Organ trafficking is clandestine, not possible in govt hospital — Dr Eze

Dr Uwom Eze, president of the African Society of Forensic Medicine, a forensic pathologist and clinical forensic physician at the University College Hospital (UCH), in this interview with SADE OGUNTOLA, speaks on organ trafficking, why it should not occur at government’s hospitals and processes for organ harvesting with consent of the donor. Excerpts:

ThERE was a case of a purported missing intestine in a Lagos hospital. What is your perspective as a forensic expert?

It is quite an unusual complaint; my strong impression is that it might be a communication issue. The case is apparently a referral from one hospital to another. The question is: what was the basis for the referral?

Again, what was the primary disease the boy presented with and was there any medical intervention that took place at the primary facility before referral? Sometimes, patients or their relatives get bits and pieces of information about medical procedures carried out. And so if another doctor makes any reference to some kinds of missing intestine, I reckon that it’s likely, but this is just speculative because I don’t have details. It will be very important for the public to know that the right questions should be asked first and discussing this case in the public domain by people who have no details about all the medical interventions that have taken place would be prejudicial to what actually happened and damaging to the confidentiality of patient’s medical information.

The best time to make a comment from a forensic point of view is after the facts are presented. However, it is unusual to have a ‘missing intestine’ as a result of some kinds of organ harvesting or somebody tampering with organs as insinuated. The intestines do not come on top of the organs that people remove for transplantation. I strongly suspect that there is a communication issue and, hopefully, the authorities will resolve the matter.

Human organs are harvested and sold; could that be the reason why there is a hue and cry about a missing intestine?

Human organ harvesting is a global phenomenon and organs have been harvested many times by traffickers. People have been abducted and their organs forcefully removed from them. So, I agree with you. But in this circumstance, what is happening is that somebody presented to a doctor at the hospital, some medical intervention or procedure took place, and that patient was referred to another higher centre for continuation of care because of some change in condition. We don’t have this information. This is not the typical scenario where organ trafficking takes place; it is usually very clandestine. Those hospitals don’t have labels; they work with criminal elements and then harvest organs for sale. It’s unlikely that a doctor will be involved in organ harvesting and then send the patient to a higher level to continue care. But I understand the public suspicion about possible organ harvesting and trafficking could have fuelled this line of thought. I reckon that in this particular case, it may be some medical condition that did not go away or a medical intervention that did not go as planned, and then a patient is referred for higher care in another setting. That is what I suspect. But I need more information.

A singer with the stage name Mohhbad died a few days ago at the age of 27. As a forensic expert, what could have caused his sudden and unexpected death?

I don’t know. But sudden and unexpected death is one of the issues for which, in virtually all parts of the world, the laws on medicolegal death investigation are applicable. This case will warrant a forensic death investigation to determine what happened. Just because somebody is famous and looks healthy while performing on stage does not mean there is no existing medical condition that might cause a sudden and unexpected death. Death can occur at any age, so that somebody is 27 years old does not make the person’s death unusual. What would make it unusual is if the death were sudden and unexpected. Of course, the suspicion his death generated has made it an issue of public interest. I believe that with the cooperation of the family and the relevant authorities in the jurisdiction, a proper forensic death investigation would be carried out.

When you’re doing a forensic death investigation, what are the things that you want to identify, or do you want answers to the circumstances? One, what is the cause of death? Two, what is the manner of death? But just because the cause of his death or the manner of death is not in the public domain does not mean that the family, next of kin, or even the treating doctor wouldn’t know. Certainly, it is only after you’ve done a proper forensic death investigation that you may be able to know the exact cause of the death.

Generally, when an apparently healthy adult suddenly dies, it calls for a forensic death investigation. It is possible that this individual is already buried, so the question will be whether a forensic autopsy was conducted before burial or not. This will complicate the death investigation and further leave room for speculation.

Certainly, if Mohhbad was apparently healthy and then died suddenly, the law stipulates that a forensic death investigation be conducted to provide answers to the questions that the family or the next of kin may want to know.

What is the difference between a forensic death investigation and an autopsy?

Autopsy is a general name for the postmortem procedure done on the dead to understand the cause and manner of death in medical-legal death investigations. You dissect a body and check for changes in the body that would have resulted in death or the progression of disease, as the case may be. Sometimes the cause of death may already be known, but in non-medical legal cases, it may be necessary to understand the extent of the disease in the body or the mechanism of death.

