Adib Rizvi

Syed Adibul Hasan Rizvi, known throughout his career simply as Adib Rizvi, was born in 1938 in British India, in the final decade of colonial rule ^[1]. His childhood coincided with the upheaval of Partition in 1947, which divided the subcontinent and set millions of families in motion across the new border between India and Pakistan.

As a young teenager Rizvi migrated to Karachi, the port city that had become the capital of the new Pakistani state and was absorbing waves of refugees ^[1]. The city he arrived in was overcrowded and short of almost everything, including doctors and hospital beds. Accounts of his early years describe a boy who had left much of his family behind and had to find his own footing in an unfamiliar city, an experience he later connected to his sympathy for patients who arrive at hospital gates with nothing ^[2].

Karachi shaped the rest of his life. He completed his schooling there and won a place at Dow Medical College, the city's oldest medical school, where he trained alongside a generation of physicians who would go on to build much of Pakistan's health system ^[2].

After graduating from Dow Medical College in the early 1960s, Rizvi travelled to the United Kingdom for postgraduate surgical training, a common path for ambitious doctors from the subcontinent at the time ^[1]. He specialised in urology, the surgery of the kidneys and urinary tract, and earned fellowship of the Royal College of Surgeons. In Britain he saw a National Health Service that treated patients according to need rather than ability to pay, and he later cited that model as a direct influence on his thinking ^[2].

He could have stayed abroad. Many of his contemporaries did, and consultant posts in Britain or North America offered incomes that Pakistani public hospitals could never match. Instead, around 1970, Rizvi returned to Karachi and joined the urology service at the Civil Hospital, a large and chronically underfunded government institution ^[1].

What he took charge of was modest in the extreme: a urology unit of roughly eight beds inside a crowded public hospital ^[2]. Kidney failure in Pakistan at that time was, for most patients, a death sentence. Dialysis machines were scarce, transplantation did not exist in the country, and families sold land and jewellery to pay for treatment abroad. Rizvi's answer to that situation, developed over the following decades, became the defining Adib Rizvi achievement: care that was free at the point of delivery, funded jointly by the state and by private giving ^[3].

Through the 1970s Rizvi and a small team of colleagues, including the nephrologist Anwar Naqvi, expanded the little urology ward step by step: more beds, then dialysis machines, then laboratories ^[3]. They begged and borrowed equipment, persuaded Karachi's business families to donate, and pressed the provincial government for recurring funds. The unit acquired a name, the Sindh Institute of Urology and Transplantation, usually shortened to SIUT ^[2].

The decisive leap came in the mid 1980s, when Rizvi's team carried out living related kidney transplants at the institute, among the earliest such operations performed in Pakistan ^[3]. The transplants were done free of charge, and the institute committed itself to supplying the expensive immunosuppressive drugs that recipients need for life, also without cost to the patient. That lifetime commitment, unusual anywhere in the world, became a hallmark of the SIUT model and was later described in the transplant literature as a workable template for developing countries ^[3].

In 1991 the provincial assembly of Sindh passed legislation granting SIUT autonomous status, giving the institute control over its own affairs while keeping it within the public sector ^[2]. Freed from some of the constraints of ordinary government hospitals, it grew rapidly. Over the following decades SIUT added dedicated buildings for dialysis, transplantation, cancer care, paediatric urology and liver disease, and it opened satellite centres in other towns of Sindh so that villagers would not have to travel to Karachi for routine dialysis ^[2]. Through all of it, Rizvi held to two rules that answer the question of who is Adib Rizvi in practice: no patient is ever billed, and no patient is asked about religion, ethnicity or means ^[1].

By the early 2000s Pakistan had developed a grim reputation as a hub of the international kidney trade. Impoverished labourers, many of them bonded workers from rural Punjab, sold kidneys through brokers to wealthy foreign patients, and private clinics profited from the transactions ^[4]. Rizvi became the most prominent medical voice against this commerce, arguing that a poor man's kidney purchased in desperation was both an ethical failure and bad medicine, since vendors and recipients alike suffered poor outcomes ^[4].

He and his colleagues lobbied parliamentarians, courts and religious scholars for years. Their campaign contributed to the Transplantation of Human Organs and Tissues Ordinance of 2007 and to the act of parliament that followed in 2010, which criminalised organ selling and restricted transplantation to regulated institutions ^[5]. Enforcement has remained imperfect, and Rizvi continued to speak publicly whenever illegal transplant rings were uncovered, but the law marked a turning point that few observers thought possible in Pakistan ^[4].

Alongside the legal fight, SIUT under Rizvi promoted deceased organ donation, a practice long hindered in Pakistan by religious hesitation and weak infrastructure. The institute sought rulings from Islamic scholars supporting donation, ran public awareness campaigns, and built the clinical capacity to use donated organs when they became available ^[4]. Rizvi himself pledged his organs for donation and encouraged staff and public figures to do the same ^[2].

Recognition came steadily once the scale of SIUT's work became known outside Pakistan. In 1998 the Ramon Magsaysay Award Foundation in Manila gave Rizvi its award for Government Service, often described as Asia's most respected honour, citing his insistence on free and dignified treatment for kidney patients regardless of their circumstances ^[1]. Pakistan conferred its own high civil decorations on him, including the Nishan-e-Imtiaz, and universities and surgical colleges at home and abroad awarded him honorary fellowships ^[2].

For a figure of such prominence, his personal life has remained deliberately plain, and the well documented Adib Rizvi facts are few and consistent. He never accumulated private wealth from medicine, refused to run a private practice, and for decades lived in modest quarters close to the hospital so that he could be reached at any hour ^[2]. Colleagues and journalists who have profiled him describe a man who still walked the wards daily well into his eighties, ate in the staff canteen, and deflected questions about himself toward the institution ^[2].

He has often said that health care is not charity but a right, and that a state which cannot give its citizens medicine has failed at something basic. That conviction, repeated in interviews across four decades, is the closest thing to a personal creed he has offered ^[1].

The institution is the legacy. From eight beds in 1970, SIUT grew into a complex treating hundreds of thousands of patients each year, running one of the largest dialysis programmes in the region and a continuous kidney transplant service, all without presenting a bill ^[2]. Its financing model, roughly a partnership between government grants and sustained private philanthropy, demonstrated that free tertiary care could survive in a poor country, and it has been studied by health planners and transplant societies internationally ^[3].

Rizvi's influence also runs through people. Generations of Pakistani urologists, nephrologists and transplant surgeons trained at SIUT, and many now lead departments elsewhere in Pakistan and abroad ^[3]. His ethical writings and advocacy, produced with colleagues such as Anwar Naqvi and engaged critically by bioethicists studying organ transplantation in Muslim societies, helped shape how the country debates donation, consent and the obligations of the state to the sick ^[4].

For readers asking who is Adib Rizvi, the shortest answer may be the one his patients give: the doctor who never sent an invoice. Historians of medicine in South Asia are likely to give a longer one, placing him among the institution builders of post independence Pakistan, a surgeon who treated the health system itself as his patient ^[1].