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.
Many believe the former deputy senate president’s search for kidney abroad would have been avoided if Nigeria had transplant facilities of world-class.
Some say organ trading should not be tagged a criminal offence, in conflict with the law.
In a tweet empathising with the Ekweremadus, Doyin Okupe, a medical director and former senior special adviser to former President Goodluck Jonathan, promoted human organ trade as a normal affair as long as all parties are satisfied at the negotiation table.
“The Ekweremadus did not have evil plans from my perspective. And I can be wrong. Organ donation is common place globally. That people pay for it is also a known and accepted fact. People even voluntarily sell their organs. I believe this matter was negotiated and agreed by all parties,” Okupe tweeted.
For a top physician not to find organ trading as out place despite clear laws, analysts say it could be an indication that a thriving market exists under the radar.
Olugbenga Awobusuyi, president-elect, Nigerian Association of Nephrology (NAN) and the Transplant Society of Nigeria, said the Ekweremadus committed an offence in two countries: Nigeria and the United Kingdom.
Read also: Ekweremadu, a chief lawmaker, on the wrong side of the law?
He said in an interview with BusinessDay that the possibility of prosecution in Nigeria is still viable as both the National Health Act and the Declaration of Istanbul Organ Trafficking and Transplant Tourism, which Nigeria is party to, opposes organ trafficking or trade, speaking in a chat with BusinessDay.
The Declaration states that because transplant commercialism targets impoverished and otherwise vulnerable donors, it leads inexorably to inequity and injustice and should also be prohibited.
“Getting someone to the UK is partly ignorance. The unifying principle is that it is illegal for you to traffic someone for the purpose of transplantation because this violates the autonomy of the individual,” Awobusuyi said.
“It is not appropriate to offer or demand financial reward for giving out an organ. That means you are turning that organ into a commodity like you can buy a piece of chocolate. Organs are not for sale. And that is what the declaration of Instabul and also the health act of many countries is against.”
According to NAN, about seven people get transplanted in Nigeria every month across various tertiary hospitals.
Nigeria’s kidney transplantation journey began 23 years ago and hospitals such as the Lagos State University Teaching Hospital; St. Nicholas Hospital; Zenith Medical and Kidney Centre, Abuja; Caroline Medical Centre, Abuja; and Federal Medical Centre, Umuahia render the service.
In the past, the Lagos University Teaching Hospital, University College Hospital Ibadan, Delta State University Teaching Hospital, Oghara had conducted transplants.
Speaking of the success rate, Awobusuyi said: “It’s comparable to anywhere in the world. It is not a rocket science. It is not something that you need high-tech solution for.” Although some countries engage in laparoscopic harvest of organs which is also done in few places in Nigeria.
