Daily Times

Death is the inevitable reality. No measure of science or prayer has been able to change it. It is inevitable that come one day, we will all die, some sooner, others later. But what if we all had the power and capacity to change the life of others, to alleviate their suffering, to end their agony? What if we had the power but were not aware of it and what if we were scared of using it?

Organ dysfunction is defined as ‘a condition where an organ does not perform its expected function’, whereas organ failure is ‘organ dysfunction to such a degree that normal homeostasis cannot be maintained without external clinical intervention’. It is estimated that each year over 50,000 people die in Pakistan because of organ failure, though there are no definite figures available. A majority of these people suffer kidney, liver and heart failure and can be helped with transplants, if organs are available.

When I turned 18 in London, the first thing that I did was to get myself an ‘Organ Donor Card’. I had decided by then that anyone who could benefit or would have a better shot at life by being the recipient of any part of my body after my death was more than welcome to it. I proudly retained and carried the red and white card for years, until it was stolen along with my favourite wallet at a crowded market in Lahore. Now, though card-less, I am still a potential multi-organ donor, with instructions to my family in this regard, but our government should issue Organ Donor Cards to potential donors to enable swift removal of organs.

Pakistan was a booming hub for the illegal organ trade as several hospitals in the country went into this business. An outcry some years ago resulted in arrests being made and the government finally waking up to the menace. The Transplantation of Human Organs and Tissues Act 2010 was promulgated after the initial ordinances lapsed. This provides for the removal, storage and transplantation of human organs and tissues for therapeutic purposes of both living and deceased donors as well as introducing evaluating and monitoring systems. This law provides that a living donor over 18 years of age may voluntarily donate any organ or tissue to his genetically and legally related living relative, provided such a donation is genuinely motivated and without any duress or coercion. However, there is no age restriction between siblings in case of donation of regenerative tissue. Any living adult who desires to donate an organ or tissue after his/her death can put such a donation in writing under his/her signatures and get it verified by the Evaluation Committee (EC), authorising a recognised medical institution or hospital. After the death of the donor, the onus is on any close relative of the deceased to inform the EC and get the organs/tissues removed as per the authorisation. The law also empowers the EC to order removal of organs/tissues of unclaimed, brain dead hospitalised patients if their relatives cannot be found within 24 hours of intense search.

Every medical institution and hospital where at least 25 transplants are carried out annually has to establish an EC that has to consist of a surgical specialist, a medical specialist, a transplant specialist, a nephrologist, a neuro-physician, an intensivist and two notable social workers. The EC has to ensure that no organ or tissue is retrieved from non-related living donors without its prior approval; determine the brain death of a person; determine the propriety of removal of a human organ from any living person using the brain death protocol and determine the fitness or otherwise for transplantation of a human organ into any other body. The law defines medical and legal death as “an absence of natural respiratory and cardiac functions and attempt at resuscitation are not successful at restoring those functions or an irreversible and permanent cessation of all human brainstem functions and future attempt of resuscitation or continued supportive maintenance would not be successful in such natural functions.” If any person removes a human organ without lawful authority, he can face up to 10 years of imprisonment and a fine up to Rs one million. If the culprit is a registered medical practitioner, his name can be removed from the register by the Pakistan Medical and Dental Council. The organ trade has been made illegal in Pakistan and a violation carries a penalty of up to 10 years imprisonment and a fine up to Rs one million.

One single human being has the capacity to save up to eight lives through multiple organ donations and the ability to enhance many others by donating tissue. An estimated one million people were the recipients of cornea and tissue transplants in the US in 2011, which helped them ‘recover from trauma, bone damage, spinal injuries, burns, hearing impairment and vision loss’ and 28,000 transplants were made possible by organ donations.

The British Medical Association says 1,000 people die each year waiting for a transplant and 7,586 people are currently awaiting a transplant in Britain. No figures are available for Pakistan. “Around 90 per cent of people, when asked, say they would donate organs and tissue, but only 31 percent are on the NHS Organ Donor Register,” explains Professor James Neuberger, associate medical director at the NHS Blood and Transplant. Any person can become a potential donor, regardless of age or medical history; whether the organs donated can be used for transplant is finally determined by the medical personnel concerned. According to Neuberger, the supposed fact that a person has to be a healthy specimen in order to donate an organ is in fact a myth. Even if a person has a condition that prevents him/her from donating blood, the organs may be used for transplants and many people can be restored to optimal health after receiving one. Organs can be donated if a person has suffered a brain death, which is different from a ‘coma’: people may recover from a coma but cannot from brain death.

The most traumatic experience that a family has to go through is definitely the death of a loved one. No matter how much one tries to console one’s self by the inevitability of death, the loss and the unbearable grief is tremendous, but add to that the decision of donating the organs of a person who was loved and will always be loved and cherished. Exactly 38 years ago today, I lost a brother. The thought of him laying there in that hospital bed hooked up to all those machines, with his head in bandages, wreaks havoc on me even today. The trauma and grief that I experience crushes my ribs, making me unable to breathe. I cannot even imagine what it does to my parents, for I do not have the courage to ask them. But now I cannot help wondering that had they been aware that organ donation was possible at the time, would they have chosen to save the life of another child as their own lay there with no chance of returning to their arms? As I write, I am overwhelmed with grief and emotion and cannot be presumptuous enough to declare that it is an easy decision for anyone, God forbid, faced with a similar situation. But the knowledge that an organ donated by one had the capacity to transform the life of another to give another living being a fighting chance at life again, wouldn’t that be a true gift of life?

The writer is an advocate of the High Court