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Bangladesh Journal of Bioethics 2020; 11 (1): 1-8 

 

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Why Is Family-Oriented Organ Transplantation Policy and Practice 

Necessary for Bangladesh?   
 

Md. Sanwar SIRAJ, Ph.D. 

 
Assistant Professor, Department of Government and Politics, Jahangirnagar University, Savar, Dhaka-1342, 

Bangladesh, Email: siraj_sanwar@juniv.edu       

 
DOI: https://doi.org/10.3329/bioethics.v11i1.49191  

 
Abstract : In the West, in countries such as the US and UK, people are equally encouraged to donate 

organs both to their relatives and nonrelatives. In practice, although family is the priority in the US 

and UK, anybody can donate organs to anyone else lawfully. Contrastingly, in Bangladesh, people are 

only legally allowed to donate organs for transplantation to close relatives. Bangladesh’s living organ 

transplantation policy and practice is in stark contrast with the Western secular biomedical 

perspective. In this artcile, I address that the notion of individual freedom and liberty in regard to the 

donation of organs for transplantation in the West is consistent with secular culture and biomedical 

perspectives, but such biomedical policy and practice is at odds with the Bangladeshi Muslim culture, 

socio-economic reality and biomedical perspective. As Bangladesh is a family-oriented collective 

society, the kinship relation and strong familial bonds may encourage relatives into donating organs to 

a patient. More than 20% of people still live below the poverty line, and the COVID-19 pandemic has 

pushed poor people into extreme poverty. The practice of allowing unrelated altruistic donors as is 

done in the West and Iran, or even in the special circumstance in Paksitan, the act of donating organs 

will comprehensievly increase organ trade in Bangladesh, which in turn will cause more harms than 

benefits. This study conludes that the government should uphold family-oriented biomedical policy 

and practice in Bangladesh until poverty is eliminated. It implies that patients who do not have close 

relatives, or whose poetntial relative donors are medically unsuitable for transplantations should wait 

for deceased organs for transplantation.  

 

Key words: Family, Organ Transplantation, Policy, Bangladesh   

 

Introduction: The first sucecssul organ 

transplantation between close relatives was 

performed in Bangladesh in 1982, and the 

practice became more regular from 19881. 

Untill the legislation of 1999, there was no 

legal provision in relation to organ 

donation for transplantation in Bangladesh. 

The Human Organ Transplantation Act 

(HOTA) was first approved in 1999. The 

act allowed organ donations from both 

living donors and brain dead donors for 

transplantation. For living donations, a 

number of close family relatives were 

lawfully allowed to donate organs for 

transplantation. The act was then revised 

in 2018 that added a number of extended 

family relatives as potential donors to the 

existing donor list. The revised act upholds 

the family-oriented nature of biomedical 

policy. Despite the transplantation of 

corneas from brain dead donors having 

commenced in Bangladesh, the 

transplantation of vital organs (e.g., 

kidney, liver, heart and pancreas etc.) has 

not yet been introduced2. The government 

of Bangladesh recently attempted to 

initiate a program of transplantation of 

vital organs from brain dead donors.  

 

Conversely, in the West, in countries such 

as the US and UK, people are equally 

encouraged to donate organs both to their 



Bangladesh Journal of Bioethics 2020; 11 (1): 1-8 

 

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relatives and non-relatives2,4. In practice, 

although family is the priority in the US 

and UK anyone can lawfully donate 

organs to anyone else. Unrelated altruistic 

donors are legally allowed to donate 

organs in the Islamic Republic of Iran if a 

patient is unable to find a potential donor 

from inside their own family, and also 

donation from the deceased is permitted 5-

8. In the Islamic Republic of Pakistan, if a 

related donor is not avilable, or if such 

potential donors are incompatible with the 

patient, an unrelated donor can donate 

organs on the condition that the Evaluation 

Committee (EC) is satisfied that such a 

doantion is “coercion-free” and 

“voluntary”9. 

 

A small group of libertarian Bangldaeshis 

recently put pressure on the governement 

of Bangladesh so as to extend the 

biomedical policy and practice beyond just 

relatives as is done in the West, arguing on 

the grounds of individual liberty and 

freedom that public policy does not 

prohibit someone from donating organs. 

