Kidney Donation: Patients suffer for legal constraints

Fahmida, who has been undergoing dialysis for the last two years, now desperately needs a second kidney transplant. Her mother Fatema Zohra had donated her a kidney in 2015, but it got damaged within a year.

According to the Transplant of Human Organ Act (amendment) 2018, Fahmida can obtain a kidney either from a “near relative” or from a brain-dead patient, whose kin would agree to this. 

Unfortunately, the 26-year-old does not have any “near relative” willing to donate the organ.

A cadaveric transplant, where an organ comes from a deceased donor, is also not an option for her.

Such a procedure has not taken place in the country till date because of a presumed religious bar that apparently exists in the society, according to Prof Harun-ur-Rashid, chief consultant and founder president of Kidney Foundation Hospital and Research Institute.

Fahmida can try to obtain a kidney illegally from a donor in the black market.

But in that case, she has to get the transplant done in a foreign country, where the law allows organ donation from a non-relative who has either an emotional connection with the recipient or an altruistic motive.

Chittagong’s Pahartali resident Lucky took advantage of the emotional donation clause in the Indian law two years ago and obtained a kidney from Md Hazrat Ali, a porter from Rajabirat in Gaibandha’s Gobindaganj.

Although Lucky did not live long to share her story, Hazrat Ali, now almost crippled after selling his right kidney, told The Daily Star how he was duped by organ traffickers active in the northern border areas of the country.

Hazrat Ali said he was persuaded to sell his kidney by a broker named Ziaur Rahman. He was then taken to Dhaka twice in 2017 -- once to undergo some tests and then to prepare his passport and visa.

The transplant was done at a hospital in Kolkata in December 2017.

“When we returned home, broker Zia gave me only Tk two lakh though the contract was for Tk 3.5 lakh,” he alleged.

Following a case filed by Hazrat and his wife against 11 organ brokers, Gobindaganj police arrested two persons, who had sold their kidneys before and then started working as agents for an organ trafficking gang, said police.

In 2011, law enforcers busted a number of kidney trafficking gangs active in Joypurhat’s Kalai, where, as per official data, 42 people sold their kidneys through agents at that time.

“The organ business spread to Gobindaganj from the adjacent Joypurhat’s Kalai upazila,” said Inspector Imranul Kabir, investigation officer of the case filed with the Boiragirhat Police Investigation Centre.

“Now we are conducting regular drives to arrest the kidney brokers.”

According to sources in Kalai, three organ trade ringleaders, Saiful Islam Daud, Abdus Sattar and Tariquzzaman Tareq, who were arrested in 2011, are currently on bail.

CHANGES IN LAW SOUGHT

On August 24, 2017, Fahmida’s mother filed a writ petition with the High Court challenging the provisions that limit donations.

Although the law was amended last year and more relatives now can donate their kidneys to a patient, the change will not bring any significant difference to the huge gap between the demand and supply of the organ in the country, said the petitioner’s lawyer Barrister Rashna Imam.

The family filed another application with the HC in August 2018 recommending changes to the law to include emotional donation from an unrelated but known donors as allowed in India; altruistic donation from unrelated living donor as allowed in the United Kingdom and United States, and safeguards to prevent illegal kidney trading.

This year in August, the court asked for the opinion of experts in this regard and in a recent report, experts opposed voluntary donations beyond certain relatives citing the risk of exploitation of the poor by the rich.

According to transplant surgeons, under the existing system in the country, attempting to prove a bona fide kidney donation between the donor and the recipient is very risky.

Prof Dr Kamrul Islam of the Centre for Kidney Diseases & Urology Hospital explained that even now when a donor can either be a spouse or a close relative, the responsibility of proving relationship falls on the hospital doing the transplant.

For relationship identification, his hospital asks for police verification of the donor and recipient, a notarised affidavit from the court, and then DNA test report, if the donor is not a parent, he said.

Such a scrutiny is necessary because doctors risk losing their licences and the hospitals their registrations if no relationship is found between the donor and patient later.

Prof Kamrul suggested the relationship identification be done by a government body like that in India.  This way, the transparency of the process will increase.

Prof Harun said most well-to-do patients in the country take advantage of the emotional donation clause in India. Every year, about 100 Bangladeshi patients are going to India for kidney transplant.

THE WAY FORWARD

Both the surgeons view cadaveric transplant as the solution to meet the current demand for kidneys in Bangladesh. 

Prof Kamrul noted that in western countries, 70 percent of the kidneys needed for transplant comes from cadaver or brain-dead patients.

Every day, around 10 to 12 people die in Bangladesh from renal failure, while at least one brain dead patient can be found in most of the 100 ICUs in the country.

As per official data, around 3,000 people die from road accidents yearly but the World Health Organisation and various bodies working on road safety estimate this figure to be much higher.

Prof Harun said if hospital medical boards are made obligated by law to declare road-accident patients brain dead following necessary tests, it may help increase the number of kidney transplant.

The physician related how cadaveric transplant attempts failed in Bangladesh mainly because of opposition from relatives of a deceased person.

He cited examples of Saudi Arabia and Iran where Islamic clerics issued fatwa in favour of cadaveric transplant, thus removing any questions in people’s mind about religious restriction on removal of organs after death.

Noting that 14 vital organs can come from a cadaver, he said, mass awareness is needed to encourage people in consenting to cadaveric transplant that can save at least 14 lives.

Prof Kamrul pointed to the Iranian system, where willing people can actually sell their kidneys to patients through a government agency at a fixed price and also get a medical insurance for any future complications.

That way if the seller faces any complications, like those described by Hazrat Ali, the insurance would help him or her to seek medical help for free and also safeguard him from exploitation, he said.

[With inputs from our Dinajpur correspondent Kangkan Karmakar]