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25 September 2017

http://dailyasianage.com/news/87652/regulating-donation-and--stopping-organ-sale

Regulating donation and stopping organ sale

M S Siddiqui

Organ transplantation is an increasingly common intervention in treatment of chronic organ failure.

Organs that can be transplanted are the heart, kidneys, eyes, liver, lungs, pancreas, intestine and
thymus. Transplantable tissues and cells include bones, tendons, cornea, bone marrow, skin, heart
valves, veins and islet cells of pancreas. Worldwide, the kidneys are the most commonly
transplanted organs followed by liver and the heart. A graft, or an organ transplant, replaces an
organ essential to life that is failing. Organ donation and transplantation provides a second chance
at life for thousands of people each year.

The fundamental truths of our society, of life and liberty, are values that should not have a monetary
price. Hence, the organs are available from donation of other human being. There are mainly 2 types
of donations - (1) Live donation - Where organ transplant takes place between the patient and his
close friend or a family member and (2) Cadaveric donation- Where a person pledges his organs for
harvesting and donated after his death for any unknown recipient. The organs of a person are
harvested after the person is declared brain dead.

The 'deceased donation' transplants where organs are removed surgically from consented donors
shortly after death or during brain death. Unfortunately Bangladesh could not be started the
Cadaveric donation, as yet hence, organ transplantation (kidney& liver) are done from 'living donor'
donation of close relatives only. The law does not permit selling organs or taking organs from living
strangers against monetary transactions.

In case of donation in all other countries, the first relatives are required to provide proof of their
relationship by genetic testing and/or by legal documents. In the event of there being no first
relatives, the recipient and donor are required to seek special permission from the government
appointed authorization committee and appear for an interview in front of the committee to prove that
the motive of donation is purely out of altruism or affection for the recipient.

The organ can be taken from the donee after his clinical death. The known history revealed that the
first heart transplant in France was performed in April 1968. The first successful kidney
transplantation in Bangladesh was done at the then IPGM&R now Bangladesh Sheikh Mujib Medical
University (BSMMU) in October 1982 and thereafter the process of going on regular kidney
transplantation from 'living donor' donations of close relatives only. More recently, the first successful
liver transplantation of the country was done in June 2010 at BIRDEM Hospital, followed by yet
another successful transplant in August 2011 in the same Institute. Recently BSMMU organized the
function at its auditorium marking 500 kidney transplantations between 1982 and 2016. Although,
the estimated number of kidney patients has reportedly reached to nearly two crore which was some
80 lakh just a decade ago.
The organ transplantation in Bangladesh is emerging steadily, but still in its budding stage of
development. The demand for kidney transplants far outstrips the number of available organ donors.
It is estimated that only 130 patients on average can manage donors to undergo kidney transplant
against the annual demand of estimated 5000.

The success of transplant technology in Bangladesh and some other poor countries has created a
social and health problem of illegal sale and purchase of human organs. Some of the countries that
have weak regulatory mechanisms have given in to the market forces and include Bangladesh,
India, Iran, China, Pakistan, Philippines, Brazil, Turkey, Moldova, Ukraine, Russia, Bulgaria, and
Romania.

These organ commodification is seriously exploitative and ethically reprehensible, as organs are
extracted from the bodies of the poor by indicting a bio-violence against them. Even the national
media openly publish classified advertisement seeking to purchase kidneys, livers, corneas, and any
other transplantable part of the human body. Every day, organ classifieds reach millions of poor
rickshaw pullers, day laborers, slum dwellers, and village farmers, some of whom eventually sell
their body parts to try to get out of poverty.

These organs are sold to local and overseas buyers in developed countries as well. The success of
transplantation as a life-saving treatment does not require-nor justify victimizing the world's poor
people as the source of organs for the rich. Letting the market forces act and making organs a
commodity is fraught with dangers and erodes social, moral, and ethical values and is not an
alternative that can be acceptable to overcome the problem of organ shortage in a civilized society.

