Human retail

All, writes Sahar El-Bahr, is for sale

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'I thought living with one kidney for the rest of my life would be better than ending up in jail'; illustrations: George Bahgory

You cannot miss the advertisement hanging off a street light on Talaat Harb Road: Kidney for Sale. Ringing the mobile phone number underneath, I eventually met Emad Abdel-Azim, owner of the organ in question. He had been eager to include his number, he explained, because he wanted to be accessible to potential buyers at all times. It doesn't take a sinister mafia or complicated kidnap scenarios for such horrors to be real, as it turns out -- just poverty. "I was working at a public-sector company in Cairo," Abdel-Azim recounted. "A year and a half ago I was made redundant with an LE8,000 good-bye gift. I thought I'd take out a loan on top of that, buy a van and use it as a service taxi to provide for my wife and three daughters." Four months ago, Abdel-Azim had a highway accident that left his van destroyed; his left leg was injured, and he could think of no way to pay back some LE29,000. "I thought living with one kidney for the rest of my life would be better than ending up in jail," he says, pricing his merchandise at LE40,000-50,000; but, aside from crank callers and others, the highest bidders offered him no more than LE25,000: not enough to pay his debt. The one bidder who offered a good price turned out to be a charitable man who paid his debt for nothing, requesting that he should never again offer part of his body for sale -- a practice, the charitable man reminded Abdel-Azim, that is strictly prohibited in Islam. Others in Abdel-Azim's position haven't been so lucky.

According to the World Health Organisation (WHO), Egypt ranks third among the five top "hot spots" for human-organ trafficking in the world today: China, Pakistan, Egypt, Colombia and the Philippines. Commercial donors, when not dead, are 95 per cent male, and their average age is 33. Physicians will usually remove the more efficient kidney, with the result that 78 per cent of donors reported a notable deterioration in their health; 81 per cent spent the money they received in compensation within five months and 94 per cent emphatically regreted selling a kidney. The figures conceal thousands of heart-rending stories of poverty, unemployment and terrible exploitation. Many have reported to the police or the Doctors Syndicate going into hospital for minor surgeries only to end up losing a kidney without prior consent: once investigated, such stories turn out to be untrue; donors simply feel duped when the money arrives, and in many cases it is less than the sum agreed on prior to the surgery. Thus they attempt to take revenge on the brokers or doctors, who tend to be sufficiently proficient at exploiting the loopholes in the law to avoid being questioned or arrested, often presenting the authorities with receipts signed by the donors for money not paid. This is no doubt aided by the fact that donors tend to be uneducated and desperate. According to Abdel-Qader Hegazi, head of the syndicate's Disciplinary Committee, complaints arrive on a daily basis: "Most have been promised LE20,000-30,000 but receive only LE5,000." There is a mafia operating a black market, he conceded, even at cafés and other well-known venues where deals are made.

With 44 per cent of the population below the poverty line, according to the United Nations Development Programme (UNDP), supply actually exceeds demand in Egypt, pushing prices down. Organ-transplant tourists from all over the world shop here. Hegazi says the law -- down to syndicate regulations does not sustain an adequately preventive punishment: an LE10 fine, recently raised to LE500-1,000 and suspension for two months, with doctors usually able to resume work once they have appealed before the court. Famous doctors and hospital officials are involved in this business. "Lately," Hegazi says, "some hospitals involved with brokers charged with bringing in a steady stream of poor unemployed people had their surgery rooms closed for eight months by way of punishment." The syndicate should have more power, Hegazi believes, with the judicial authority to enter hospitals without prior consent to investigate violations of the law. Punishments should include prison sentences and more debilitating fines. But the law is bogged down by controversy regarding differences in legal, religious and medical views on such issues as whether clinical death constitutes death and whether organ transplants should be allowed; issues have not been resolved for 25 years. Head of the Doctors Syndicate Hamdi El-Sayed says the issue of clinical death continues to obstruct the release of such draft laws as that proposed by MP Mohamed Queita and submitted annually to parliament since 1996, only to be referred to the Shura Council and never heard of again. The draft law incriminates removing organs from patients in deep coma and those who are clinically dead. "Some physicians maintain that the clinically dead are really dead," Queita says. "But this is not true even from the medical point of view. Why, otherwise, would such patients require anaesthetic prior to the removal of organs? They can feel the pain."

With real death, Queita added, only the skin, some heart valves, eye parts and bones will work effectively, whereas organs like the liver, kidney and heart are no longer of any use. Queita argues that the lack of prohibition on removing organs from the clinically dead leaves the door wide open to illegal organ trade, pointing out that on the computer of a famous laboratory the names of 1,500 patients who had been tested for kidney transplants have been found together. "Hospitals," he says, "carry out the transplants overnight and remove patients to nearby affiliated flats before sunrise." And indeed the trade is thriving, with newspaper advertisement galore. Some are explicit while others make elusive references to the propositions: "Save a life and win LE50,000 by donating a litre of blood with a certain medical test." There are certainly enough young people who will be swayed by the idea. Negad El-Borai, a lawyer before the Cassation Court, says Egypt is the only country in the world that lacks a comprehensive law regulating organ transplants, whereas Muslim countries like Iran, Saudi Arabia and Pakistan all have such laws. "Back here only some Ministry of Health instructions stipulate that organs can only come from first-degree relations." For the time being, Borai insists, there should at least be a law regulating the transplant of organs from those who die in car accidents -- facilitated, rather more improbably, by requiring those who would like their organs to be used on dying should state the fact on their IDs. According to Sheikh of Al-Azhar Mohamed Sayed Tantawi, indeed, Islam does not prohibit organ transplants but conditions that: the transplant pose no risk to the donor, be of vital importance to the recipient and, most significantly, the donor should receive absolutely no form of compensation in any form since the sale of human organs is very strictly prohibited by Muslim law. People's Assembly head Fathi Sorour has promised that the law will be discussed in the next parliamentary term, but he added that it would not be passed until all the main issues had been resolved, with clear definitions of what a transplant constitutes, who is dead and who is authorised to diagnose it as well as the measures to be taken to put an end to the practice of organ trafficking. The law, Sorour added, would in no way be un-Islamic.

The bill drafted by the People's Assembly's Health Committee stipulates the setting up of a new authority affiliated with the Ministry of Health to regulate the process, with transplants prohibited in all but the most necessary cases and then taking place only when the health of the donor is not at risk. A donor must be of legal age and sound mind, they must be willing to make the donation and have the right to refuse to go through with the surgery up to the last minute. The bill also prohibits the treatment of body parts as commodities; doctors are required not to go ahead with the surgery should they discover that the donor will receive compensation. Finally, transplants are to take place only in specifically licensed hospitals subject to Ministry of Health supervision. Death is defined as "the complete separation from life" judged medically according to international criteria: if a clinically dead person did not approve of a transplant prior to their death, in writing or as witnessed by two of their first-degree relations, no transplant can take place. Tougher punishments will be imposed on hospitals found to be in violation of these standards, with implicated parties subject to LE50,000- 100,000 fines and prison for up to 10 years, and doctors subject to suspension for three years and confiscation of equipment used to perform the transplant.