President Asif Ali Zardari of Pakistan today signals top-level personal support for a new national organ transplantation service by signing an organ donor card to bequeath his organs upon his death. The signing will takeplace at a ceremony at Bilawal House, Karachi.
The new service is based on donations from deceased donors. It prohibits commercial transplantation and outlaws the organ trade.
Advertisement"Pakistan has taken an important step in passing this new law to regulate organ transplantation, and is setting an excellent example to other countries," said Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean. "The commercialization of organ transplantation is unethical, inequitable and unhealthy - both for vendors and recipients."
Kidney transplantation took off in Pakistan in the late 1980s. To begin with, most transplanted kidneys were donated by family members but by the late 1990s, the majority of kidneys were bought from individuals from villages located around major cities. By 2003, most kidney transplants were undertaken in private hospitals in the cities of Punjab.
In 2005 (the last year for which figures are available), 1500 commercial transplantations were conducted openly in Pakistan.
An article published online in the journal Clinical Transplantation on 6 July 2010 by a group of researchers from Skopje, Macedonia, describes 36 patients who travelled from the Balkans to buy kidneys in Pakistan. Following operations in Lahore and Rawalpindi, seven patients died, while many others suffered serious complications such as infected wounds, renal artery thrombosis, active hepatitis C, steroid diabetes and acute myocardial infarctions.
Meanwhile, many people who have sold a kidney say that their health has suffered as a result, citing general overall weakness and an inability to work long hours.
Organ transplantation is the only viable treatment for a range of fatal and non-fatal diseases affecting the heart, liver or lungs. Although patients with terminal renal diseases can be treated through other renal replacement therapies (notably dialysis), kidney transplantation is generally accepted as the best treatment both for quality of life and cost effectiveness. Kidney transplantation is by far the most frequently carried out form of transplantation globally.
Worldwide, approximately 100 900 solid organ transplants were performed in 2008 (based on information from the 104 countries in which 99% of the world's organ transplants take place). Kidney transplants made up the majority of all transplants (69 300), followed by liver (5330), heart (5330) and lung (3330) transplants.
Demand for organs outstrips supply in almost every country of the world. WHO estimates that less than one tenth of estimated global needs in organ transplantation are currently met. This results in offers of incentives for donation, profiteering and exploitation of the disadvantaged.
In 1987, the World Health Assembly noted that the commercialization of organ transplantation contravenes the Universal Declaration of Human Rights and the spirit of the WHO Constitution. WHO subsequently developed a unified legal instrument to regulate transplantation, which led to the approval of a set of Guiding Principles at the World Health Assembly in 1991. The Guiding Principles emphasize voluntary donation and non-commercialization of human organs. In May 2010, the sixty-third World Health Assembly adopted a further resolution (WHA63.22) endorsing an updated set of Guiding Principles on Human Cell, Tissue and Organ Transplantation. The resolution highlights the social risks associated with trafficking in human materials, and the need for public support to stamp out the trade and increase donations from deceased donors.
Meanwhile, in March 2010, the Third Global Consultation on Organ Donation and Transplantation agreed to aim for self-sufficiency by scaling up preventive measures (such as healthy lifestyle campaigns) to reduce the numbers of people needing organ transplants, and to encourage people to do what President Zardari is doing today: demonstrating a commitment to the community by bequeathing his organs for use by others after his death. Ensuring adequate local supply of voluntarily donated organs is critical to eliminating commercial trade and "transplant tourism".