Organ transplantation authority facing organic issues  

LAHORE: Twenty two cases of illegal renal transplants have been reported through Punjab Police and Federal Investigation Agency (FIA) since 2012, questioning the efficiency of Punjab Human Organ Transplant Authority (PHOTA) which received little support from the officials concerned, The News has learnt.

Of these 22 cases of illegal transplantation, the police registered 19 cases while the FIA registered three in various parts of the province. Ironically, the regional and district officials, assigned the task of assisting the PHOTA in implementing its agenda, didn't help the law enforcers in any manner, whatsoever.

The fate of the 19 cases registered by the police is uncertain because the police have not pursued the required legal course under the PHOTA Act. The police are required to make the Authority the complainant in all such cases. The police have not consulted the PHOTA in these 19 cases, leaving room for the alleged criminals to get legal benefit in the court on this count. Of the nominated 94 accused, three have already been acquitted with none sentenced so far by the courts.

To remove this lacuna in the procedure, the PHOTA has decided to become party in these cases. This move by the Authority might rescue around 48 victims who have been robbed of their organs. Interestingly, Rawalpindi is topping the list of illegal transplants with seven cases registered, including one at airport police station (FIR No. 29/2015 dated January 10,2015) and Civil Lines (FIR No. 867/2015 ), and the remaining five FIRs were registered at Morgah police station (FIRs Nos. 215/2016, 216/2016, 217/2016, 346/2016 and 413/2016).

Hot on the Rawalpindi's heels is Lahore with five cases. These five cases in Lahore were registered at North Cantt police station (FIR No. 1381/11), Factory Area (FIR No. 1509/15 and 1589/15) and Sundar (FIR Nos. 227/17 and 239/17)

Even the smaller towns are no exception to this illegal activity as three cases have been registered in Kotmomin, Sargodha, police station (FIR No. 568/2016) Mela police station (265/2016) and

Nawan Lahore, TT Singh, police station (FIR No. 102/2016). Near Gujrat, the police have registered two cases, one at Lalamusa city police station (FIR No. 440/16) and the other at Sadr police station (FIR No. 329/16). While, one case has been registered in Gujranwala at Aroop police station (FIR No.736/15).

Meanwhile, the Federal government also gave the Federal Investigation Agency (FIA) a role to assist the PHOTA in fighting the menace.

The FIA conducted three raids soon after getting the legal cover in April 2017. The first raid FIA conducted was at EME Housing Society in Lahore in April and arrested 16 accused persons. Similarly, the second raid FIA conducted was at Toba Tek Singh on October 12, 2017. The FIA conducted its third raid at Dua Surgical Hospital Pabbi, District Naushehra, KP, on September 26, 2017. The FIA managed to arrest over 30 accused persons in those three FIRs.

More interesting is the fact the two recipients - an Omani and a Saudi national - died after the transplants in Pakistan. It implies this illegal business has overseas clientele. This development is alarming and warrants further efficiency of the PHOTA before it leads to some untoward diplomatic crisis.

It may be relevant to mention here after adopting the Transplantation of Human Organs and Tissues Act (HOTA) soon after the 18th amendment in 2012, the PHOTA was set up in 2013 while the Punjab Chief Minister established the PHOTA network at the divisional level in 2014 before expanding it to the district level in 2016. The job of the network was to continuously monitor the hospitals registered under the PHOTA. Its job was to investigate and redress the grievances of complainant vis-a-via illegal transplants in their respective domains. Provincial Health Minister Kh Salman Rafique was handed over the charge (chairman) of the Monitoring Authority with the Punjab Secretary Health deputed as the secretary.

Other members of the monitoring authority include Secretary Home, President, Transplantation Society of Pakistan, Executive Director Pakistan Medical Research Council, President, Ophthalmologic Society of Pakistan, President, Pakistan Medical Association of Pakistan, President, Pakistan Society of Gastroenterology, Surgical Transplant Specialist nominated by the government, Chairperson of the Punjab Health Care Commission and any other outstanding medical specialist nominated by the government.

The Authority in July 2013 appointed the then Vice Chancellor KEMU as Administrator/Director General PHOTA Prof Dr Faisal Masood on additional charges to run its day to day affairs, without any human and financial resource.

