Dhaka, Bangladesh
Transplantation of Human Organs Bill 2018

Transplantation of Human Organs Bill 2018

The Jatiya Sangsad that on Tuesday passed the "Transplantation of Human Organs (Amendment) Bill, 2018" will ease sufferings of patients and their relatives in organ transplantation, help physicians expand tertiary medical service and bring back a sound system in the health services, said Professor Dr Kamrul Islam, Managing director of Center For Kidney Diseases and Urological Hospital. The "Transplantation of Human Organs (Amendment) Bill, 2018" has also aimed at providing with better health services riding on the improvement in technology and medical science in the country. At present, several thousand patients and their relatives go to India to transplant human organs (kidney, heart and lever) as the previous law was very complicated and thorny that did not allow transplantation of human organs beyond certain relations. Health and Family Welfare Minister Mohammad Nasim moved the bill in the House for passing it to improve the country's medical facilities and services with the unfolding of science and using latest technology. Placing the bill, he said the bill has a provision of three years of rigorous imprisonment or Taka 10 lakh fine or both for violation of the law, aiming to check the illegal trade of human organs. According to the bill, no hospital can conduct human organ transplantation in the country without government's approval while the public hospitals having specialised units in this regard can do the job without taking prior approval. Private hospitals have to apply to the authorities concerned to do the job within 60 days of enactment of the law. As per the proposed law, there will be a medical board in every hospital for deciding the transplantation matter and a National Cadaveric Committee to oversee the human organs transplantation in the country. According to the proposed law, any organ transplantable to the human body, including kidney, liver, bone, eye, heart, lung and tissue, could be transplanted after their collection from human bodies having heartbeats or in active with life support for transplantation purpose. Any doctor convicted under the law will lose his or her registration with Bangladesh Medical and Dental Council. As per the new proposed law, a National Cadaveric Committee will be constituted with Vice Chancellor of the BSMMU as its Chairman to oversee the human organ transplantation, visit transplantation activities as well as to advise the government regarding human organ transplantation. Later the bill was passed by voice votes with Speaker Dr Shirin Sharmin Chaudhury in thechair. The government should mull over constituting a high-powered committee comprising former judges, physicians, journalists, bureaucrats, police personnel and lawyers who will monitor the process of kidney donors and recipients to prevent irregularities in the kidney transplant process, said Professor Dr Kamrul Islam, Managing director of Center For Kidney Diseases and Urological Hospital. He has expressed concern that some vested and influential quarters are reportedly engaged in buying and selling of kidneys by alluring some poor people to sell their kidneys. The high-powered committee can prevent unethical and illegal selling and buying of kidneys and bring back healthy and normalcy in the kidney transplant. The government should mull over a broader and inclusive policy on the kidney transplant in Bangladesh as the number of chronic kidney patients is on rise, said Professor Dr Kamrul Islam, Managing director of Center For Kidney Diseases and Urological Hospital The kidney dialysis is not only expensive, but also cumbersome, said the doctor. Doctors say over 200 kidney transplants were performed annually in the last few years at the 10 government and private hospitals approved by the ministry for carrying out such procedures. BSMMU, Birdem hospital, National Institute of Kidney Diseases and Urology, Kidney Foundation, Dhaka Medical College Hospital, Chittagong Medical College Hospital, Shyamoli Center for Kidney Diseases and Urology Hospital, Apollo Hospital, United Hospital and Popular Medical College and Hospital have successfully implanted kidney transplants. However, the cost of kidney transplant is comparatively less at BSMMU at Shahbag, Center For Kidney Diseases and Urological Hospital at Shymoli and Kidney Foundation at Mirpur. The cost of kidney transplant is taka 160,000 at BSMMU while the same at private CKD is taka 185,000. Professor Kamrul Islam, a surgeon trained in the United Kingdom, successfully transplanted as of November 97 kidneys transplant at his clinic at Shymoly this year. He has successfully transplanted some 500 kidneys in the last few years. If a chronic patient successfully goes under kidney transplant , he or she does not need dialysis in rest of his or her life. Every-year a good number of patients go to India to transplant their kidney spending millions of US dollars. Every kidney transplant cost at least taka 10-15 lakh taka in India, taka 20-25 lakh taka in Thailand and taka 30-40 lakh taka in Singapore. Corporate and business houses in Bangladesh should support kidney treatment as many poor and middle-class patients are becoming bankrupt bearing the cost of kidney treatment in Bangladesh, said Professor Kamrul Islam, a leading kidney transplant surgeon. The cost of kidney treatment is reasonable at BSMMU, Kidney Foundation, Gonoshasthya Nagar Hospital, NIKDU and Center For Kidney Diseases and Urological Hospital at Shymoli. A professor of the urology department of the BSMMU has viewed that the government should form a high-powered committee comprising leading physicians, surgeons, nephrologists and urologists on the kidney treatment and transplant. Center For Kidney Diseases and Urological Hospital has gained the confidence thousands of kidney patients over the years as this institute offers treatment at most competitive cost in Bangladesh at