Last year in July, I decided to donate my organs after death. This decision was inspired by some of my friends who had donated their organs and had shared their donor cards on social media. Most of them donated their organs to the Karachi-based Sindh Institute of Urology and Transplant (SIUT).

Founded by Dr Adibul Hasan Rizvi almost four decades ago, the SIUT is a dialysis and kidney transplant centre, in the Burns Unit of Civil Hospital in Karachi. In 1991, through an act passed by the Sindh government, the SIUT

became an autonomous body that runs an active organ donation programme under the Transplantation Society of Pakistan (TSP).                    

A single donor can save the lives of eight people, and help about 75 people — that’s a lot of charity

Anyone can become an organ donor with the TSP by filling an online donation form on its website. This form requires information such as name, CNIC, email, phone number and details of next of kin. After submission, it takes two to three weeks for the card to be issued.

Each of my friends who signed up to donate their organs had different reasons. A friend, who is a doctor at a private hospital in Karachi, decided to donate her organs after she saw people dying of organ failure. Another friend, a journalist in Islamabad, became an organ donor a few years back, when he attended an awareness session on organ donation.

I read more about organ donation before filling the online form at the TSP website. Several weeks passed. I did not hear from them, until on my birthday, all of a sudden, I received my organ donation card via courier.

It was the best birthday gift ever.

I had become an organ donor. I was happy but my parents were not and that was something I already expected. No parent would like to see their child being carved up after death. We had a brief argument. I told them how important it was to donate organs and how it can save humanity.

I told them that hundreds and thousands of people all around the world donate their organs to save lives. By donating one’s organs one person can save the lives of eight people, and help about 75 people with cornea and tissues donations.

I knew my parents would take some time to accept my decision, so I decided to give them space for a while and gather more information on how organ donation works. My parents and siblings should know what they will have to do after my death to honour my wish.

While searching answers for this, I discovered Punjab Human Organ Transplan­tation Authority (P-HOTA) which is respon­sible for supervision of organ and stem cell transplantation, and for initiatives to increase organ donor registration and donation in Punjab. 

There is also a Human Organ Transplant Authority (HOTA) in Islamabad which was working as the central body for the whole country before the 18th Amendment came into effect, after which health became a provincial subject. The provincial bodies were made in Punjab, Sindh and Khyber Pakhtunkhwa. Balochistan and Azad Jammu & Kashmir are still waiting for their respective authorities. The HOTA only monitors transplantations in the federal capital.

THE P-HOTA

The P-HOTA was set up in 2013 after a number of events revealed a culture of illegal trade and transplantation of human cells, organs and tissues in Punjab. After the first kidney transplant in Pakistan, at an army hospital in Rawalpindi, in the mid-’80s, at least 200 surgeons were trained only in Punjab.

“A limited number of surgeons were allowed to do transplant surgeries in Sindh,” says Prof Dr Faisal Masood, director general of P-HOTA. “At least 200 surgeons were declared authorised transplant surgeons in Punjab although some of them started a culture of illegal transplants in the country.”

There was no regulation on kidney transplant in Pakistan at that time, which attracted people from the United Arab Emirates to come here and get a transplant done at cheap rates. This gave birth to a whole new human organs trade culture.

“It cannot be called illegal transplantation because there was no law to regulate it at that time. It was simply organ trade,” says Dr Masood.

It damaged Pakistan’s reputation globally. The pressure from the international community pushed Pakistan to regulate its transplantation procedures. The Transplantation of Human Organs and Tissues Ordinance 2007 was promulgated on September 4, 2007, and Human Organs Transplant Authority (HOTA) started working under this act.

With 32 registered hospitals and 71 registered transplant surgeons on its panel, the P-HOTA operates under the Specialised Healthcare & Medical Education Department, Ministry of Health, Punjab.

The list of registered hospitals and surgeons can be found on the website. Dr Masood suggests people who are advised to get a transplant go on the website, look up the registered hospitals and get registered suitably.

