The unethical and illegal practice
The current years saw several raids in a renewed cracking down on the unethical and illegal practice of organ trade which is a welcome augury. After the FIA was given the mandate earlier this year to act against organ trade, there is a discernible change in the situation. Recently, the Federal Investigation Agency carried out a raid on a private hospital in Nowshera and busted a gang involved in the racket. Around 10 suspects were arrested. Earlier, an FIA raid in April on a private villa in Lahore, even as a transplant was under way, unearthed a large gang engaged in procuring organ ‘donors’, matching them with kidney patients, running the infrastructure and carrying out the procedure. It is a pity that the organ smuggling trade has always targeted the poor and vulnerable, which organised crime syndicates either kidnapping people for their organs or offering them a pittance, so that the wealthy and powerful do not have to wait in queues to receive transplants. In Lahore, the individuals whose kidneys were removed included a rickshaw driver and a young woman with onerous debt. Those who were caught receiving the kidneys were two wealthy Omani nationals. Pakistan has long been a prime destination for “transplant tourism”, with the elite the Middle East and other places buying organs in the black market and paying off doctors to perform transplants. The FIA believes that there is an organised network of medical professionals operating throughout Punjab. The agency, which became responsible for tackling organ smuggling after the Interior Ministry made the enforcement of the Transplantation of Human Organs and Tissues Act part of its duties last month, must now break this network and ensure the poor are no longer exploited for the benefit of the rich. But we must also work to eliminate organ smuggling by eliminating demand. Before 2007, when organ trafficking was criminalised in Pakistan through an ordinance, an estimated 2,000 transplants using vended kidneys were being carried out in the country every year. In 2010, parliament passed the Transplantation of Human Organs and Tissues Act, further cementing the state’s position on the issue. Back in 2010, after a unanimous consensus was reached among medical professionals and religious scholars, the Transplantation of Human Organs and Tissues Act was passed which declared that not only was it legal for a patient to donate his or her organs after being declared brain-dead but that it would be considered a noble act. Former President Asif Zardari even filled out an organ donation form to become a donor after his death to publicise the importance of the issue. But since then there has been a failure to encourage and educate people about the value of becoming an organ donor. Doctors rarely talk to families about the option and often even fail to declare a patient brain-dead so that their organs can be recovered. This has contributed to the persistence of the black market, where criminals and unscrupulous doctors, often working in unhygienic conditions, prey on the weakest among us to satisfy the needs of the wealthy. Stronger law-enforcement needs to be accompanied by better education to finally end the menace of the organ smuggling racket. What makes organ trafficking all the more reprehensible is that the offending doctors cloak their actions in the garb of social service. In reality, it is pure and simple skullduggery, fuelled by greed and a breathtaking contempt for humanity. Certainly, it is true there is a dire shortage of organs for those who need them, and their yearning for restored health is understandable. Nevertheless, that need cannot – must not – be met by exploiting the most disadvantaged amongst us. This is not a situation to which market forces of supply and demand, in the ordinary sense of the term, apply. Those driven by circumstances to offer their organs for sale – let alone those who are duped into parting with their kidneys – cannot be considered autonomous actors with freedom of choice. Moreover it is an unequal, one-way exchange: if the impoverished organ vendor’s remaining kidney fails – a reasonable possibility given his less than optimal health plus the lack of post-operative care he receives – will anyone from a (usually privileged) kidney recipient’s family step forward to offer him his kidney for free? The answer to the apparent conundrum lies in deceased organ donation, practised in many parts of the world, including several Muslim countries. The provincial governments here should proactively promote this procedure which can, to an extent, meet the requirement for organs as well as address the reasons for the prevalence of kidney disease in Pakistan. But first they must ensure that those involved in the illegal organ trade are punished without fear or favour. As long as organs can be purchased on the market, the efforts of those trying to promote ethical transplantation and deceased organ donation will always be undermined.