Speaking at a press conference at the Sindh Institute of Urology and Transplantation (SIUT) on Friday, they said it was due to their long struggle and the concerns of civil society members that the federal government had revised the draft of the ordinance in question once again.
But a majority of the speakers maintained that there were still certain loopholes in the proposed ordinance, which would “pave the way for naked commercialisation of human organs, including kidneys, in the country.”
According to reports, a revision of the draft of the Transplantation of Human Organ and Tissue Ordinance, 2007, apparently aimed at regulating the removal, storage, sale and transplantation of organs and tissue, is being considered so that it could be placed before the president for an early promulgation.
The lead speaker at the briefing, president-elect of the Transplant Society of Pakistan (TSP) and Director of the SIUT, Prof Adibul Hassan Rizvi, said that it was heartening that the government had now started realising the problems of organ transplantation.
‘Transplant tourism’
Dr Rizvi said that transplant activity in the country started in the early 1980s when India was the main centre for the organ trade. After imposition of the ban on unrelated transplants in that country the whole trade shifted to Pakistan, which has now become important in the transplant tourism industry.
“Commercialism is at the maximum in our country. The poorest of the poor are being exploited and their organs are made available to the rich at cheap rates,” Dr Rizvi added, saying that people in many cases had been forced by unscrupulous elements to surrender their kidneys.
He said that the government should ensure complete elimination of transplants from unrelated donors, otherwise considerable health complications for both the kidney recipient and donor could arise. He suggested that the proposed set of laws should be reconsidered and amended further with the consultation of his group of consultants as well in order to make the document meet the norms and protocols of international agencies, including the WHO.
According to the ordinance’s draft, part of which was made available to newsmen during the press briefing, section 3, subsection 2 states as follows:
“In case of non-availability of a donor as explained under subsection (1) and there is a threat to life of an end stage renal disease failure patient, liver, heart, or lungs patients, the evaluation committee may allow donation by a non-blood relative or relative or non-relative, after satisfying itself that such donation is voluntary.”
“The donor under this sub-section shall be compensated as may be prescribed.”
Fears of commercialism
Commenting on the clause, Dr Rizvi said that it should be omitted entirely as it would open the floodgates for commercialism.
“In a life threatening situation end stage kidney failure patients can be successfully treated by dialysis. As for patients with liver, heart or lung failure, living donors cannot provide organs in most cases because of very high risks to the donor,” he added, saying that one could not donate a heart as one would die instantaneously.
The SIUT director further said that the rate of “unrelated kidney transplants,” which was around 25 per cent in 1999, had increased to 85 per cent in the country, which was likely to shoot up further, that too in an organised way through the law under study.
“No law is better than a bad law,” he remarked.
At present, in addition to local exploitation, patients from abroad, including those from some Middle Eastern countries, the US and other developed countries manage to lure the economically-deprived donors. In fact, pools of kidney vendors have formed in different parts of the country, particularly in Punjab.
The SIUT has long been advocating for “cadaver laws.” Answering a question, Dr Rizvi said that there was now a ray of hope as the Supreme Court of Pakistan had also called for the enforcement of a human organ law in the country and that was why his society, which enjoyed the support of the Pakistan Society for Nephrology and the Pakistan Association of Urological Surgeons, had also sent a draft on kidney transplant and donation laws, which was proposed originally in the 1990s.
Wrong signals
Stressing the need for the rectification in the reported fresh draft, another senior doctor, Anwar Naqvi, who is also the secretary-general of the TSP, said that certain sections of the proposed ordinance suggested donation of organs against payment, which was going to have a bad connotation.
He gave an overview of the proposed legislation and suggested the deletion or amendment of some sections or subsections of the proposed legislation, including section 3 and its subsection 1, section 4 and its subsection 1, section 5 and subsections 1 and 2 section 8 and subsections 1, 5 and 6. He also demanded provisions in regard to post-transplant care and medicine for the organ donors.
He said that rules should be framed to establish a transplant registry to document all transplantations.
Dr Sajjad Husain, President PAUS, said that the proposed laws would cause exploitation by few at the cost of many.
Dr Farhat Moazzam, Chairperson of the Centre for Biomedical Ethics and Culture, said that giving monetary value to any organ transplantation was unethical. Devising a law that prohibits buying and selling of organs is the only way to be fair to all stakeholders, she added, and referred to some international protocols which, according to her, compared the organ trade with human trafficking.