The Organ Bazaars of South Asia

Published in SouthAsia (August 2007)

Nothing substantial has so far been attempted to check rampant illegal organ trafficking in South Asia or to provide systematic treatment for organ failures and ailments, writes Ayesha Hoda

The bazaars of human organs are bustling with activity in South Asia. The underdeveloped world seems to be more privileged than the developed world, at least in one aspect: it has a large population of live donors, with organs for sale at cheap rates!

Peasants, bonded labourers, slum-dwellers and other poverty-stricken people with large families to support, are more than eager to offer their organs, especially kidneys, for meagre amounts of compensation.

In 2005, Shefali Begum, a penniless mother in Bangladesh, offered one of her eyes for sale through a newspaper advertisement. This resulted in a massive outcry from the public and the international press. So did a number of organ-rejection cases in Britain recently, concerning twenty Scots who had unofficially bought kidneys in Pakistan. But this is just a small glimpse of the horrendous world of organ trafficking.

In the village of Eranavour, Tamil Nadu (India), one hundred and fifty Tsunami survivors have been left on the streets sans compensation, after having their kidneys removed at very posh hospitals in Chennai. Sadly, the merciless organ mafia was their last hope when the Indian government failed to provide them with any protection or means of survival.

The question is, who has made the entire process of illegal inter-human allotransplant so easy and successful? The black market in the region is full of internationally-affiliated organ brokers, with government officials as accomplices. The former may be outlawed surgeons or medical technicians operating underground laboratories or anyone interested in making skyrocketing profits quickly.

“Pakistan has become a factory for regional transplant tourism,” says, Dr. Syed Adibul Hasan Rizvi, founder and director, Sindh Institute of Urology and Transplantation. “Recipients travel to Pakistan, where the temptation for money and greed is great.”

The gap between the number of recipients and the number of donations is widening. There is a higher incidence of kidney and renal failures. Most people, especially in South Asian societies, do not like to give away organs of their deceased loved ones. There is a serious lack of data and no systematic way to bring recipients and willing donors into contact. Hence, there are fewer deceased or cadaveric donations.

According to the World Health Organisation (WHO), around 200,000 people around the globe are on waiting lists. Patients with kidney failure, registered on these official lists, often die waiting to receive organs or looking for the perfect match. Some have no proper access to transplantation or dialysis. In such cases, an argument is often forwarded by some that the human body only needs a small percentage of one kidney to survive. Therefore, with donations, two people can live instead of just one.

However, others such as medical anthropologist Nancy Scheper-Hughes, firmly declare this practice as unethical:

“The ultimate fetish is the idea of ‘life’ itself as an object of manipulation. This fetishization of life – to be preserved, prolonged and enhanced at almost any cost – erases any possibility of a social ethic.”

This also leads to the issue of forced donations. Very few donations are altruistic or Good Samaritan (donating willingly to a relatively unknown recipient, without acquiring any benefits in return).

The lower classes have been exploited for a very long time, in every way imaginable, and this is one common example. Mostly, donating kidneys is not even the end of the story. Such people are ignorant of some adverse consequences and complications that may result from the operation. They are left without any post-surgical advice, care or treatment. Medication is unaffordable.

In view of all this, laws have been formulated in different countries pertaining to the legitimacy organ trade. In 2006, Iran became the only country in the world to legalise the sale of kidneys to unrelated recipients, at market prices of $2000 to $4000! However, some may argue that countries like India, which actually have laws against this practice, have rather booming markets for organs.

The Human Organs Transplant Act was passed in 1994 in India. This set down rules and regulations for organ transplant and banned organ sale, with high penalty for any parties involved. It only allowed organ donation out of affection, that is, only to recipients well-known to the donor. In the case of family members, there is no requirement for a government clearance. However, there have been numerous cases of transplantation marriages in India, where poor girls are forced to tie the knot, donate their kidneys and are then divorced.

Even in Nepal, the Organ Transplant Committee, formed by the government to check the smuggling of kidneys from the country, only allows donations to relatives. However, fake relationships are established on paper to combat this rule.

In Pakistan, a few years back, Dr. S.A. Jaffar Naqvi, CEO, Kidney Foundation, introduced the Bill for Organ Transplant in the Senate and obtained a fatwa from Justice Tanzeel ur Rahman (the then Chairman of the Council of Islamic Ideology), which declared organ transplant to be legal in Islam. However, there was no further development for a proper donation system, which would have been beneficial for all.

More recently, however, and after much deliberation and hindrances, the federal cabinet has approved the Transplantation of Human Organ and Tissues Ordinance 2007. But there are many apprehensions about this law, as it does not provide a transparent system for promoting a positive organ donation culture and disrupting trading activities in the black market. Some analysts are of the opinion that there are certain clauses within the ordinance, which actually legalise rather than curb or criminalize unofficial and coercive organ sale.

Trading organs, irrespective of whether the donor is living or deceased, is illegal in Bangladesh. However, as with all the other countries mentioned above, the implementation of this law is rather questionable.

Organ trade is growing day by day. It is not only a cause for concern for social scientists or bio-medical ethicists. It is a very serious problem pertaining to the violation of basic human rights (Articles 3 and 4 of the Universal Declaration of Human Rights). In accordance with this, payment to live unrelated donors is also forbidden under the WHO Guiding Principles.

There is then a need for the WHO to overview, along with its promotion of health systems and altruistic donations, the negative impact that such publicity might unintentionally have had and it should suggest and formulate ways to counter this.

On the medicinal front, people should have cognisance of the possibility of transplant failures, due to rejection of foreign organs by the body’s immune system. Requirements of thorough check-ups before transplantation will lead to a lower death rate due to organ-rejection. Also, the introduction of more preventive drugs and medical care will check the rise in diseases, such as diabetes, which may lead to organ failure.

There should be awareness programmes to promote and encourage donations after demise as well as about factors causing damage to organs. Governments of South Asian countries should improve access to donors by collecting relevant data and building more kidney care and research centres.