LAUSR

The recent death of a Jordanian national, following an illegal kidney transplantation carried out by two local doctors in Lahore, Pakistan has once again highlighted the increasingly widespread illegal organ trade that has flourished in private hospitals in the country. It has been reported that other foreigners, including Omani, Saudi and Libyan nationals had also sought kidney transplants through the convicted doctors, who have been arrested along with their active accomplices, including a local anesthesiologist and paramedical staff while an investigation to arrest other doctors involved in this crime racket is underway. Organ trafficking was criminalized in Pakistan in 2007 by the Transplantation of Human Organs and Tissues Ordinance, followed by the Transplantation of Human Organs and Tissues Act 2010. This legislative revolution stemmed from a triad of influences; advocacy by local medical community, national media coverage spreading awareness of the exploitative nature of this transplant commercialism and reinforcement of the above via efforts of international medical bodies: the Transplantation Society and the WHO. Prior to this legislature, Pakistan was a destination for ‘transplant tourism’, with two-thirds of the 2000 kidney transplants performed on foreign nationals, by 2006. Although the incidence of illegal kidney transplants fell sharply before the 2007 ordinance, it began to rise again in the wake of weak implementation and corruption. Several factors contribute to the decreased effectiveness of Pakistan’s legislative changes. The desperation of susceptible populations such as illiterate and impoverished individuals, undocumented immigrants, prisoners, political or economic refugees and the bonded labor working in the agricultural sector (Pakistan’s economic backbone), compels such unfortunate individuals to donate their kidneys in order to make ends meet, with very little priority given to the long term health effects of organ removal. Furthermore, with the local nature of these undercover transplantations carried out in private hospitals, any attempt to shut down this practice via law enforcement, encounters strong resistance from physicians and hospital owners involved in the lucrative organ trade as well as from the feudal system that encourages bound labor and peonage. Not only does illegal organ trade risk the lives of both donor and recipient but is also tarnishing Pakistan’s international reputation, since the country is currently a signatory of Declaration of Istanbul Custodian Group (DICG) which works under the WHO to prevent transplant tourism and organ trafficking. Suo-moto notice of this matter was taken by the Supreme Court in August 2016. A viable alternative to this problem is to increase awareness and encourage deceased organ donation, by devising various programs, among the general public, the majority of which is either unaware of or else has religious reservations regarding the concept. Unfortunately, despite having a population of around 200 million, Pakistan has only seven deceased organ donors on record, the most well known being the philanthrophist Abdul Sattar Edhi. The onus of responsibility lies upon the government to push forward this option, which will not only put an end to the illegal kidney trade but also serve to benefit the thousands of Pakistani citizens suffering from end stage renal failure annually.