New laws, same old organ trafficking

About two months back, 28-year old Asif Ahmed* put up an announcement on the internet to sell one of his kidneys. “I lost a lot of money in business some four years back and pumped in more money by taking a loan, but I’ve lost all. I know there is a law that prohibits selling of any organ, but I can’t think of any other way to pay back this loan,” he told IPS over the phone. However, not one person has contacted him even to inquire or show any interest. But then Ahmed is based in the southern port city of Karachi, in Sindh province, where the illegal organ trade is well under control, unlike reports of a rise in Punjab province, Zofeen Ibrahim of the IPS reported.
Pakistan enacted a transplant law in 2010 to shake off its reputation as a leading destination for transplant tourism and bring a stop to illegal organ trafficking. After the passage of the transplant law, organ trafficking stalled to some extent, due to the “attention it garnered,” said Dr Farhat Moazam. But, she added, there is new evidence that “since last year, cases are beginning to surface again.”
Moazam is chair of the Centre of Biomedical Ethics and Culture at the Sindh Institute of Urology and Transplantation (SIUT), institutions that relentlessly campaigned for the organ law for over two decades before the law was promulgated in 2010.
She said while there is “suspicion” that both foreigners and Pakistanis are buying kidneys, the former draw more attention in the media.
“We also get information from our international colleagues (often from the Middle East) about their citizens who have landed in their hospitals with problems following a kidney transplant especially in Lahore and Rawalpindi”.
After the SIUT, the Transplant Society of Pakistan (TSP) and members of civil society filed a case against the government for its failure to implement the Transplantation of Human Organ and Tissue Act 2010 (THOTA), in turn failing to stem the flourishing trade, the Supreme Court issued directives in July to the provincial governments to take action. “The law remained static and I would call it the failure on the part of the law enforcement agencies and the transplant authority,” Adib ul Hasna Rizvi, head of the TSP, said. “Reports of illegal trade were brought to the notice of the ministry of health and the national Human Organs Transplantation Authority (HOTA), but no action was taken on any of the complaints sent to them.” Data compiled by the National Human Organs Transplantation Authority in 2010 found that 14 out of a total of 42 illegal kidney transplant facilities were in Punjab.
“Our advantage is that we have the support of the press, the judiciary, and the medical community; what is missing is the will of the government to enforce it and to do so transparently and with an even hand,” Moazam said. According to the World Health Organisation, an estimated 10,000 illegally purchased organ transplants take place each year. It says illicit organ trafficking rings have been uncovered in China, India and Pakistan.
Kidneys make up 75 percent of the global illicit trade in organs, according to WHO estimates. Of the 106,879 solid organs known to have been transplanted in 95 member states in 2010 (legally and illegally), about 73,179 (68.5 percent) were kidneys.
“It is of great concern to see that laws are not enforced,” said Dr. Luc Noel, with the WHO in an email. Citing the data from the Global Observatory, Noel concluded: “TT (transplant tourism) had probably decreased around 2006-2007 and may be increasing again, but we are still estimating that roughly 10 percent of organ transplants are OT (organ trafficking).
“In Pakistan, this could translate into a strong HOTA associated with the police and efforts to develop donation from deceased persons, for instance along what has been initiated by SIUT,” said Noel.
In July this year, Abdullah Halame Nur and his wife Naado, ethnically Somali, arrived in the eastern city of Lahore, in Punjab, from the Netherlands to buy a kidney for Nur. Just as the buyer was being prepped for the operation, the police busted the illegal transplant network and arrested all present, including the foreign nationals. The well-connected surgeons and the anaesthetists, identified by the sellers as the ringleaders of the trade, are on ‘interim’ bail for the last few months in violation of THOTA and the Pakistan Penal Code.
“We have yet to see a physician convicted and punished for transgressing the law,” said Moazam. Noel points out that the organ trade cannot be completely eradicated as long as there is “an unmet need of wealthy patients in search of transplantation, access to vulnerable individuals willing to sell an organ, and weak or absent enforcement of the law leading to the development of organ trafficking and possibilities for corruption driven by huge illegal profit.” With the change in dietary pattern like the spread of fast food, renal failure of “epidemic proportions” is being predicted in developing countries, said Moazam. But with a weak, or worse still, non-functional health system, and lack of screening, early diagnosis and treatment of kidney diseases, kidney trade will only increase, she predicted.
However, there is a dearth of voluntary donors, and many people are not willing to bequeath their bodies when they die. In a yet-to-be published study conducted in Karachi by Moazam and her team in 2010, detailed interviews with 100 people – 61 percent of whom were educated up to class 10 or above – about their opinions on live and deceased donations showed that while there was an acceptance of live donations, many opposed taking organs from the deceased due to a mixture of cultural norms and interpretation of religious teachings revolving around respecting the dead body.
“Some believed that the nephrectomy would cause the deceased pain,” said Moazam. What she found striking was that almost one-third of those interviewed were unaware or unsure that it was possible to take organs from the deceased for transplantation. In addition, the study found that 70 percent of the interviewees said they would buy a kidney if they could afford to, rather than ask a relative. What was even more unfortunate: fewer than ten percent of those interviewed knew of the existence of a law that criminalises the organ trade.
* Name changed to protect identity.