Some even urge to the government to 

extend biomedical policy and practice, 

likley as using the model of Iranian 

practice. Some threfore urge the 

governement to allow unrelated altruistric 

donations conditionally in special 

circumstances as in Pakistan. They view 

that extending bioemdical policy and 

practice to beyond relatives in Bangladesh 

will save the lives of many patients, and 

will cause greater benefits than harms. I 

contend that the government should 

uphold the family-oriented character of 

bioemdical policy and practice of living 

organ donation for transplantation in 

Bangladesh until poverty is eliminated. 

The practice of allowing unrelated 

altruistic donors to donate organs lawfully 

will force poor people into selling their 

organs to alleviate poverty.  

 

Stipulations of the Policy and Practice 

of Living Organ Donation for 

Transplantation in Bangladesh: The 

Human Organ Transplantation Act 

(HOTA) was first passed by the 

Bangladesh Parliament in 1999, allowing 

both brain dead donors, and living related 

donor transplantations. According to the 

1999 act, the first degree blood relatives 

such as the father and mother, adult sons 

and daughers, adult sisters and brothers, 

and second-degree relatives by blood are 

the uncles and aunts both from paternal 

and maternal sides, and emotional relatives 

such as husbands and wives are the only 

people who can legally donate organs for 

transplantation (Section 1: 4). The existing 

act that was revised in January 8, 2018 and 

came into force officially on January 28, 

adds a number of extended family relatives 

to the existing donor list. The act redefines 

the term ‘close relatives’ and adds a 

number of third-degree blood relatives, 

namely grandparents, grandchildren and 

first cousins (Section 1: 4). Apart from 

these family relatives, unrelated donors are 

not legally allowed to donate organs for 

transplantation in Bangladesh. The 

stipulation of the new act also adds that 

anybody can donate skin, tissues, bone 

marrow and corneas to anyone else 

(Section 3:1), but that vital organs (e.g., 

kdiney, liver, and pancreas etc.) are to be 

donated only among these relatives listed 

in the act. The act does not allow the 

selling of organs or receiving of financial 

benefits for donating organs. It also 

completely prohibits advertisements for 

the purpose of selling organs (Section 9). 

Thus the policy and practice of living 

organ transplantation in Bangladesh has 



Bangladesh Journal of Bioethics 2020; 11 (1): 1-8 

 

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remained family-oriented because 

unrelated altruistic donors are not lawfully 

allowed to donate organs for 

transplantation.  

 

Stipulations of the Policy and Practice 

of Living Organ Donation for 

Transplantation in the West: In the US 

and UK, people are equally encouraged to 

donate organs both to their relatives and 

non-relatives3,4. In practice, depite family 

members being the priority in the US and 

UK, anyone can lawfully donate organs to 

anyone else. In the UK, for example, a 

living donations can be classified 

consequently as a directed altruistic 

donation, non-directed altruistic donation, 

paired/pooled donation or non-directed 

altruistic donor chain donations. The first 

category of donation, directed altruistic 

donation, is where an individual can 

donate an organ to a family member, 

partner or good friend. Donating organs to 

someone with whom donors have no 

genetic or pre-existing emotional 

relationship with is called a non-directed 

altruistic donation. If a donor is not 

medically suitable for someone whom they 

wish to donate to, they may join a joint 

scheme and be matched with another 

donor recipient pair in the same situation, 

so that more than two people in need of a 

transplant are able to exchange compatible 

organs. In the final category, the non-

directed altruistic donor can donate their 

organ into a paired/pooled scheme. By 

matching two or more potential donors and 

recipients, a chain of operations can be 

carried out. At the end of the chain, the 

remaining organ is then donated to the 

best-matched patient on the basis of a 

national waiting list3. I contend that as 

Bangladesh is a family-oriented collective 

society1, introducing the UK biomedical 

policy and practice of living organ 

transplantation into a non-Western country 

is culturally and socio-economically at 

odds, and such policy and practice would 

encourage poor Bangladeshis to sell their 

organs to to non-blood relatives to 

alleviate poverty.  

