Do we want kidneys from deceased or living donors?
By Aileen Qaiser
WHILE many countries have long had laws that prohibit the sale of human organs for transplantation, whether from living or deceased donors, we seem to have had considerable difficulty over the past 15 years in promulgating a similar law that would make the sale of human organs illegal, despite international and local pressure.
Apart from pressure by the local organ sales mafia, the inability to promulgate a law on organ procurement and transplant so far seem also to have its roots in our inability to decide on whether we want to have organs from mainly deceased or living donors.
While the policy guidelines on the procurement and transplant of organs — as set by the developed nations and the UN — advocate the supply of organs from deceased patients followed by organs from living related donors, and forbid the sale of or compensation for human organs from live unrelated donors, two recent developments have favoured a growing lobby in the world which is challenging the organ sales taboo and advocating increasing the number of living donors by legalising compensation payment of live unrelated donors.
One development is the emergence of transplant tourism or the black market trade in human organs, an activity for which we unfortunately have had a notorious contribution. As if our role in the trading and sale of human organs alone was not enough to defame our country, reports of forced abduction and drugging of people and removal of their kidneys by unscrupulous gangs involved in the trade — gangs whose members include not only the middlemen or agents but surgeons and police officials as well — doubled our infamy.
Thus, the international anti-organ sales lobby like WHO, the World Medical Association and the Transplantation Society argue for the urgent need of countries like Pakistan to enact a law allowing organ transplants from deceased donors to beat black marketing and exploitation of the poor in organ sales.
But the pro-organ sales lobby on the other hand argue that legalising and regulating organ sales to increase organ supplies is necessary for eliminating the exploitation and black market in organs and thus, making the growing demand for organ transplantation safer for both recipients and donors.
Another development which has favoured the pro-organ sales lobby is the legalisation of organ sales by Iran and Saudi Arabia, the first countries in the world to do so.
When Iran legalised the sale of organs by living donors, The Economist hailed its regulated system of compensation for living donor organs as a model humane move, better than the illicit trade. The officially approved Association of Kidney Patients in Iran, a non-government organization which is responsible for all legal kidney transplants, oversees the transactions of kidney sales, with each donor reportedly getting between $2,000 to $4,000.
In order to stop its citizens from patronising the black market organs trade in China, Egypt, Pakistan and the Philippines, Saudi Arabia reportedly passed a law in October 2006 establishing a regulated live donor organ procurement system under which the government pays a monetary reward of $13,000 and other benefits, including life-time medical care, for unrelated organ donors.
Unlike Saudi Arabia and Iran, however, most major international health concerns and governments and their national professional institutions encourage organ transplantation from deceased donors, object to the procurement of live organs for transplant through payment, consider this practice as unethical and repugnant, and forbid their surgeons from being involved directly or indirectly in the organs trade.
Similarly in Pakistan, major transplantation institutions like the Transplant Society of Pakistan, the Pakistan Society for Nephrology, the Pakistan Association of Urological Surgeons as well as the Sindh Institute of Urology and Transplantation have been advocating for legislation against the sale of organs for transplantation and for the procurement of organs from deceased donors (cadavers).
Our attempts to legislate on the issue date as far back as 1992 in the form of the first bill on organ transplants which, instead of being passed by Parliament then, was thereafter delayed, redrafted time and again and tabled in parliament in 1994 and 1996, according to an expert writing in a letter-to-the- editor in Dawn.
The most intensive effort at redrafting the organs bill and tabling it before Parliament has, perhaps, taken place during the past two years. But despite the intervention of the Supreme Court last year asking the government to promulgate the law against the organ trade, we are back at square one when instead of a law at last, a fresh bill was tabled before Parliament again on August 17.
During the past two years, we have been told off and on by several leaders, including the federal health minister, the Senate Chairman, and the Deputy Attorney General, that a bill prohibiting the sale of human organs was being drafted and would be tabled before parliament soon.
Even President Musharraf chipped in on this issue. In November 2006 at a ceremony in Karachi where 700 live altruistic organ donors were presented medals, the Sindh governor reportedly read a letter from the president who denounced the commercialisation of organs and supported legislation to ban organ sales.
The organs bill finally tabled in the Parliament on August 17 reportedly provides for a system of procurement from deceased donors and prohibits the sale of organs by living donors. The crucial question remains: Will this bill get pass Parliament this time and become law when other bills on organ transplant previously tabled couldn’t?
For the sake of the tens of thousands of people who suffer from end stage organ disease and require transplants, it is hoped that the recently tabled bill regarding organ procurement and transplants will soon finally become a law that would help establish an ethical, humane and fair national system of organ procurement and distribution, providing for life-saving transplants from deceased donors as well as from voluntary altruistic unrelated living donors.
For this law to be effective there should also be provisions in it to curb misuse and abuse of the cadaver organ donation system. After all, if a black market in living donor organs can thrive in Pakistan, so can a black market in cadaver organs emerge.