The World Health Organization (WHO) in its statement on the sale of organs clearly states that it
violates the Universal Declaration of Human Rights as well as prohibited by law in Bangladesh.
Recently, the representatives of the world transplant community met in Istanbul to discuss the
growing transplant donation commerce and transplant tourism. It defined 'Transplant commercialism'
as a policy or practice in which an organ is treated as a commodity, including by being bought or
sold or used for material gain.

Bangladesh Organ Transplant & Donation Act, 1999 was passed in parliament, allowing two types of
organ donation - 'living donor' donation from close relatives and 'deceased or cadaveric' donation
after brain death. But, despite the Act, neither has the commerce stopped nor have the number of
deceased donors increased to take care of organ shortage. The law allows donation of kidneys by
blood-related relatives-- father, mother, siblings, children, maternal and paternal uncles or aunts and
spouses. But unknown people can in no way donate organs for others, as per the law.

Now the government moved to amend the 1999 law following a High Court order of 2011. The draft
law has a provision for three years of imprisonment or 1 million taka (12,400 U.S. dollars) fine or
both for violation of the law. The draft of "The "Organ Transplantation Act (Amendment) law 2017"
approves by Cabinet allowing some other relatives such as grandparents, grandchildren and first
cousins as potential donors. The 'close relations' of a donor willing to donate body organs have been
redefined widening the list of blood relations that would now include both parental and maternal
cousins, grandfathers, grandmothers and grandchildren besides parents, siblings and children,
spouses and blood-related uncles and aunts in the existing law.

By this time, The High Court issued a rule asking the authorities concerned to explain why three
sections (2ga, 3, and 6) of the Organ Transplantation Act-1999 will not be declared unconstitutional.
The close and blood-connected relatives have been allowed for donating organs. Parents, siblings,
uncle (paternal), aunt (paternal), uncle (maternal) and husband-wife have been defined as close
relatives.
But in the law related to organ transplantation in India, grandfathers, grandmothers (both maternal
and paternal ones) and cousins have been included in the list who can donate organs. Besides, in
special cases, it had been relaxed that donor need not be close relatives. The petition was filed due
to failure in formulation of rules in this regard (FE report, August 25, 2017).

The law will indict others including doctors, involved in influencing others to donate human organs,
will face a maximum of seven years and a minimum of three years in prison or a fine of Tk 300,000
or both. According to proposed law, all the private hospitals will require to obtain prior approval for
such procedures from the regulatory authority after a formality of investigation and approval of
donation. The authority may co-ordinate activities of and networking for procurement and distribution
of Organs and Tissues and registry of Organs and Tissues Donation and Transplantation in the
country.

The proposed law may be strengthen by making law or rule thereafter to scrutinize the reason of
donation of organs with investigating following issues: An explanation of the link between them and
the circumstances that led to the offer being made, reasons why the donor wishes to donate,
documentary evidence of the link, e.g., proof that they have lived together, old photographs showing
the donor and recipient together, there is no middleman or tout involved, the financial status of the
donor and the recipient is probed by asking them to give appropriate evidence of their vocation and
income for the previous three financial years.

Any gross disparity between the status of the two must be evaluated with the objective of preventing
commercial dealing, the donor is not a drug addict or known person with criminal record, the next of
kin of the proposed unrelated donor is interviewed regarding awareness about his or her intention to
donate an organ, the authenticity of the link between the donor and the recipient and the reasons for
donation.

Lack of awareness, social, mental and religious barriers and superstitions are main obstacles for
organ donation. This is more acute problem in developing countries including Bangladesh. To
overcome acute shortage of 'living organ donor from close relatives', 'deceased donor transplant' as
approved by law should be started and promoted. However, for such 'posthumous organ donation',
massive coordinated awareness programs will be needed. Such programs should specifically aim to
eliminate social, mental and religious barriers and superstitions, besides targeted appeal like 'Donate
Organs, Save Live' etc.

There may be a national slogan "One does not choose to be a recipient. But to choose to donate is
to honor and give courage to those who struggle day after day against death, and to honor the
memory of the deceased, through whom life continues."

The writer is a Legal Economist

mssiddiqui2035@gmail.com