KARACHI: Even though legal provisions were made for the donation of organs from brain dead patients (or ‘cadaver donation’) two years ago, a large number of people continue to die from end-stage organ failure in Pakistan, as there seems to be little progress on the deceased donor programme, Dawn has learnt.

The reasons for this perpetual state of inactivity are an acute lack of awareness and misconceptions about cadaver donations, say doctors at the Sindh Institute of Urology and Transplantation (SIUT).

Speaking to Dawn, the doctors said that the only way these obstacles can be removed is if a concerted effort is made by the government, the media and civil society to spread awareness on the issue.

There are no religious concerns involved, they say, as cadaver donation is being widely practised in many Muslim countries, including Saudi Arabia and Iran. In fact, Saudi Arabia is running the single largest deceased donor programme in the Muslim world. The first international conference on Islamic medicine in Kuwait in 1981 strongly sanctioned organ donation. Earlier this year, Pakistan’s Federal Shariat Court also declared the practice to be in accordance with Islamic law.

Of the 2,800 kidney transplants that have so far been carried out at SIUT since 1985, there have been only three cases in which organs were obtained from brain dead patients, as willed by them and with the consent of their families.

‘With only three such cases on record, the chapter of the deceased donor programme is almost closed at the moment. Since SIUT is one of the stakeholders, it is imperative that awareness about the significance of cadaver donation be created by the government or any other party through the media,’ says Dr Altaf H. Hashmi, a senior member of Dr Adibul Hasan Rizvi’s team at SIUT.

In Pakistan, an estimated 50,000 people die each year due to end-stage organ failure. This figure includes 15,000 patients dying due to kidney failure, 10,000 due to failure of the liver and 6,500 from heart failure.

According to doctors, these lives could be saved if the organs were available for transplant, and if more medical facilities existed to carry out such procedures. At the moment, facilities exist for the transplantation of kidneys, livers, corneas and bone marrow.

Currently, SIUT is running a deceased donor programme under which 800 to 900 patients have been registered. Referring to a survey, Dr Hashmi said that around 1,014 cases of brain death are reported every year at Karachi’s four major hospitals.’

‘At the moment we have an ordinance on transplants, and it needs to become a law. With a proper legal framework in place, we can work to improve emergency services and infrastructure and to create awareness about cadaver donation,’ says Dr Hashmi.

The picture on cadaver donation at Layton Rehmatullah Benevolent Trust is not so different. The institution working towards the cause of providing latest eye treatment facilities to the poor free of charge in the country has been in operation for over two decades. But it has registered only few cases for cornea donation so far.

‘There have been very few cases of cornea donation. This situation is, no doubt, regrettable. Actually, in our country, there is a cultural hang-over on this issue. We need to come out of this,’ said Saqib Hameed, honorary vice-chairman and chief executive LRBT.

‘We treat around 1.8 million patients every year at our 16 hospitals and 39 clinics in the country. Last year, LRBT had 150 cornea implants. We import these corneas free from Sri Lanka and Canada as they are all donated.’

The gift of life

Telling Dawn about the first deceased donor case, SIUT’s Dr Anwar Naqvi said that 24-year-old Naveed Anwar, a trainee chartered accountant, was declared brain dead at the Liaquat National Hospital (LNH) in October 1998.

‘The young man was going to a gym when he had a serious accident. Inspired by a TV programme, he had willed in his lifetime that his organs be donated after death. Naveed’s family members themselves came forward and approached doctors with their request to honour their son’s wish.

‘At that time, there was no law on cadaver donation and we had to seek legal advice. A prominent lawyer told us that there was no harm in cadaver donation, if so willed, in the absence of a law.

‘Naveed not only donated his two kidneys, but also two corneas. That means four people benefited from his great altruistic decision. The donated kidneys were transplanted into Wajid and Farhan, two young men, in November the same year,’ he said.

According to Dr Naqvi, the procedure to declare a patient brain dead is quite comprehensive. A team of specialists declares a person brain dead after carrying out a series of tests and firmly establishing that irreversible change has occurred and that there is no chance of recovery. This team, he says, has nothing to do with the transplant team. This is done to maintain transparency and to avoid a conflict of interest.

After Naveed, two more cases of deceased donors were reported to the institution: 20-year-old Shamim Bano, a dedicated social worker (who died in 2005) and Dr Razzak Memon, a professor at Dow Medical College (2007), also chose to give the gift of life to someone after their death.

Myths about deceased donation

Though anyone can volunteer to register himself with the deceased donor programme, the criterion is highly specific when it comes to actually choosing a prospective donor.

‘All natural deaths are excluded and only those patients who are declared brain dead and are on life support systems are considered for donation. Also, the organs to be donated need to function normally before they are harvested. About 95 per cent of brain death cases are those of patients suffering serious injuries or haemorrhages,’ says Dr Naqi Zafar.

Dr Anwar Naqvi also dispelled the notion that the sanctity of the body is violated during the process, saying that the procedure ‘is performed by a skilled operating team and the body is not mutilated, as many people believe’.

The doctors say that it is important for the potential donor to discuss the subject with his or her relatives and to inform them before taking the decision, in order to avoid any delays at the crucial time of donation.

Speaking to Dawn, retired Major-General Dr Abdul Qadir Usmani, administrator of the Human Organ Transplant Authority (HOTA), said that a committee headed by Dr Adibul Hasan Rizvi had been set up to forward recommendations on the deceased donor programme.

‘The government realises the importance of the issue. We believe that if the trend of cadaver donation develops in the society, this will help check the business of organ trade. We are planning to initiate an awareness campaign and at the same time set up a system for cadaver donation in Karachi, Rawalpindi, Lahore and Islamabad.’

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