A half win for science

First the good news: Pakistanis are increasingly eager and willing to act rationally, set aside traditional human body-related taboos, and embrace possibilities offered by medical science. Many Muslim clerics are now on board too. Although most still oppose contraception, they are willing to make concessions considered unthinkable a century ago.

Significantly, cadaver dissections are permitted in all Pakistani medical colleges; no screams of outrage accompany a dead body being cut to bits. Medical professors complain, however, that it is hard to get one’s hands on hands — as well as feet and spleens and brains — demanded by both research and teaching. So, courtesy the Edhi Foundation, some dead beggars make it to lab tables. I am also told of the availability of dead Americans who have willed their bodies to science. With no local donors, the morbid cottage industry of grave-snatching supplies the remainder.

And, hooray, now there’s blood everywhere! Remember the time when people thought that blood was a non-transferable sacred inheritance? Even today bloodlines determine honour-shame dynamics in our ghairat-bound culture. And yet every hospital in town has a blood bank where you can buy, donate, or sell blood. Few notice the contradiction of the “wrong” kind of blood being injected into their veins.

The sheer benefit of life-saving blood supplies has trumped earlier objections. Clerics have only mild recommendations to make: “one should abstain from the blood of non-Muslims, transgressors and sinners, when reasonably possible, for there is a risk that the evil effects found in such people may affect the one in whom the blood is transfused”.

The news on organ transplantation is even better. The very thought of implanting another human’s organs inside one’s own body was once utterly abhorrent. But today, it is (almost) uncontroversial. Is your kidney about to conk out? Well, take a hike to the SIUT (Sindh Institute of Urology and Transplantation) in Karachi and get another one. The hospital motto reads: “No patient is turned away from our hospital or asked to pay for our services. The SIUT does it free — with dignity”. Indeed, the SIUT does hundreds of free kidney transplants a year.

Fitted with a spanking new kidney, you can then hop across to one of LRBT’s (Layton Rehmatullah Benevolent Trust) 17 branches and get a corneal transplant. As at the SIUT, all treatment at the LRBT is “totally free so that no man, woman or child becomes blind just because he/she cannot afford the treatment. There should be no discrimination due to gender, caste, ethnicity, language, religion or sect”.

The SIUT and the LRBT are superb charitable institutions; they do Pakistan proud. But, for those who believe in societal progress based upon science and reason, it is an additional delight to behold the triumph of pragmatism. The Enlightenment-era philosopher Rene Descartes should be especially pleased. About 300 years ago, this Frenchman had hypothesised that every human organ operates strictly on physical and chemical principles. With the Christian Church thinking very differently, what Descartes claimed had placed his life at great risk. And now for the bad news: we Pakistanis don’t seem to mind being fitted with somebody else’s kidneys and eyes, but almost none are willing to volunteer our organs after death.

A young American-trained ophthalmologist, Dr Azhar Salahuddin, who spends his vacations in Pakistan doing free corneal transplants for the LRBT, told me that hardly any corneas (perhaps five to ten annually) are gifted by local donors. Although it is impossible to know true numbers, his guess is that most corneas come from Sri Lanka (80 per cent) and some from Canada.

But imported corneas are no solution. First, there are just not enough to go around; some 300,000 corneal blind Pakistanis could see again if corneas became available. Currently the number of local transplants performed annually is probably 500 to 700, a pittance compared with the 40,000 done in America.

A second consideration is inferior organ quality. Dr Salahuddin says the quality of an organ depends on several factors — the cell count of the donor cornea (which decreases as people age and have eye surgeries), the death to preservation time (the time between death and harvesting of the organ), utilisation time (the time from the harvesting to the time of actual transplantation) and the manner in which the cornea is handled. Usually, the best corneas stay in the country of origin, while poorer quality ones are exported. Therefore, Pakistan tends to get the bottom of the barrel — and even then, there aren’t enough. As a result, even the few transplants that are done locally have a higher chance of failure.

Why won’t Pakistanis donate their eyes, kidneys, hearts, and livers after death? Are we less altruistic than Sri Lankans? I am not aware of any survey done in Pakistan, but one in Iran shows that most transplants are live donations; just 13 per cent of renal transplants performed in 2006 were deceased donations. Eyes are a particularly sensitive matter: some Iranians are told by their clerics that, having given away their eyes, they will not be able to see heaven.

Dispelling such popular prejudice against organ donations was the focus of the 2010 International Congress of the International Society for the History of Islamic Medicine in Istanbul. Attended by some 200 experts on medicine and theology from 15 Muslim countries, the conference said that the majority of Islamic legal scholars do permit organ donations. But it noted that the general public remains distrustful.

Eventually organ donation comes down to a matter of religion and culture. In the US, many Hispanics are uncomfortable with the idea. According to organ donation experts, first and second-generation Mexican-Americans are said to be less likely to donate organs than Americans as a whole. The conclusion reached by the Texas Organ Sharing Alliance is remarkably similar to that found by the Iranian researchers: “They [Hispanics] feel that their loved one will be disfigured, or the person will not be able to get into heaven because their body will not be whole.”

Unreason sometimes appears impregnable. But, just as the hardest of rocks ultimately get worn down by wind and weather, so does every castle of superstition and irrationality crumble before the ceaseless battering by science and reason. Say what you will and think what you want, but science shows the human body comprises interchangeable parts, each made of atoms and molecules in a complex arrangement. That’s just a fact of life; one that could help save your life.

Published in The Express Tribune, May 14^th, 2012.