 

Why is Western living organ 

transplantation policy and practice 

inappropriate with Bangladeshi 

indigenous culture, socio-economic 

situation and biomedical perspectives? 

As mentioned earlier, people in the West 

such as the US or UK are equally 

encouraged to donate organs both to their 

relatives and nonrelatives. In practice, 

although family is the priority in the US or 

UK anyone can lawfully donate organs to 

anyone else. This article argues that 

Westerners are free, autonomous, 

independent and rational individuals and 

this gives individuals the right to make 

their own decisions regarding organ 

donation for transplantation. Western 

secular values stipulate that humans should 

be treated equally, that individual 

autonomy should be the basis of all 

national activities, and that biomedical 

laws and practices should be guided by the 

Western emphasis on individual autonomy, 

equality and freedom of choices10. 

Westerners hold the view that as long as 

people abstain from doing harm, they 

should be permitted to donate to anyone 

they choose. As Westerners also believe 

that organ donation is an altruistic activity 

as a gift of life, so, these charitable and 

altruistic activities should not be limited to 

relatives only. Conversely, I contend that 

traditional family bonds and relations in 

the West are not strong enough, but have 

become broken and strained 11, secular-

minded, freely-motivated Western people 



Bangladesh Journal of Bioethics 2020; 11 (1): 1-8 

 

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are not obliged to only donate to family 

members. Thus, modern secular 

biomedical policies and practices allow 

anybody in the West to donate freely to 

anyone they wish.  

 

I argue that the Bangladesh governemnt 

ought not to establish the Western 

approach of individual freedom, equality 

and free choice in biomedical policy that 

legalises donations to both family 

members and unrelated patients. Despite 

the difference of the survival rate between 

unrelated and related donor-recipient pairs 

not being statistically significant, I contend 

that Western individual free choice is 

inappropriate for a non-Western country 

whose cultural ties are strongly connected 

with the community such as the family. 

The application of such secular Western 

values to biomedical decisions are contrary 

to the Islamic emphasis on religious 

dignity and the Muslim tradition of 

collective decision-making12, which 

prioritizes non-individualist values. 

Establishment of the Western biomedical 

approach in the Muslim society of 

Bangladesh would thereby cause 

enormous societal, economic and familial 

problems.  

 

If the government established Western 

secular biomedical policy in Bangladesh, it 

may encourage donors to donate both to 

families and unrelated patients, and as 

such will increase the organ trade in 

Bangladesh. In the name of altruistic 

motivation, poor Bangladeshis may easily 

sell their organs to alleviate their poverty. I 

argue that if Bangladesh’s governemnt 

endorses Western biomedical policy, such 

as that of the UK, it will cause more organ 

business in Bangladesh. I argue that 

extending biomedical policy beyond 

family relatives would make Bangladeshi 

families more vulnerable and perilous. In 

the name of respecting individual 

freedoms, as in Western cultures, or saving 

the lives of vulnerable patients, the 

extension of biomedical policy to 

unrelated donors would place poor 

Bangladeshis into markets as daily 

commodities. Organ selling is an immoral 

practice 13-22, because potential donors and 

recipients involve bargaining position for 

organs what sellers and buyers do in 

markets for a commodity exchange1. 

These immoral practices should not be 

allowed in Bangladesh. 

 

Despite individuals being seen as 

possessing the human right to donate 

organs to anyone else altruistically, I argue 

that allowing unrelated altruistic donors to 

donate organs legally on the grounds of 

individual rights, social justice or equity 

would be unrealistic and unjustified for 

Bangladeshis. As Bangladesh is a family-

oriented collective society and almost all 

Bangladeshis are born, raised and live in 

the familial structure, the kinship relation 

and familial bond may encourage 

Bangladeshis to donate organs to their ill 

patients1. As the government has already 

extended the donor list to include third-

degree blood relatives, Bangladeshi 

patients may find potential donors from 

inside their own families. Allowing a 

Western-style free donation system may 

create social burdens for Bangladeshis. 