A forensic death investigation is a whole constellation of things done to determine the cause and manner of the death. The autopsy is a critical aspect of forensic death investigation, but it also includes a police investigation of the scene, the medical records, and other ancillary investigations like checking the constituents in the blood or in the tissue as part of the autopsy to answer what the cause and manner of death are in any particular case. So, an autopsy can be forensic or non-forensic.

However, the autopsy in the case of Mohhbad may be forensic if it is geared towards addressing medicolegal concerns, unlike the regular hospital autopsy, which is non-medicolegal.

How can forensic investigation help to better understand cases of suicide among youths so that cases can be stemmed?

Forensic medicine comes in to help determine that such a case termed as suicide is actually one. When you say somebody has committed suicide, you’re making a very sweeping comment. That can only be determined after a proper investigation of the manner of death. There are different manners in which people die. It may be natural, homicide, accident or suicide. Sometimes, it does not fit into any of the categories and is thus stated as “unclassified.”

So when you say younger people are committing suicide, in forensic medicine, we will question that assertion because we cannot say they die by suicide without investigation. One, we need to confirm it is suicide. There may be a lot of reasons why people are committing suicide, but people can also be induced to commit suicide. In cyberspace, young people have been coerced to kill themselves.

The stress of life has made some to have mental health problems like depression. Now, if such deaths are subjected to investigation, you will realise that not all cases are suicide at the end of the day. Some are homicide cases.

Each case is peculiar and is investigated on its merit. If you put everything in one basket, you may miss homicide. When they bring people and say this person has killed himself, we still do a forensic autopsy because sometimes things may be staged. For instance, the person could have been killed before being hanged to make it look like suicide. Through our training, we can look at everything and find out if somebody has made a homicide appear like a suicide.

The Plateau NMA said they want to investigate a medical doctor over an alleged case of organ harvesting. Can an individual know or feel that his organ, say a kidney, has been removed from his body?

Again, I don’t have details of that case. Humans have two kidneys, but we can live successfully with one kidney. That is why people can donate one of their kidneys to another person. You may not feel anything (if that means any significant ill health) if one kidney is removed from you.

But removing other organs like the liver, lung, or heart requires massive surgery; there is no way such organs are removed that the individual will not feel it (if the person is not already dead!). It will impact the person’s health and wellbeing, depending on the person’s pre-existing health condition. Even removing a part of the lung will require quite complicated surgery that will leave some after-surgical effects.

So, a person’s organ can be harvested and the person will feel unwell; the degree of which depends on the organ removed. He or she will not attribute it to organ removal unless he or she is aware that a particular organ has been harvested.

Basically, organs are harvested most often for medical reasons. Medically, the term harvesting organs is used when people donate their organs for postmortem donation. They would have agreed that if they died, their organs could be harvested and used for medical care if such organs were viable. The donors are apparently healthy people. Any part of the body can be harvested, including the heart, lungs, liver, cornea, pancreas, kidney, bones, and even the skin. It is like somebody giving life to other people in the event of his death, and they generally do so out of altruism.

However, the same thing that is done legally can also be done illegally, and that usually happens in the context of criminal activity. So it is done clandestinely. For instance, under the pretence of an intended surgery, they can remove a vital organ.

So harvesting is not a criminal word; it is all about saving lives. But just like taking what does not belong to you becomes stealing, so it becomes criminal when an organ is removed without the consent and knowledge of its owner.

But for the Plateau case, what is alluded to is the criminal harvesting of organs from someone. We also need to understand what happened.

Doctors see things in their line of work that others don’t know about: people are walking around with one kidney. Some have fused kidneys, some have only one functioning kidney. But they don’t know about such things until there is a medical condition and they are requested to carry out some tests, including radiological investigations.

If the person goes to do a test after surgery, not related to the kidney, and then the test shows it is only one kidney that is seen, it may be assumed that the doctor has harvested the kidney. But the organ was never there in the first place!

However, there are ways to find out if somebody has harvested organs; it only needs appropriate intervention.

That is why we have regulatory bodies. If the patient is alive, the Medical Council will set up a panel to look into everything to find out what happened. If the person is dead, that is where a forensic autopsy comes in to examine the body and determine if a kidney was actually there before. A purported case of missing organs is not something that the public can discuss without adequate information. Each patient is different. Remember, Kanu Nwankwo had a hole in the heart and Sam Okwaraji had a heart condition and died while playing football. They had pre-existing conditions nobody knew about until they entered professional soccer.