“We advise patients to start processing the standard operating procedures of the hospital,” says Dr Masood. “Once we get a complete file from the hospital, we start working on our procedures. Within three days, we give our decision.”

The P-HOTA has several departments which handle a variety of operations. The technical department deals with patient-donor evaluation, hospitals visit, donor registry and cadaveric transplantation.

The vigilance department does vigilance against illegal transplantation, manages the complaint centre at the P-HOTA, along with coordination with divisional vigilance committees, regional network and law enforcing agencies.

The legal department registers cases against those accused of illegal transplantation. It also checks and verifies legal documents of donors and recipient.

With its headquarter in Shadman, Lahore, the authority also has sub-offices in Rawalpindi, Faisalabad and Multan.

P-HOTA’S ORGAN DONATION PROGRAMME

Other than monitoring transplantation procedures in Punjab, the P-HOTA runs an organ donation programme, too.

It regulates private and public hospitals that remove, store and use human cells, organs and tissues for medical treatment, and supervises all approvals for donations from deceased and living people.

The P-HOTA has obtained fatwas from mainstream Islamic scholars of Pakistan which will soon be published in the form of a booklet. Khateeb Badshahi Mosque and Chairman Ulma-i-Karaam Council Pakistan Maulana Abdul Khabeer Azaad has promised his support to the P-HOTA for this noble cause.

“Organ donation is the biggest charity,” says Dr Masood.

The most commonly donated organs are kidneys which can be used to help patients with end-stage renal disease (severe kidney failure), while cornea transplantation can restore vision for those with eye diseases and corneal infection.

“There are some organs which a person can donate in his/her life, for example, kidney, a lobe of a lung, partial liver, pancreas and intestine,” Dr Masood says. “And there are some organs which can be donated only after death such as lungs, liver and heart. These organs can be used to help patients with emphysema, a heart defect or failure and short-gut syndrome, respectively.”

So far, the authority has only nine registered donors from Punjab — eight men and one woman — but they are hopeful to see an increase after they practically start their awareness activities. They plan to use mass media, outdoor advertising and seminars along with Friday sermons to raise awareness on organ donation after death.

HOW TO BE A DONOR WITH P-HOTA?

The P-HOTA has developed an online organ donation form on its website for those who are interested in becoming an organ donor. Those who do not have access to the internet can visit P-HOTA office and fill a form there. After submission, the P-HOTA issues an organ donor card and certificate to the donors. The whole procedure takes about seven to 10 working days.

WHAT HAPPENS WHEN A DONOR DIES?

A donor’s organs must be harvested and preserved within three to four hours after his death. It is only possible if the person is in a hospital at the time of death. If the deceased had enrolled as a donor, registration will serve as legal consent. If there is an absence of registry or any other legal consent the team will seek consent from the next of kin.

ORGAN PROCUREMENT CELL

Besides authorising and supervising all donations and transplants, the P-HOTA also operates an Organ Procurement Cell (OPC) at Lahore General Hospital, where donated organs are preserved under ideal conditions. The organs can be preserved up to four hours, during which time harvesting and implantation must be completed.

“Under this project, Lahore General Hospital is a donor hospital and Shaikh Zayed hospital is the recipient. Organs are harvested at Lahore General Hospital and transplantation done in Shaikh Zayed hospital,” says Dr Masood.

Transplants are performed in many public and private hospitals. Over a period of 20 years, these OPCs will be developed in other hospitals as well, both in public and private hospitals.

Any suspicious activity regarding illegal organ trade can also be reported to the P-HOTA. The vigilance department deals with illegal transplants. A complaint can be filed in person or through an online complaint form available on the authority’s website.

The writer is a journalist based in Lahore. She is currently handling digital media for Shirkat Gah. She tweets @tehreemazeem

Published in Dawn, EOS, April 28th, 2019