Aamir M. Jafarey

Conversations with Kidney Vendors in Pakistan: An Ethnographic Study

In theory, a commercial market for kidneys could increase the scarce supply of transplantable organs and give impoverished people a new way to lift themselves out of poverty. In-depth sociological work on those who opt to sell their kidneys reveals a different set of realities. Around the town of Sarghoda, Pakistan, the negative social and psychological ramifications of selling a kidney affect not only the vendors themselves, but also their families, communities, and even the country as a whole.

Pediatric urolithiasis: To cut or not to cut

Urolithiasis is a major source of morbidity in children of the third world. Since its advent in 1982 and despite uncertainties about the long-term effects on the kidney, extracorporeal shock wave lithotripsy (ESWL) has rapidly replaced traditional surgery in the management of this condition. A retrospective study was conducted to compare the outcome of ESWL with that of open surgery in the management of paediatric urolithiasis in a single institution between November 1988 and December 1991. Emphasis was placed on the rate of stone clearance, complications, duration of follow-up, and cost of treatment of each modality. A total of 83 patients under 14 years of age underwent management of 101 stones; the stones were located in the kidneys (63), ureters (13), or bladder (25). Thirty-one patients who enrolled directly through the Lithotripsy Clinic underwent a total of 65 ESWL sessions for 44 calculi (mean, 2.1 sessions per patient). The overall stone clearance rate was 82%, with an 83% clearance rate for renal stones. There were three failures. Nine patients did not return after the first ESWL session, and by the end of 6 months, 93.5% were lost to follow-up. The cost of ESWL ranged from

Presumed consent: a problematic concept.

600 to

Biobanking in the subcontinent: exploring concerns

1,000 (mean,

Physicians in Cyberspace: Finding Boundaries

780). Fifty-two children were managed through the Pediatric Surgery Clinic and underwent open surgery (57 stones). The overall stone clearance rate was 96%, with a clearance of 88% for renal calculi. There were two wound infections and no deaths. All patients returned for the first follow-up visit, but by the end of 6 months, only 34.5% were available for follow-up. The total cost of treatment ranged from

Plagiarism and the medical fraternity: a study of knowledge and attitudes.

520 to

“Indigenizing” Bioethics: The First Center for Bioethics in Pakistan

900 (mean,

Ethical review in Pakistan: the credibility gap.

580). The authors believe that with the present level of knowledge, use of the lithotriptor should be restricted to children with small stones and/or those for whom long-term follow-up is possible.

Experience of a New Kind: External Review of a Bioethics Centre

issue, that of the increasing shortage of kidneys available for transplantation worldwide (1). As a solution for India, Kaushik favours the introduction of the “presumed consent” system to allow retrieval of organs from recently deceased persons. In this system, unless an individual has specifically expressed, in writing, during her/his lifetime, that he/she is unwilling to donate an organ following death, his/her organs can be routinely harvested by healthcare professionals for transplantation into others. In our commentary we examine some of the arguments put forward by the author in support of presumed consent, and discuss ethical, professional and social problems connected to the use of this system as a way to address the scarcity of transplantable organs. However, we will begin by first highlighting what we consider to be a critical factual error in the article.

Towards deceased organ donation in Asia: negotiating the challenges.

Biobanking is an important tool for biomedical research. However, it raises a variety of ethical issues, which are compounded in the developing world. This paper is based on data from three sources on the ethical issues associated with biobanking, including a mixed method pilot study conducted with students in Karachi, Pakistan, a workshop in Karachi, and another workshop held in Bengaluru, India. Findings from these sources reveal a unanimous lack of clarity about what constitutes a biobank. While informed consent was deemed necessary for storage of materials, participants were unsure of how this could be achieved for samples stored indefinitely for future research. Although study participants showed limited understanding of genetic research, concerns were raised in the Karachi workshop. A majority of survey participants found it acceptable to transfer biospecimens across borders, but possibility of misuse was highlighted in both workshops. This paper reveals ambiguities with respect to ethical challenges of biobanking, indicating the need for further discourse.