THE Dawn report (Feb 13) about a proposed amendment in the current law on organ transplantation shows several ethical and procedural misunderstandings about deceased organ donation a few of which I will try to rectify here.

First, except in the case of corneas, the donation of all solid organs is only possible if death occurs within a hospital and after the patient has been pronounced brain dead. It is misleading, therefore, to state that organs can be “removed just after death or as soon as a body is brought to the hospital”.

Second, several countries provide a box to tick, generally on the driving licence, as to whether the individual wishes to donate an organ. The amendment proposes to do something similar, using the CNICs. In either case this step does not constitute “consent regarding organ donation” which the Nadra Chairman appears to believe. For a consent to be valid, the consenter must be provided full information about what the proposed action will entail, must comprehend this information, and then voluntarily agree to the process. Are Nadra officials in a position to undertake this exercise and also ask “what organs [the individual] would like to donate?”

Third, experience within industrialised countries reveals that despite individuals having signed donor cards, following their death, if distressed family members refuse to allow the donation, physicians will not procure the organs.

Our research reveals a majority belief (on cultural and religious grounds) that the decision of the family should override that of deceased kin. If physicians were to insist on obtaining organs against family wishes based on CNICs, the repercussions to deceased organ donation and physicians in Pakistan would be disastrous.

There is no question that we need to develop strong, sustainable deceased organ donation programmes in Pakistan to address citizens who can be saved from a life of servitude to, often inaccessible, dialysis and sometimes early death. However to achieve this requires careful thought and planning in which our public comes to see themselves as partners in this endeavour rather than merely cogs within the medical and ill-informed legislative machinery.

Dr Farhat Moazam
Centre of Biomedical Ethics and Culture (CBEC), SIUT
Karachi

Published in Dawn, February 15th, 2019