Thread: Pakistan: Medical tourism is a cover up for cheap kidney bazaar

Medical tourism is a cover up for cheap kidney bazaar

Issued on 19 January ,2007

The government of Pakistan has recently adopted a policy to promote medical tourism in the country. It has waived off duties and taxes on import of certain machinery and medicines in support of the tourism industry. But can the country offer any type of medical excellence at economical rates to the foreign visitors? A research by TheNetwork reveals that the country has nothing to offer the world but cheap kidneys. Desperate to earn dollars, the government is ready to sell any thing to foreigners even the kidneys of its poor population. The medical tourism is in fact a label for protecting and promoting trade in human organs.

Medical tourism is traveling to some country for some treatment, which is economical compared with one's home country. Many Asian governments are developing medical tourism as industry for the last few years and the experts estimate that it will become a 4 billion dollar industry by 2012 in Asia alone. There can be two attractions for a foreign patient to become a medical tourist in another country. Firstly the health facilities being offered by the host country are economical yet meet international quality standards, secondly the tourism sector of the host country is developed and offers the patient additional attraction of spending vacations there.

It does not need an argument to establish that Pakistan neither has world class health facilities nor does it have a developed infrastructure for tourism. In fact whatever tourism industry the country had, has been in crisis since the 9/11 and the subsequent war of terror. Similarly the country's health care infrastructure is in appalling condition. Pakistan spends only 0.5 per cent of GDP on health and a considerable portion of the population is deprived of the basic health facilities.

This makes Pakistan a totally unattractive destination for medical tourists. However, Pakistan has some other kind of attractions for medical tourists; the kidney transplantation. Pakistan is among handful of countries where human organ trade is not covered with any legislation and the extreme poverty forces people to sell even their organs. Organ trade is an affront to human dignity and is outlawed or strictly regulated in most of the countries.

Pakistan in spite of introducing legislation to check the growing organ trade through law (the bill on human organ transplantation is pending with parliament for the last 15 years) has come up with special incentives for the transplant industry. It has exempted from duty and taxes the import of plant, machinery, equipments for 'kidney dialysis and transplantation' and exempted all duties on the imports of 'drugs used for kidney dialysis and kidney transplant'. These exemptions cost the government a revenue loss of Rs 230 million in the current fiscal only.

As the result foreigners are flocking to Pakistan to get a 'donated' or 'purchased' kidney transplanted by spending lesser energy and money on the process, which is otherwise very costly in their own countries.

It can take as low as Rs 300,000 ($5000) to a foreigner to spend on a renal transplant in Pakistan. The lion's share of this amount is pocketed by middlemen, doctors and transplant centers. The so-called 'donor' gets only Rs 50,000-100,000 for selling his or her kidney to an alien patient. In US a kidney transplant normally costs Rs 60 lakh ($ 100,000) and the patient has to himself seek a donor.

The buying and selling of kidneys commodifies human organs. The people who resort to such unethical practices exploit the vulnerable and powerless members of society by treating them as means to an end. By legalizing the transplantation under the beautiful cover of medical tourism, it seems, government has also acknowledged humans as commodities, the organs of whom can be sold and used to earn revenue, especially the foreign exchange.

Kidney business in Pakistan

Every year, thousands of people suffering from irreversible kidney failure get a new lease of life by receiving the transplant of kidneys donated by some individuals. There are two kinds of transplantation; cadaver transplant and live human to human transplant. In cadaver transplant the kidney of a person, who is medically proclaimed brain dead is transplanted to a patient. Most of the countries prefer this transplantation and provide it a legal cover as well.

In live transplant, according to legislation of various countries only genetically related people or donors with blood relation to patient (like brother, sister, son, daughter) can donate their kidneys for their loved ones. The organ trade is legally outlawed in all but a handful of countries. Even the countries where unrelated donations are accepted follow a strict regulatory protocol, like Iran.

In Pakistan kidney transplantation was introduced in the mid-1980s and currently more than 2,000 transplants are undertaken each year. However, in our country the sense of selflessness that has traditionally motivated organ donation is being rapidly submerged in a tide of commercialism in which “body parts” are being sold in a market controlled by buyers. As Pakistan has no legislation on the issue, the human organ trade is rampant and there is no dearth of medical professionals who tend to justify the trend citing that it helps the poor donors.

According to Dr Farhat Moazam of Centre of Biomedical Ethics and Culture, Pakistan is rapidly establishing itself as an international leader in this practice. She says that in the year 1991, 75 per cent of kidneys transplanted in Pakistan were donated by family members to their relatives. In contrast, by 2003, 80 per cent of all transplanted kidneys in country were being obtained from unrelated donors. “Over half of the 2023 transplantations performed in 2003 were undertaken on citizens of other countries, especially those from the Middle East.

In addition, more than 1,400 of all transplants were performed in private hospitals in Punjab, especially those located in Lahore and Rawalpindi. This burgeoning transplant tourism is no secret; the healthcare community and the government of Pakistan are well aware of the names of physicians and institutions involved in this practice. Those who are in the dark have only to go to the Internet to view “transplant packages” being offered in newspapers around the world by hospitals located in the private sector in Punjab”, Dr Moazzem suggests.

In these advertisements posted on the Internet, foreigners are given a “transplant package cost” that ranges from $1300 to $25,000, and includes the cost of a kidney labelled euphemistically as “donor cost”.

