Pakistan Needs to Take Stringent Measures to Curb Illegal Organ Trade

by VR Sreeraman on Aug 19 2007 3:43 PM

When a man called Tariq offered 24-year-old Usman Rana more than 16,000 dollars for one of his kidneys, he thought his fortune was made.

Soon after Rana arrived in the Pakistani capital Islamabad from his hometown Lahore in February in search of work, police said Tariq "lured him into selling one of his kidneys for one million rupees (16,666 dollars)."

A patient from Britain was the buyer, Rana was told, and he was given a down payment of 100,000 rupees, a fortune in the impoverished country, before being operated on in a private hospital just outside the capital.

Not long after the operation, as Rana's remaining kidney began to cause him pain, he still didn't have the rest of the money. So he started knocking on doors and ended up contacting police who uncovered a complicated scam.

Newspapers reported that four people, including a doctor and a policeman, appeared in court Friday in connection with Rana's case and were remanded in custody as police hunt for two more men, including a policeman.

According to Pakistan's government, Rana's story is not unusual and last week it introduced legislation aimed at controlling a lucrative illegal trade in human organs that preys on the "poorest of the poor."

Under the Transplantation of Human Organs and Tissues Bill, 2007, the unauthorised sale and transplantation of human organs will be punishable with 10 years' jail and hefty fines.

The bill prohibits the sale of organs by Pakistanis to foreigners, who until now have come from across the world for life-saving operations that cost a fraction of the price at home, without the complications of waiting lists and legislation.

The bill said the sale of kidneys was on the rise and newspaper reports put the annual value of the trade in Pakistan at one billion rupees.

It's a trade that has made Pakistan infamous as an international human organs supermarket, with apochryphal stories -- such as unemployed men waking up in baths of ice to find a scar the only evidence of surgical theft -- hinting at the gruesome toll.

Most people who sell their kidneys do so to escape conditions of virtual slavery in the hope of paying off their debts and buying their freedom.

They almost never do, rather seeing the money they are promised for their organ syphoned off by middlemen and hospitals.

Rana told The News he had been unemployed for two years and was close to starvation when he moved to the capital and met a barber who talked him into selling a kidney to feed his family.

He didn't even get to keep the down payment. "When I came out of the hospital the three agents were waiting for me. They snatched 100,000 rupees saying that the total amount would be paid after complete recovery of my health."

Surveys quoted in Pakistani media have found that 70 percent of the kidneys traded on the private market come from bonded labourers in rural Punjab province, the agricultural heartland of the country where most farmers are indentured to feudal landlords.

Forced to borrow from their landlords to cover costs of weddings, funerals and other traditional obligations, as well as indirect taxes, many believe selling a kidney for between 70,000 and 120,000 rupees will enable them to pay off their debts.

But 95 percent of those who sell a kidney remain desperately poor, according to Dawn newspaper. Their health deteriorates to the point where they cannot work and they are plagued by guilt and depression.

Dawn said Saturday that 2,000 kidney transplants are performed each year in Pakistan, 500 of them in government hospitals with the organs supplied by living relatives of the recipients.

The remaining 1,500 kidneys were from unrelated sellers, the transplants performed in private hospitals.

"About 900-1,000 of these are for foreigners who come from more than 20 countries in the Middle East, North America, Europe and South Asia and pay hefty amounts," Dawn said. "The rest are locals."

With average monthly income around 2,400 rupees, many people who bought kidneys from non-relatives could not afford proper follow-up care after paying for private operations, the newspaper said.

It added that essential immunosuppressive drugs cost between 10,000-15,000 rupees per month.

"Ultimately they stop medication and lose their transplanted kidneys," it said.

The new law aims to stamp out the illegal and exploitative trade.

Transplants and removal of human organs, it says, can only be done by recognised professionals after written certification from an evaluation committee.

Violations will be punishable with 10 years in prison, fines of up to one million rupees, and possible deregistration for the doctors involved.

Donors must be aged over 18 and can only give their organs to close relatives, the bill says.