March 4, 2004

When a six-month-old baby became the first recipient of a liver transplant at SIUT in Karachi, the issue of organ donation re-surfaced, opening a Pandora’s box with no end in sight, reports Zofeen Ebrahim

When Sohaib’s parents brought their then six month-old sickly-looking child from Rawalakot, Azad Kashmir, to the Sindh Institute of Urology and Transplantations (SIUT) last November, little did they know that they would be making history when Sohaib would become the first recipient of a liver transplant in Pakistan.

But for his parents what was more scary was that if they had not come to Karachi or to the SIUT, he would have died within months. “He was this yellow,” says Dr Anwar Naqvi, a senior urologist at the institute, pointing to the bright yellow balloons hanging in his cubicle. The seven-hour operation was carried out in November 2003 by the SIUT team headed by director, Dr Adeebul Hasan Rizvi, with the assistance of a team of surgeons from King’s College, London.

Sohaib’s maternal uncle Wasim Khan, 21, a lanky frail fellow in the construction business was the donor and shared part of the limelight with his infant nephew. “I feel proud because God chose me to save Sohaib’s life. That is my reward.”

In a country where people hesitate to give even blood to save lives of near and dear ones, his is a feat. As for Saima, Sohaib’s mother, and Wasim’s younger sister, she’s overwhelmed. “I don’t know what to say. The night before the operation was the longest, most grueling night I’ve spent. I wanted my son to be normal and healthy again, but I couldn’t help worry about my brother. What if something went wrong? How would I ever face my parents? My faith in God has strengthened.” She is lucky to have six brothers, all of whom had offered their liver for transplant.

Sohaib, his parents and his uncle, have not had to pay a single rupee to the institute since the day they set foot in the SIUT. With humble beginnings as a department of urology at the government-run Civil Hospital, Karachi, in 1970, it grew into an institute in 1991. This large public sector state-of-the-art health facility provides free, comprehensive medical care in kidney diseases and transplantations. A similar operation in the US would cost approximately $250,000.

However, there is a downside to this growing island of excellence. While there has been an increase in the pool of philanthropists as well as an increase of grant-in-aid from the government, all of it seems to be insufficient in keeping up with the increasing patient load and SIUT’s expansion programmes.

That may be reason enough for the SIUT team to be losing sleep, but what they are more concerned about is getting the law that would allow cadaver donation to become legal. In making history, Sohaib has also re-opened the Pandora’s box. The nearly decade-old debate of legalizing cadaver organ donation — a law that has been lying dormant before the legislature waiting for approval — has given a new lease of life for people like Sohaib.

“Things seem to be looking up. We have the blessings of Prime Minister Jamali whose son went through a liver transplant some five year’s ago at King’s Hospital in London. When the team was here in November, he came to meet them at our institute and when the issue was raised, he promised to get it done.

“He understands the importance of organ donations,” says Dr Naqvi. According to him almost all Muslim countries have accepted this including Saudi Arabia, Egypt, Malaysia and Bangladesh, etc., so why can’t it be done in Pakistan? Is it the people? Are they so indifferent?

Not Fouzia Mapara, a young woman working in a multinational corporation, who has no compunctions about donating her organs after her death, “As long as everything is legal and utilized correctly for Pakistani human beings and not exported like everything else — our meat and tomatoes and fruit.”

But M. Saleem Dada, who teaches Islamiyat, is against cadaver organ donation. “If some Muslim countries have made the law in their favour, that is no reason to consider it an Islamic decision, nor does the fatwa (Islamic decree) of Al-Azhar University matter for the same reason.”

Quoting Surah Nisa’s verse 119, he gives reasons why he thinks cadaver organ donation is wrong. “To change the shape of a body is a satanic attitude. Allah has created the human being with great art and perfection and to add or subtract anything from a person is against this setting. Little wonder then that organs donated are always rejected where they are put and heavy and very expensive medicine is needed to control their work.”

