House of angels

The writer is a lawyer based in Islamabad.
I was pleasantly surprised when Rahul Kulshreshth, the affable Indian deputy High Commissioner in Pakistan, advised that the process of getting a medical visa for India would not take more than a day. We had been forced to withdraw my mother’s application for a UK visa because despite our urgency and my mother’s frail health she was required to personally visit the High Commission (despite being bedridden) for an interview and biometrics to qualify for a medical visa. Seeking an exemption from this process would have taken a week at a stage when we didn’t have time on our side. It is inexplicable that our good old British friends won’t create a process for immediate issuance of visas in Islamabad even for medical emergencies and insist on sending all applications to Abu Dhabi.
China, the other option, was most confusing. The Chinese embassy in Pakistan doesn’t offer medical visas. You have to falsely state that you need a business or visit visa and then pay off a Pakistani intermediary to get the visa stamped. The other complexity is that foreigners are not authorised to get transplants in China. They do, but the whole thing works on a don’t-ask-don’t-tell basis. But China remains an attractive option for other reasons. There are two types of liver transplants: a cadaveric (or full-organ) transplant where the liver comes from someone who is no longer alive and has donated the organ; and a live donor transplant, where a living person offers the larger lobe of his liver to the patient whose cirrhotic liver is replaced with such graft.
The medical cost of living donor transplant in China is around $70,000. But if you can dish out $200,000 and not worry about legality, you could possibly buy yourself the cadaveric option. When confronted with a life-and-death situation of a loved one, you don’t lose much sleep over the legality of your choices. That is why it is imperative for countries to have in place procedures and checks that simply don’t present illegal and unethical options to desperate families. Pakistan has a transplant law meant to prevent organ harvesting. But most people who head to China for a living donor transplant have the option of purchasing a liver graft from an indigent donor in Pakistan for less than a million rupees. Pakistan’s foreign office issues documents certifying that the donor is a relative of the recipient and the patient and donor can thus proceed to China for a transplant.
It is hard to draw ethical lines when it comes to issues of life and death. People donate blood to benefit patients they don’t know. But it ought to be unethical for an eligible donor to buy blood. The same logic must apply to liver transplants. We need organ donation programmes in Pakistan so that people passing on to the other world can give the gift of life to those still here. We also need an ethical mechanism that allows you, as a living person, to offer the same gift of life to others on a philanthropic basis, if you can and wish to, even when you are not related to the patient. But to be able to purchase life saving organs from one coerced by destitution, especially when you are an eligible donor and just want to protect yourself from the risk that any donor faces, is definitely conduct that must be legally and socially proscribed.
India until recently was a haven for organ harvesting. But it has made amends. In transplant centres such as Apollo, each donor is required to undergo a psychiatric evaluation, a DNA test and a panel interview to determine the legitimacy of the transplant and its voluntary nature. Other than these logistic, legal and ethical advantages of opting for India, a place like Apollo offers liver transplant expertise that favourably competes with the best facilities around the globe. Dr Subash Gupta, who heads the liver transplant centre at Apollo, has performed over 500 transplants. An overwhelming majority of these are living donor transplants that Pakistanis need (as opposed to cadaveric transplants available to citizens in western countries). India is also attractive because in comparison to China or Taiwan there are no cultural or linguistic barriers.
The Indian High Commission issued us visas the same day we submitted our applications. Shahid Malik, our capable, solicitous and thoughtful High Commissioner in India, had made arrangements to facilitate our arrival at Delhi airport. The Indian immigration staff was professional and courteous. Satvik Varma, friend and noted lawyer in Delhi (and our life-line through this journey), was at the airport to drive us to Apollo. Within two and a half hours of leaving Pakistan we were sitting in front of Dr Subash Gupta. A few minutes into the conversation it was obvious that this man knew his job exceptionally well. It took a few days to fully appreciate the meticulousness of the team he has put together, his strength as a leader and his compassion as a human being.
The standard of care we received was astounding. We were briefed on the course of my mother’s treatment. In my capacity as liver donor I was apprised of the surgical process and how I would feel after surgery. When I gained consciousness Dr Gupta was present in the recovery room to reassure me that my mother’s and my surgery had both been successful. On a Sunday morning during the first week after surgery when I was still in choppy waters, Dr Gupta called to check how I was doing and offered to swing by the hospital. The nursing staff at Apollo wasn’t any less impressive: it had professionalism of the West wedded with the courtesy and mannerism of the East.
India is confronted with many of the challenges that Pakistan faces: poverty, illiteracy, corruption. But amidst such difficulties and the attendant chaos it has managed to create centres of excellence such as Apollo. Dr Gupta says he would be happy to welcome a couple of young Pakistani surgeons, who possess basic training and skill, to join his transplant team for a period of six months, participate in around a 100 surgeries and their pre- and post-transplant management, and then head home to afford Pakistanis the benefit of their expertise and experience.
Here is an invaluable opportunity for a health facility in Pakistan to enter into a partnership with Apollo and Dr Gupta’s team to establish a credible liver transplant facility in Pakistan and hit the ground running. A team comprising surgeons, anaesthesiologists and nurses could join Dr Gupta’s setup for a while and maybe a similar team of experienced transplant professionals from Apollo could be convinced to spend an equal amount of time in Pakistan. Here is an opening to build bridges of peace and trust between Pakistan and India by joining hands to establish a facility that will offer end-stage liver patients the gift of life within Pakistan that they are presently denied.
It is a part of our folklore that good neighbours are a blessing for they are the first ones to show up in moments of celebration as well as distress. Delhi and Apollo turned out to be a house of angels in our time of distress. Having experienced such care, consideration, hospitality and compassion at the hands of professionals and ordinary citizens alike, one realises that it will be such experiences of ordinary folks that will serve as foundations of peace and not memories from 1947, 1965 or 1971. We cannot erase our history and the bitterness and suspicion it brings along. But we can certainly create new memories that underline the humanism, industry and sense of humour that Indians and Pakistanis share. Let us give the people of these estranged countries the opportunity to freely interact with one another and build peace by discovering the similarities that overshadow their stated differences.

(Concluded)
Email: sattar@post.harvard.edu