Allowing unrelated donors to donate 

organs legally will compromise the strengh 

and integrity of the family. If unrelated 

patients are lawfully allowed to receive 

organs, rich patients will easily buy organs 

from the poor, and Bangladeshi families 

may no longer be able to find donors 

inside their own familiess in their time of 



Bangladesh Journal of Bioethics 2020; 11 (1): 1-8 

 

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need1. Almighty surely has defined limits 

for the use of the body. Scholars permit 

Muslims to donate organs to their relatives 

even though it may risk one’s life to save 

another, this belief prohibits Muslims from 

donating organs to unrelated patients 13,14 

Also, saving the life of a relative by 

donating organs is more valued in Islam as 

the Qur’an states “And give to the near of 

kin his due and [to] the needy and the 

wayfarer, and do not squander wastefully” 

(Qur’an, 17:26).  

 

Some argue that how could Bangladeshi 

practice save the life of an orphan who 

does not have any relatives? The view that 

as organ donation for transplantation is a 

charitable and humanitarian activity, the 

public policy does not and can not prohibit 

individuals from donating their organs to 

anyone else, because the aim of public 

policy is to ensure benefits rather than 

harms for all members in the society. I 

contend that as these cases are very few, 

allowing unrelated altruistic donors to 

donate organs legally in order to save the 

lives of a few orphans may create many 

social problems in Bangladesh that would 

outweigh the total benefits. Allowing 

unrelated donors to donate organs to save 

the lives of orphans may encourage poor 

people to sell organs. If orphans do not 

have relatives, they should wait for 

deceased donation for transplantation. As 

the government is recently trying to 

establish transplantation of vital organs 

(e.g., kidney, liver, heart, and pancreas 

etc.) from brain dead donors, the 

successful immediately introduction of a 

program allowing deceased organ donation 

for transplantation would be a good 

solution for saving the lives of orphans and 

other patients. Otherwise, permitting 

unrelated donors to save the lives of few 

orphans may severely increase organ trade 

in Bangladesh, causing more harm than 

good.    

 

Stipulations of the Policy and Practice 

of Living Organ Donation for 

Transplantation in Iran and Paksitan: 

Some refer to the policy and practice of 

living organ transplantation in the 

perspective of Iran where unrelated donors 

can donate organs for transplantation. Let 

me berifly discuss the policy of living 

organ transplantation in Iran. Once a 

patient is identified, medical professsionals 

search for a medically-suitable living 

related donor for transplantation. In doing 

so, physicians advise the patient to find a 

potential donor within their family 23. If a 

patient does not have any related potential 

donors, or a potential relative donor is not 

willing to donate, then the recipient is 

referred to the Dialysis and Transplant 

Patients Association (DATPA) to find an 

organ from a deceased donor (DD), 

waiting in the queue for a maximum of six 

months 8. If the patient does not find an 

organ from a DDs the DATPA searches for 

suitable organs from living unrelated 

donors (LUD)8. LUDs receive a fixed 

amount of compensation (10 million 

Iranian rials), one year post-operative 

medical insurance, medicines at subsidized 

costs, and waived hospital fees from the 

government or charities after 

transplantation7. LUDs also receive extra 

financial compensation from recipients for 

their donation7. If such unrelated donation 

is adopted in Bangladesh, the poor will 

easily sell their organs to rich patients to 

get out poverty, in line with what happens 

in Iran 24,25. This biomedical policy and 

practice should not be introduced in 

Bangladesh, as the harm it causes will 

outweigh benefits.   



Bangladesh Journal of Bioethics 2020; 11 (1): 1-8 

 

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Some even refer to the biomedical 

perspective of Paksitan where unrelated 

altruistic donors are conditionally allowed 

to donate organs for transplantation in 

special circumstances. Let me briefly 

discuss the stipulations of the policy and 

practice of living organ donation for 

transplantation in Pakistan. An unrelated 

altruistic donor is allowed to donate organs 

only in the situation when close relative 

donors such as parents, adult progeny, 

adult siblings, and spouses are not 

available and/or such potential relative 

donors are medically unsuitable for 

transplantation. In the case of 

unavailability of such close relatives, the 

law prescribes that the EC may permit 

donation by unrelated donors only after 

satisfying the EC that such a donation is 

fully “voluntary” and “coercion-free” 9. 

