By Zili Yang and Amy Ma
A poverty-stricken Pakistani is unlikely to be a globe-trotter, but his heart, liver or kidney can travel across the world when ‘donated’. What is called “transplant tourism” in the World Health Organization (WHO) parlance receives global wings thanks to the China-Pakistan Economic Corridor (CPEC).
The Chinese now find easier access to touts who deal in human organs. The ‘players’ include the doctors and medical personnel and the middlemen who recruit poor Pakistanis willing to sell their organs to make some survival money or for the lure of a job in one of the many CPEC projects.
The Sino-Pak connections came to light in Lahore on September 8, 2020 when for the first time, Pakistani Federal Investigation Agency (FIA) arrested seven suspects involved in a major international racket that transported poor and needy people from the country to China for illegal transplant surgeries.
According to FIA Punjab Deputy Director Sardar Mavarhan Khan, an international gang was active in Lahore in illegal transplant of human organs in China, a team conducted a raid at the passport office and arrested seven suspects, including donors and agents, Dawn newspaper reported.
While ‘donor’ may get up to Pakistani Rupees four lakhs, which is good money for an organ although that invalids him/her for lifetime, the middle-men grow richer. It is difficult to assess who earns, and how much, when the organ reaches China for more lucrative destination where the demand outstrips the supply.
As of January 2020, there are more than 112,000 candidates waiting for organ transplant in the United States alone. The median wait time for heart and liver transplants in the U.S. between 2003-2014, was approximately 148 days. Organs are in demand in the more prosperous Europe and Southeast Asia.
Both China and Pakistan are global hubs for “transplant tourism”. Significantly, the CPEC has changed the equations: of the two “iron brothers”, China, investing $ 60 billion in the Corridor, is clearly the Big Brother.
China and Pakistan are also known to conduct their trade, together and separately, playing on the human misery. Organs are sourced from prisoners in China while in Pakistan, it is, besides the prisoners, the poor and the ‘nationalist’ rebels who ‘disappear’ – kidnapped and illegally held captive – who are released if they survive, or simply dumped in some water body or along the highway.
Both are adapted at the job. Since the late 1980s, China relied on executed prisoners to provide the bulk of its transplanted organs. This ready source of organs made it second only to the United States for numbers of transplantations performed. The Chinese government attempted to downplay the scope of organ harvesting through confidentiality agreements and laws, such as the Temporary Rules Concerning the Utilization of Corpses or Organs from the Corpses of Executed Prisoners.
Due to low levels of voluntary organ donation, most organs used in transplants are sourced from prisoners. The Chinese government approved a regulation in 1984 to allow the removal of organs from executed criminals, provided they give prior consent or if no one claims the body.
Pakistan had no laws till 2010. It is poorly executed. In an editorial decrying the China links published on September 10, 2020, Dawn newspaper lamented: “This year marks a decade since Pakistan’s ethical organ transplantation law was enacted in March 2010. Prior to that, the country was infamous as a market for vended organs. Although illegal transplants declined steeply after the law was passed, every time there has been lax implementation the practice has seen a comeback. In an inequitable society, the exploitation of the poor knows no limits.
An AFP (French news agency) report of June 27, 2017 showed Pakistan as the principal hub for organs for the Gulf region. It quoted officials and doctors as complaining that they have been unable to act against the practice, frustrated by ineffective enforcement policies and what they perceive as a lack of political will to crack down on it.
Organ donation is legal as long as it is voluntary and given without duress or the exchange of money. There are thinly covered-up violations on both counts.
The limited supply means Pakistan’s wealthy routinely exploit its millions of poor with the help of an organ trade mafia, the report appearing in South China Morning Post said.
“Kidneys can be bought so cheaply that overseas buyers are also tapping in, largely from the Gulf, Africa and Britain.
“In many countries such trafficking is confined to the shadows, but in Pakistan it is brazen.
“Within minutes of a reporter entering the lobby of an upmarket general hospital in the capital Islamabad, staff had helped him find a so-called agent who offered to get a donor and ease government approval for a kidney transplant – all for a tidy US$23,000.
“The government’s Human Organs Transplant Authority (HOTA) says it is toothless. If a donor claims they give their consent, “there is nothing else we can do”, said Dr Suleman Ahmed, a HOTA monitoring officer.
“This illegal trade benefits the rich and elites of the country,” said Mumtaz Ahmed, head of nephrology at Benazir Bhutto public hospital in Rawalpindi.
“The agents would allegedly motivate poor and needy people to sell their liver and kidney and then had the organ transplant conducted in China. During investigation it has transpired that the agents had contacts in China where they managed to get the organ transplant conducted by Chinese doctors,” he said.
“The high demand creates a market that inhabitants of Pakistan’s vast rural areas see as an opportunity to drag themselves out of poverty.
Employed in factories, fields and brick kilns, they borrow money from employers for medical bills or to raise children, but are unable to repay their debt.
Instead they are forced to work it off in a never-ending cycle of bonded labor – one they hope to break with the income from selling their organs.
This shows up the poor Pakistanis, their politicians displaying a lack of will, with Chinese connivance, as the modern-day slaves with no relief or escape in sight.
 Luc Noël ,“Current concerns in transplantation”, WHO website, https://www.who.int/bulletin/volumes/85/12/07-049734/en/
 Zulqernain Tahir, “Illegal organ transplant gang with contacts in China busted”, September 08, 2020, https://www.dawn.com/news/1578446/illegal-organ-transplant-gang-with-contacts-in-china-busted
 Yosuke Shimazono,“The state of the international organ trade: a provisional picture based on integration of available information”,https://www.who.int/bulletin/volumes/85/12/06-039370/en/
 Philip Reeves,“In Pakistan, Illegal Kidney Trade Flourishes As Victims Await Justice”, November 3, 2016 https://www.npr.org/sections/parallels/2016/11/03/500215155/in-pakistan-illegal-kidney-trade-flourishes-as-victims-await-justice
 “Historical development and current status of organ procurement from death-row prisoners in China”, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668660/
 “ Organ transplant bill signed into law”, https://www.dawn.com/news/525854/organ-transplant-bill-signed-into-law
 “Organs & China link”, Published in Dawn, September 10th, 2020,https://www.dawn.com/news/1578903/organs-china-link
 “Wealth, poverty propping up Pakistan’s illegal kidney trade”, Published in Daily Times, June 29th, 2017, https://dailytimes.com.pk/4537/wealth-poverty-propping-up-pakistans-illegal-kidney-trade/