"I came from my village, about 20km outside Lahore to sell my kidney, but I can’t find anyone to help me,” 25-year-old Haroon Ahmed said as he sat beside a busy road in Lahore, the capital of Pakistan’s populous Punjab Province.
Haroon, who is illiterate, knows nothing of a new bill in parliament, according to which kidney donations from unrelated donors would be illegal.
He has not read the headlines in recent weeks on the controversy over the issue of kidney donations, nor the ruling of Pakistan's Supreme Court at the end of July ordering the government to immediately enact a law to regulate the trade in human organs - particularly kidneys.
The court was responding to complaints that poor people were being coerced by unscrupulous middlemen into selling kidneys, for which they often received only a tiny percentage of the price promised.
The court also looked into media reports that at least 10 hospitals in Lahore were discovered in early July by police to be involved in the illegal trade - a fact prompting a strong rebuke from the authorities.
In May 2007 at least three doctors were arrested in Lahore for their alleged involvement in the kidney trade. Commenting on the practice, Punjab Health Minister Chaudhry Iqbal told IRIN "strict action will be taken against anyone responsible".
Government bill
Following the Supreme Court ruling, the government in the middle of August tabled the Transplantation of Human Organs and Tissues Bill 2007 in the National Assembly. The bill proposes a number of measures, including a restriction on organ donation to "close blood relatives" over the age of 18, and a ban on donations by those not related to the recipient.
Under the new law, an evaluation committee of medical experts would establish that the donation was fully voluntary. The bill proposes action against any physician guilty of violating clauses of the act and lays down a 10-year jail sentence for anyone involved in the commercial trading of organs.
However, the bill has yet to make it through parliament, a fact that has raised concern amongst experts.
Professor Abdul Hassan Rizvi, director of the Sindh Institute of Urology based in Karachi and a pioneer of transplant surgery in Pakistan, has called for an "immediate end to this terrible form of exploitation".
Rizvi has been leading the campaign against illegal kidney transplants in Pakistan and has criticised the delay in the passage of the legislation.
"Queries regarding the illegal trade of organs are very embarrassing for us when attending conferences overseas, as are the practices of some medical practitioners," Dr Sajjad Hussain, president of the Pakistan Association of Urological Surgeons, recently told members of the press.
Illegal surgery halted for now
Yet the recent focus on the issue, coupled by action taken in the Punjab against doctors alleged to be involved in illegally removing kidneys in exchange for money, has meant that, for the moment at least, such illegal surgery has largely been halted.
"I have been told no one is doing this business now," Haroon Ahmed said, adding that while trying to sell his kidney, he had visited "at least half a dozen people who had arranged such operations in the past", and had been told to keep a low profile.
In recent years, Pakistan has gained a reputation as an international centre for the sale of human organs, with rough estimates suggesting 1,500 kidneys are “sold” each year by desperately impoverished donors.
Poverty driving donations
Many, such as Haroon, are jobless and virtually penniless. Others, including brick-kiln workers, sell kidneys to pay off large debts owed to employers. It is thought the largest numbers of kidneys available on the “market”, around 70 percent, come from such labourers.
Numerous tales of such sales have emerged over the last few years, with about 1,000 kidneys “bought” each year by foreign nationals travelling into the country, most often from the Gulf, Europe or North America. Others are bought by rich Pakistanis.
Around 500 kidneys, according to a recent report in the Karachi-based Dawn newspaper are thought to have been voluntarily donated to close relatives.
Private clinics and hospitals engaged in the trade have cropped up in Lahore, and many other major cities. Donors are often “recruited” by middlemen engaged by these centres, and promised sums ranging from US$1,165 to $2,500.
However, even where all or a portion of the money promised to donors changes hands, surveys have shown they remain dismally poor, often facing long-term health issues which can make them unable to work.
But men like Haroon, desperate for quick, hard cash, do not realise this. It is hoped that if the new law is passed and implemented, it can save hundreds of people like him from the cycle of exploitation that has continued unhindered across much of the country for at least the past five years, as kidney transplantation surgery expanded and the lure of illegally obtained kidneys drew in people from many places to benefit from the desperation of the most poor.
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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
