While on the one hand there are institutions in this country like the Sindh Institute of Urology and Transplantation (SIUT), highly respected for providing free and best possible treatment to poor patients, on the other hand goes on a thriving illegal trade in human organs. A press report chronicles depressing details of how poverty and helplessness are exploited by greedy doctors and middlemen to buy kidneys and sell them, in many instances, to wealthy patients from Arab countries. A study done in 2008 is quoted to have found 70 percent of the donors were bonded labourers, and 90 percent of them illiterate, which means they could be made to put their thumb impression on any paper containing terms of agreement without knowing what they agreed to. Although these people take the extreme step of selling a kidney to obtain freedom from debt bondage, they are paid a pittance. The study notes 88 percent saw no improvement in their economic situations. There is the case of a young man whom an agent had offered Rs 250,000 but afterwards gave him only Rs 150,000 - far short of what he owed to a landlord. Similarly, a bonded labourer from a brick kiln near Lahore who sold a kidney for just Rs 200,000 has not helped him as he continues to work at the kiln to payback Rs 400,000 still outstanding against him. What is more, a staggering 98 percent complained of substandard treatment leading to health issues, including chronic pain from large incisions. Since the operations are performed in secretive makeshift facilities proper post-'surgery' care is not available for the recipients either. Many of them end up registering in regular hospitals.
Needless to say, this inhuman, exploitative business must be brought to an end. It is worthwhile to note in the context that after the issue was agitated by rights groups and raised by legislators in Parliament, the Transplantation of Human Organs and Tissues Act, 2010, was passed. For a while, there was a significant drop in illegal transplants; once the fear of the law subsided it was business as usual again. The law of course calls for ensuring that donation is "voluntary, genuinely motivated, not under duress or coerced". More to the point, it says if a donor is not available within a patient's immediate family (parents, siblings, spouses and offspring) "a non-close living blood relative" willing to donate his organ can do so provided an evaluation committee of the transplantation facility concerned is satisfied that no financial consideration is involved. Under special circumstances, a non-related person can donate an organ, provided there is no financial compensation involved. The law is pretty good, and clear on that money must have no role in any organ donation decision. It contains appropriate punishment for violators: 10 years behind bars and a fine up to Rs 1 million.
But as the present report shows, the law by itself is not enough. A determined effort is also needed to ensure implementation. Towards that end it would be helpful to put in place an oversight body, comprising respected health professionals and/or civil society members. They could use complaint cells to have people identify unethical medical practitioners, their secret clinics and middlemen preying on the weak. Provincial governments must act quickly and effectively to fulfil their responsibility.