SO we are back to square one. The Transplantation of Human Organs and Tissues Ordinance (Thoto) promulgated in 2007 to check the commercialisation of organ transplantation in Pakistan has virtually become a dead letter.

It is being flouted with impunity. The Aadil Hospital that proudly claims to be the first 'ISO Quality Management System certified hospital' in the country continues to offer a transplant 'package' to patients with end-stage kidney failure. It would be wrong to say it is back in business. From information I have gathered it never pulled down its shutters.

With poverty on the rise it is easier now to exploit impoverished, debt-stricken men and women and get them to sell their organs for a pittance. Elements abound who are willing to punish the poor for their 'crime of poverty' by violating their dignity. Two hospitals in Punjab — Aadil Hospital in Lahore and the Kidney Centre in Rawalpindi — are openly being cited as being in the forefront of this organ sale racket.

This has shocked those who had believed that the enactment of Thoto would put a halt to this avarice-driven medical malpractice. There have been sporadic press reports of touts — the middlemen in the billion-rupee scam — being hauled up by the police.

But no big fish has been netted. Without the expertise of the transplant surgeons the business would collapse. What is most damning is that one of them went to the Federal Sharia Court to have some sections of Thoto declared un-Islamic. He failed to convince the honourable judges and in April 2009 the FSC ruled 'unequivocally' that the “sale and purchase of human organs is against the principles of Islamic Sharia”.

For Dr Adibul Hasan Rizvi, the director of SIUT — the only institution in the country that provides free organ transplant — the revival of the kidney trade amounts to the country being pushed back into the “state of shame” from which it had pulled itself out when the organ law was enacted. He blames the government and law-enforcers who, he says, are conniving in making Pakistan a “bazaar for cheap organs”.

His anger is understandable given a clutch of emails he has received from fellow transplant surgeons in Saudi Arabia, Kuwait, Bahrain and India and various medical organisations disclosing that their patients were still visiting Pakistan to obtain illegal kidney transplants.

When Dr Rizvi visited Chandigarh recently for a conference, his Indian hosts confronted him with a number of patients who had crossed the border to obtain illegal transplants in Lahore. Cross-questioning revealed that all kinds of fraudulent means had been employed to circumvent Thoto even though the Aadil Hospital website appears to swear by it again and again.

Once more Pakistan is in the international media limelight. The death of an Indian who had visited Lahore to sell his kidney and died of complications was widely reported. Last week, BBC broadcast an interview with a Londoner, Sukhi Johal, who had obtained a transplant in Pakistan that cost her £30,000. She was deceived into believing that no violation of the law was involved.

The law that is in place specifically bans the sale of organs and prohibits organ transplantation from unrelated live donors. In cases where the latter are allowed the conditions stipulated by the ordinance are so stringent that no foreigner on a short visit to Pakistan can ever meet them.

The conditions in the country today are reminiscent of W.B. Yeat's words, “Things fall apart; the centre cannot hold;/Mere anarchy is loosed upon the world”. In this mayhem, the advocates of the kidney trade feel encouraged to flout the law.

Their problem is that there are others — within the country and abroad — who refuse to turn a blind eye to their shady deeds. Apart from the moral dimension of the exploitation of the poor, there is also the medical ethics aspect. Transplants done illegally are always done in a hurry and surreptitiously — one was performed at 3am and the patient sent home after four days — and as such lack professional thoroughness required to prevent any harm coming the way of the donor and the recipient. This carries health hazards for both. It is now established that commercial donors do not receive the post-operative follow-up that is essential for their wellbeing

The recipients also suffer the adverse effects of neglected post-operative care. The scam is now coming to light from countries whose nationals are the recipients of organs in Pakistan and report to their own hospitals back home when complications set in.

Pakistan is earning notoriety it could do without. The Transplantation of Human Organs and Tissues Authority (Thota), the agency set up under the ordinance to regulate organ transplantation, is seized with four cases of illegal transplantation surgery allegedly done in a Lahore hospital. The recipients came from Saudi Arabia, Kosovo, Turkey and Bulgaria.

The hospital in question — Aadil Hospital named in the emails — has denied the scam saying the reports were “totally false and baseless” and “a conspiracy”. From information available, it seems Thota has yet to investigate the case thoroughly.

The roots of this scam go far and deep. There are numerous institutions and persons involved in it — not just the hospitals and surgeons carrying out the surgery — but apparently also visa officers in our embassies who facilitate the issuance of visas, and the touts who procure the donors.

In April, Gen (retd) Usmani, administrator, Thota, had reassured the media at a press conference that the number of foreigners being transplanted commercially with organs in Pakistan had dropped to nil from 1,500 per annum before the

ordinance was enacted. He acknowledged that 49 transplants had been performed with the help of live unrelated donors in the September 2007 to March 2009 period. He did not confirm whether the procedure laid down under the rules was followed by the evaluation committee.

This is an improvement. But with cases continuing to be reported (including foreign nationals) and Thota fast proving to be a toothless body, we can expect to be back to the seedy world of kidney tourism that prevailed two years ago.

It is deplorable that Punjab, our largest and most developed province, is taking the lead in this criminal activity. Its chief minister has the reputation of being a strong and efficient administrator. Can we request Mr Shahbaz Sharif to take action to check the scam that is bringing a bad name to his province — and to the rest of the country?

zubeidam@gmail.com