Even before that, when Dr Masood had the acting charge at the PHOTA, he designated 17 public and private hospitals, which were authorised to conduct renal, corneal, liver and bone marrow transplants. These included Sheikh Zayed Hospital, Lahore, Jinnah Memorial Hospital, Rawalpindi, Bahria Town Hospital, Lahore, Surgimed Hospital, Lahore, Ihsan Mumtaz Hospital, Lahore, National Hospital & Medical Centre, Lahore, Sharif Medical City, Lahore, Bilal Hospital, Rawalpindi, Doctor Hospital & Medical Center, Bahria International Orchard, Lahore, Punjab Medical College, Allied Hospital, Faisalabad, Lahore General Hospital, Mayo Hospital, Lahore, Children Hospital, Lahore, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, DHQ Hospital, Gujranwala and Shoukat Khanam Hospital, Lahore.

Since 2013, 40 transplant surgeons registered with these 17 hospitals have conducted around 900 transplants in the entire province. The Regional Network at the divisional and the District Vigilance Committees at the local level are supposed to update the Authority fortnightly under the CM's notification. The provincial health and the home departments were supposed to ensure the smooth operation of the authority at the regional and district level respectively.

The PHOTA's regional arm is headed by the commissioner, while the Director Health Services serves under him as the secretary. The Regional Police Officer (RPO), Principal/s of Medical Colleges, and one expert from the relevant field formed the committee.

The district arm of PHOTA is headed by District Coordination Officer and Executive District Officer Health (EDO) serves him as Secretary. The District Police Officer, District Officer Intelligence Bureau, District Officer Special Branch, Principal Medical College, Medical Superintendent of DHQ Hospital and any other relevant official serve as members of the DVCs.

The established DVCs were directed to collect information from district intelligence committees regarding illegal transplants for sharing with the Regional Network as well as with the Monitoring Authority. These DVCs were directed to meet at least twice a month and send report to PHOTA. The regional networks and the DVCs were further directed to develop methods to obtain evidence in order to ascertain veracity of offence, nomination of culprits and collection of prosecutable evidence through the police. They were also asked to gather data from all hospital with regard to any violation.

With the PHOTA merely surviving on scarce human resource, it had to thrive on the already promised support from the health and the home departments for effectively monitoring all areas under its ambit. The much needed support from assisting departments never came.

This attitude left the PHOTA high and dry for the five years till the government appointed Prof Dr Faisal Masood as Administrator/Director General of PHOTA in April 2017. The same year, the government earmarked, for the first time, an amount of Rs 80 million.

The Authority then started sending letters to regional networks as well as to the DVCs from May 2017 for seeking details on the activities they were supposed to monitor and submit the report.

However, the official data points otherwise. Since May 2017, only once these Commissioners respond to PHOTA whereas during the remaining seven months they didn't bother to respond much to the annoyance of the DG PHOTA. Similarly, around 11 officials of the district administrations cared to correspond with the Authority and that too sporadically.

Those who occasionally responded to PHOTA include the officials of districts Pakpattan, Vehari, Khanewal, Narowal, Jehlum, Dera Ghazi Khan, Faisalabad, Mandi Bahauddin, Layyah Sargodha and Bahawalpur. Spokesperson of the Punjab Government Malik Muhammad Ahmed Khan rejected the impression divisional commissioners were not cooperating with the PHOTA.

"The establishment of PHOTA as a watchdog was meant to discourage all sort of illegal organ transplantations and Punjab government was committed to discouraging any "red-tapism" in this regard", he said. He categorically stated that "zero tolerance" shall be adopted in case of any failure on the part of PHOTA and the DVCs.

However, he didn't mention whether head of regional networks as well as DVCs were ever questioned of their failure in responding to the Authority. The spokesperson praised the efforts of the CM for the measures taken to curb illegal transplants. He lauded the CM's decision of establishing Pakistan Kidney and Liver Institute (PKLI) in Lahore.

Administrator/Director General of PHOTA Prof Dr Faisal Masood told The News the Authority is committed to serving the nation and assuring the international protocols and standards in Pakistan regarding transplantation.

"We shall curb the menace of illegal transplantation by coordinating with law enforcement agencies. The Punjab government is fully committed to provide full support," he said, adding that there were certain discrepancies which would be addressed soon.

To a question, he made it clear that no hospital in entire Punjab can conduct any transplant if it hasn't been registered with PHOTA yet. "All transplants conducted in un-registered hospitals would be considered as illegal and we will deal with them accordingly."

To another query, Dr Masood said the prosecution department pointed out blunders of police in registering FIRs and now PHOTA would become the complainant and fight those cases in courts. "We have delegated our powers to DVCs and now they can lodge FIRs on illegal transplants on behalf of the Authority."   Several attempts were made to contact Punjab Health Minister Kh Salman Rafique for his response on the subject but to no avail.