KARACHI, Oct 8: Amendments proposed to the Transplantation of Human Organs and Tissues Ordinance, 2007, by three members of the National Assembly, if enacted, will destroy the soul and character of the original legislation.
This is what the president-elect of the Transplantation Society of Pakistan (TSP), Dr S. Adibul Hasan Rizvi, who is also the director of the Sindh Institute of Urology and Transplantation (SIUT), had to say about the proposed changes.
He was speaking after a pledge signing ceremony for organ donation held at the SIUT on Wednesday.
Dr Rizvi told newsmen that on invitation, he had sent comments on the proposed amendments in the THOTO to the administrator of the Human Organ Transplant Authority (HOTA), Islamabad, expressing his strong protest. The copy of the letter recently sent to Islamabad was also made available to the newsmen.
Dr Rizvi was of the view that the statement made by the movers of the amendment bill that “there were certain lacunae in the 2007 ordinance” was due to their improper and incomplete understanding of the law.
He further said that in his opinion — shared by a number of others in his profession and beyond — the bill, if enacted, would send the country back to the dreadful conditions that prevailed before the promulgation of the ordinance.
Until the promulgation of the ordinance, Pakistan had become a leading destination for “kidney tourism” involving largely poor, destitute and illiterate donors. The organised kidney trade mafia, comprising middlemen and the so-called hospitals and persons motivated by greed, had been shepherding the so-called voluntary donors of organs, Dr Rizvi says in his letter, adding that the recipients of the organs included wealthy non-blood relatives and often foreigners fearful of the social and ethical taboos or the prohibitive costs in their own lands.
He said that under the garb of removing lacunae there was all likelihood that commercialism would flourish afresh.
The quality of the present legislation, its contents and clarity of purpose, have been acknowledged by international bodies on health as well, but it was disturbing now for him and his peers why certain important features of the legislation were being proposed to be altered, without proper need of the same and without a wide and open national debate, the senior doctor observed.
Open to interpretation
While giving his summary comments, the TSP president-elect also made a detailed presentation on the amendments. Taking up the amendments proposed in Section 3 of the 2007 ordinance, Dr Rizvi noted there is a proposal to add “half brother” and “half sister,” along with the words “brother” and “sister” in the definition of “close blood relative” and to exclude “spouse” from the document.
However, the expressions “half-brother” and “half-sister,” according to him, have not been defined in the bill and are accordingly susceptible to a wide meaning within the local social milieu.
Referring to another proposed amendment — “If there is a threat to life of end stage renal disease” will be inserted in Section 2(2) of the ordinance — Dr Rizvi said that the amendment was technically incorrect for two reasons.
“It appears that the proposer has not completely and properly comprehended (i) medical need and (ii) procedure and timing of the ‘transplantation’ of human organs. There are two technical aspects which have been ignored. Firstly, it should be appreciated that the whole concept of ‘transplant’ of human organs arises ab initio where there is ‘immediate’ or ‘prospective’ threat to life.
“Nobody is expected to replace an organ unless that stage has arrived. I am totally unable to understand the rationale of placing the words ‘threat to life’ in the legislation. It is a general principle of legislative construction that something that is implied is not stated, as otherwise misinterpretations and misapplications may arise. Thus from this technical aspect the amendment proposed is not required.”
According to Dr Rizvi, the second and other important technical aspect which should be properly appreciated was that “transplant” of a human organ — whether altruistic (voluntary) or commercial — could only be undertaken when both the recipient and the donor were medically fit for the procedures. As such, it is technically wrong to assume that there is any concept of “emergency” transplant of human organs.
He feared that such insertions were being proposed to create a sense of emotional emergency to justify sale and purchase of organs.
He also criticized some amendments suggesting compensation to the donor and said that perhaps the proposers of the bill have not properly comprehended the rationale, basis and underlying concept of Section 3(2), where this amendment is being proposed.
Transplant tourism
He also criticized the amendment in Section 7 of the ordinance proposing permission for foreigners visiting Pakistan for medical purposes in emergency. The section in question pertained to restriction of human organ transplants for persons not being citizens of Pakistan.
He is also not able to comprehend the rationale of insertion of the proposal to the effect that “10 per cent of the total number of transplants performed by any hospital may be permitted for persons not being citizens of Pakistan.”
“It appears that this strange provision, which is totally unwarranted, is being placed to defuse the sentiments which reasonably exist against the ‘organ trade.’ Will not a hospital give priority to foreign citizens to ensure full utilization of the quota? Let us not kid ourselves into believing that a foreigner pays the same amount as the average citizen. Do we now intend to have an ‘organ quota’ much like we had the textile quota, transferable and saleable between hospitals or sold at a higher price when there is more demand than quota supply?,” the SIUT chief says in the letter to the HOTA administrator.
The amendments proposed in Section 8 by the National Assembly members also drew criticism from the seasoned surgeon, who concluded that the set of proposed amendments have been moved without taking into account the prevalent practices of organ trade in Pakistan, the technical nature of transplant of human organs, the concept underlined in international best practices, the legislation in various regional and Islamic countries and other relevant factors.
Pledge signing
In the meantime, the federal health secretary, Suleman Ghani, signed a pledge to donate his organs after brain death to save the lives of others. During the last two years about 2,350 people, including some prominent personalities, have pledged similar donations at the SIUT.
Replying to the questions of newsmen, the secretary said that some amendments had been proposed in the Organ Transplant Ordinance of 2007 and the government was examining things seriously so that the real spirit of the existing organ legislation was not negated at any stage.
Mr Ghani said that it was a long-standing urge of his to sign such a pledge at the SIUT, while on the other hand being the health secretary in the federal government he also wanted to set an example for others.
He said the culture of related living organs donation and deceased cadaver donor transplant should be promoted in the country in line with the available legal tools.
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