15 October 2004	Friday	29 Shaban 1425

KARACHI, Oct 14: With an annual patient population of more than 275,000 (including 125,000 who visit its outpatient department every year) and more than 1,700 kidney transplantations, besides two liver transplant operations , the Sindh Institute of Urology and Transplantation (SIUT) represents a world of what has already been made possible as well as what more could be done.

The SIUT's rate of growth, by all accounts, has been noteworthy. It started off as an eight-bed facility in 1970, which has now grown into a fully-fledged hospital having several ambitious plans.

Its own oncology centre, being built at a cost of Rs400 million, is under construction, which is expected to be ready by the middle of next year. A separate Institute for Transplantation and Medical Sciences is also proposed to be built.

Lately, however, this world of possibilities has been facing a host of problems which threaten, not only to slow down its growth, but to wipe off some of the ground already covered. According to its director, Prof Adibul Hasan Rizvi, one of the main problems relates to legislation and the other to fund-raising.

Talking to a group of journalists, Prof Rizvi pointed out that on an average three kidney transplant operations could be undertaken at the institute every day. However, this goal was not being achieved, first because not enough kidneys were available, and secondly due to financial constraints.

He said at present three kidney transplant operations were performed every week. The SIUT was unable to make much headway in the area of liver transplantation too largely because of lack of brain death and cadaver donation laws.

"If our national legislature had passed the cadaver donation or brain death laws, a number of livers would have been made available for transplantation by now." In addition to lack of the required legislation, growth in the area of liver transplantation was hampered by the poor law-and-order situation in Karachi.

"As you may be knowing, we have a collaboration in this area with the King's College, London. But every time their professors and surgeons were invited to visit Karachi, we have had one terrorist attack or the other."

Prof Rizvi said a couple of years ago, a draft of the mentioned laws was in the Senate. "But at present we simply don't know where this draft is. We don't know on which bed and which ward this patient is lying," he remarked.

In response to a question, the professor said he was yet to come across a religious scholar or a politician who opposed the cadaver donation and brain death laws. "Yet, these laws are not getting passed."

He said many Islamic countries, including Saudi Arabia, Iraq, Iran, Malaysia and Egypt, had adopted these laws. "Pakistan is perhaps the only Islamic country in the world which has not passed these laws."

In the absence of the laws, the SIUT could only allow transplantations involving relatives. "Under the circumstances, the donor and recipient should be related." Turning to the issue of lack of funds, he said over the years the government had cut the yearly grant allowed to his institute. Today the governmental grants accounted for only 30 to 35 per cent of the Rs400 million needed every year.

The money donated by various philanthropists, has also become stagnant, setting off alarm bells within the institute because the number of OPD patients is increasing at a minimum rate of 13 per cent. Apart from this direct burden on its resources, Prof Rizvi advocates life-long provision of medicines for kidney donors as well as recipients.

The SIUT already spends Rs200 million on the medicines provided to the patients. The annual cost of medicines given free to one transplant patient comes to about Rs120,000. Prof Rizvi said the number of transplant patients was increasing at a rate of three per week.

"The cost of medicines is thus rising exponentially. In short, it is a challenge for the SIUT to keep up with the rising costs." Prof Rizvi, however, expressed the hope that philanthropists as well as the common people would rise to the occasion and stop the SIUT's growth from coming to a halt.