Organ Donation Law in Bangladesh

Organ Donation Law in Bangladesh law firm in bangladesh tahmidur
10.26.2022
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Bangladesh has a population of approximately 180 million, of which approximately 2 million suffer from kidney diseases and an additional half a million suffer from corneal diseases. Although the need for organ transplants to cure a growing number of patients is growing, the culture of organ donation in the United States is not well-established.

Even though Act No. 05 of 1999 was enacted in response to instances of abuse in terms of Organ donation, it is riddled with flaws that defeat the very purpose for which it was enacted. Section 3 in conjunction with sections 2(ga) and 6(1) of Act No. 05 of 1999 provides a very narrow definition of donor, namely “close relative.”

This narrow definition of donors in Organ donation exacerbates the already substantial disparity between the demand for and supply of kidneys, resulting in kidney patients dying without transplant.

 

Organ-Donation-Law-In-Bangladesh-Tahmidur-Rahman-Best-Law-Firm-In-Dhaka

The large disparity creates a thriving black market for kidneys, which disproportionately affects the poor. According to Global Financial Integrity (GFI) of Washington, many people in Bangladesh, particularly in rural areas, are compelled to sell their organs to settle debts or for brief financial relief. They are poor, uneducated, destitute, and oblivious to the after-sale complications.

Several of them develop chronic health problems. A minority are better off. The brokers minimize the risk of future complications, and sometimes physicians even assure prospective sellers that their kidneys will regrow. Common postoperative complications include infection, persistent pain, fatigue, and impaired function of the remaining kidney.

Provision for exceptional circumstances for Organ Donation Law in Bangladesh

As a result, a provision had to be made for exceptional circumstances in which a donor may not be a “close relative,” and “exceptional circumstances” must be defined and/or criteria must be established for their determination. The Act No. 05 of 1999 does not establish a central authority to regulate the removal and use of Organs for Transplantation.

The enactment of Act No. 05 of 1999 was necessitated by the need for such a regulatory body to prevent abuse. In the United Kingdom, one such authority is the Human Tissue Authority (HTA) (UK).

Due to the inadequacies of Act No. 05 of 1999, kidney patients are compelled to travel abroad with donors (who do not fall within the Act’s narrow definition of “near relative”) for the purpose of Transplantation in violation of the Act; kidney transplant abroad is very expensive compared to the cost of having it done locally and is therefore out of reach for many.

Organ-Donation-Law-In-Bangladesh-Best-Barristers-In-Dhaka

If section 2(4) is further amended, anarchy will ensue in the organ transplantation sector of our nation. Section 7(kha) of Act No. 01 of 2018 establishes the Cadaveric National Committee, which will oversee all cadaveric kidney transplants in Bangladesh. The Government has already formulated (briefly, the Rules of 2018) in accordance with Act No. 05 of 1999 in order to carry out the purposes of Act No. 05 of 1999.

In light of the global trend of increasing the number of organ donors, the high prevalence of kidney disease in Bangladesh, and the vast disparity between the demand for and supply of kidneys in Bangladesh, the court deemed it necessary to obtain the expert opinions of several individuals prior to deciding the Rule Nisi.

Therefore, by order dated 28.08.2019, this Court directed seven prominent experts in the relevant fields to provide their opinions. Accordingly, the experts provided the court with their consolidated written opinion. In the interest of the public, respondent No. 1 will adhere to the opinion of the experts. Moreover, if this Court issues any directives, the government will comply. Consequently, the Rule may be discarded.

 

Organ-Donation-Law-In-Bangladesh-Best-Barristers-In-Dhaka

Prevalence of kidney disease and the need for organ transplants in Bangladesh:

There is no study in Bangladesh that estimates the prevalence of kidney disease and the need for organ transplants. However, some estimates indicate that at least 20 million people in Bangladesh suffer from kidney disease, and 35,000 of them die annually from kidney failure. The estimated annual demand for kidney transplants is 5,000. However, only about 100 people on average can obtain kidneys from relatives for transplantation.

