ONLINE SUBMISSION
  February, 2008

Organ donation law in Pakistan: An overview of the current situation

  Syed Faraz Kazim  ( Class of 2008, Aga Khan University Medical College, Karachi, Pakistan. )
 


Madam, Beyond  doubt,  organ  transplantations  save  lives  of  thousands  of  patients  throughout  the  world  every  year.  But  at  the  same  time,  the  procedure  endangers  the  lives  of  organ  donors  because  of  the  exploitative  organ  trade  widely  prevalent  in  developing  countries.  Every  year  thousands  of  people  from  Europe,  Middle  East,  United  States,  and  Australia  come  to  India,  Pakistan,  China,  Egypt,  Philippines,  and  other  countries  in  search  of  poor  donors  who  are  willing  to  give  one  of  their  kidneys  for  financial  compensation.1  According  to  WHO,  up  to  10%  of  the  63,000  kidney  transplants  that  occur  annually  through  out  the  world  involve  donors  from  developing  countries  who  are  unrelated  to  the  recipients.2  A  common  feature  of  this  commercial  organ  trade  is  that  the  donor  usually  does  not  receive  any  post  operative  care  which  can  lead  to  grave  consequences.  Another  dark  aspect  of  this  inhumane  and  unethical  business  is  that  the  donor  receives  only  a  small  fraction  of  the  amount  which  the  recipient  pays.  It  involves  malpractice  and  immoral  behaviour  on  part  of  doctors  and  hospitals  where  these  transplant  surgeries  are  carried  out.  Clinics  in  Pakistan  have  been  reported  to  charge  on  average  US  dollar  40,000  from  organ  recipients  whereas  a  donor  gets  only  US  dollar  1500  to  2000.2
The  dilemma  that  the  world  faces  today  is  to  make  organ  transplants  legitimate  and ethical  so  that  the  patients  requiring  transplantations  get  the  organs  without  exploitation  of  the  vulnerable populations.3In  developed countries, genetically unrelated organ donations are   strictly  restricted  to  altruistic  donors  who  do  have  a close  and  emotional  relationship  with  the  recipients. By legislature, commercial organ  transplantation  is  prohibited. The situation is alarmingly different in  a  Third World  country  like  Pakistan.1 It  is  one of  the  favourite  resorts  worldwide  as  far  as  "transplant  tourism"  is  concerned.  According  to  WHO  estimates,  Pakistan  hosts  up  to  1500  transplant  tourists  every  year,  second  only  to  China.4  Pakistan  didn't  have  any  law  to  curb  the  human  organ  trade  until  recent  past.  In  the  end  of  July  2007,  Supreme  Court  of  Pakistan,  the  premier  judicial  body  in  the  country,  issued  a  ruling  which  ordered  the  Government  of  Pakistan  to  enact  a  law  regulating  the  illegal  organ  trade  in  the  country,  especially  the  kidneys.  This  ruling  came  out  as  a  response  of  complaints  that  poor  people  were  forced  to  sell  their  kidneys  by  middlemen  for  very  meager  monetary  compensations.  It  was  also  a  result  of  media  reports  in  July  that  at  least  10  hospitals  in  Lahore,  a  major  city  of  the  country,  were  found  to  be  involved  in  the  black  marketing  of  human  organs.  The  Government  of  Pakistan,  following  the  Supreme  Court  ruling,  formulated  the  "Transplantation  of  Human  Organs  and  Tissues  Bill  2007"  in  the  National  Assembly.  The  bill  proposes  a  number  of  measures,  including  the  restriction  of  organ  donation  only  to  close  blood  relatives  who  are  over  the  age  of  18  as  well as  a  ban  on  the  donations  by  those  who  are  not  related  to  the  recipients.  As  per  this  law,  every  donation  has  to  be  evaluated  by  a  committee  of  medical  experts  that  would  determine  that  the donation  is  fully  voluntary.  The  bill  proposes  a  10  year  jail  sentence  for  anyone  found  guilty  of  being  involved  in  the  commercial  trading  of  organs.5
The  bill  was  converted  to  an  ordinance  by  the  President  of  Pakistan  as  there  was no  time  for  discussing  it  in  the  Parliament.  According  to  the  legislation  an ordinance  is  valid  for  4  months  and  within  this  period  the  bill  should  be  passed by  the  assembly.  We  are  still  at  cross  roads  regarding  the  implementation  of  the law.   The  delay  in  the  process  has  evoked  serious  concerns  among  the  experts  in  the  field  of  ethics  of  organ  transplantation  in  the  country  as  well  as  among  general  population.6,7  Nevertheless,  this  recent  development  has  halted  the  illegal  organ  trade  at  least  for  the  time  being.  Only  time  will  tell  whether  this  law  will  be  able  to  mark  an  end  or  at  least  decrease  the  black  marketing  of  organs  in  the  country.  Pakistan  also  has  as  yet  no  law  allowing  the  transplantation  of  organs  from  the  deceased. The much  needed  cadaver  legislation  can not  only  help  patients  who  require  an  organ  donation,  but  it  can  also  help  in  curbing  the  illegal  organ  trade  in  the  country.  Dedicated  efforts  from  Government  and  Public  sector  institutions  are  required  to  put  an  end  to  this  inhumane  trade  in  Pakistan.

