Rehmat Masih, 35, who lives in the predominantly Christian Youhanabad suburb of Lahore, capital of the eastern province of Punjab, is facing hard times.
On a monthly income of around Rs 6,000 (US$70) which he earns by selling sweet drinks from a stall, he can barely provide food for his family of six. To make matters worse, his wife is sick with hepatitis and, to help meet the costs, his two oldest children, Saleem aged 13 and Sumera 11, are forced to work as garbage collectors. High food price inflation has added to their difficulties. Consumer prices rose by 15.71 percent in September, according to official figures.
A few years ago Rehmat would have known just what to do: He would have sold a kidney to gain at least temporary respite from poverty. But though he has approached two middlemen who arrange for hospitals to sell kidneys to wealthy clients requiring transplants, he has not yet received any guarantee he will be able to find a buyer.
Things had been quite significantly different until three years ago. Pakistan had gained a reputation as an international marketplace for kidneys, with around 4,000 kidney transplants taking place annually and only around 25 percent of the organs coming from related donors.
Around half of those receiving kidneys came in from other countries to receive an organ they had bought, usually from impoverished people in Punjab.
“Around 2,000 transplants took place each year, with about 1,500 of these involving foreign buyers who travelled to Pakistan to buy a kidney,” Maj-Gen (retd) Abdul Qadir Usmani, administrator of the National Human Organ Transplantation Authority (NHOTA), told IRIN.
Much of this changed with the passage of the Transplantation of Human Organs and Tissues law in 2007. The legislation, under which NHOTA was set up, lays down rules that all hospitals and doctors are bound to follow, bars the purchase of kidneys, and restricts donations - essentially to blood relatives.
Action by police, courts and tough monitoring has helped enormously, as has the awareness raising campaign spearheaded by the Karachi-based Sindh Institute for Urology and Transplantation (SIUT), which actively campaigned for years to have the law passed.
Farhat Moazam, chairperson of the centre for biomedical ethics at SIUT, told IRIN there had been a “decline in kidney sales following the law, though the practice has not ended entirely”. She also said the media had played an important part in driving home the message about the ethical and medical issues posed by the exploitative practice of kidney purchases.
Many of those who have sold kidneys in the past have ended up receiving little aftercare. Some suffered a decline in health or serious psychological issues.
Such people can be found everywhere in Youhanabad - till 2007 a favourite recruiting ground for those engaged in the kidney trade. “I have been suffering pain in my side, blood in the urine and other issues since the operation to remove my kidney in 2006. I was also not paid the full amount of Rs 300,000 [$3,529] that I was promised,” Pervaiz Ahmed told IRIN.
“Today we are afraid to approach people openly to obtain a kidney and those who wish to do so are sworn to strict secrecy,” said a middleman who asked not to be named. He said “most hospitals” which had previously bought kidneys had stopped doing so, especially after the high-profile arrest of six people, including five doctors in 2007, for involvement in selling kidneys.
Such measures have also led to people re-thinking about selling organs. “My uncle sold a kidney, but I would never do so because it is wrong for a rich man to buy a part of my body. Besides police can arrest anyone who sells an organ,” said Nadeem Ahmed, 25, a bicycle repairer.
Maj-Gen Usmani said the law had been “very successful” and since 2007 there have “been allegations but no proven cases of violations”.
Courts have also played their part in acting to stop the practice. In June 2009 the Supreme Court of Pakistan sought details of kidney transplants carried out at two hospitals, after a complaint that illegal transplants continued. Both hospitals gave an undertaking that illegal transplants were not being carried out.
But despite such measures, violations are occasionally reported. In October this year an Omani national died in Lahore after receiving a kidney that had been bought from an unknown donor.
“When surgeries take place in backdoor clinics there is a much greater risk of complications for both the recipient and the vendor,” Moazam said. She also told IRIN that only an increase in the donation of organs by those who had died would reduce the demand for kidneys, which fuels illegal purchases. The law lays down procedures for such donations, but these are extremely rare due to social taboos and a lack of awareness.
Rehmat Masih is aware of the new law and says he would “rather not” sell an organ, but says for now he has no choice, because he has no other way to meet his family’s pressing needs.
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