The Bangladesh Organ Donation Law of 1999 permits posthumous or brain-death kidney donation outside of living close relatives, but such donation has never been implemented. In accordance with the law passed in 1999, only brothers, sisters, father, mother, maternal and paternal uncles and aunts can donate kidneys. Since 1982, approximately 1400 kidney transplants, 5500 cornea transplants, and 4 liver transplants have occurred in Bangladesh. Cornea transplantation, on the other hand, has reached an acceptable level with a threefold increase in transplantation since 2009.

Organ transplantation is a modern medical and technological treatment that saves the lives of hundreds of thousands of patients with end-stage organ failure who are suitable candidates. In Bangladesh, the first successful kidney transplantation from living-related donors was performed in 1982, and the procedure became routine in 1988. This was followed by cornea from deceased donors in 1984, liver from living-related donors in 2010 and bone marrow from living-related donors in 2014.

Organ-Donation-Law-In-Bangladesh-Best-Barristers-In-Dhaka

The Human Organ Transplantation Act was initially passed by the parliament of Bangladesh in 1999, allowing both brain-death donation and transplants from living-related donors. Before 1999, religious approval (fatwa) was obtained from religious leaders that acknowledged brain death donation and permitted deceased donation for transplants. In January 2018, the current law was revised. Only 1791 kidney, six liver, and 25 bone marrow transplants were performed from living-related donors between 1982 and 2017. In Bangladesh, no transplants of deceased organs have yet begun. Only 5,500 corneas from deceased donors have been transplanted.

Long-standing concerns exist regarding the lack of transplantation of vital organs from deceased donors in Bangladesh and its effect on the rising demand for organs from living donors. However, living-related donors are extremely scarce. Patients with multiple failing organs are frequently forced to purchase organs from the poor. In Bangladesh, it creates an illegal and unethical market for human organs.

Condition of Government Hospitals and Clinics:

However, government hospitals and clinics are always overcrowded because the vast majority of treatment, drugs, and medications are supposed to be provided for free or at minimal cost, whereas privately funded hospitals are expensive and unaffordable for the vast majority of the population. Due to limited resources, organ transplantation and other tertiary-level healthcare services are not a top priority for the Bangladeshi government.

Bangladesh was classified as a lower-middle-income country by the World Bank in 2015, with aspirations to become a middle-income country by its 50th anniversary of independence in 2021. The Country Partnership Framework (2016–2020) of the World Bank supports Bangladesh’s goal of achieving middle-income status by its golden jubilee in 2021.

Removal and Transplant and exceptions in regards to Eye and Bone Marrow

According to the initially proposed “Transplantation of Human Organs Act-2017,” organ removal and transplant cannot be performed in any hospital without government approval.

 

Organ-Donation-Law-In-Bangladesh-Best-Barristers-In-Dhaka

Eye and bone marrow transplant donors are not required to be blood relatives.
However, public hospitals with specialized transplant units could perform transplants without government authorization.

In accordance with the current law, which was enacted in 1999, a person who violates the law could face between seven and three years of imprisonment or a fine of Tk 3 lakh, or both. The proposed law stipulated a maximum prison sentence of three years and a fine of Tk 10 lakh, or both.

In addition, there would be a four-person hospital certification board led by the director of the health directorate. Without the board’s certification, no organ transplants would be permitted in any hospital. Under the proposed law, anyone who provides false information about the relationship between an organ donor and a recipient, or who encourages, provokes, or threatens another person to provide such information, faces up to two years in prison or a fine of Tk 5 lakh, or both.

Kidney, liver, bone, eye, heart, lungs, and tissue are among the transplantable organs.

The parliament has passed the “Transplantation of Human Organs (Amendment) Bill, 2018” in an effort to improve health services in Bangladesh in light of technological and medical advancements.

According to the proposed law, there will be a medical board in each hospital to decide transplantation issues and a National Cadaveric Committee to oversee the transplantation of human organs in Bangladesh. According to the proposed law, any organ transplantable to the human body, including the kidney, liver, bone, eye, heart, lung, and tissue, could be transplanted after their collection from heart-beating or actively supported human bodies for transplantation purposes.