Mohammad Ali Naqvi, a Shia scholar, also believes that, “Cadaver organ donation or that of a living person is un-Islamic.” Although he believes that donating blood is equivalent to Godliness, “It does not require any surgical procedure, organ transplantation for research or for saving lives is not allowed in Islam.”

Farahnaz Moazam, another Islamic scholar believes that “saving a life is of extreme importance, but I also understand that mutilating a dead body is against the sanctity of the dead. A major concern I would have is whether cadaver donation relates to only life-saving organs or would sperms, follicles and DNA also be part of it? If it opens the doors to cloning and re-productive adventurism, it needs careful thought.”

“Giving life to people could never be un-Islamic,” argues Dr Rizvi. “When it comes to life and death, something that is not permissible in Islam becomes permissible. That is Islam.”

Niilofur Farrukh, art critic and an art activist, is far more optimistic. She says: “The common person has a good instinct. We are a generous spirited nation, but unfortunately ill-informed. However if the advantages of cadaver donations are explained in the scientific and religious context, I see no reason why acceptance will not come. Testimonials of the families and direct beneficiaries of these transplants will appeal to the human aspect, which to my mind, should remain the focus of such a campaign.”

She adds: “Cadaver organ donation is the ultimate gesture of generosity a human being can make for the other. It is a sadqa-e-jaria (continuous and on-going alms giving). Enlightened religious leaders should also endorse this to address religious concerns. Young citizens in school and college should be taught more about this area of national duty.”

Imtiaz Taj Kamal, 76, and a health care provider, strongly feels that “with health education people can be motivated to make wills to donate their bodies/organs.” He says: “My late husband had donated his body for research. So have I. Any organ that can be utilized to save someone’s life or better the quality of someone’s life should be donated.”

However, Nuzhat Lotia, can’t fathom the fact that “if eyes can be donated after death, what holds people back from donating other organs?” Beena Sarwar, a journalist and a human rights activist adds, “Blood is also defined as an organ and it’s donated all the time.”

“The right to life is considered very sacred in Islam and I don’t see why cadaver organ donation, if meant to save another life, should be illegal,” says Lotia. However, she is rather sceptical, “The problem arises when such donations become commercial.”

For that Dr Laila Gardezi adds, “The law will have to be stringent and proactive. Knowing our people and the extreme poverty that they are entrenched in extreme caution will have to be ensured at the implementation stage.”

To this Dr Naqvi adds, “While India had almost fallen into the slippery slope of commercialism with a $20 million trade in kidnesy, it has got back on its feet and got out of the ugly predicament it was in. Now they don’t allow any transplants for foreigners. If we have a law that allows genetically related and unrelated cadavers, we may get out of such sticky situations that India faced.”

For far too long SIUT has been talking about donor cards, but even that scheme has never really taken root. “This is because no one carries the donor cards on them. We have suggested that the new driving licenses should have a line that says that the victim has allowed donation of his organ in case of sudden death due to an accident,” explains Dr Naqvi. So far nothing like this has materialized.

On an average 25,000 Pakistanis die of organ failure every year. At the moment about four per cent of the population is suffering from Hepatitis B, and a similar number from Hepatitis C, coupled with post-hepatic cirrhosis. There is an estimated need of 5,500 livers per population per annum in the country.

“Despite the technical advances, donor organ shortage persists in the absence of a cadaver organ donation and transplantation law,” says Dr Rizvi. The end-stage organ failure, a considerable clinical problem in Pakistan, leads annually to an estimated 10,000 patients requiring renal replacement and 3,000 a new heart.

Whether it is public apathy, indifference or an ill-informed nation, statistics show that not more than 150 corneas have been donated by Pakistanis during the last 50 years. This is in the backdrop of a population of 1.5 million blind people in the country which is increasing at a rate of half per cent.

According to Eye Bank Society some 1,500 corneas have been procured from Sri Lanka during the last 35 plus years. Though 30,000 consent cards have been signed in Karachi alone in the last 20 years, very few donations actually came forward as the survivors fail to approach the Bank. Courtesy IPS

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