Much ado about human organs and their harvesting
By Femi Olugbile
There has been a lot of talk in mainstream news outlets and social media in Nigeria in the recent past on the transplantation of human organs, and issues surrounding it. This followed the well-publicised travails of a Senator of the Federal Republic and his family at the hands of the authorities in the United Kingdom.
The transfer of a body organ, or part of it, from one human being to another is a development that has been made possible by rapid advances in Medicine in the past few decades. It is now possible to remove organs and tissues from living or recently deceased human beings and transfer them to other human beings who require them. Such organs include the kidney, the heart, and the liver. Tissues such as the cornea – the transparent covering over the eye, are also regularly harvested and transplanted.
For many of the recipients of transplanted organs, getting a willing and suitable donor in time is a matter of life and death. In the United Kingdom at present, there is said to be a waiting list of over sixty thousand people with Chronic Renal Failure who are being maintained on dialysis while praying that their turn would come to get a donated kidney. This process may last for several years. Sadly, many will die before it gets to be their turn.
There are some additional pertinent considerations. Each human being has only one heart. The only way one person’s heart can find its way into another person is if the ‘donor’s’ heart is removed and safely transported to the recipient within a narrow time window at a point where the donor is ‘brain dead’ and adjudged to be no longer capable of viable existence.
With the kidney, matters are rather more nuanced. The average human being has two kidneys, where in general he only needs one healthy kidney to live a reasonable life. Of course, God help the donor if his sole remaining kidney develops a problem later.
Donating a kidney is a labour of love that many have undertaken for their siblings or their spouses, and many, frankly, despite even the strictest rules and restrictions, have undertaken for a hefty fee.
The kidney is also the organ most frequently caught up in ethical and legalistic dilemmas. There is an active economy surrounding it, and the possible involvement of criminal procurement gangs.
There are medical interventions carried out routinely nowadays which were previously the stuff of Science Fiction. Unfortunately, those innovations also raise ethical and legal questions which every society needs to answer according to its own values. European countries regularly update their laws for this purpose. In doing so, they answer such questions as: Should people sell their kidney or part of their liver, even if they can do without them? Should people be able to order ‘designer babies’ – a feat Hitler would have loved to be able to perform in his time in his quest to populate the world with the ‘perfect’ Aryan race? Should the genes of babies be altered in utero to confer them with desired attributes? Should people be able to sell their blood? Should surrogate mothers be able to carry babies conceived through Assisted Reproductive Techniques for homosexual ‘couples’ – male or female, leading to a situation where the baby has two ‘mothers’ but no ‘father’, or two ‘fathers’ but no ‘mother’? Should babies detected through intrauterine tests to have chromosomal or genetic defects such as Down’s Syndrome, or even Sickle Cell disease, be aborted, if the parents so desire?
The Western world would like to think their own responses to the legal and ethical questions should constitute the ‘received’ version for all humanity. However, the truth is that preferences vary from society to society.
It is worrisome to note that there are no strong indigenous laws regulating the content and the ethics of practice of many of these procedures in Nigeria.
Some years ago, in the Ministry of Health, Lagos State, a committee was set up to address Ethics, and Regulations to guide the practice of Advanced Medical Interventions in the State. It arose out of worry that more and more people were setting up shop offering Transplant Surgery, Assisted Reproduction, and other interventions. There was a felt need to standardise their practices and make rules to protect and guide the public.
The Nigeria Health Act of 2015 contains a slight nod to the need to regulate these entities, but it lacks detail.
Currently, Nigeria is effectively a ‘no man’s land’ on these important, delicate matters. It is generally understood, for instance, that it is not right for people to sell their blood. The reality on the ground, though, is that most of the blood used in hospitals in the country is either sold by poor people desperate for income or coerced from relatives of patients giving birth or having procedures in government hospitals, as there is no strong ‘voluntary donation’ culture yet.
It is in the light of all these background details that the reader should see the UK law affecting the Nigerian VIP. That law stipulates that organ donation must be entirely voluntary, from an adult, or a minor whose parents have signed consent. He must be a blood relative, except where there are strong extenuating circumstances. And there must not be any financial or other reward involved.
It is not enough to say that the Senator could have got his daughter’s surgery safely done in Lagos, and everybody would be smiling home by now, which is true. That fact itself is a problem, because it shows that Nigeria is ‘ungoverned space’, as far as the matter of organ transplants is concerned. That should be a cause of worry for Nigerian citizens.
The incident is a wakeup call for Lagos State to revisit the recommendations of its expert Committee and update them into law, and for the Nigerian nation to codify a body of laws and regulations that represent Nigerian values and realities, which it will be prepared to enforce. These laws will be similar to what is in practice in the UK, mostly. However, in some details, they will certainly be different. Many Nigerians, for example, would not think there is anything wrong with giving a financial reward to an organ donor, even if that donor is a blood relative. They may also worry about a voluntary donor being preferentially guided to donate into a pool to service a ‘waiting list’, instead of giving their organ to a preferred beneficiary. All of these matters require informed discussion in order to arrive at a position that fits the culture and meets the needs of Nigeria.