 

The Bangladesh Medical and Dental Council will revoke the license of any physician convicted under the law.

In the early years of organ transplantation, there was no law in Bangladesh prohibiting the sale of organs in underground markets. The Human Organ Transplantation Act (HOT A, 1999) was initially passed by the parliament of Bangladesh and published in the Gazette on April 13, 1999 in an effort to restrict organ trade. This act applied to the removal of organs for transplantation from both deceased and living donors. In addition to the kidney, heart, liver, pancreas, bone, asthimajja, eye, skin, and tissue, it authorized the removal of any other transplantable organs or body parts (section- 2a).

Human Organ Transplantation Act and Religious leaders:

Before 1999, religious leaders in Bangladesh issued a fatwa (religious approval) that recognized both living and brain death criteria and permitted both living and brain-dead donors to donate organs for transplantation.

A close relative may only donate organs to save the lives of other close relatives, per the Human Organ Transplantation Act 1999 Act. Only first and second-degree blood relatives and spouses are included. First-degree blood relatives are the father, mother, adult brother and sister, and adult son and daughter; second-degree blood relatives are the paternal and maternal uncles and aunts. Spouses consist of both husbands and wives. Except for these close relatives, no one was legally permitted to donate organs.

A few provisions of the existing law were revised and approved by the government in January 2018. The 2018 revision of the Act expands the definition of “close relatives” to include third-degree blood relatives in addition to the existing donors. Grandparents, grandchildren, and first cousins comprise third-degree blood relatives.

The new law stipulates that anyone can donate bone marrow and cornea to anyone else, but other organs and body parts may only be donated between close relatives who are on the act’s donors list. This act prohibits the sale of organs and the receipt of monetary compensation for organ exchange. It also prohibits organ sales advertisements in their entirety.

Organ-Donation-Law-In-Bangladesh-Top-

 Current Scenario for the need of transplants:

Bangladesh has a population of approximately 1.6 million, of which approximately 20 million suffer from kidney diseases and an additional half a million suffer from corneal diseases. Although the need for organ transplants to cure a growing number of patients is growing, the culture of organ donation in the United States is not well-established.

Even though Act No. 05 of 1999 was enacted in response to instances of abuse, it is riddled with flaws that defeat the very purpose for which it was enacted. Section 3 in conjunction with sections 2(ga) and 6(1) of Act No. 05 of 1999 provides a very narrow definition of donor, namely “close relative.” This narrow definition of donors exacerbates the already substantial disparity between the demand for and supply of kidneys, resulting in kidney patients dying without transplant.

The large disparity creates a thriving black market for kidneys, which disproportionately affects the poor. According to Global Financial Integrity (GFI) of Washington, many people in Bangladesh, particularly in rural areas, are compelled to sell their organs to settle debts or for brief financial relief. They are poor, uneducated, destitute, and oblivious to the after-sale complications. Several of them develop chronic health problems. A minority are better off.

The brokers minimize the risk of future complications, and sometimes physicians even assure prospective sellers that their kidneys will regrow. Common postoperative complications include infection, persistent pain, fatigue, and impaired function of the remaining kidney.

Organ-Donation-Law-In-Bangladesh-Top-

Close Relative and Exceptional circumstances for Organ Donation Law in Bangladesh

As a result, a provision must be made for exceptional circumstances in which a donor may not be a “close relative,” and “exceptional circumstances” must be defined and/or criteria must be established for their determination. The Act No. 05 of 1999 does not establish a central authority to regulate the removal and use of Organs for Transplantation.

The enactment of Act No. 05 of 1999 was necessitated by the need for such a regulatory body to prevent abuse. In the United Kingdom, one such authority is the Human Tissue Authority (HTA) (UK). Due to the inadequacies of Act No. 05 of 1999, kidney patients are compelled to travel abroad with donors (who do not fall within the Act’s narrow definition of “near relative”) for the purpose of Transplantation in violation of the Act; kidney transplant abroad is very expensive compared to the cost of having it done locally and is therefore out of reach for many.

