Pakistan becoming a kidney market
28 December, 2006
By Kamran Yousafzai
No one had ever thought that poverty in Pakistan would assume such an alarming proportion that will compel people to sell their organs. Besides shocking reports of suicides being committed due to poverty, Pakistan is earning notoriety for being a 'flourishing kidney market'.
An increased number of visitors from abroad are traveling to the country to fly out with a brand new kidney, and Pakistan is now thought to be a growing centre of global 'organ tourism'. The trade has flourished in the country, most notably since India placed a ban on the practice 10 years ago, diverting traffic to Pakistan.
Transplantation in a developed country is not an easy task. Any patient suffering from renal failure who needs a kidney transplant has to wait for many months not only in search of kidneys but also for transplant surgeries. That is why Pakistan is considered the most congenial place to have a kidney at an affordable rate and also its transplantation in a shorter length of time.
People living in abject poverty have no option but to resort to sell their organs to fulfill their financial needs. It is assumed that people can survive with one kidney and this perception has led to a considerable increase in the number of kidney sellers. Although no consolidated data is available regarding the number of those persons who have sold their kidneys,
undoubtedly they are in thousands. Mostly such people belong to different backward areas of the country but a village of Yazman in Bahawalpur district is notoriously popular for this sale and it has been reported that no young male member in this village has two kidneys. Every man has sold out one and is surviving on one. The area police have confirmed 30 reported cases all from the same village whereas there must be other unreported cases.
Besides Yazman in Bahawalpur, Kot Momin in Sargodha district and Sultanpur Mela in tehsil Bhalwal, there are many people with a distinctive zip-like scar above their right or left hip which shows that they have sold one of their kidneys.
Hundreds of bonded labourers are believed to have sold kidneys to pay off debts to their employers. Normally these poor workers get advance payment and sometimes mortgage their family members into the hands of employers.
Consequently they feel it an easy option to sell their kidneys to liberate the mortgaged family members. Debt bondage is banned under the 1992 Bonded Labour Abolition Act but it is rampant at brick kilns particularly in Punjab and rural Sindh province.
Newspapers printed photographs of at least a dozen brick kiln workers who showed their scars and demonstrated against the lack of official attention to their plight.
Presently there is no law to check this illegal sale. Parliamentarian Commission for Human Rights did draft a legislation suggesting punishments for those involved in this illegal and heinous trade but this law has so far not been incorporated in the statute book.
Recently the Supreme Court of Pakistan took suo motu notice of this trade. Chief Justice of Pakistan Justice Iftikhar Muhammad Chaudhry, while conducting the hearing of this case, ordered registration of cases against those involved in the sale of kidneys. He also ruled that those doctors who conduct these surgeries are equally responsible of committing a crime and they should be proceeded against. The bench has issued notices to the federal health secretary, attorney general of Pakistan and all the four provincial advocates general asking them to ensure that this practice is stopped in their respective jurisdictions.
The court issued these directions a few days ago on the application of one Muhammad Asghar, a resident of village Yazman in Bahawalpur district, who had complained that a few persons had forcibly operated upon his son, Muhammad Amjad, and removed his kidney. And the district and sessions judge had exonerated all the accused of charges.
On court notice DSP Investigation Yazman, Khawar Zaman Lodhi, submitted before the bench that the boy willingly sold his kidney for Rs75,000 but when he did not get the promised payment, he lodged an FIR in the police station. The DSP submitted that the victim gave his kidney with his consent. But the bench rejected the assertion and said even then it was illegal and liable to prosecution.
The chief justice also referred to a documentary of a private TV channel wherein a village was shown where almost all the male residents had sold their kidneys because of poverty.
"I feel pain while urinating; I cannot run fast and start panting very quickly.
I made a very wrong decision to sell my kidney. The amount I have received is just peanuts," Amjad said while talking to weekly Pulse. He admitted that no one forced him to sell his kidney and he decided after his father asked him to do that.
But from medical point of view expert doctors are of the opinion that there are 100% chances of survival with one kidney and there are no after effects.
Dr Muhammad Umar, Professor of Medicines at Rawalpindi Medical College, when contacted on this issue, said doctors were not part of this mafia. "In fact doctors are misguided by the sellers and purchasers. It is told to them that it is not a sell-off but a donation from a family member to another member".
Dr Umar said medically there was no harm in kidney transplantation. But it should be restricted only to the extent of donations to blood relations. There should not be any ban on it. "If I want to save the life of my mother by donating my kidney to her. Then who can prevent me from doing this? Truly speaking this a life saving issue but certain mafia has made it an illegal trade.
So medically and morally this transplantation is good but from commercial point of view it is condemnable. My personal opinion is that this should be restricted but not completely banned. Don't you give and get blood when in need. If blood can be given and taken to save a life then why not a kidney," he said.
Asma Jehangir, chairperson of Human Rights Commission of Pakistan, said that in our country where majority of the people were living below poverty line, the trend of donating organs had assumed financial dimension. Poor people easily agree to sell their organs against a very meager cost and the middlemen or agents who are operating like a mafia in our country always accumulate the real benefit.
She said even donation of organs should be restricted to blood relations and there should be complete ban on this illegal sale.
In fact there is a network of middlemen or agents and unscrupulous private clinics that find poor and needy donors. Each kidney is bought from a donor in a range of Rs50,000 to Rs80,000, which is sold to rich recipients for up to 10 times that amount. The real donor is always financially exploited and the mafia members mint money in real terms.
But the underlying fact is that more and more desperate people see the sale of kidney as at least a temporary solution to their woes.
Then middlemen exploit these people, offering huge amounts for a kidney. Often the sum promised is not given, and the cost of medicines after removal of the kidney is so high that people lose much of what they earned. The above-cited case of Muhammad Amjad also came to light when the middleman did not give him the promised amount.
In some cases forcible and deceitful extraction of kidneys was also reported with the connivance of agents and some doctors. The Chief Justice of Pakistan has observed that doctors who perform surgeries to facilitate a sale of kidney are equally responsible. It was also submitted before the Supreme Court that patients undergoing different types of surgeries had also complained that their kidneys were removed during the operation.
"It is need of the hour to come up with a legislation and implement it in order to check this illegal trade otherwise the poor will continue to be exploited in the hands of mafia," said Asma Jehangir, adding that while our lawmakers mull over the passage of such legislation, it would be a good idea for our law-enforcers to launch an investigation to identify those hospitals and arrest those doctors and individuals engaged in such illegal trade. The problem is that the foul game is being played in connivance with the influential quarters who are very much part of the mafia.