HC sets out guidelines for kidney donation

The High Court (HC) in a verdict has set out guidelines for donating kidney to known persons on emotional grounds in order to ensure check and balance as well as reducing the possibility of illegal kidney trade.

The verdict is now available on the Supreme Court (SC) website, which stipulates that the donor must give his kidney to the recipient under a well-regulated legal regimen.

The HC bench, comprising Justice Moyeenul Islam Chowdhury and Justice Khandaker Diliruzzaman, on December 5 declared the verdict in an open court. Copy of the verdict details were released on the SC website Thursday after the judges put their signature on the verdict copy.

“We  may  profitably  refer  to  the  Transplantation  of Human  Organs  and  Tissues  Rules,  2014  of  India wherein  some  guidelines  on  how  the  Authorisation Committees  in  India  regulate  emotional  donation,” the copy of the verdict said, adding “We, in Bangladesh, can adopt the guidelines which are spelt out as follows:

(a) Evaluate  that  there  is  no  commercial transaction between the recipient and the donor  and  that  no  payment  has  been made  to  the  donor  or  promised  to  be made to the donor or any other person; (b) Prepare an explanation of the link between them and the circumstances which led to the offer being made; (c) Examine the reasons why the donor wishes to donate; (d) Examine the documentary evidence of the link; (e) Examine  old  photographs  showing  the donor and the recipient together; (f)Evaluate  that  there  is  no  middleman  or tout involved; (g) Evaluate the financial status of the donor and the recipient by asking them to give in support of their vocations and the income for the previous  three financial  years  and  any  gross  disparity between  the  status  of  the  two  must  be evaluated    in    the    backdrop    of    the objective    of    preventing    commercial dealing; (h) Ensure that the donor is not a drug addict; and (i) Ensure  that  the  near  relative  or  if  near relative is not available, any adult person related to the donor by blood or marriage interviewed  regarding  awareness  about his/her   intention   to   donate   an   organ/ tissue,   the   authenticity   of   the   link between the donor and the recipient, and the  reasons  for  donation,  and  any  strong views  or  disagreement  or  objection  of such kin shall also be recorded and taken note of.

Besides, we think, there should be an evaluation of the mental health of the donor and the Authentication Board will have to apprise the intended donor of the possible adverse effects, if any, of kidney donation.”

If following  the  above-mentioned  guidelines,  the  authenticity  of  an emotional  donation by a known or related donor (but  not  unknown  or unrelated)  is  ascertained  rigorously by the Authentication  Board,  there  will be  a  check  and  balance  and  the  possibility  of  illegal  kidney  trade  will  be greatly  minimised.

In its observation, the HC bench said that the wholesale altruistic donation as prevalent in some countries of the world such as the United Kingdom, United States of America, India and France will not also be compatible with the socio-economic and cultural realities of Bangladesh.

If the definition of pool of donors (close relative)  is  expanded without  any  restriction  whatsoever,  that  will  definitely  spur  the  illegal kidney  trade  in this country to an  unimaginable extent. Hence, the HC bench observed, any wholesale expansion of the definition of pool of donors (close relative) cannot be countenanced.

In  Iran,  there  is  a  regulated  market  of  sale  of  various  human  organs including  the kidneys. In that country, kidney donors are compensated by the government. Now  kidney  transplants  are  carried  out on  a  massive  scale there  to  meet  the  growing  demands  of  end-stage  renal  patients.

In  the  1st place, Bangladesh being a resource-constraint country cannot afford  to  pay  compensation  to  each  and  every  kidney  donor at the moment.

Secondly, a regulated market of sale of various human organs including kidneys as found in Iran, in the eyes of the HC, will not be welcomed by the people of Bangladesh, lest the illegal organ trade flourishes here. Even if the ABO-incompatible   kidney   transplant   is   practised   in Bangladesh to an appreciable extent, that is unlikely to improve the overall scenario and reduce acute kidney shortage.

However, having regard to the growing number of kidney patients and especially the end-stage renal patients, a sort of mechanism must be evolved to provide succour to them, said the HC bench.

In this connection, it may be recalled that there is an annual demand of around 5,000 kidneys for transplantation; “but in reality, we get only 120 to 130 kidneys for transplantation. So, a large number of end-stage renal patients with recipients go abroad for kidney transplantation resulting in illegal flow of money.”

Again, many end-stage  renal  patients depend  on  costly  dialysis  and  most  of  them,  due  to financial  stringency, discontinue dialysis within three years or so – resulting in their eventual death. So this state of affairs cannot be allowed to continue ‘sine die’. Under  the circumstances, “we  think,  only  emotional  kidney  donation  by  a  related  or known  donor  (but  not  altruistic) can be permitted by making necessary amendments to the law.

But in order to determine and verify the authenticity of such emotional donation, there should be an inquiry in line with the guidelines.

The HC verdict directed the government to take steps in order to make further amendments to the Act No. 05 of 1999 and the Rules of 2018 in the light of the observations, guidelines and findings made and recorded in the body of this judgment within 6 (six) months from the date of receipt of a copy of this judgment.

The HC bench came up with the verdict following a writ petition filed by Fatema Zohra, the mother of a kidney patient, in 2017 challenging the constitutionality of Sections 2 (ga), 3 and 6 of the Organ Transplantation Act 1999 (amended in 2018) that only allows the donation of human organs among the related persons and the near-related persons.