If section 2(4) is further amended, anarchy will ensue in the organ transplantation sector of our nation. Section 7 of Act No. 01 of 2018 establishes the Cadaveric National Committee, which will oversee all cadaveric kidney transplants in Bangladesh. The Government has already formulated (briefly, the Rules of 2018) in accordance with Act No. 05 of 1999 in order to carry out the purposes of Act No. 05 of 1999.

In light of the global trend of increasing the number of organ donors, the high prevalence of kidney disease in Bangladesh, and the vast disparity between the demand for and supply of kidneys in Bangladesh, the court deemed it necessary to obtain the expert opinions of several individuals prior to deciding the Rule Nisi.

Illegal Organ Donation:

According to various news reports, illegal Organ donation is causing illicit financial flows out of the country, and as a result, people are turning to dialysis as a treatment method, which is economically and medically unsustainable in the long run; patients typically discontinue treatment within three years. In order to prevent the loss of 35,000 to 45,000 lives annually due to completely preventable causes, it is essential that some guidelines are formulated and eventually amendments are made to Act No. 05 of 1999 in order to address the crisis of kidney donation and transplantation.

There is no study in Bangladesh that estimates the prevalence of kidney disease and the need for organ transplants. However, some estimates indicate that at least 20 million people in Bangladesh suffer from kidney disease, and 35,000 of them die annually from kidney failure. The estimated annual demand for kidney transplants is 5,000. However, only about 100 people on average can obtain kidneys from relatives for transplantation.

The Bangladesh Organ Donation Law permits posthumous or brain-death kidney donation outside of living close relatives, but such donation has never been implemented. In accordance with the law passed in 1999, only brothers, sisters, father, mother, maternal and paternal uncles and aunts can donate kidneys.

Since 1982, approximately 1400 kidney transplants, 5500 cornea transplants, and 4 liver transplants have occurred in Bangladesh. Cornea transplantation, on the other hand, has reached an acceptable level with a threefold increase in transplantation since 2009.

Organ Donation Law in Bangladesh and technological treatment

Organ transplantation is a modern medical and technological treatment that saves the lives of hundreds of thousands of patients with end-stage organ failure who are suitable candidates. In Bangladesh, the first successful kidney transplantation from living-related donors was performed in 1982, and the procedure became routine in 1988. This was followed by cornea from deceased donors in 1984, liver from living-related donors in 2010 and bone marrow from living-related donors in 2014.

The Human Organ Transplantation Act was initially passed by the parliament of Bangladesh in 1999, allowing both brain-death donation and transplants from living-related donors. Before 1999, religious approval (fatwa) was obtained from religious leaders that acknowledged brain death donation and permitted deceased donation for transplants.

In January 2018, the current law was revised. Only 1791 kidney, six liver, and 25 bone marrow transplants were performed from living-related donors between 1982 and 2017. In Bangladesh, no transplants of deceased organs have yet begun. Only 5,500 corneas from deceased donors have been transplanted.

Long-standing concerns exist regarding the lack of transplantation of vital organs from deceased donors in Bangladesh and its effect on the rising demand for organs from living donors. However, living-related donors are extremely scarce. Patients with multiple failing organs are frequently forced to purchase organs from the poor. In Bangladesh, it creates an illegal and unethical market for human organs.

Healthcare system in Bangladesh and Organ Donation Law in Bangladesh

The healthcare system in Bangladesh is hierarchically structured from top to bottom. The Ministry of Health and Family Welfare is positioned at the top and provides policy advice to the two directorates of health services and family planning.

After receiving policy recommendations, the Directorate General of Health Services and the Directorate General of Family Planning implement these policies throughout the nation’s hospitals and healthcare facilities. The healthcare service delivery system is hierarchical, proceeding from the national level to the district, subdistrict, union, and ward levels.

This system provides primary, secondary, and tertiary levels of promotion, prevention, and treatment for outdoor and indoor patients. In rural areas, sub-district, union, and ward-level hospitals and clinics provide primary healthcare services; district hospitals provide secondary services; and hospitals and institutes in divisional and capital cities provide secondary and primarily tertiary level services. In addition, medical college hospitals and institutes supported by the public provide healthcare services.

