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IN his recently published memoirs, Jagtay Lamhay, Justice Haziqul Khairi, retired chief of the Federal Sharia Court, recalls his judgment upholding the transplantation law in Pakistan. The Transplantation of Human Organs and Tissues Ordinance (2007) had been challenged by some surgeons on the ground that it violated the Sharia.
Justice Khairi writes that the World Health Organisation’s (WHO) country chief in Pakistan, Dr Khalif Bille, described this as a “great” judgment. Soon thereafter the two Houses of parliament passed unanimously an act by the same name in 2010 to replace the ordinance. On that occasion the Assembly gave a standing ovation to Prof Adibul Hasan Rizvi, the director of the Sindh Institute of Urology and Transplantation and the person responsible for spearheading the 15-year campaign for legislation to regulate organ transplantation and check organ trade in Pakistan. The Transplantation of Human Organs and Tissues Act (THOTA) was acknowledged by WHO as the best law on this subject in the world.
What has been the fate of this law? Dr Adib Rizvi is a saddened man today. “Even the best of laws if not implemented will fail,” he remarks bitterly.
Dr Rizvi’s frustration is understandable. Only last week an item in this paper datelined Bosnia-Herzegovina by Associated Press (AP) reported that a Montenegrin was booked for organising trips to Pakistan for Bosnians seeking an illegal kidney transplant.
Circumstantial evidence suggests that the organ trade is rife again in the country although THOTA categorically bans the transplantation of organs in foreigners. Five years ago, when the ordinance was promulgated, it produced dramatic results. For some time it seemed the unscrupulous agents and the more unscrupulous surgeons had moved over to other lucrative trades. One hospital in Lahore that had been advertising kidney transplants on its website turned to cosmetic surgery.
In hindsight, it seems that was just the lull before the storm. Those involved in this nefarious activity had paused to test the post-THOTA waters especially when vigilance had been stepped up and some people were taken to task for indulging in this crime. Two doctors had to appear before the Supreme Court where they apologised for their wrongdoing. They tried to get the law upturned by going to the Sharia court but failed when Justice Haziqul Khairi proved to be a man of integrity.
The organ mafia now seems to be back in business, notwithstanding the fact that the Supreme Court is seized with the matter and hearings are being conducted.
The AP report comes against the backdrop of a recent WHO warning that illegal organ trade is on the rise with a surge in the incidence of kidney failure attributed to the rise in diabetes which often affects renal function. Pakistan figures among the main destinations of the desperate patients from the West who have the resources to travel to the East for the expensive operation.
In their own country the option of illegal organ transplantation is not readily available, given their stringent laws. Kidney tourism in Pakistan can be risky business because fly-by-night surgeons are known to perform the surgery in improvised venues that do not even fit the description of a health facility. Patients are dispatched home within a day of the operation. One of the Bosnians mentioned above died on the plane.
The entire trade is unethical to the core. The agents pay the donors a pittance (Rs50,000 to Rs100,000 while hefty sums are pocketed by the agents and the surgeons. The amount quoted in the Bosnians’ case was $75,000 — up from $40,000 a few years ago. The profits are shared with the surgeons and the police.
Villages in Punjab are said to be the catchment area for organs. Given the abject poverty in which people live and their lack of education, it is not too difficult to lure them with false promises to sell their organs. Ironically their problems remain unsolved.
Today the picture is grim. Poverty is on the rise and international networks of ‘fixers’ are active connecting patients with local intermediaries in the ‘organ-exporting’ countries who have links with donors and surgeons. Embassy officials are also said to be involved since crossing boundaries means visas have to be issued. Dr Adib Rizvi attributes the return of this evil to the failure of the government to empower THOTA by drawing up rules and the organ mafia being hand in glove with the administration and the police. People have been caught red-handed but have been let off because high-ups are beneficiaries of the huge amounts that the trade generates.
The most plausible approach would be to break the triangular nexus between exploitative agents, wealthy patients and unscrupulous surgeons. The key element in this nexus is the surgeon whose expertise cannot be easily replicated. It speaks volumes for the ‘integrity’ of a government which cannot even nab a handful of individuals who have been so clearly identified.
Mercifully Sindh has escaped this malaise. The province suffers from greater poverty and the people are equally vulnerable to exploitation. Yet we have not heard of villagers selling their organs in Sindh. That is because the province does not have transplant surgeons who have sold their souls to the devil. It cannot be denied that it is not easy to defy the moral pressure exerted by the SIUT which serves as a strong anchor for ethical practices in medicine and surgery. Believing healthcare to be the basic right of a person, Dr Rizvi has ensured that all treatment — even the most costly — is provided free of charge as is enshrined in his philosophy. Commercialism cannot thrive in the proximity of compassion and altruism.
