The right to health under Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), as interpreted in UN Committee on Economic, Social and Cultural Rights in General Comment No. 14, obliges states to do far more than pass legislation. They must take concrete legislative, administrative, and regulatory steps to ensure healthcare is genuinely available, accessible, acceptable, and of good quality. For organ transplantation, this means more than expanding who is legally permitted to donate — it means building a system that protects donors, prevents commercial exploitation, and ensures fair access for patients.

Protecting the living donor

A rights-based transplant system must protect donors as carefully as recipients. Living kidney donors take on real surgical risk, yet Bangladesh has historically lacked systematic long-term medical follow-up and welfare support for donors once the transplant is complete. When a person undergoes major surgery with no guaranteed post-operative monitoring or continuing care, the state’s duty to protect health is only half-discharged. Donor protection is not simply good clinical practice; it is part of what the right to health requires.

The gap between law and practice

The same problem applies to deceased donation. Brain-death-based donation has been legally recognised in Bangladesh for years, yet it remains negligible in practice, because statute itself cannot establish an effective deceased-donor programme. To make it successful, hospitals require functioning brain-death determination committees, trained specialists, organ procurement systems and sustained public awareness initiatives — capacities that have yet to be developed in the country. Without these institutional foundations, the legal recognition of deceased donation risks remaining largely symbolic, leaving patients without meaningful access to transplantation despite legislative reform.

Exploitation is a human rights issue

Widening donor eligibility without matching regulatory safeguards can open new space for brokerage, coercion, and informal payment, particularly where economic vulnerability is widespread, and oversight is thin. The UN Special Rapporteur on trafficking in persons has affirmed that organ-removal trafficking is fundamentally a human rights violation, and that states bear a binding obligation to prevent it, prosecute offenders, and protect victims. Also, the WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation emphasise that organ donation systems must be transparent, effectively regulated, and protected against commercialisation and exploitation. Seen in that light, licensing, mandatory donor registration, long-term monitoring, and enforcement against brokers are not bureaucratic add-ons. They are safeguards necessary to protect bodily integrity, human dignity, and public trust in the transplant system.

Measuring success correctly

Bangladesh deserves credit for modernising its transplant law. But the Act’s success should not be measured by how many people are now legally eligible to donate. It should be measured by whether the reform delivers safe, equitable, and ethically governed access to transplantation — and whether it protects those whose generosity makes that access possible.

Bangladesh’s experience carries a wider lesson for low- and middle-income countries pursuing similar reforms: legislative change, however welcome, cannot realise the right to health on its own. Realising rights requires effective institutions. The next test for Bangladesh is not writing better law, but building the administrative capacity — donor registries, brain-death infrastructure, anti-brokerage enforcement — that turns legal permission into genuine care.