KARACHI, Dec 20: More than two months after Pakistan passed a law to encourage cadaveric organ donations and do away with commercial transactions in live human organs, doctors are struggling to establish and popularise a cadaver donor programme.

The seemingly insurmountable hurdles include low government spending on public health, poor infrastructure and the religio-cultural mindset such as the permissibility in Islam to harvest organs from the dead.

Dr S.A. Jaffar Naqvi, a prominent nephrologist and chief executive of the Kidney Foundation, said that he had not heard of a single case of cadaveric donation since the passage of the Transplantation of Human Organs and Tissues Ordinance on Sep 2 this year.

“But that is where the role of the media comes in,” said Dr Jaffar Naqvi, who was optimistic that despite dismal health indicators “setting up a deceased-donor programme was really not an impossible task given the philanthropic nature of people.”

However, he conceded that such programmes “need the full backing of and commitment from the government” as institutions and programmes cannot be run on donations alone. He said that the government should not be absolved of its duties just because of a few generous people.

It took Pakistani doctors and activists 15 years to steer the law past powerful vested interests with stakes in a thriving ‘organ bazaar’ that dealt in live human kidneys transplanted to rich local people and foreigners.

Dr Adibul Hasan Rizvi and Dr Anwar Naqvi of the Sindh Institute of Urology and Transplantation (SIUT) put years of technical expertise into drafting the law. They believe that there is still reason for cheer despite the sluggish start.

Dr Anwar Naqvi said that, going by the data collected by SIUT from three big public sector hospitals in Karachi, some 1,000 people are declared brain-dead each year. “If we had a law in place and with even 10 per cent of the people consenting, can you imagine how many lives may be saved?” he pointed out.

However, he conceded that “it is difficult to come to terms with the fact that your loved one is brain-dead and is physically alive only because of life-support machines. For doctors, the task becomes doubly difficult convincing them [the next of kin].”

“We have the expertise; all that needs to be done is to get ourselves organised,” said Dr A. Naqvi. He expressed the belief that there is no further room for debate on the ethics of retrieving an organ from a dead person. “The issue has been settled on both the Islamic and ethical fronts,” he commented. “I don’t feel we will meet with any resistance due to that.”

Gargantuan task

The ordinance stipulates that a person over 18 years may, during his lifetime, donate any organ or tissue for transplantation after his death. “The cases of unclaimed, brain-dead hospitalised patients shall be presented to an evaluation committee for transplantation after an intense search for their relatives within 24 hours,” states the law. The idea is borrowed from the Spanish model of cadaveric donation in which a person automatically becomes a donor if he or she does not carry a card forbidding organ removal in case of sudden death.

So far, Pakistan has had a poor track record in cadaveric donations. Before the law was passed only two persons, 24-year-old Naveed Anwar in 1998, and 22-year-old Shamim Bano in 2005, were known to have donated their kidneys and corneas. Both had met with accidents and were pronounced brain dead. There is a sprinkling of instances where men on death row pledged their organs.

Besides creating awareness, there are practical issues. “With just a handful of intensive care units dotting Pakistan, a miniscule national health budget, almost non-existent private investment in healthcare in remote places, untrained human resources and the absence of national transplant registry software,” it is a gargantuan task, said Dr Jaffar Naqvi.

Transportation is a problem in a country where the road networks are not fully developed. And few can afford the charges involved in retrieval, storage, transport and transplant, even if organs are available. Doctors point out that the lack of ready transport is one of the reasons behind the high maternal mortality rates in Pakistan.

Dr Jaffar Naqvi suggested initiating the programme on a small scale from a metropolis such as Karachi. “That will have an impact and convince people to donate,” he commented.

The deposed chief justice of the Sindh High Court, Sabihuddin Ahmed, television artist and writer Anwar Maqsood and the director of a private television channel, Sultana Siddiqui, are amongst the first few to have pledged to donate their organs after their deaths.

While most doctors agree that the organ donation programme can become successful by creating awareness and educating the masses to donate, Dr Anwar Naqvi feels that public awareness will come “if we start recognising those who did the noble deed, bring in the element of charity — sadqa-e-jariah — as is given in our faith, and earning rewards even after death by saving lives.”

Instead of donor cards, which many people may not carry all the time, doctors suggest an indication of consent on the computerised national identity card. “Almost everyone carries that,” said Dr Anwar Naqvi. “That information can eventually be used to form a national registry.”— Dawn/IPS News Service