is of paramount importance in Pakistan.
A major source of deceased kidney transplants could be road fatalities. Hundreds of people die in road accidents every year; and if their families allow, their kidneys can be used to save twice as many lives.
According to Dr Ramesh Kumar, the author of Kidney Transplants and Scams, India’s Troublesome Legacy, “Two kidneys save not just two lives but four, for this also renders free two dialysis machines.”
Published in The Express Tribune, March 12th, 2020.