Dawood Ibrahim
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Organ trafficking: doctors, police and middlemen
A vast network of players sustains the kidney trade racket.
NAZIHA SYED ALIUPDATED about an hour ago
Sometime last October, Allah Wasaya, a labourer in Karachi, sold his only valuable possession, a small house in Future Colony, Landhi, for Rs1,700,000 to buy a kidney for his eldest son, 32-year-old Mohammed Afzal. The young man had been suffering from kidney problems for some years. Allah Wasaya himself had high blood pressure and his wife had a different blood group which made them unfit as donors. Their other son, who had refused to donate his kidney to his brother, was so angered by the sale of the house that he severed his ties with his family.
Around Nov 14, Mohammed travelled by train to Rawalpindi. There he was met by Amir, an ‘agent’ or middleman of the kidney trade, who drove him in a Suzuki van with tinted windows to a house about 30 minutes away where he was to stay for the next few days. “No one else seemed to be living there,” said Mohammed. “Amir would bring me my meals. He’d say ‘don’t go out, don’t talk to anyone, there’s a lot of sakhti by the government. If you get caught, it’ll be difficult to get out of it’.”
Mohammed underwent several tests including a CT scan on Nov 15 and cross-matching on Nov 19. On the latter occasion, he met Hassan, a bonded labourer from Hafizabad who would end up becoming his donor. “He was about my age and was there with his wife,” said Mohammed. “I asked him why he was selling his kidney. He told me he wanted to put the money towards buying a house.”
This is the sordid reality of Pakistan’s organ trade, where one individual’s desperation to regain health meets corresponding desperation arising from dire poverty. This need not be the case if government health authorities set up a deceased organ donor programme (see box), which is a viable and ethical alternative to preying on the most disadvantaged sections of society. But as long as organ trafficking continues with impunity, bringing fortunes to well-connected individuals in the medical community and the other players in this racket, there is little incentive to do that, or even to implement the law against the practice.
A second chance at life
An estimated 50,000 people die each year in Pakistan from end stage organ failure. Deceased organ donation can give patients suffering from failing organs a second chance at life. The Transplantation Society of Pakistan explains deceased organ donation as “acquiring organs from a person after death to be transplanted into other persons who are dying from organ failure, in order to save their lives. It is an established medical procedure and is considered as an act of profound generosity.”
Unfortunately, in a country of over 200 million plus people, there have so far been only seven deceased organ donors, the most well known of them being Abdul Sattar Edhi. Their organs were transplanted into deserving patients, each of whom could now, by virtue of a stranger’s altruism, live a fuller life. Sri Lanka, with one-tenth of Pakistan’s population, has so many deceased cornea donors that they export surplus corneas to other countries. In 2014, its Eye Donation Society exported 850 corneas to Pakistan.
Many in Pakistan are either unaware of the concept of deceased organ donation or have reservations about it on religious grounds. However, a number of religious scholars, including those from Pakistan, have issued fatwas in support of the procedure, which is carried out in a number of Muslim countries including Saudi Arabia, Egypt, Jordan, Morocco, etc.
For more information about deceased organ donation, and to become a donor, click here.
Organ trafficking was criminalised in Pakistan first by the Transplantation of Human Organs and Tissues Ordinance in 2007, followed by the Transplantation of Human Organs and Tissues Act 2010. According to the law, organ donation must be “voluntary, genuinely motivated, not under duress or coerced”: if a donor is not available within a patient’s immediate family (parents, siblings, spouse and offspring), then “a non-close living blood relative” can be a donor provided no financial consideration is involved. Only in very special circumstances — such as unavailability of a family donor — can a non-related person donate an organ, but after a thorough evaluation process to ensure that he/she is doing so on a voluntary basis.
Most illegal transplants, almost invariably of kidneys, are known to take place in Punjab, specifically in Rawalpindi, Lahore and Islamabad. Although the incidence of illegal kidney transplants fell sharply from an estimated 2,000 per year before the 2007 ordinance, it began to rise again in the wake of weak implementation.
On Sept 16, 2016, Dawn carried an expose of organ trafficking titled ‘Of human organs, desperate poverty and greed’. This is the sequel to that story.
COVERING THEIR TRACKS
Close to midnight on Nov 20, five days after he arrived in Rawalpindi, Amir drove Mohammed to a large, double-storey building — a “kothi” as he described it — that seemed to be a long distance away. He was prepared for his surgery and taken straight into the operating theatre. His transplant took place in the early hours of Nov 21. Mohammed claims he never met the surgeon but had been told he would be coming from Lahore. His patient file, however, is that of Heart International Hospital in Rawalpindi. Although the documents do not mention the word ‘transplant’, the cross match test result notes the patient name as “M. Afzal + Ghulam Hassan”. And the name of the referring clinician? Dr Khalid Farooq, the urologist at Heart International Hospital.
Mohammed said he had no idea of the location of the building where his operation took place, only that the drive was around two hours long. There are two blood test reports among the documents in his file, one dated Nov 21 and the other Nov 23, the period immediately following his transplant. Both have been issued by Wahid Clinical Laboratory, located in Abbottabad. It takes about two hours to drive from Rawalpindi to Abbottabad.
