By Alleh Okpeh Alleh Esq
Medically, organ transplantation is a scientific process in which an organ is removed from a donor and placed in a recipient. It is usually done to replace a damaged or missing organ in the recipient. It could be by a process of autograph wherein the organ or tissue is gotten from and implanted within a same body or allograft – the organ or tissue is gotten from and implanted in same species. In any of these instances, the organ or tissue may originate from a living being or a dead source medically referred to as cadaver or stored corpse. In the ordinary understanding, a cadaver is the remains of a dead human being that may be used by doctors and other scientists in the study of anatomy (the contents of the human body), identify disease sites, determine causes of deaths and provide tissues to repair a fault in a living human being.
Scientifically, organs or tissues that have been successfully transplanted in currently accepted methods of treatment includes the heart, kidneys, liver, lungs, pancreas, intestine, thymus or simply the thyroid gland or lymphocytes (medically called) located within the chest cavity and which produces immune cells by way of white blood cells which fight infections, and the uterus. Among the tissues that are successfully transplanted includes bones, corneae or the eye cover, skin, heart valves (sometimes by way of bye pass), nerves and veins. In all of these organs and tissues, those with the highest demand are the kidneys, the liver and the heart while cornea and the tendons makes that of the tissues.
In the science of organ transplantation, donors may be dead or living persons. Living persons make donations either willingly for free or for compensation which is outlawed. Donors however, are never to be either coerced or manipulated into donating. In the case of dead donors, these are persons who, either before death, make an undertaking for their organs or tissues to be harvested for those whose organs could be harvested upon death and such processes from dead donors are made from persons who are either brain dead or certified circulatory dead. Needed organs of dead donors can be harvested within 24 hours after cessation of heartbeat and tissues with the exception of corneae can be harvested and stored for up to 5 years unlike the case of organs.
In other words, storable tissues can be banked within the appropriate period and used when they are needed. The essence of the fore explanations is for the literal audience to have a layman assimilation of the topic so as to appreciate the objective of the discussion and the social-legal challenges confronting the development.
The question then is, what is the cultural context of the process of organ transplantation in the country today? We understand cultural context in a broad sense to encompass the current moral, social psychological, legal and ethical challenges confronting the process. With the decay being witnessed in the country and which affects all societal spheres, the organ transplantation sector will not be an exception. The essence and objective of organ transplantation can be deduced from the simple definition ascribed to it. Organ transplantation has being adjudged to be the best therapy for terminal and irreversible organ failures in man. Accordingly, it has been established that successful organ transplantations save lives in patients affected by terminal organ failures and improve their quality of life. How this process is done in any society forms the basis of the challenges it face and Nigeria inclusive.
One of the guiding principles upon which this medical feat is based is that of respect for human autonomy by which the organs are sourced. Donation is generally a decision to donate in an entirely voluntary response devoid of coercion, manipulation or undue influence. However, in contrast to this underlining principles, the supply of organs has been highly commercialized such that in Nigeria today, it has become a practice where donors do so under some subtle form of coercion while, in some cases, economically dependent families on victims see it as a service to render to their benefactor. In some other cases, spouses of patients see it as an obligation to survive the partner and, above all, the current economic hardships has turned the practice into a commercial venture where people prefer to risk the donation and leap into affluence of some sort than to live in perpetual penury. This is in spite of the fact that practitioners are supposed and assumed to have provided the donor with clear and adequate information on the dangers involved, including the long and short term risks and the opportunity to withdraw consent at any time.
A story is told a few years ago where a political figure in Nigeria came down on kidney failure. The wife prevented her children from donating the kidney and the lot then fell on one of his aides who were healthy and young to save his master and, of course, they did. A little after, the particular young donor came down with some complications suspected to be related to the donation, dying off shortly after while the political master is still alive, hale and hearty. There is the pressure all across the world on donation because the demand for organs has far outstretched the available donors. This upsurge in the demand chain gave rise to commercialization of the practice and the creation of organ market resulting in trafficking in organs and donors especially across the developing countries to the developed world.
The unfortunate thing is that even aside the crime and damage done to this noble principle, the victims are the poor donors as most of the payments accrue to the middle men and the scrupulous professionals. Across the poor and developing countries, Nigeria inclusive, the rich and unscrupulous professionals create this chain of organ black markets to poach on donors who are paid paltry sum while they smile to the bank. Though this practice is condemned and being fought across the world, it has become a lucrative business across the third world and poor countries and efforts being made to control it is not yielding the expected results.