Shymoli. According to BSSMU, about 1,600 kidneys have been replaced at the 10 approved hospitals in 34 years until 2016. Every year, around 45,000 patients are registered as patients suffering from kidney related diseases. According to an estimate the cost of kidney replacement is between Tk2-5 lakh in Bangladesh, some private hospitals, which are approved by the government for doing transplants, are doing it for a much higher cost. "Risk of death of from kidney disease is 10 times higher than death from heart attack. The law's provision for relatives donating organs to patients will ensure safety, but the law should not act as a barrier for patients who fail to manage organs from relatives," said Bangladesh Medical Association President Dr Mustafa Jalal Mohiuddin. According to the draft law, if a person gives false information about the donor, they can be punished with a maximum of two years of rigorous imprisonment or a maximum penalty of TK5 lakh or both. In addition, violating any of the other sections of the law, or for aiding or abetting anyone else to do so, can result in a maximum penalty of 3 years' rigorous imprisonment and a fine of TK10 lakh or both. If a physician is convicted of this act, they will lose their licence. The law states that without government approval, no hospitals can conduct human organ transplantation in the country. It, however, also stipulates that public hospitals with specialised transplantation units can do the job without taking any approval. In an effort to develop treatment services and to prevent illegal organ trade, on July 17, 2017 the cabinet approved a draft law expanding the list of relatives who can donate organs to a person. The draft also mentions stricter rules to check organ trafficking and trade. Once the law is enforced, grandparents, grandchildren, and first cousins would be able to donate organs. The existing law allows only parents, spouses, children, siblings and blood-related aunts and uncles to donate. This, move, however, may not suffice. Professor AK Azad Khan, president of the Diabetic Association of Bangladesh, told the Dhaka Tribune: "The sale of any human organ is illegal in Bangladesh, but the government needs a high powered committee to address the issue so that illegal trading is identified." "Although the amended law may help reduce the illegal trade somewhat, it may also become problematic for many patients. If they cannot manage organ from close ones, how will they get organs?" he explained. Doctors feel that desperate patients may now resort to passing off unrelated donors as relatives as it would be difficult for hospitals to verify the recipient's true relationship with the donor. For over a decade, illegal trade of organs has reportedly been going on in as wealthy recipients and brokers convince poor and illiterate people to sell their organs by making false promises of money, jobs and travel to foreign countries. According to a 2017 report by Global Financial Integrity (GFI), entitled "Transnational Crime and the Developing World", a kidney is available for as little as $2,000 (around Tk160,000) in Bangladesh. Although dealing in organs is illegal in Bangladesh, many poor people, particularly from rural areas, are compelled to sell their organs primarily to settle debts or for brief moments of financial respite, states the report. It suggests that out of around 120,000 organ transplants in 2014, approximately 12,000 were illegal. Two-thirds of these illegal transplants were of kidneys, followed by liver, heart, lung and pancreas transplants, respectively. "Once the law is enforced, grandparents, grandchildren and first cousins will be able to donate organs while the existing law allows only parents, spouses, children, siblings and blood-related aunts and uncles to donate. It is expected that the crisis of organs may decline as the number of donors have been increased," says Bangabandhu Sheikh Mujib Medical University Vice Chancellor Kamrul Hasan Khan. However, Sandhani National Eye Donation Society President Professor AKM Salek said the law did not go far enough to solve the crisis. "Complying with this law is difficult as cases show organs are matched with family members in only 50% of cases," he said. "There are cases when people want to donate a kidney to a friend or someone else for humanitarian reasons. But the law creates a barrier." The expert suggested that the government form a strong monitoring committee to stop illegal organ business. Prof Zulfiqar Rahman Khan, chairman of surgery department of Bangabandhu Sheikh Mujib Medical University (BSMMU) hailed the law saying it would bring discipline in organ transplants. With the enforcement of the law, doctors would not be blamed anymore for illegal transplant of organs and it would bring transparency to the process. Prof Zulfiqar, the president of BSMMU Teachers Association, lauded the extended list of family members who could donate organs. The recent amendment to the draft Transplantation of Human Organs Act, 2017 is not only unlikely to stop illegal trade of human organs but may well cause a new problem for doctors, claim experts. With nearly 20 million of Bangladesh's 160 million people suffering from some form of kidney disease, and given the rise in the spread of chronic kidney diseases, the country's highest number of organ transplant surgery is, naturally, kidney transplants. Experts say that Bangladeshis spend an estimated Tk300cr annually for kidney transplants abroad, as the procedure is still rather restricted in Bangladesh. As per the "Transplantation of Human Organs Act-2017", organ removal for transplant and transplant cannot be done without the government's consent in any hospital, Additional Cabinet Secretary Ashraf Shameem told reporters after the weekly cabinet meeting at the Secretariat. However, public hospitals with specialised units could transplant without government approval, he said.

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