One story once doing the rounds in Cairo reported on a mother and her two children who had sold their kidneys in order to buy a television and a refrigerator among other electrical appliances, only to have the latter stolen the same night that they had bought them. The message of the story is clear: Those who sell their organs end up losing everything.
Organ transplantation is undoubtedly one of the most significant achievements of modern medicine. In many cases, it is the only treatment, and perhaps the only hope, for late-stage organ failure and chronic heart, liver and kidney disease.
Although organ transplantation is an effective therapy for end-stage organ failure and is widely practised around the world, obtaining the organs needed has unfortunately developed into a black market for trafficking in many countries, including Egypt. The shortage of organs and other tissues needed for transplantation has become a global issue, inviting various forms of trafficking.
Although it is a basic principle that donation must be the foundation for all organ and tissue transplants, the rarity of organs has given rise to a growing commercial market for organs on the local, regional and international levels. The result has been abuse and the exploitation of the poor for the benefit of the rich and local or cross-border intermediaries in the organ trade or “transplant tourism.”
In 2010, the World Health Organisation (WHO), which has been monitoring transplant tourism worldwide, described Egypt as “a hub” for organ trafficking and a regional centre for organ transplantation ranking among the top five countries where it is widespread together with China, the Philippines and Pakistan. According to the WHO, Egypt is the top organ transplant market in the Middle East.
Many specialists in the field agree that laws regulating organ transplantation in Egypt have loopholes that allow for manipulation and the development of an illicit organ trade, especially in the light of the growing demand for organ transplants and the existence of contradictory religious rulings (fatwas) on the issue.
For many years, Egypt was one of the few countries in the world without legislation criminalising the organ trade and regulating organ and tissue transplants particularly from deceased to living patients. Nevertheless, the issue was the subject of broad public debate amid repeated warnings of “a mafia of organ-traffickers” whose victims have been the poor and vulnerable. There were strong demands for strict legislation that would regulate this critical issue.
After years of debate, a law regulating organ transplantation was passed in Egypt in 2010. Article 2 of Law 5 stipulates that it is not religiously allowed to transplant an organ or part of an organ or tissue to another human being unless this is necessary to save the life of the person to whom the organ is being transplanted and on condition that there is no alternative way of saving the life of the patient and that it does not pose any danger to the donor.
Organ transplantation, the same law says, is also prohibited because it could result in the intermixing of genealogical lines. Article 3 prohibits transplanting organs from Egyptians to non-Egyptians, unless the donor and the recipient have been married for at least three years.
It is a basic tenet of the law that any organ transplantation that does take place should be by donation among relatives. In the case of a non-relative donor, the law stipulates that a committee should ensure that the transplant does not violate the criteria stipulated in the law. Article 6 prohibits the buying or selling of human organs or tissues. Organ transplantation may not result in any financial benefit for the donor, his family or the heirs of a deceased person, and it imposes stiff penalties on those who violate the law and on doctors who proceed with such operations knowing of any such violation.
The law was drafted to curb the illicit organ trade via brokers and intermediaries, especially since WHO estimates show that transplant tourism now accounts for 10 per cent of organ transplantations worldwide. However, critics say that it has failed to curb the organ business. Mahmoud Fouad, head of an NGO working on the issue in Egypt, said that “the law has not been strictly applied and the penalties are too lax.”
“Since the law was passed, few penalties have been imposed, and these have ranged between a year and six months of imprisonment,” Fouad told Al-Ahram Weekly. “The harshest penalty has been that of 15 months in prison handed down against a doctor found guilty of involvement in illegal organ transplantation.”
Some 56 countries impose the death penalty on those found guilty of involvement in organ-trafficking, according to Fouad, who said that many have wanted to see Egypt follow suit. Instead, Article 20 of Egypt’s anti-trafficking law imposes a penalty of no less than a year and a maximum of five years imprisonment on those found guilty of violating the law, in addition to a financial penalty of between LE50,000 and LE200,000. More often than not, Fouad said, “the culprits end up getting the lowest possible punishment.”
“We in civil society organisations have pushed for the death penalty to be handed down against anyone breaking this law and for doctors involved in illegal practices to be deprived of their right to practise for ten years and have their clinics shut down for the same period,” Fouad said. “The recent recurrence of organ-trafficking crimes has drawn the attention of parliament, and harsher penalties including life imprisonment have been added to the original law, though these have not been imposed to date,” he said.
Professor of surgery Sherif Omar explained that kidney transplants started in Egypt in the 1980s, while liver transplants started in 2002. Both have meant the “abuse of the poor in favour of the rich,” he said. “The 2010 law came late in the day, but it was a step in the right direction,” he noted, adding that there should be further government oversight over organ transplantations in order to avoid abuses.
CRIMES PERSIST: Although seven years have passed since the transplantation law was issued, crimes are persisting in violation of it.
One such incident occurred last December when the security forces clamped down on an international network in the organ trade that included 12 doctors and eight nurses. Four well-known private hospitals and six laboratories were found guilty of involvement, and the police confiscated millions of pounds in cash in addition to gold found in the possession of the culprits.
According to police investigations, the criminals had exploited the poor economic condition of the victims and convinced them to sell their organs. They had also abused desperate patients who had paid huge sums to get life-saving organ transplantations. The investigations revealed that the donors had received only small amounts of money in return for selling their organs, while doctors and intermediary brokers had taken the largest share of the prices paid for trafficked organs.
The WHO has confirmed such reports, saying in a recent survey that donors sometimes get just $2,000 for selling a kidney, while the patient undergoing the transplant can pay $20,000 for a kidney transplant. The rest of the money goes to a network of brokers and doctors.
