Human organ and tissue transplantation in Pakistan; when a regulation makes a difference

Abstract

Organ transplantation must be viewed in relation to the prevailing cultural, religious and socio economic conditions of a nation. Over the past two decades, Pakistan has emerged as one of the largest centres for commercial renal transplantation. Government efforts, supported by professional associations, civil society organizations and the media, along with World Health Organization technical assistance, have led to the development of legislation regulating this practice and curbing organ trade in conformity with international guidelines. Although only two years have passed since the enactment of the law, there is evidence that conditions have significantly improved, raising hopes for ethical and safe organ transplantation in Pakistan. This study reviews the salient features of the legislation and lists the foreseeable evolving challenges and opportunities.

Epistemic Communities, Human Rights, and the Global Diffusion of Legislation against the Organ Trade

“…Although several bills banning the organ trade were proposed in Pakistan during the 1990s and early 2000s, the lack of political support and a strong opposition lobby meant proposed bills were never translated into law [35,216]. Within the opposition, a strong group of private medical institutions and physicians actively lobbied against the enactment of prohibition laws on the grounds that transplant tourism aided the economy [35].…”

“…With Pakistan's absence of legislation eliciting global shame, a number of domestic organizations and professional bodies, including the Sindh Institute of Urology and Transplantation (SIUT), the Transplantation Society of Pakistan (TSP), the Pakistan Society of Nephrology (PSN), and the Pakistan Association of Urological Surgeons (PAUS), began to strongly advocate for a law denouncing the organ trade [216]. Their efforts would receive a strong injection of support in 2004 when the WHO offered its formidable backing.…”

“…Pakistan's thriving organ trade, often referred to as an "organs bazaar" [214,215], was a direct outgrowth of high levels of corruption, as well as the country's long "lack of regulation [and] the presence of a large vulnerable rural population" ( [216], p. 160). Countless reports and media articles documented how wealthy foreign recipients travelled to Pakistan to purchase organs from poor vendors, with 2000 to 4000 organs purchased annually and an annual turnover of approximately US$20m [217,218].…”

“…Their efforts would receive a strong injection of support in 2004 when the WHO offered its formidable backing. Specifically, the WHO provided extensive technical advisory support to the Ministry of Health towards implementing ethical regulations, and strongly suggested the country ban the organ trade [216].…”

“…As well, the TTS, WHO, and SIUT collaborated on several highly publicized seminars and symposia to highlight the extent of the organ trade, delineate its consequences, and encourage the implementation of a law [167,219]. The broad campaign efforts were combined with the development of a strong alliance between the Ministry of Health and the Standing Committee for Health of the National Assembly, and together they decisively countered the opposition lobby [216].…”