To Be or Not to Be an Organ Donor-Legal and Ethical Dilemmas in a Patriarchal Society

Trafficking of human organs is a major global ethical concern. The Transplantation of Human Organs and Tissues Act of 2010 was enforced in Pakistan to curtail organ trafficking. This law suggests serious punitive action against those involved in human organ trafficking. The act permits only blood relatives to donate organs. Kidney transplantation is the most common form of organ transplantation in Pakistan; hence, this law raises ethical concerns for patients and healthcare providers. A country’s laws must reflect the prevalent social, cultural, and religious norms of that society. Pakistan has a huge burden on patients with end-stage renal disease (ESRD) requiring renal transplantation. Similar to other organ transplants, renal transplantation is challenging because of the limited number of donors. Moreover, not every patient has a blood relative who fulfills the criteria of an organ donor, nor does every blood relative volunteer to donate. The social pressure on female donors is particularly immense in Pakistan. I argue that in Pakistan’s paternalistic and patriarchal society, vulnerable populations are rendered more susceptible to coercion because of the limitations in law to address these socio-cultural disparities and because of the weaker implementation limiting the agency of organ donors as well as recipients; hence, this law is restrictive to social justice. A few factors in the culture make the law insufficient to achieve equitable transplantation. The Act requires revision and improved implementation to adequately consider the social and ethical aspects of the challenges faced by female organ donors in Pakistan.