Fatema had donated a kidney to her ailing daughter Fahmida, but the kidney got damaged after a year. Then, she managed a donor for her daughter, but the donor could not donate the kidney due to the bar in the law.

Later, the woman submitted the petition to the HC, seeking necessary order on the issue.

 

HC sets out guidelines for kidney donation

The High Court (HC) in a verdict has set out guidelines for donating kidney to known persons on emotional grounds in order to ensure check and balance as well as reducing the possibility of illegal kidney trade. The verdict is now available on the Supreme Court (SC) website, which stipulates that the donor must give his kidney to the recipient under a well-regulated legal regimen. The HC bench, comprising Justice Moyeenul Islam Chowdhury and Justice Khandaker Diliruzzaman, on December 5 declared the verdict in an open court. Copy of the verdict details were released on the SC website Thursday after the judges put their signature on the verdict copy. We may profitably refer to the Transplantation of Human Organs and Tissues Rules, 2014 of India wherein some guidelines on how the Authorisation Committees in India regulate emotional donation, the copy of the verdict said, adding We, in Bangladesh, can adopt the guidelines which are spelt out as follows: (a) Evaluate that there is no commercial transaction between the recipient and the donor and that no payment has been made to the donor or promised to be made to the donor or any other person; (b) Prepare an explanation of the link between them and the circumstances which led to the offer being made; (c) Examine the reasons why the donor wishes to donate; (d) Examine the documentary evidence of the link; (e) Examine old photographs showing the donor and the recipient together; (f)Evaluate that there is no middleman or tout involved; (g) Evaluate the financial status of the donor and the recipient by asking them to give in support of their vocations and the income for the previous three financial years and any gross disparity between the status of the two must be evaluated in the backdrop of the objective of preventing commercial dealing; (h) Ensure that the donor is not a drug addict; and (i) Ensure that the near relative or if near relative is not available, any adult person related to the donor by blood or marriage interviewed regarding awareness about his/her intention to donate an organ/ tissue, the authenticity of the link between the donor and the recipient, and the reasons for donation, and any strong views or disagreement or objection of such kin shall also be recorded and taken note of. Besides, we think, there should be an evaluation of the mental health of the donor and the Authentication Board will have to apprise the intended donor of the possible adverse effects, if any, of kidney donation. If following the above-mentioned guidelines, the authenticity of an emotional donation by a known or related donor (but not unknown or unrelated) is ascertained rigorously by the Authentication Board, there will be a check and balance and the possibility of illegal kidney trade will be greatly minimised. In its observation, the HC bench said that the wholesale altruistic donation as prevalent in some countries of the world such as the United Kingdom, United States of America, India and France will not also be compatible with the socio-economic and cultural realities of Bangladesh. If the definition of pool of donors (close relative) is expanded without any restriction whatsoever, that will definitely spur the illegal kidney trade in this country to an unimaginable extent. Hence, the HC bench observed, any wholesale expansion of the definition of pool of donors (close relative) cannot be countenanced. In Iran, there is a regulated market of sale of various human organs including the kidneys. In that country, kidney donors are compensated by the government. Now kidney transplants are carried out on a massive scale there to meet the growing demands of end-stage renal patients. In the 1st place, Bangladesh being a resource-constraint country cannot afford to pay compensation to each and every kidney donor at the moment. Secondly, a regulated market of sale of various human organs including kidneys as found in Iran, in the eyes of the HC, will not be welcomed by the people of Bangladesh, lest the illegal organ trade flourishes here. Even if the ABO-incompatible kidney transplant is practised in Bangladesh to an appreciable extent, that is unlikely to improve the overall scenario and reduce acute kidney shortage. However, having regard to the growing number of kidney patients and especially the end-stage renal patients, a sort of mechanism must be evolved to provide succour to them, said the HC bench. In this connection, it may be recalled that there is an annual demand of around 5,000 kidneys for transplantation; but in reality, we get only 120 to 130 kidneys for transplantation. So, a large number of end-stage renal patients with recipients go abroad for kidney transplantation resulting in illegal flow of money. Again, many end-stage renal patients depend on costly dialysis and most of them, due to financial stringency, discontinue dialysis within three years or so resulting in their eventual death. So this state of affairs cannot be allowed to continue sine die. Under the circumstances, we think, only emotional kidney donation by a related or known donor (but not altruistic) can be permitted by making necessary amendments to the law. But in order to determine and verify the authenticity of such emotional donation, there should be an inquiry in line with the guidelines. The HC verdict directed the government to take steps in order to make further amendments to the Act No. 05 of 1999 and the Rules of 2018 in the light of the observations, guidelines and findings made and recorded in the body of this judgment within 6 (six) months from the date of receipt of a copy of this judgment. The HC bench came up with the verdict following a writ petition filed by Fatema Zohra, the mother of a kidney patient, in 2017 challenging the constitutionality of Sections 2 (ga), 3 and 6 of the Organ Transplantation Act 1999 (amended in 2018) that only allows the donation of human organs among the related persons and the near-related persons. Fatema had donated a kidney to her ailing daughter Fahmida, but the kidney got damaged after a year. Then, she managed a donor for her daughter, but the donor could not donate the kidney due to the bar in the law. Later, the woman submitted the petition to the HC, seeking necessary order on the issue.