 Syed Faraz Kazim
  Class of 2008, Aga Khan University Medical College, Karachi, Pakistan.


References:
1. Editorial  :  Humayun  A.  To  sell  or  not  to  sell  an  organ.  Dawn.  2007 August  30.
2. Garwood  P.  Dilemma  over  live - donor  transplantation.  Bulletin  of  the  World  Health  Organization :  2007; 85: 5-6.
3. An  ethically  defensible  market  in  organs.  BMJ 2002;325:114-5
4. Heneghan T.  China,  Pakistan  bowing  to  pressure  on  organ  trade.  Reuters.  2007 April  4.
5. Pakistan  :  Government  mulls  new law  on  Illegal kidney  sales.  IRIN  :  Humanitarian  news  and  analysis. 2007 September  5.
6. Birsel  R.  Pakistani  law  unlikely  to  stop  organ  trade  -  expert.  Reuters.           2007 May  24..        
7. Editorial.  Promises  but  no  action.  Dawn.  2007 August  29.

News & Events

WHO/GOARN Request for technical assistance for Cholera Control in Northern Iraq

Request for assistance

WHO is requesting assistance from GOARN partners to identify the following cholera and diarrhoeal diseases expertise to support the Ministry of Health of Iraq in cholera risk assessment and immediate preparedness activities to improve the health outcomes of the Syrian refugees current living in camps in the Kurdistan region of Iraq.

  • two (2) epidemiologists
  • two (2) clinical management experts
  • one (1) environmental health expert (WATSAN)
  • one (1)laboratory expert

Duration

6 day mission starting 13 June 2014 (this excludes travel time).

Location

Northern Iraq (Kurdistan region).

Language requirements

All candidates must be fluent in English- written, spoken and comprehension. Fluency in Arabic is an asset. Knowledge, abilities and skills All candidates are expected to demonstrate the following

  • Ability to conceptualize and promote innovative strategies and policies.
  • Ability to communicate and write in a clear concise manner, and to develop effective guidelines.
  • Excellent negotiation and interpersonal skills complemented by ability to motivate and lead others and to promote consensus. Tact, discretion and diplomacy
  • Demonstrated ability for project appraisal, project management, monitoring and evaluation and project impact assessment.
  • Ability to work with host governments and their agents, INGOs and national NGOs an advantage.
  • Proven experience of managing a large workload and multiple priorities.
  • Ability to work in difficult conditions.

Support to the mission

WHO/GOARN will cover the travel and per diem (to cover daily expense in the field) expenses for the duration of their mission. GOARN missions do NOT offer salary, consultancy fees or any other form of remuneration.

WHO will provide appropriate logistics support for the field mission. Pre-deployment orientation/training may be required at WHO.

Partners offers of assistance

Partners are requested to reply with offers of assistance, together with CVs and details of the availability of staff for this mission by email to goarn@who.int latest by 30 May 2014. Details of all offers from partners and eventual deployments will be maintained on the GOARN SharePoint.

Operational Contacts

Mamunur Malik WHO EMRO malikm@who.int

William Perea WHO HQ pereaw@who.int

Patrick Drury GOARN druryp@who.int



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