The estimated new cases per year of end-stage kidney disease (ESRD) in Pakistan are about 100 per million population. This translates to about 15,000 cases per year, said a release issued jointly by Transplantation Society of Pakistan, Pakistan Society of Nephrology and Pakistan Association of Urological Surgeons, here on August 16.
About 60 percent of these could not be transplanted due to complications of longstanding diabetes, old age, malignancy etc and they need to remain on dialysis. Thus, presently about 6,000-8,000 patients per year are on regular dialysis in Pakistan in about 126 centres.
The actual requirement for transplantation of kidneys in the country is about 6,000 per year. The annual transplantation rate in Pakistan is about 2,000 per year. Of these 500 are performed in government sector hospitals from ethical living related donors. The rest 1500 are from unrelated kidney sellers and these transplants are performed in private hospitals.
Unfortunately, about a 900-1000 of these are for foreigners who come from more than 20 countries of the Middle East, North America, Europe and South Asia and pay between Rs 1.5-2.5 million depending on their country of origin. The rest 500 are Pakistanis who pay Rs 0.6-0.7 million for transplants.
Those who are non-affording and have no family donors rely on donations from family, friends and social welfare organisations to pay for the package mentioned above in private hospitals. Once transplanted they find payment for follow-up medicines particularly immunosuppressive drugs difficult, which can cost between 10,000 to 15,000 rupees per month. Once out of funds they stop medication and loose their transplanted kidneys.
The unrelated commercial transplant did not help them in the long-term as the poor recipients were not informed about subsequent costs. This emphasises the need for increasing transplantation in the government sector.
Majority of the kidney sellers is from rural Punjab and almost 70 percent of them are bonded labourers. These desperate people, who sell their kidneys for Rs 70,000 to 120,000 mainly to pay off their debts to landlords.
Unfortunately, a recent local survey and many from international media have shown that 95 percent of the sellers do not achieve their objectives and remain desperately poor and in debt.
Selling their kidneys brings no financial benefit and many complain of their payment being siphoned by middleman and hospital for travel and operation expenses. Moreover most have feeling of guilt and they are depressed and often unable to keep their livelihood.
No country in the world has legislation for compensation to the donor for sale of organs. In fact the only help to donors in some countries of the Western world are reimbursements for out of pocket expenses for travel, hospitalisation and days off work. There is no payment for donations of the organ as it is considered a disgrace for the human body and this is also not permitted by all major religions as well.
Thus cadaver (deceased) organs are the need of the hour for transplantation in Pakistan. This will not only help patients with kidney failure but also help patients with heart, liver, lung, pancreas and other organs, who total up to 50,000.
Islamic perspective on cadaver organ donation was resolved many years ago by rulings from Al-Azhar University, Council of Islamic Jurists and World Islamic League. In fact cadaver transplants are performed in many Muslim countries including Saudi Arabia, Iran, Kuwait, Egypt, Jordan, Oman and many others for the last 8 to 10 years.
For cadaver transplants to progress there is need of ICU facilities where patients are treated and when all medical avenues have been exhausted the patient is confirmed as brain dead by neuro-physicians and intensivists who are not connected with transplantation for this procedure. Thereafter, the next of kin are approached if the dead person can save lives of 10 dying patients by donating the organs if permitted.
ICU facilities are available in all major cities of Pakistan. In fact in Karachi alone over 100 brain deaths are diagnosed each year in ICU's of three hospitals excluding trauma. All that is required is to engage already trained transplant surgeons for organ retrieval and transplantation.
Enactment of an ethical Transplant Ordinance will put an end to unrelated commercial transplants. The effected will be the local recipients who prefer to buy rather than motivate family members to donate due to ignorance. This shortfall can be met by increasing the related ethical transplant activity.
Providing modest funds to government hospitals can easily remove this shortfall. As in the case of India where there was temporary reduction of transplant activity after enactment of law against unrelated transplants in 1994 due to absence of transplantation for foreigners in the form of transplant tourism. However, the activity has gradually grown to over 4,000 per year in 2006.
The fundamentals of Transplantation are based on human altruism. Be it living or deceased donor - the willingness to donate has propelled this science which saves hundreds of thousands of lives each year world-wide. Use of unrelated donors on commercial basics can only follow one path "rich buying from the poor". This is and will remain the highest form of human exploitation.
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