As the need for organ donation increases with the increase in organ failures across the world, so is the challenge of fouling the principle upon which the medical feat and principle was based. Many professionals have spoken about the existence of rings of organ mafia made of middle men and professionals who run the cartel of sourcing and convincing donors whose main reason for donation is purely commercial and exploitative. Lagos, Abuja, Port Harcourt and Owerri have been mentioned in several studies.
It should be noted that organ transplantation has not taken full root in the country and the program need to be encouraged and developed using comprehensive health care policy where government, professionals and individuals are involved. Currently there are a few foundations that are involved in footing bills and sourcing funds for indigent victims or recipients. Thus there should be a comprehensive national donor policy and legal framework which is not fully developed yet. In the West and other developed countries where such policies exist, the major sources of organ supply is the cadaver supply policies. Here, there are standing policies wherein organs of dead persons are harvested for the purpose of transplantation to needy patients. This has greatly enhanced the sustenance of supply in those countries.
In those countries with comprehensive organ transplantation policy, the major source of organ supply is by harvesting that of dead persons as stated earlier. In such countries, persons while alive are expected to document their consent to have the organ harvested upon death and as appropriate, the doctor is made to harvest such organs with due diligence, with particular reference to consent of relatives where applicable and respect for the body of the dead, doing it without undue mutilation. Here, it is equally expected that as with the case of a living donor, consent should be freely given without any form of pressure or inducement. In some countries, there is the presumption that all citizens consent to donating and harvesting of their organs upon death except where such person expressly declined the practice by documentation. Where there is no such documentation, the organ is appropriately harvested and used. But even with the level of advancement in development in those countries, there are still issues of religion, moral and ethical challenges faced by the policy. Therefore, every action to be taken towards developing such policy in Nigeria will not be devoid of such challenges in relation to respect for the dead, religious, cultural and moral consideration.
In most African communities, religion and culture have serious regard for the dead and a strong belief in reincarnation, especially the aspect that frowns at distortion of body parts because the dead will manifest such distortions upon his or her reincarnation. It is assumed that if, for instance, the womb or uterus of a dead woman is removed, the reincarnate will be barren as a result of that. The same applies to if the eye or heart or kidneys were removed. There is equally the cultural belief that using the organ of the dead is unhealthy and a taboo because the dead spirit will be hunting the recipient hence the tendency to die from spiritual vengeance will be high. As a result of this, recipients may be reluctant to use organs of the dead. Other considerations for concern will be in the area of medical competence as to effectively determine at which point one can be said to have died considering the temptation to fraudulent actions by many Nigerians. The fear will be if doctors won’t arbitrarily declare a person dead even when he could be revived, with the aim of harvesting the organs. Such issues are not new in Nigeria as nurses have severally been accused of exchanging babies based on desire for certain gender or outright stealing.
The next challenge to the organ transplantation policy in the country will be the legal framework to control the practice. Currently, there hasn’t been a comprehensive medical policy on that yet though the National Health Act 2014 contains some aspect of it. That is for the regulation of the organ donation and transplantation as well as other subsidiary legislations that can be referred to as a way of misuse or violation of individual rights and rules of professional practice.
Beyond the conventional legal infractions of criminal assault, battery and negligence for which practitioners may be held responsible, the National Health Act 2014 provides in section 53 that it is an offence to receive remuneration for donation of body parts such as organs, blood, and tissues except appropriate reimbursement for the upkeep and effective recovery of the donor. The same provision prohibits the commercialization of body parts such as organs, tissue or blood.
On this regulation, there are liberal proponents who believe that liberalizing access to organs by way of compensation will enhance availability and, therefore, should be open to whoever wants to donate to be paid. Those opposed to such argument are of the opinion that liberalizing the practice will be a deliberate turning of human body into mere commodity for sale and it will be opened to all sorts of abuse. Rather, scholars have argued that a way out of the shortage of organs for recipients is to intensify the study on the possible breeding of animals of same family species with man for the purpose of harvesting their organs.
Thus a comprehensive education and enlightenment to disabuse citizens on cultural and religious challenges and the orientation of donors to do so on humanitarian basis along with a comprehensive legal policy and program is needed for effective execution of the development as obtains in other countries. The provision of the needed technology and comprehensive training program for professional will equally be another big hurdle to cross considering the failings in the educational sector in Nigeria.
The Abuja based author is accessible via firstname.lastname@example.org