Some Bangladeshis argue that if Pakistan, 

being a South Asian Muslim society, can 

allow unrelated altruistic donors to donate 

organs for transplantation in special 

conditional circumstances, the Bangladesh 

governemnt should also allow the same 

practice. I contend that Bangladesh’s 

biomedical policy already allows a wider 

number of relatives (e.g., parents, adults 

progeny, adult siblings, spouses, paternal 

and maternal uncles and aunts, 

grandparents and grandchildren, and first 

cousins) to donate organs for 

transplantation, while in Pakistan the 

number of potential donors is fewer (i.e., 

parents, adult sons and daughters, sisters 

and brothers, and spouses). Bangladeshi 

patients are thus more likely to find a 

potential donor from inside their family. 

To cite the view of Moniruzzaman (2010); 

extending biomedical policy to beyond 

relatives is a concession of a few rich 

patients who might want to avoid harming 

the body of their own relatives, and instead 

try to obtain an organ donation from a 

poor person2. Despite the Bangladesh 

governemnt having extended its 

biomedical policy to third-degree blood 

relatives, I agree with the view of 

Moniruzzaman (2010) that it is the corrupt 

intention of a few rich patients to buy an 

organ from a poor person instead of 

obtaining it from their relative 2. As more 

than 20% of people still live below the 

poverty line26, and the COVID-19 

pandemic pushes poor people into extreme 

poverty and makes others economically 

vulnerable (27), allowing unrelated donors 

to donate organs even in special cases will 

severely increase the organ selling 

problem in the country. In the name of 

altruistic donations, poor people will easily 

sell their organs to rich patients to get 

away from poverty, thereby outweighing 

possible benefits.  

 

In addition to the poor socio-economic 

conditions of people in Bangladesh, I also 

argue that allowing unrelated donors to 

donate organs lawfully will severely 

increase organ trading in Bangladesh, 

where there is no effective accountability 

mechanism, and corruption has been a 

burden for many years 28. For instance, in 

2012, TI ranked Bangladesh as the 

thirteenth most-corrupted country in the 

world29. In 2015, the National Household 

Survey on Corruption in the Service 

Sectors of Bangladesh estimates the cost 

of bribery in regard to unauthorised and 

informal payments annually to be 8,822 

crore BDT, which equals 0.6% of the 

Gross Domestic Product (GDP)30. In this 

reality, allowing unrelated donors to 

donate organs lawfully will 

comprehenssively increase the organ trade 

in Bangladesh, which may negatively 



Bangladesh Journal of Bioethics 2020; 11 (1): 1-8 

 

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affect the health of larger sections of the 

population. The vested interest groups 

such as rich patients and brokers will be 

the only beneficiaries of such an extension 

to bioemdical policy and parctice.    

Concluding Remark: The policy and 

parctice of living organ donation for 

transplantation in Bangladesh should be 

family-oriented until poverty is eliminated. 

Otherwise, allowing unrelated donors to 

donate organs to anyone else or in special 

circumstances will encourage poor 

Bangladeshis to sell their organs to get 

away from poverty. The successful 

implementation of a program for deceased 

organ donation for trasnplantation may 

save the lives of many patients, especially 

those whose who do not have potential 

relative donors avilable, or if they do, are 

medically incompatible with their 

relatives. Bangladeshi policy makers, 

health professionals, legal experts, 

transplant communities and bioethicists 

should consider this with the utmost 

attention. 

 

Acknowledgments and Funding Information:I 

deeply acknowledge the suggestions that I received 

from my Ph.D. supervisor, Professor Ruiping Fan. I 

am also thankful to Dr. Rebecca Dewey, University 

of Nottingham for providing me with meticulous 

editing work on the manuscript. A part of this study 

was supported by the Research Activities Fund 

(Grant Number: 000669), University Grants 

Committee (UGC) of Hong Kong.  

 

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Author contribution: Author conceived the idea, 

did the literature review, wrote the manuscript and 

checked the manuscript meticulously.  

Conflict of interest: The author declares that there 

is no conflict of interest in this study.  

 

 

 

 


