PAKISTAN faces a silent, but growing transplant crisis. According to data from major transplant centres, thousands of patients remain on the waiting list every year, while deceased organ donation in the country remains almost non-existent despite legal approval under the Trans- plantation of Human Organs and Tissues Act, 2010.

The current law operates on an opt-in consent model, requiring prior donor registration or family consent at a time of profound grief. While the Act recognises brain and brainstem death, the absence of a robust deceased donation framework, hospital-based coordination systems, and public trust has severely limited donor availability. As a consequence, potentially life-saving organs are lost on a daily basis.

There are countries that offer instructive examples. Spain, which leads the world in deceased organ donation, has adopted an opt-out system supported by strong hospital coordination and public awareness. Wales has also reported similar improve-ments following due legislative reforms.

Importantly, these systems focus not just on law, but also on transparency, public education and highly trained transplant coordinators.

In Muslim-majority countries, such as Saudi Arabia, religious endorsement and structured national campaigns have played a central role in increasing acceptance of organ donation.

Pakistan does not necessarily need to replicate any foreign model wholesale. However, revisiting consent mechanisms, strengthening hospital-based donation systems, and launching sustained public and religious awareness initiatives could significantly expand the donor pool.

Such reforms would honour both ethical principles and the urgent needs of patients whose lives depend on timely transplants.

Toqeer Abbas
President, Dow Organ Support Society
Karachi

Published in Dawn, January 24th, 2026