According to the initially proposed “Transplantation of Human Organs Act-2017,” organ removal and transplant cannot be performed in any hospital without government approval, Additional Cabinet Secretary Ashraf Shameem told reporters after the weekly cabinet meeting.
Eye and bone marrow transplant donors are not required to be blood relatives.
However, public hospitals with specialized transplant units could perform transplants without government authorization.

 

Organ-Donation-Law-In-Bangladesh-Tahmidur-Rahman-Law-Firm

Transplantation of Human Organs (Amendment) Bill, 2018

In accordance with the current law, which was enacted in 1999, a person who violates the law could face between seven and three years of imprisonment or a fine of Tk 3 lakh, or both. The proposed law in Organ donation stipulated a maximum prison sentence of three years and a fine of Tk 10 lakh, or both.

In addition, there would be a four-person hospital certification board led by the director of the health directorate. Without the board’s certification, no organ transplants would be permitted in any hospital. Under the proposed law, anyone who provides false information about the relationship between an organ donor and a recipient, or who encourages, provokes, or threatens another person to provide such information, faces up to two years in prison or a fine of Tk 5 lakh, or both.

Kidney, liver, bone, eye, heart, lungs, and tissue are among the transplantable organs.

The parliament has passed the “Transplantation of Human Organs (Amendment) Bill, 2018” in an effort to improve health services in Bangladesh in light of technological and medical advancements.

According to the proposed law for Organ donation, there will be a medical board in each hospital to decide transplantation issues and a National Cadaveric Committee to oversee the transplantation of human organs in Bangladesh. According to the proposed law, any organ transplantable to the human body, including the kidney, liver, bone, eye, heart, lung, and tissue, could be transplanted after their collection from heart-beating or actively supported human bodies for transplantation purposes.

The Bangladesh Medical and Dental Council will revoke the license of any physician convicted under the law.

Organ-Donation-Law-In-Bangladesh-Tahmidur-Rahman-Law-Firm

Prohibiting the sale of organs in underground markets

In the early years of organ transplantation, there was no law in Bangladesh prohibiting the sale of organs in underground markets. The Human Organ Transplantation Act (HOT A, 1999) was initially passed by the parliament of Bangladesh and published in the Gazette on April 13, 1999 in an effort to restrict organ trade.

This act applied to the removal of organs for transplantation from both deceased and living donors. In addition to the kidney, heart, liver, pancreas, bone, asthimajja, eye, skin, and tissue, it authorized the removal of any other transplantable organs or body parts (section- 2a). Before 1999, religious leaders in Bangladesh issued a fatwa (religious approval) that recognized both living and brain death criteria and permitted both living and brain-dead donors to donate organs for transplantation.

A close relative may only donate organs to save the lives of other close relatives, per the 1999 Act. Only first and second-degree blood relatives and spouses are included. First-degree blood relatives are the father, mother, adult brother and sister, and adult son and daughter; second-degree blood relatives are the paternal and maternal uncles and aunts. Spouses consist of both husbands and wives. Except for these close relatives, no one was legally permitted to donate organs.

 

Organ-Donation-Law-In-Bangladesh-Tahmidur-Rahman-Law-Firm

A few provisions of the existing law were revised and approved by the government in January 2018. The 2018 revision of the Act expands the definition of “close relatives” to include third-degree blood relatives in addition to the existing donors. Grandparents, grandchildren, and first cousins comprise third-degree blood relatives. The new law stipulates that anyone can donate bone marrow and cornea to anyone else, but other organs and body parts may only be donated between close relatives who are on the act’s donors list. This act prohibits the sale of organs and the receipt of monetary compensation for organ exchange. It also prohibits organ sales advertisements in their entirety.

