• Fear and suspicion
• Winning public trust
• Pakistanis should not have to look for foreign benevolence for hearts and kidneys.

Mansoor Ahmad, who gave his heart and soul to bring glory to Pakistan on the hockey field, died last Saturday waiting for a new heart.

While the National Institute of Cardiovascular Disease (NICVD), a tertiary care hospital in Karachi, optimistically tweeted that Ahmad would be its first heart transplant candidate, this could not erase the reality that, in the absence of an established deceased organ donation programme in Pakistan, procuring a heart for transplantation was not possible for Ahmad in the foreseeable future.

In order to live some more, Ahmad, Pakistan's World Cup-winning hockey goalkeeper and captain, was willing to have an Indian heart beat in his chest.

Many like Ahmad die daily in Pakistan, waiting for organs that are buried with the bodies of potential organ donors.

Our greatest tribute to this fallen hero can be in making his story the catalyst for an important change in our health system: a formalised deceased organ donation programme that can, according to estimates, save thousands of lives of people dying from organ failure every year.

For decades, Pakistan has been relying on healthy, living donors for transplants, limiting the scope of organ transplantation primarily to kidney and some liver transplantation.

Kidneys, being paired organs, are easier to donate with minimal operative and long term risks for the donor.

Major kidney transplant programmes, such as the one at the Sindh Institute of Urology & Transplantation (SIUT) in Karachi, have relied primarily on living related donors to meet the needs of patients suffering from renal disease, so far transplanting around 5,400 patients between 1994 and 2017.

Donating portions of the liver, however, carries high risk to the donor. A retrospective study looking at data from nine US transplant centres in 2013 concluded that 37 percent of donors underwent one or more medical complications.

It is no surprise that most liver transplant programmes around the world rely mainly on obtaining the organ from deceased donors, thereby obviating any donor health risks.

Given that living donors are the primary source of organ donations in Pakistan, heart transplantation is currently not a possibility.

Transplant programmes relying entirely on living donations are fraught with multiple difficulties and challenges.

For one, the huge demand for organ replacement cannot be met with the limited supply of organs coming from living donors related to the patient, creating space for the organ trade to emerge.

This particularly abhorrent form of exploitation was rampant until a few years ago with rich — and often foreign — buyers purchasing kidneys from poor Pakistani peasants.

Mafias facilitated every step of this trade and earned Pakistan the notorious reputation of a kidney bazaar.

A 2012 study conducted by one of the co-authors of this piece at the Centre of Biomedical Ethics and Culture, SIUT showed that most donors who sold their kidneys, especially in rural Punjab, were poor farmers wanting to pay off their debts.

But instead, the donors only sank deeper in despair.

Fear and suspicion

Pakistan banned the organ trade with the Transplantation of Human Organs and Tissues Act in 2010.

While this landmark law went a long way in reducing exploitative transplants, curtailing the organ trade, and improving Pakistan’s reputation in the international medical community, it has done little to address an ever-widening gap in the supply of healthy organs.

The only viable way to increase organs available for transplants is through establishing a deceased organ donor programme.

It is the responsibility of the medical community to show a way towards deceased organ donation and its subsequent acceptance in society.

Pakistanis should not have to look for foreign benevolence for hearts and kidneys.

To date, Pakistan has only had eight deceased donors whose organs have been transplanted. These include three who could only donate their corneas because their other organs were unviable due to age or disease-related factors. Abdul Sattar Edhi was a corneal donor.

Most of those eight people became organ donors long before the 2010 transplant law was enacted, which recognises brain death as a legal cessation of life.

Part of the problem lies in the many misconceptions surrounding posthumous organ donation, as we found out in another study conducted by our centre in 2014.

We discuss some of these misconceptions below, and address them also.

Winning public trust

Before a programme can be set up, the misconceptions and fears surrounding the subject have to be dispelled.

The medical community has to engage with the public to help alleviate fears around donating organs and spread greater understanding of the process.

It is mind-boggling to see that the ultimate gesture of kindness and benevolence — which continues well beyond one’s own life and can change the lives of up to 17 others — requires so much convincing for wider acceptance in the society.

The most unexpected of people sometimes can become the harbingers of change. A simple event can ignite profound societal shift.

Perhaps Mansoor Ahmad’s demise while waiting for a heart can become a beacon for that change.

Visit the Transplantation Society of Pakistan’s website to register yourself as an organ donor.

Pakistani scholars and ulema of different schools of thought have weighed in on donating organs. Read their views here.

Are you an organ donor? Have you pledged to donate an organ? Share your thoughts and experience with us at blog@dawn.com