Ekweremadus saga: What local law says

Ike Ekweremadu, a former deputy senate president, and his wife Beatrice Nwanneka Ekweremadu

Two things can force an organ donor: acute financial pressure or coercion under organised crime.

None of these would be fit as motivation for anyone donating an organ in Nigeria, even if the country had the best-in-class transplant facilities and expertise in the world, the Nigeria Health Act, 2014 shows.

If a desperate patient could pick anyone up from the streets, feign to offer a better life or boldly bid millions to whip up interest to sell an organ, Nigeria would be near the degenerate state of Herat, the third-largest city in Afghanistan.

Finding a kidney seller there can be easy-peasy. The misrule by the Taliban government has stirred an unprecedented humanitarian crisis, with fathers who were once breadwinners forced to sell their children’s kidneys to settle the very basics like food debt or cash borrowed from neighbours. Otherwise, the child would be taken forcefully by debtors.

With the economy crashed and most aids blocked, extremely poor families thrive on an illegal but open business of kidney trade and buyers only need to have the right amount.

Many from across Afghanistan flock into Herat to buy kidney at about $4,500 from impoverished individuals and families, according to an investigation by Wall Street Journal. While authorities look away, hospitals charge around $4,600 for the surgery and $1,500 for medication.

The sellers often have to ignore the lifelong costs to fix immediate needs as over half of the country’s population suffer acute hunger and 95 percent don’t get enough to eat, according to the United Nations.

In Nigeria, about 25 percent of the population are at risk of hunger between June and August 2023 due to climate change, inflation and soaring food costs, according to the United Nations Children Fund (UNICEF).

But brazen organ trade is yet to be legal, and having enough transplant is not likely to make it so.

Going by the National Health Act 2014, a framework for the regulation and management of health services standards, Ike Ekweremadu, Nigeria’s former deputy senate president, committed an offence worthy of fine or imprisonment in his plot to harvest the kidney of a 21-year-old.

“It is an offence for a person who has donated tissue, blood or blood products to receive any form of financial or other reward for such donation, except for the reimbursement of reasonable costs incurred by him or her to provide such donations,” the Act states.

“It is an offence to sell or trade in tissue, blood or products except for reasonable payments made in appropriate health establishment for the procurement. A person who contravenes…is liable on conviction to a fine of N100,000 or to imprisonment for a period not exceeding one year or to both.”

Even for organs obtained from a deceased person, the procedure for use is not arbitrary. The National Tertiary Health Institutions Standards Committee has to review the procedural measures before granting approval for such organ transplant. Ignoring the procedures to charge a fee for a human organ attracts a minimum of five-year imprisonment without the option of fine on conviction, the Act states.

The Act demands that anyone willing to donate an organ in death has to include it in a will or in a document signed with at least two competent witnesses or in a written statement made in the presence of two competent witnesses.

And if the donor decides to rethink before removal for transplant, the Act provides for intentional revocation in the same way the donation was made.

Since the Ekweremadus’ ordeal with the UK authorities began to unfold, the spotlight has shifted on how Nigeria’s weak healthcare system is complicit to their scuffle.