And now transplant tourism

By Zubeida Mustafa
Source: Dawn

IT IS ironical that at a time when the Pakistan government has dismally failed to promote the tourist trade, some unethical transplant surgeons in Lahore and Islamabad have succeeded in firmly placing the country on the world map of ‘transplant tourism’.

This is not something to be proud of as it is bringing a bad name to the country and also its medical profession.

For those not familiar with this term, it may be pointed out that coined by a medical anthropologist from Berkeley, Nancy Scheper-Hughes, this kind of tourism implies trafficking of the poor to provide organs to wealthy patients of endstage kidney failure. The oiling person makes a pre-arranged trip to the country offering such a transplant, undergoes tests and surgery — often shoddily done — for the graft of an organ purchased through a middleman, stays for a week or so for post-operative care and then flies back home.

All this is included in a package deal which costs anything from a few thousand to some hundred thousand dollars. The three elements that are present in every deal are the poverty of a donor, the desperation of a rich organ failure patient and the cupidity of an unscrupulous surgeon who has forgotten the Hippocratic oath he took when he graduated from medical school.

This has become a racket in Pakistan because of the extremely easy availability of cheap organs — after all we have nearly 50 million people officially classified as poor in the country. In the absence of any law to regulate organ donation and transplantation, society is left only with its ethical values and sensitivities to determine how this practice is to be dealt with. And as we know ethics is not really our forte.

Hence the need for a law, which is being pushed for relentlessly by the Sindh Institute of Urology and Transplantation since the 1990s. Initially, when the demand for a law for deceased organ donation was made, the director of SIUT, Dr Adib Rizvi, was more concerned about the shortage of organs in the country. According to him there are 15,000 patients with endstage kidney failure in Pakistan in any given year and only 2,000 or so receive an organ. Farming organs from the dead would increase the availability of organs and save life.

For 12 years, Dr Rizvi and his colleagues have campaigned for the law to be passed and a bill introduced in the Senate in 1994 has not been adopted, one presumes, because the legislators fear that its social, cultural and religious implications would disturb a section of society. The draft lays down internationally prescribed stringent guidelines for determining brain death to ensure that it is not misused. With the passage of time it has become clear that these fears were unfounded.

In 1998 and then in 2005 the families of two young people donated their organs when they were declared brain dead after a traffic accident. In their lifetime they had expressed the wish to become organ donors. The reservation that people may have initially felt has gradually melted away as ulema have come forward to express support for the concepts of brain death, deceased organ donation and transplantation.

The situation has now assumed a new urgency, thanks to the transplant tourism business. In the international seminar that SIUT organised last week to draw attention to the law waiting to be adopted, the focus was equally, if not more, on the kidney trade that has sprung up in the country in a big way. In recent years, the media has reported prolifically on villages where people survive on one kidney having sold their other organ to pay their debts. With donors so readily available here, patients do not have to go far for a healthy organ.

It is the unethical dimension of this business that makes it so repugnant. How can one ever justify organ sale on the ground that it helps a poor person tide over his debt and overcome poverty? If the argument were to be accepted, then can we support trafficking of human beings to eliminate poverty? Justice Sabihuddin Ahmad, the chief justice of Sindh, who presided over the international seminar, pointedly asked this question.

Besides, the sale of organs does not alleviate poverty as it has been discovered time and again because the donor gets only a fraction of the money that changes hands and he continues to be trapped in debt. He may also end up poorer in terms of health since he does not receive the after care he should. He is worse off in terms of dignity and self respect.

A survey in Iran, where paid organ donation is strictly controlled by the government, found 94 per cent of such donors saying they suffer from a sense of shame after the act and 85 per cent said they would say no if given another chance. This is contrary to the satisfaction the related live donors derive from an act of altruism.

Therefore, a law that bans the sale of organs is the need of the hour. The human organs and tissue transplant bill that is a revised version of the earlier bill prescribes a punishment of not less than five years and a fine of not less than Rs 500,000 for people involved in this crime.

As we strive to move in this direction, there are some health professionals in the West calling for legalisation of the sale of organs. Last month, the Economist of London argued powerfully in support of legalising the sale of organs under official supervision. This would eliminate the black-marketing in organs and ensure that the removal and transplantation of organs are done in a risk-free manner with proper screening and tissue matching, the paper argued. Some transplant surgeons in Britain have made a similar demand, citing Iran as an example. But surveys in Iran have pointed to the negative psychological effects on a person who sells his organs.

Hence it is perverse to argue for legalising the organ market. Even in Britain there is a strong section of the medical profession that opposes this “commodification of the human body”, as one surgeon called it derisively. We know all too well that in our conditions legalising the sale of organs will not check the unscrupulous practices that accompany the trade.

It is always the weaker section of humanity that suffers the most when the so-called magic of the market is allowed to operate, as is happening now. The rampant corruption and economic inequities in this country will preempt the market from activating its own regulatory mechanism. The government must intervene to protect the poor.