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.
"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
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".