Organ transplantation in Pakistan

7/27/2019 Organ transplantation in Pakistan

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Muhammad Shahzad

ID: 1127032


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Shifting of Kidney Bazar from India

to Pakistan

Over past two decades Pakistanhas become a zone of commercial

renal transplantation.

Dilemma of Kidney trade is

confused even among medicalstudents and young doctors and

consider it Life Saving procedure.


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The organ-importing countries

richer European countries, Israel, United

States, Canada, Australia, New Zealand,

Japan and some Arab countriesetc.

(Norm Barber, 2007 & WHO)

The organ-exporting countries Pakistan, India, South Africa, Peru, Romania, Bolivia,

Brazil, and Chinaetc.


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Organ transplantation: Primary Treatment of End

Stage Organ Failure.

Benefited more than 1 million people worldwide No of pts survived for well over 25 years.

Shortage of organ is a Universal Phenomenon

(WHO).

Kidney Transplantation is carried out in 91countries.

Organ Transplantation Global Statistic by

2005(WHO)

66000 Kidney Transplants, 21000 Liver Transplant,6000 Heart Transplants.

Shortage of organ donation has led to the organ

trade

A World Health Assembly resolution adopted in2004 WHA57.18 ur es Member States to take


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Living organ Donation

Living Related (first or second

degree relative)- living donor getsdisadvantaged- not favored e.g.

renal transplantation is most

common worldwide and most ofdebate revolve around it.

Living non-related (where anybody

else donates. So many issues are

there when donor is unrelated. The

various situations can be


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A. Altruistic Organ Donation: onemust consider the unrelated donorwho has a stable and closeemotional relationship with recipientsuch as husband or wife.

B. Paid Organ Donation: This is an

important Ethical Issue. There areregional variations in its acceptanceand practice e.g. In France it iscrime. In Iran it is legal and person

who sell his organ is insured andalso he gets money from the donor.


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Cadaveric Transplantation: Organs for

transplantation are usually obtained from

living genetic relatives or from heart-beating

cadavers. Unfortunately, these sources have

so far been unable to keep up with demand.

As a result, there are a large and steadilyincreasing number of potential recipients

awaiting transplantation, some of whom will

die before an organ can be found. Cadavericsource is beneficial in another way that it

provides multi-organ donation [17]. To utilize

cadaveric organs effectively, most of the


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Legislation in Pakistan regarding organ

transplantation: Government efforts,

supported by professional associations, civilsociety organizations and the media, along

with World Health Organization technical

assistance, have led to the development of

legislation regulating this practice and

curbing organ trade in conformity with

international guidelines.

1979 Renal transplantation started in

Pakistan in public sector hospitals using

living related family donors


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1990s Renal transplantations exceeded 500transplantations per year with first violationsobserved, whereby some hospitals shifted fromdealing exclusively with living, related donor to

unrelated, paid donors until these unethicalpractices accounted for more than 80% of alltransplantations. Later in the decadetransplantations exceeded 1000 per year

2000s Opposition to promulgating the law wassustained and commercial kidney transplantationflourished with over 1500 expatriates receivinglocally procured kidneys. The Ministry of Health,supported by SIUT, media and civil society

organizations, sustained its efforts to promotelegislation and bring an end to these unethicalpractices. WHO provided the necessary technicalsupport through its country, regional andheadquarter institutions.

2004 A bill was tabled in the Pakistan Senate by amember raisin the momentum for action.


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2006 The organ transplantation agenda submitted

to the Cabinet in 2004 was deferred in October

2006. This action ignited an active campaign,

where informed and investigative media reportsand SIUTs bold and challenging technical

deliberations exposed the growing unethical

lucrative kidney trade.

2007 Exploitative organ transplantation led to a

judicial action in July 2007, whereby the Supreme

Court of Pakistan took a suo moto notice advising

the Government to promulgate the transplantationlaw.

2007 The transplantation ordinance was

promulgated in September 2007 by the President of

Pakistan.


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2008 Attempts were made by the counter lobby through the Standing

Committee for Health at the National Assembly to water down the law by

introducing loopholes implicitly condoning organ sale and allowing expatriates

to acquire kidneys for lucrative fees. These endeavours were rejected by the

Standing Committees for Health and

Human Rights.

2008 A case was filed before the Federal Shariat Court of Pakistan, challenging

the law, whereby 12 hearing sessions were held in Islamabad, Lahore and

Karachi, unanimously defeating all submitted objections and rendering all

stipulated clauses of the law sustained, including the illegality of all forms oforgan sale.

2009 On 23 June 2009, the Supreme Court took suo moto notice against

private hospitals accused of violating the law and performing illegal

transplantations, who when summoned by the court made commitments to

comply with the law.2009 On 12 November 2009, the National Assembly of Pakistan unanimously

passed the bill on the recommendation

of its Standing Committee on Health.

2010 On 10 February 2010, the Senate of Pakistan passed the bill.

2010 On 17 March 2010, the President of Pakistan signed the bill making it alaw


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To evaluate the public health contribution of organtransplantation

services, the Ministry of Health needs to establish adatabase, for both donors and recipients, supported by thecentres providing these services. The capacity of thehealth system to offer dialysis to end-stage chronic renalfailure needs to be strengthened, to reduce patient

morbidity and improve quality of life. Moreover, the Ministryof Health should closely monitor surgical, medical andimmunosuppressive protocols and establish a mandatory2-year follow-up of donors and recipients to providemedical, emotional and psychosocial support and also

evaluate the outcome of these interventions nationwide.

Documents

Organ transplantation in Pakistan