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December 2018, Volume 68, Issue 12

Letter to the Editor

Deceased Organ Donation in Pakistan _ A haunted will or an under-researched topic?

Mahnoor Hafeez  ( Dow University of Health Sciences, Karachi, Pakistan )

Madam, Few days back, I heard a young brave boy making a will of Deceased Organ Donation (DOD)!Yes, sounds haunted, for me too, it is, because most of us don’t want to think about death related phenomenon; but it is true that thousands of patients have been waiting for the procurement of the vital organs. The exact figure for Pakistan is not available but according to a conservative estimate, more than 50,000 people die each year due to end stage organ failure. This figure includes 15,000 people with kidney failure, 10,000 with liver failure and 6500 with heart failure!1 One report shows that around some 150,000 people die every year due to organ failure in Pakistan!2 It has probably been one of the least researched topics in Pakistan; to the best of author’s knowledge, only one study regarding DOD in Pakistan was found3.Here, the importance of DOD, the Practices in Pakistan and to discuss the Islamic perspective and ethical issues regarding it are discussed. DOD is an established medical procedure- it means acquiring organs from a person after death to be transplanted into other persons who are dying from organ failure, in order to save their lives. It is a donation of life to those for whom the only alternative is dying from organ failure. Organs and tissues that can be donated include corneas, kidneys, heart, liver, lungs, pancreas and intestine. Further inquiry revealed that in ‘natural death state’, only cornea can be donated because of blood clotting phenomena, while on individual can become the donor of all the major organs if one meets accidental death or suffers from brain death (loss of function of brainstem- the center for control of breathing). If at the time of brain death, the patient is on a ventilator, thei heart beat and breathing can be maintained artificially for some time, and this person becomes a DOD. In 2005, Ashraf O et al4 conducted a KAP study regarding organ donation (OD) in Pakistan. Knowledge of OD was significantly associated with education and socioeconomic status. Awareness of OD and the knowledge that OD can save lives was also significantly associated with the willingness to donate. According to a study by N Khan et al5 from Faisalabad which analyzed the knowledge and attitude of people towards organ donation (OD) showed that none of the respondents were actual donors, though 67.4% of respondents agreed that religion allows OD. Only 27% knew about the law in Pakistan regulating OD. It concluded that multi-sectorial approach (e.g., electronic and print media, religious scholars, doctors and teachers) should be used to promote awareness of OD. The big dilemma of our society is to believe the myth that we, the Muslims should not harm the human body in a post death state. In contradiction to this belief, the 4 th conference of the Islamic Fiqha Council convened in Jeddah 6, Kingdom of Saudi Arabia,from 18-23 Safar, 1408A.H.(6-11 February,1988) submitted the recommendations on the benefits of donating an organ to another person with organ failure. This recommendation was made after studying the Fiqha and medical research results. It stated the following: “It is permissible to transplant an organ from a ‘dead person’ to a living person whose life or basic essential functions depend on that organ, subject to the condition that permission be given by the deceased before his death, or by his heirs after his death, or by the authorities in charge of the Muslims if the identity of the deceased is unknown or he has no heirs.” The Constitution of Pakistan7 elaborates DOD– “Any person who is not less than 18 years of age may before his death, in writing duly signed and verified by the respective Evaluation Committee, donate any of his organ or tissue for transplantation and for this purpose may authorize any medical institution or hospital, duly recognized by the monitoring authority”. Pakistan, a country with more than 190 million people, is currently reliant on live donors. Colloquially, we as health care professionals have to set the example in our society, by taking the initiative, becoming a deceased organ donor, because not only our actions have major impact on the general population, but also it will be a source of motivation for the general population. Further, researchers have to put their effort in this regard to increase the awareness about this serious issue and also lessen the wide numerical gap amongst our current organ donors in Pakistan, in comparison to foreign countries. It is also known that the human corpse naturally undergoes a process of decomposition, so it’s better to donate and benefit than to let ‘these’ getting in vain. There are various online docudrama run by Sindh Institute of Urology and Transplantation(SIUT) whose main theme is that one human can save 8 humans. Founder of SIUT mentioned that around 10-12 Live related transplants are performed weekly at SIUT- the major unit in Asia involved in transplantation.8 And Allah says in Qur’an (Chapter 5, Verse 32): “whoever saves one life - it is as if he had saved entire mankind”. Deceased Organ donation-It’s not about humiliating the corpse, it’s about humanity and broadening our vision, its about saving lives, and nothing is more important than saving lives!

Keywords: Deceased Organ donation, attitudes, awareness, Pakistan.
Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding disclosure: None to declare.

References

1. Donating organs. DAWN. 2012 April, 22. [online] 2012 [cited 2018 Jan 12]. Available from: URL: www.dawn.com/news/712695
2. Ilyas F. Thousands die waiting for organ donations, seminar told. DAWN 2016 April 17. NOT FOUND
3. Moazam F, Jafarey AM, Shirazi B. To donate a kidney: public perspectives from Pakistan. Bioethics. 2014;28:76-83. doi:10.1111/bioe.12010. Epub 2012 Dec 21.
4. Ashraf O, Ali S, Ali SA, Ali H, Alam M, Ali A, et al. Attitude toward organ donation: a survey in Pakistan. Artif Organs. 2005; 29:899-905.
5. Khan N, Masood Z, Tufail N, Shoukat H, Ashraf K, Ehsan S, et al.
Knowledge and attitude of people towards organ donation. JUMDC 2011;2:15-21.
6. Ruling on organ donation. [online] [cited 2018 Jan 12]. Available from: URL: islamqa.info/en/107690
7. Section IV, The Transplantation of Human Organs and Tissues Act
2010 (Act VI of 2010) [online] 2010 [cited 2018 Jan 19]. Available from: URL:
http://www.na.gov.pk/uploads/documents/1479810285_726.pdf
8. Dr Rizvi inspires 40 medics to pledge for organ donation. Daily Times. Media Times Ltd. [online] 2016 [cited 2018 Jan 12].
Available from:
URL:

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