There are more indications of attempted subterfuge. The documents in his file also include a sheet of paper with a detailed record of the medication administered to him. The top of the page has been carefully torn off, apparently to avoid revealing the printed header. At the bottom, however, is an address: Behind Al-Najam Plaza, Mandian Abbottabad.
That, it turns out, is the address of a hospital named Al-Shifa. In any case, whoever was taking these precautions failed to notice that the test reports from Wahid Laboratory in Abbottabad say that the patient, Mohammed Afzal, was referred by Al-Shifa Hospital.
Last August, the Supreme Court took suo moto notice of a letter written by Dr Adib Rizvi of the Sindh Institute of Urology and Transplantation (SIUT), in which he had said that transplant tourism — in which kidney patients living abroad visit Pakistan for the purpose of transplantation with vended organs — was earning the country a bad name. SIUT, Karachi’s leading public sector hospital in the field of kidney transplantation, is in the forefront of the campaign to promote ethical, legal transplantation in Pakistan. In his letter, Dr Rizvi had cited Rawalpindi’s Kidney Centre, also known as Al-Sayed Hospital, as a major offender in this context and reproduced emails from overseas urologists to support his claim.
Located on an elevation alongside GT Road in the city where the armed forces medical corps is headquartered, the Kidney Centre has been the subject of at least a couple of police raids in the past. But the owner, retired Colonel Dr Mukhtar Hamid Shah, and his sons Drs Tauseef and Zahid Mukhtar Bukhari are well connected within the power elite. That, and their financial clout, had managed to thus far ensure that matters never came to a head.
On August 30, during a stormy hearing of the suo moto case at the SC in Islamabad, high-powered lawyers for the Kidney Centre demanded that Punjab Police be restrained from delving into their client’s internal records. The apex court had directed the police to look into the allegations against the medical facility.
Al-Rehman Plaza in Rawapindi where the 24 detainees had been confined.— Photo by writer
Unknown to the judges presiding over the case in Islamabad, the very same day in Rawalpindi’s Bahria Town, in a red and gray multi-storey building named Al-Rehman Plaza, several individuals were being held captive in five flats for the purpose of harvesting their kidneys. Almost all of them were bonded labourers, and had been brought to the location at different times; some had been lured by the promise of employment. According to the building owner, Zafar Iqbal, the space had been rented to the same tenants since 15 months. “I was told it was needed to house the male staff of Al-Syed Hospital, and that it was convenient because the hospital isn’t far and they sometimes have to do night duty.”
When police raided the building at 5.30pm on Oct 15, they found 24 individuals inside — 20 men and four women. The period of their captivity ranged between one to three months. There would have been two more men there, but they had been taken that very morning to have their kidneys removed. “I was held captive for a month, during which they ran tests on me eight or 10 times,” recalled one of the detainees named Bashir, 29. “They used to take us to the Kidney Centre for the procedures.”
Mohammed Bashir, one of the 24 who were detained in Al-Rehman Plaza.— Photo by writer
He told Dawn that everyone’s cell phones had been taken from them when they were brought to the plaza. “We were instructed not to go near the windows or call out to anyone passing because this was an army area and the police would think we were terrorists and kill us.” For an illiterate farmhand from Kasur, that did not seem a far-fetched notion. Ironically, Al-Rehman Plaza, which lies on a main road in the upmarket locality’s commercial area, overlooks a private zoo with caged deer and other animals.
The recovery of the 24 individuals caused a furore.
The police went up these stairs at the rear of the building when they raided the apartments.— Photo by writer
Among those arrested were building owner Zafar Iqbal and Kidney Centre employees Faqeer Hussain alias Faqeeria, Shahzad Qayyum alias Shani, and Bilquis Hussain. An investigation has been launched into the circumstances surrounding the people’s detention and their allegations that the Kidney Centre was involved in organ trade. The three doctors named in the FIR, retired colonel Mukhtar and his sons Zahid and Tauseef, disappeared. They have applied for bail before arrest.
However, Mohammed’s transplant in Abbottabad on Nov 21 illustrates that despite the media coverage of the Kidney Centre detainees’ case and the fact that the issue of organ trafficking is in the Supreme Court, the lucrative business continues in the country.
Some of the detainees waiting to give evidence in court.— Photo by Syed Yasir Shah Tirmizi
On Nov 25, four days following his operation, Amir the agent put Mohammed on a flight to Karachi from Islamabad and told him to get his follow-up visits done at a private hospital, an impossible proposition for a man working as menial labour. But things were about to get much worse. A few days after he returned home, now living in a rented house with his family, Mohammed began passing blood in his urine. When doctors at Liaquat National Hospital told him his transplanted kidney was failing, his father brought him to SIUT where surgeons had to extract the non-functional organ. Mohammed is now back on dialysis.
“We keep transplant patients in hospital for eight or nine days at the very least,” said Dr Rizvi who heads the transplant programme at SIUT. “To send him back on a plane, alone, given his low immunity, was asking for trouble. By the time he came to us, he had high fever and was nearly at death’s door. It was also a case of a very bad transplant.”