Karim and Hanna:

Hanna, an Egyptian scientist in his late 40s, and established resident of Europe , was diagnosed with renal failure for several years before he decided to seek a kidney from an unrelated donor for a transplant. The waiting list in his country of residence was long but his maintained Egyptian citizenship could enable him to skip this wait and seek a donor and the transplant in Egypt . After making arrangements with a hospital in Cairo , a local laboratory identified Karim as Hanna's donor.

Karim, a 24 year old baker from near the Sinai Peninsula region of Egypt , faced the prospect of imprisonment when he could not afford to pay debts to flour and sugar companies. His attempt to expand his earnings beyond 25 Egyptian pounds per day (approximately $4 USD) with these additional supplies failed after the Ministry of Interior made sudden price hikes of these products. When he could not repay his debt, the companies threatened that they would tell authorities which would lead to his arrest and imprisonment. Karim fled to Cairo hoping to find a way to generate money to pay his debts. Brokers who worked out of coffee shops, “ahwas,” in low-income neighborhoods targeted Karim in his vulnerable state. They enticed him with the option of selling his kidney to pay his debt, explaining to him that the procedure was “risk-free.” Karim opted to make the "donation" and sell his kidney rather than face imprisonment.

The laboratory's broker offered Karim 17,000LE (2,956USD) as the price for his kidney but Karim knew that some donors received 20,000LE (3,478USD) and insisted on this higher price amidst dropping rates due to individuals living in abject poverty increasingly resorting to organ vending. Upon the agreement, Karim and Hanna were introduced. The transplant procedure went smoothly and Karim walked down the hospital corridors for visits to Hanna while they were both in recovery. Hanna tried to make further arrangements for a labor job for Karim in Libya but Karim wanted to return to his hometown, pay his debts and marry. Hanna returned to Europe and is recovering well with his new kidney.

Karim subsequently returned to his hometown and paid his debts with his kidney money, but has nowhere to turn for clinical follow-up. Brokers encourage him to become a recruiter to identify others in vulnerable situations who might be persuaded to sell their organs. The brokers promise to compensate him with considerable profit on a commission basis of his recruitments. Upset by having resorted to selling his kidney, Karim tells brokers, “I don't trade in humans” and has become an advisor for COFS in creating donor advocacy programs.

Soheila and Hamid:

Hamid, a 35-year old father of two young sons and laborer from the city of Asyut in Upper Egypt , had been undergoing dialysis for seven years as a treatment for his end stage renal failure when he entered a large public hospital in central Cairo . Hamid described the onset of his condition when he experienced symptoms of “nefisi te'il“ (heavy breathing) and fatigue while working as a laborer in Saudi Arabia . After consultations with seven doctors, one doctor noticed Hamid's creatinine levels were markedly above range and immediately prescribed dialysis. Soon after his diagnosis Hamid returned to Egypt where he paid between 85 and 160 Egyptian pounds per dialysis session, an average of approximately $20 USD, depending on which of two surgically created dialysis sites, in his forearm or abdomen, were used. ....more