Recently, an opposition party’s MNA was reportedly planning to move legislation on posthumous organ donation. It is an important issue, however mired in controversy. A deceased person can donate vital organs (e.g. kidneys, heart, liver, pancreas, cornea, etc.). Even in death, one can end up saving few lives given there is an arrangement for consented and timely transplants.
The debate around organ donations and transplants tends to be polarizing. There is socioeconomic rationale to allow organ donations. Globally, demand for organ transplants exceeds supply, more so in countries which frown upon organ donations. Consequently thriving black markets exist for organ trade in poor countries. Pakistan, especially, has been referred to as an “organ selling bazaar” in the recent past.
In the West, most of the organ transplants come from the deceased. When posthumous organ donations are barred, those who need the transplants have no option but to turn to the living. This leads to commercial trade of vital organs. The dark side of this illegal exchange mostly befalls the organ donor, thanks to middleman’s exploitative behaviour and the distant recipient’s indifference to donor’s health.
Commercial organ trade is mostly a result of living humans selling their organs. To alleviate financial deprivation, such donors end up being physiologically compromised for the rest of their lives.
In contrast, the argument for posthumous organ donation carries a lot of weight: one, it’s a donation, not an exchange; and two, the organs can be put to productive use, thus saving lives.
Yet in Pakistan, resistance to that has mostly stemmed from religious grounds, even as the practice is thriving in other Muslim countries. But the religious opinion is slowly changing. For instance, at a seminar organized by the Sheikh Zayed Islamic Centre and the Sindh Institute of Urology and Transplantation last week, many religious scholars who spoke reportedly agreed that organ transplants were permissible in Islam.
Echoing others, a scholar noted that “organ transplantation was a means that did not humiliate but respected humanity…”
The respected parliamentarian’s proposed legislation, “Transplantation of Human Organs and Tissues Bill’, is an opportunity to address the socioeconomic and religious issues surrounding organ donations. Since Health is a devolved subject post-Eighteenth Amendment, provinces must be taken on board in order to have a uniform organ donation and transplant regime throughout the country.
But mere passage of the bill won’t be enough. Society must be made aware of the need for individual action. In their bestselling 2008 book, Nudge, Richard Thaler and Cass Sunstein touched upon the dilemma that organ donation programs can create. If you make donations a matter of expressed consent – that is, an opt-in system, where you ask people whether they want to donate – it will often lead to the case where consent doesn’t translate into action, they caution.
However, if you go a step further and use an opt-out regime – rather than opt-in – every citizen would be presumed to be organ donors unless they express it otherwise by opting out. Thaler and Sunstein recommend using national IDs or driving license for the opt-out mechanism.
This column suggests the parliament to contemplate, among other things, this libertarian-paternalist nudge that can help save many lives, besides making the society more responsive towards valuing human life.
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