“Based on rough calculations of the number of kidneys being transplanted each year in “foreigners” in this country it is easy to arrive at an estimate of a lucrative business of about $15 million annually for transplant physicians, surgeons, and their hospitals”, she elaborates.

In recent past, newspapers have carried multiple stories about destitute individuals from villages in Punjab who have sold their kidneys to hospitals. Most of these 'donors' are brick kiln workers, caught in a vicious web of loans of kiln owners. They are often bounded labourers and put their body parts for sale to meet some urgent needs like marriage of sister or daughter or medical treatment of some severely ill family member.

According to Dr Farhat a pilot survey was recently conducted in which 70 people from three sites in Punjab, villages from where people are known to sell their kidneys, were interviewed and the findings were ignoble to say the least. Almost all the villagers interviewed were illiterate. Most of the men worked as bonded labourers and their womenfolk were employed in the households of the landowners.

On an average, an individual who sold a kidney was left with a net of around Rs80,000 after paying off the middleman. The majority of the money obtained from this transaction is spent to try and pay off interest on debts owed to landowners. The rest is used to arrange marriages and burials in the family. It was learnt that in some villages 30 per cent of the villagers have only one kidney. Once a kidney is removed in the hospital and the individual sent home, there is no further contact with the hospital.

Besides such donors driven by poverty, there are complaints of kidney thefts in hospitals. A few months back a case in Peshawar was highlighted in the press in which a surgeon was charged with the depriving a child of his kidney. The complainant told that his son was brought to the surgeon who carried out an operation on him at a private hospital. He said that since the boy was not feeling well after the surgery, he took him to a government hospital where they were informed that one of his kidneys had been removed.

Absence of law

World Health Assembly in 1991 had endorsed several “guiding principles” (Resolution WHA 44.25) which all member states (including Pakistan) are expected to follow in formulating policies on organ transplantation. One of the principles states that “the human body and its parts cannot be the subject of commercial transactions,” and that “advertising the need for or availability of organs with a view to seeking payment should be prohibited.”

In the last few years, almost all countries have complied with and formulated laws that criminalise organ trade. Here Pakistan stands alone as the only Muslim country that has failed to pass an organ and tissue transplant law as well as the one dealing with brain death (a prerequisite for instituting cadaveric organ transplantation programmes and decreasing the reliance on living donors). The Transplantation of Human Organs Bill 1992 was presented in the parliament and a Senate Standing Committee approved the bill with several amendments in 1994. However, it is yet to be passed by the parliament. Although various governments tried to take up the issue but no headway is actually made in any direction due to unstated reason. Present government also made claims many times to get this bill passed but nothing is happened yet.

The 1994 bill faces severe opposition by transplant surgeons, who of course have a powerful lobby as the law clearly outlaws the human organ trade. The proposed bill prohibits the live organ donations from the people who are not genetically related to the patient. Even the donation by the spouse, under the proposed law, would be accepted after its approval by a relevant committee, who would see each and every transplantation taking place in the country. The law encourages the cadaver transplant and legalizes the process.

Despite some flaws in the draft law (as the article 7 allows some donation from a person with his express consent without clearly referring to article 3 and vagueness in defining the 'good faith' as article 9 protects the acts of some person done in good faith, lack of complaint and redress mechanism and very low penalty, which is only 3 years RI for the culprit etc etc) it is overall a very good Act, which, if passed and implemented, would definitely check the illegal organ trade.

Why Pakistan should not be offering medical tourism?

Medical tourism can be seen in Pakistan's blind run to the market after it liberalized its health related services sector more as compared to its counterparts in South Asia.

Some quarters also validly fear that profitable private-sector medical tourism will add to ever decreasing public health services. It will further undermine the equity by providing health services to visitors, scarce public resources and personnel will be reallocated away from much needed public health institutions and programs. The local population will not be provided with access to quality health services.

Pakistan already lacks human resource in medical sector. There are 123, 000 doctors for 16 million people and brain drain ration from this sector is also very high. Skilled human resource in medical sector is flying out of the country and the promotion of medical tourism in the country would further undermine the equity and the local populace would have to invest more time and money to find a doctor for even simple treatment

What is medical tourism?

Medical tourism, a 'rising star', is fast becoming a worldwide multibillion-dollar industry and offers great promise in generating foreign exchange earnings, cultural harmony, transfer of technology and skills for the country.

In general, there are three types of products that comes under medical tourism

i) Wellness (massage, herbal treatment, spas, meditation etc.)

ii) Treatment (elective surgery, cosmetic surgery, joint replacement, cardiothoracic services, eye surgery, diagnostic services, cancer treatment etc.)

iii) Rehabilitation (dialysis, addiction and elderly care programs etc.)

Hi-tech healing is a type of medical tourism products that specifically require advance technology for treatments (such as cosmetic surgery, dialysis and kidney transplant refractive surgery, vascular surgery etc.).

Asian countries are promoting the hi-tech healing and medical tourism exploiting the high healthcare cost in Europe and USA. India is promoting the 'high-tech healing' of its private healthcare sector as a tourist attraction. India has established world-class expertise in practices such as cardiac care, cosmetic surgery, joint replacements and dentistry. Interestingly in the early 1990s, foreigners travelled to India for kidneys but this trend decreased dramatically after 1994 following passage of the Indian Transplant Law criminalizing this practice. Now Pakistan is the main kidney street for people of Gulf, USA, Europe and Central Asian States.