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Muhammad Shahzad
ID: 1127032
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Shifting of Kidney Bazar from India
to Pakistan
Over past two decades Pakistanhas become a zone of commercial
renal transplantation.
Dilemma of Kidney trade is
confused even among medicalstudents and young doctors and
consider it Life Saving procedure.
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The organ-importing countries
richer European countries, Israel, United
States, Canada, Australia, New Zealand,
Japan and some Arab countriesetc.
(Norm Barber, 2007 & WHO)
The organ-exporting countries Pakistan, India, South Africa, Peru, Romania, Bolivia,
Brazil, and Chinaetc.
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Organ transplantation: Primary Treatment of End
Stage Organ Failure.
Benefited more than 1 million people worldwide No of pts survived for well over 25 years.
Shortage of organ is a Universal Phenomenon
(WHO).
Kidney Transplantation is carried out in 91countries.
Organ Transplantation Global Statistic by
2005(WHO)
66000 Kidney Transplants, 21000 Liver Transplant,6000 Heart Transplants.
Shortage of organ donation has led to the organ
trade
A World Health Assembly resolution adopted in2004 WHA57.18 ur es Member States to take
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Living organ Donation
Living Related (first or second
degree relative)- living donor getsdisadvantaged- not favored e.g.
renal transplantation is most
common worldwide and most ofdebate revolve around it.
Living non-related (where anybody
else donates. So many issues are
there when donor is unrelated. The
various situations can be
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A. Altruistic Organ Donation: onemust consider the unrelated donorwho has a stable and closeemotional relationship with recipientsuch as husband or wife.
B. Paid Organ Donation: This is an
important Ethical Issue. There areregional variations in its acceptanceand practice e.g. In France it iscrime. In Iran it is legal and person
who sell his organ is insured andalso he gets money from the donor.
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Cadaveric Transplantation: Organs for
transplantation are usually obtained from
living genetic relatives or from heart-beating
cadavers. Unfortunately, these sources have
so far been unable to keep up with demand.
As a result, there are a large and steadilyincreasing number of potential recipients
awaiting transplantation, some of whom will
die before an organ can be found. Cadavericsource is beneficial in another way that it
provides multi-organ donation [17]. To utilize
cadaveric organs effectively, most of the
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Legislation in Pakistan regarding organ
transplantation: Government efforts,
supported by professional associations, civilsociety organizations and the media, along
with World Health Organization technical
assistance, have led to the development of
legislation regulating this practice and
curbing organ trade in conformity with
international guidelines.
1979 Renal transplantation started in
Pakistan in public sector hospitals using
living related family donors
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1990s Renal transplantations exceeded 500transplantations per year with first violationsobserved, whereby some hospitals shifted fromdealing exclusively with living, related donor to
unrelated, paid donors until these unethicalpractices accounted for more than 80% of alltransplantations. Later in the decadetransplantations exceeded 1000 per year
2000s Opposition to promulgating the law wassustained and commercial kidney transplantationflourished with over 1500 expatriates receivinglocally procured kidneys. The Ministry of Health,supported by SIUT, media and civil society
organizations, sustained its efforts to promotelegislation and bring an end to these unethicalpractices. WHO provided the necessary technicalsupport through its country, regional andheadquarter institutions.
2004 A bill was tabled in the Pakistan Senate by amember raisin the momentum for action.
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2006 The organ transplantation agenda submitted
to the Cabinet in 2004 was deferred in October
2006. This action ignited an active campaign,
where informed and investigative media reportsand SIUTs bold and challenging technical
deliberations exposed the growing unethical
lucrative kidney trade.
2007 Exploitative organ transplantation led to a
judicial action in July 2007, whereby the Supreme
Court of Pakistan took a suo moto notice advising
the Government to promulgate the transplantationlaw.
2007 The transplantation ordinance was
promulgated in September 2007 by the President of
Pakistan.
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2008 Attempts were made by the counter lobby through the Standing
Committee for Health at the National Assembly to water down the law by
introducing loopholes implicitly condoning organ sale and allowing expatriates
to acquire kidneys for lucrative fees. These endeavours were rejected by the
Standing Committees for Health and
Human Rights.
2008 A case was filed before the Federal Shariat Court of Pakistan, challenging
the law, whereby 12 hearing sessions were held in Islamabad, Lahore and
Karachi, unanimously defeating all submitted objections and rendering all
stipulated clauses of the law sustained, including the illegality of all forms oforgan sale.
2009 On 23 June 2009, the Supreme Court took suo moto notice against
private hospitals accused of violating the law and performing illegal
transplantations, who when summoned by the court made commitments to
comply with the law.2009 On 12 November 2009, the National Assembly of Pakistan unanimously
passed the bill on the recommendation
of its Standing Committee on Health.
2010 On 10 February 2010, the Senate of Pakistan passed the bill.
2010 On 17 March 2010, the President of Pakistan signed the bill making it alaw
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To evaluate the public health contribution of organtransplantation
services, the Ministry of Health needs to establish adatabase, for both donors and recipients, supported by thecentres providing these services. The capacity of thehealth system to offer dialysis to end-stage chronic renalfailure needs to be strengthened, to reduce patient
morbidity and improve quality of life. Moreover, the Ministryof Health should closely monitor surgical, medical andimmunosuppressive protocols and establish a mandatory2-year follow-up of donors and recipients to providemedical, emotional and psychosocial support and also
evaluate the outcome of these interventions nationwide.