EGYPT:

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Organ Trafficking in Egypt :

A recognition of brain stem death and the procurement of organs from both brain stem dead and non-beating heart cadavers- “non-living donors” - advocated by medical professionals has met relatively little resistance throughout much of the West (Lock 2002). In many Middle Eastern and Islamic countries these issues have provoked distinct discourses and responses largely around Islam and the sanctity of the dead. Although living donorship still exceeds non-living donorship in these regions, where transplant programs exist, there is generally established legislation that also enables the procurement of organs from non-living “donors.”

In the case of Egypt however, legal restrictions prohibit the procurement of organs from non-living donors. This eliminates the possibility of donations of organs and tissues that are procured only from the non-living and renders living donors as the only source for organs, mainly kidneys and partial livers, for transplant. In addition to a strong sense of the sanctity of the dead from pharonic times to the present in Egyptian society, legislators and religious authority share concerns about the procurement of organs from non-living donors without prior consent or directives as well as misdiagnosis of brain stem death and the difficulties of regulating transplants accordingly. Furthermore, in addition to several publicized scandals of doctors procuring organs or tissues from non-living donors without proper consent procedures, the use of living bodies of poor Egyptians as a source of kidneys by wealthy patients’ from the Persian Gulf has also been documented in the media. Accordingly, legislation prohibits organs procurement from the non-living, prohibits payment for an organ donation from the living, and requires recipients and donors’ to be Egyptian nationals. Many draft laws to regulate organ transplants and the distribution of organs beyond these policies however have failed to be enacted in the People’s Assembly (Maglis alShaab). In the absence of federal policies that address living donorship, the national Doctors’ Syndicate provides the only framework from which doctors, patients and donors maneuver to regulate transplants by issuing a license for each transplant surgery. Patients in need of transplants are thus left with narrower alternatives for managing “scarcities.”

National policies and fatawa (formal Islamic legal guidelines and opinions) work to inhibit living unrelated (LU) organ donorship and prohibit commercial living donorship. Dozens of partial liver transplants are performed annually in Egypt and have been increasing rapidly over the course of the last few years. The number of licensed kidney transplants is estimated at approximately 500 per year. Despite such rulings, most transplant doctors estimate that at least 90 percent of kidney donors are in fact unrelated, recruited, and compensated. Although presently there are more efforts to maintain related donorship for partial liver transplants, this may well soon share the trends of kidney donorship. Furthermore, donors have reported that some transplants are performed without licenses and that donors are increasingly being brought to Egypt from neighboring countries or Egyptians are brought to Gulf countries for donorship to take place there.  The head of the Medical Syndiate, Dr. Hamdy AlSayed, estimates that at least a third of transplants in Egypt are taking place unlicensed (personal interview with COFS). 

This situation presents bio-ethical concerns including the reliance upon an underclass as the main supply of organs, induced and inadequately informed consent, an absence of short- and/or long-term follow-up care for donors, and a lack of standards employed for evaluating donors.  The reliance upon these donors is also a grave concern amidst the absence of longitudinal studies on donors in the developing world where those living in abject poverty confront additional threats to their health from poor sanitation, air and water quality, harsh labor conditions, and infections disease. This situation also presents breaches of regional declarations which prohibit the use of payments, compensation, or reward for organs including that of official Islamic rulings by Islamic Jurists and the Islamic Code of Medical Ethics, the Council of Arab Ministers of Health, as well as international declarations such as the World Health Organization, and the World Medical Association.

Preliminary data suggests that donors/organ sellers in Egypt consist largely of young men between the ages of 22 and 27 years old. Recipients/ organ buyers are largely above the age of 45 years. Although the price of a kidney was approximately 40,000 LE a decade ago, the price now ranges between 17,000-20,000 LE (5.75LE= 1USD) but can be as low as 10,000LE for a commercial living donor (CLD) who does not do sufficient comparative shopping for brokers who pay the higher rate. Many CLDs also report being denied all or some of the payment post-donorship. Some hospitals where transplants are performed have intervened to secure payments for donors. CLDs largely resort to this means of income generation within a context of peonage or as a way to afford the marriage of their siblings and themselves in increasingly harsh local market conditions.  Egyptian public and officials may chose one of various solutions to the problem of organ trafficking within Egypt including stricter measures on verifying relations between donors and recipients, penalties to all parties involved in recruiting and facilitating a transplant with a paid donor (i.e. brokers, labs, doctors), a public campaign for deceased donorship, and/or encouraging other treatment measures such as hemodiafiltration (an advanced dialysis treatment that is reported to have as good of results as renal transplants in treating end stage renal failure).

Brokers work in public gathering spaces in Egypt

to solicit vulnerable individuals for an organ sale.