Punishment for illegal dealings in Human tissue in Bangladesh-

Whoever-

(a) makes or receives any payment for the supply of, or for an offer to supply, any Human tissue; or

(b) seeks to find person willing to supply for payment and Human tissue; or

(c) offers to supply any Human tissue for payment; or

(d) initiates or negotiates any arrangement involving the making of any payment for the supply of, or for an offer to supply, any Human tissue; or

(e) takes part in the management or control of a body of persons, whether a society, firm or company, whose activities consist of or include the initiation or negotiation of any arrangement referred to in clause (d); or

(f) publishes or distributes or causes to be published or distributed any advertisement-

(i) inviting persons to supply for payment of any Human tissue; or

(ii) offering to supply any Human tissue for payment; or

(iii) indicating that the advertiser is willing to initiate or negotiate any arrangement referred to in clause (d); or

(g) abets in the preparation or submission of false documents including giving false affidavits to establish that the donor is making the donation of the Human tissues as a near relative or by reason of affection or attachment towards the recipient, shall be punishable with imprisonment for a term which shall not be less than one year but which may extend to three years.

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What is the Sunni Muslim Perspective on Organ Donation?

Many Muslims have historically and currently held the view that organ donation is haram, or forbidden. 

This is due to the fact that the human body is regarded as sacred, and the Prophet Muhammad, upon whom be peace, stated that the body remains sacred after death and should not be harmed. He stated that breaking the bones of the deceased is equivalent to breaking the bones of a living person. 

Similarly, the Quran states, "Whoever saves a life is as if he saves the lives of all humanity." 

Therefore, many Muslims conclude from this verse that organ donation is a blessed act. 

In 1995, the Muslim Law (Sharia) Council of the United Kingdom issued a fatwa allowing organ donation. In 2019, Mufti Muhammad Zubair Butt agreed in principle that it was permissible, but he disagreed with the earlier opinion, stating that organs can only be extracted after the heart has stopped beating, whereas the earlier ruling stated that they can be extracted after brainstem death. Most recently, in 2020, Shaykh Dr. Rafaqat Rashid has written further on the subject, reiterating the Islamic legitimacy of using brainstem death as the accepted definition of death for organ retrieval. 

In conclusion, Sunni Muslims may adopt one of three positions regarding donation after death. They may decide to: 

1.Donate their organs following brainstem death (DBD) or circulatory death (CD) (DCD) 

2. Donate their organs, but only after they have died of circulatory failure 

3. Refuse to donate organs

What is the definition of 'donor' as per the Transplantation Act in Bangladesh?

The verdict stated, "The already large gap between demand and supply of kidneys is widened by this narrow definition of donors, resulting in kidney patients dying without a transplant," adding, "The large gap disproportionately affects the poor by creating a black market for kidneys where abuses are rampant." 

The verdict stated that if the definition of a donor pool (close relative) was expanded without any restrictions, the illegal kidney trade in Bangladesh would increase to an unfathomable degree. Therefore, a wholesale expansion of the definition of donor pool (close relative) cannot be tolerated. 

To determine and verify the authenticity of emotional kidney donation, the court ruled that an investigation should be conducted in accordance with the following guidelines. 

According to the ruling, the Authentication Board in Bangladesh, similar to the Authorization Committee in India, could decide on the petitioner's exceptional circumstances. 

The court ruled that the board must ensure that any adult person related to the donor by blood or marriage donates an organ or tissue if a close relative is unavailable.

What are the responsibilities of authentication board in terms of donor law in Bangladesh?

The board must determine that no commercial transaction would take place between the recipient and the donor, and that no payment has been made or promised to be made to the donor or any other person. 

The board must also prepare an explanation of the relationship between donors and recipients, as well as the circumstances that led to the offer being made. 

To investigate why the donor wishes to donate, the board must examine documentary evidence of the link as well as old photographs of the donor and the recipient together. 

The board must ensure that no middleman or tout was involved. 

The board also requires evaluating the donor's and recipient's financial status by asking them to provide evidence in support of their vocations and income for the previous three fiscal years, as well as any gross disparity between the two parties' statuses to prevent commercial dealing. 

The board also requires that the donor not be a drug addict. 