The WHO report also showed that the recent economic and political instability in the region had pushed many illegal immigrants heading to Europe via Egypt to fall prey to organ traders. A case in point occurred last April when nine Somali immigrants were found dead on an Alexandria beach, with scars and cuts on their bodies bearing witness that they had been subjected to organ theft.
Immigrants, however, are not the only victims of organ theft and trafficking. There has been a growing trend among impoverished Egyptians whose dire financial straits have turned them into easy prey for traffickers. Press reports have related stories such as that of Mohamed Sayed who was convinced by a trafficker to sell his kidney to a Gulf-based patient in return for LE25,000 three years ago. Sayed told the press at the time that he had needed the money to start a private business, but that he had lost it all in a failed project.
Moreover, not all of those who have lost an organ to traffickers have known about it, as organ theft is reportedly rife. Last April, police investigations made the headlines when Shaaban Ibrahim was admitted to hospital to remove a kidney stone only to discover later that his kidney had been removed in an organ theft.
Sayed and Ibrahim are not the only ones to have been abused in this way. Fouad said that estimates had shown that nearly 7,000 illegal organ transplantations are carried out in Egypt each year and that 90 per cent of these take place in private hospitals. The hunt for organ-sellers, however, usually takes place in state hospitals, he said. “It’s a form of organised crime that involves a network of traffickers that includes intermediaries including nurses, lab staff, doctors and brokers,” Fouad added.
The story usually starts with a state hospital nurse fishing for prey, usually a patient suffering from economic adversity, and handing information about the patient to an organ-broker. The broker then calls the targeted patient and tries to persuade him to sell an organ. If the patient agrees, the broker takes him to a lab where he carries out all the medical check-ups needed for the transplant and refers him to a doctor who carries out the operation in a private hospital. The donor usually receives little money, while the traffickers and doctors receive large sums, Fouad said.
Kidneys are the best-selling organs in Egypt, compared to livers and hearts, due to the fact that kidney failure is more widespread, according to figures provided by the NGO the Egyptian Kidney Organisation in 2015. The figures show that there are some 50,000 patients suffering from kidney failure and undergoing dialysis in Egypt, with potential kidney-failure patients almost doubling that number. An estimated 10 to 15 per cent of all kidney-failure patients in Egypt die every year.
There has been a growing demand for kidney transplants in Egypt as a result. “Infected drinking water and the spread of bilharzia have been reasons why kidney failure is widespread,” Fouad said.
The WHO report showed that 95 per cent of organ donors and sellers are men, compared to five per cent who are women. 78 per cent of donors suffer from post-operative complications and spend the money they get from selling their organs in a period of no more than five months, it said. There are conflicting figures regarding the price of kidneys in Egypt, the British Journal of Criminology estimating this to be around 100,000 pounds sterling. The WHO said that the donor only receives around $2,000 of that.
Recent research on human-trafficking by the National Centre for Sociological and Criminological Research has warned that children are also vulnerable. The children in the research sample said they had been asked to sell their organs, and two said they had already sold their organs, one for LE15,000 and the other for LE25,000. Most of the children in the survey were boys aged between 11 and 18, with the two cases who actually sold their organs being aged 11 and 15 and dropping out of school.
Poverty and dire need were the prime motivation behind selling organs, and most of the victims were Egyptians, followed by Jordanians, Yemenis and Sudanese. According to the study, those who sold their organs received sums ranging from LE5,000 to LE120,000, and in many cases the victims were subject to fraud and ended up not receiving any money at all.
The study showed that communities targeted by human-traffickers were those where people had fewer problems with organ-trafficking. It speculated that trafficking was bound to spread further if poverty persists. The most-targeted communities included the informal areas of Manshiyet Nasser and Istabl Antar in Cairo, Husseiniya and Ezbet Al-Shahateen in Daqahliya, and Abu Hilal and Salakhana in Minya.
All these communities, according to the study, had similar demographic, economic and social characteristics that made them vulnerable to organ-trafficking.
CONTRADICTORY FATWAS: Poverty aside, religious edicts or fatwas regarding organ transplantation have also varied in a way that has confused public opinion even after the issuance of the law regulating it in 2010.
The most radical of all has been that issued by sheikh Shaarawi, who prohibited and even criminalised all sorts of organ transplants in the 1990s on the grounds that Islam does not allow Muslims to give up any of their organs, whether by selling or donating them, or during a person’s lifetime or after death, because these organs are the sole possession of God.
In the same vein, member of the Al-Azhar-affiliated Islamic Research Academy (IRA) sheikh Abdel-Rahman Al-Adawi presented a study later that prohibited all sorts of organ transplants, whether through donation or sale, or from living or clinically dead donors. According to Al-Adawi, obtaining organs from a clinically dead person is murder (because the clinically dead person is not yet fully dead), and a person who donates his organ would be harming himself in a way similar to committing suicide.
“No law should be passed on a matter that is prohibited in Islam,” the paper concluded, recommending instead that a law be drafted prohibiting all organ transplantations on the grounds that they are prohibited by God.
Many scholars disagree, however. Egypt’s official religious body the Dar Al-Iftaa (Fatwa Council) has allowed organ transplants from living or dead donors in cases where they are meant to save the life of a patient who would otherwise die and on condition that such transplants do not involve any sort of trade in the form of selling, buying or trafficking. There should also not be any financial benefit for the donor, his family or his heirs in cases where the donor is deceased.
It is also a precondition that the transplant does not result in any confirmed complete or partial harm to the donor, or affect his physical or psychological ability to work and carry out his normal daily chores, the Fatwa Council has said.
The writer is a freelance journalist.