The court ordered the Authentication Board to assess the donor's mental health and inform him of any potential negative consequences of kidney donation. 

The court stated that if the Authentication Board rigorously ascertained the authenticity of an emotional donation by a known or related donor (but not unknown or unrelated), there would be a check and balance and the possibility of illegal kidney trade would be greatly reduced.

What is the most recent high court ruling on Organ Donation law in Bangladesh?

In December 2019, the High Court of Bangladesh issued an order amending the 2018 law to allow known persons other than relatives to donate kidneys. A nine-point policy was issued. Physical and mental examinations, as well as a "authenticity of emotional donation of a known or related donor," old photographs, a record of finances for the previous three years to look for gross anomalies in income, and other procedures were required. 

In light of the high court's plea for such relaxation of Bangladesh's rule, and its contrast with laws in many other countries, it is worthwhile to investigate the possible and known arguments for restricting the act of organ donation. 

Arguments for Donation Restrictions:

Restrictions on organ donation are typically justified by a number of arguments.

Corruption and Commodification: If organs can be sold for a profit, human trafficking may increase. Organ trafficking is a real issue in places like Bangladesh .It has been demonstrated that even when organs are exchanged between known people, money is likely to be exchanged. Any restrictions on behind-the-scenes dealings are nearly impossible to impose. 

Exploitation: An open market for organs would result in the exploitation of weaker parties for organ harvesting. Unevenness in relationships does not have to be monetary. 

Coercion: Similar inequalities in relationships can lead to coercion, even within a family.

Crowding Out:

If organs are bought and sold, wealthy clients will simply participate in the market rather than have an incentive to donate altruistically. Indeed, it has been demonstrated that loosening the restrictions on LURDS (organs exchanged for money) does not increase the number of transplants, but rather shifts the curve from altruistic donations to financially acquired organs. 

The expansion of kinship in 2018 was expected to reduce the black market for organs. 

The recent high court decision wishes to extend this to any known person with a proper mechanism in place, in order to avoid some of the problems mentioned above. While it is possible to distinguish a completely altruistic donation in extremely emotionally charged cases, a permission-based donation may be difficult to implement and manage when the number of donations is large. 

Given that Bangladesh already has a black market for organs, ensuring the genuineness of many of the criteria may be difficult, even if the two are known to one another and come from financially compatible groups. Furthermore, limiting the right to donate for emotional reasons to those who are financially secure may appear discriminatory. 

The poor may have feelings for related fellows to whom they would like to donate organs. A law requiring equal treatment for equal cases increases the possibility of abuse, though it is certainly possible to use the criteria to coerce someone from a wealthy family. The ability to resist is not always linked to one's financial situation, especially when family and peer pressures are involved.

What is the rule on unclaimed bodies in Bangladesh?

The laws of property, trust, and wills do not apply to the dead body because it is not a legal property of the former legal person. The sentiment of society toward the dead is valuable. When possible, a good law balances various interests and also considers social sentiments in policymaking while providing forms of freedom. This takes into account both individual rights and societal cohesive factors. 

The law considers the fabric of the specific society and understands the implications for the various adhesive factors. While Lord Devlin and Hart disagree on the extent to which moral sentiments should be considered in a law, deterioration of values, eventually leading to corruption, which is the consequential corruption of allowing a certain procedure, is important if these consequences can be properly identified. At times, the law refuses to enter areas where the end result is unknown, causing society to slide down a cliff (R v Conway). 

Allowing the acquisition of organs from unclaimed bodies in Bangladesh, where a large number of people are not covered by any social welfare scheme and where homeless and drifting people abound, may be analogous to taxing the dead for a life lived with little social support, placing an undue burden on the already neglected part and possibly creating further social alienation or corruption of values regarding social cohesion.

While obtaining organs from unclaimed bodies may reduce pressure on the black market, the act may also reinforce the notion that certain people are disposable. In the author's opinion, while harvesting organs from unclaimed bodies may increase the number of transplants, it may be a better choice in Bangladesh's socioeconomic context to first try to increase the number of consenting donors.

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