A new law that aims to stop Egypt’s poor from selling their kidneys and other organs faces an uphill battle as the country’s deteriorating economy pushes more and more people into making desperate and dangerous decisions to raise money.
The new law, which went into effect this month after years of debate, bans the practice of paying money for human organs and restricts donations from live donors to family members of the fourth degree. That, in effect, bans foreigners from receiving transplants. Removing organs without government authorization will be treated as first-degree murder. Transplant procedures for the poor will be financed by the State.
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Egypt is one of the last countries of the Arab world to implement organ-transplant legislation. As lawmakers dawdled and religious scholars debated the definition of death, the country became a hub for regional trafficking in organs, according to the United Nations World Health Organization (WHO).
“After the revolution people are talking much more about human dignity and ending poverty. There is much more awareness that selling an organ isn’t the equivalent of donating blood,” Sherine Hamdy, whose book Our Bodies Belong to God: Organ Transplants, Islam and the Struggle for Human Dignity in Egypt
will be published next January, told The Media Line, “On the other hand, the economic situation is pretty severe …That’s a problem to be addressed.”
For many, a couple of thousand dollars for a kidney – even if the amount ultimately paid was typically less than promised – meant debts could be paid off or enough money accumulated to start a business in an economy were unemployment is in the double digits and growing.
A woman identified as Aisha recalls her bitter experience selling her kidney. “My financial circumstances became very difficult and I didn’t know what to do. Some people told me to donate my kidney and get money. I went to a lab and they told me I would get money for donating my kidney and that nothing would happen to me physically,” she recalled in a filmed interview for Coalition for Organ-Failure Solutions, an organization combating the trafficking of humans for organs.
But after she completed the operation, her health never quite recovered and she could no longer work. Her husband abandoned the family, taking the proceeds. “I lost my kidney, my money, everything,” she said.
Hamdy, who is an anthropologist at Brown University, said that because transplants have lived in a legal twilight zone, people who were victimized couldn’t turn to the law.
“A lot of times you have people coming to police claiming their organs were stolen,” she said. “Often what happened was that people were promised larger sums of money than they were delivered or that the operation was much less risky than it (ultimately) was. Not wanting to incriminate themselves as having sold their organ, they would claim their organs were stolen. But prosecutors hadn’t yet been able to do anything because of the absence of a law.”
If anything, however, the economic pressures that helped create the problem have been magnified by the collapse of the Egyptian economy by the protests and strikes that brought down President Hosni Mubarak in February and continue to this day. The government has promised big increases in subsidies and other welfare spending, but it doesn’t have the means to pay for it.
A survey by the US-based International Republic Institute in April found that 41% of those polled said they have trouble covering their basic needs and feeding their families.
Susanne Lundin, a professor of ethnology at Sweden’s Lund University who studies the global organ trade, told The Media Line that the new law is unlikely to deter either demand for or supply of organs, and instead will drive the market underground as has happened in other countries that passed similar legislation.
Egypt is one of a handful countries identified by the World Health Organization as organ-trafficking hot spots. Others like China, Pakistan and the Philippines have outlawed organ sales and barred foreigners from undergoing transplants to stop transplant tourism. Even before the law went into effect, Cairo was cracking down on the phenomenon, but even that effort stalled amid the chaos surrounding Mubarak’s fall from power.
The Philippines passed its law in 2007 but just four years later finds itself debating how to revise it.
“It didn’t work at all. The illegal trade grew much more after that. So now the Philippines are trying to revaluate it and legalize people coming to buy organs. There is a big fight underway,” Lundin said. “When it was legal or half legal for foreigners to come, they could do it openly. When they were excluded they had no choice but to do it on the black market.”
For legislation to work, the government has to undertake an extensive
information campaign aimed at both donors and recipients, Lundin said.
Donors are usually poor and often so uneducated they don’t understand
the risk they take, she said, recalling an interview with a man who,
when asked he if would be prepared to donate his liver, responded he
didn’t know what a liver was. Recipients risk getting a diseased organ
and often get improper follow-up care.
Legislation governing organ transplants was first broached by Egypt’s
Doctors Syndicate eight years ago, but the effort got ensnared in a
controversy over the Islamic definition of death. Iran and Saudi Arabia
both accept brain death as enough to allow organs to be removed for
transplants and Grand Sheik Mohammed Sayyed Tantawi of Cairo’s Al-Azhar,
Sunni Islam's pre-eminent institution, endorsed a brain-death standard.
But many lawmakers opposed it, saying it would open the door to abuses
by doctors. The popular television preacher, Muhammad Mutwali
ash-Sharawi, who died in 1998, opposed organ transplantation in any
forms, arguing that the body belongs to God, a view shared by many
ordinary Egyptians, according to experts.
As a result, Egypt may find it hard to convince people or their families
to donate organs even though the law establishes a fund to help pay
transplants. Samia Sabri, a cornea specialist at Cairo University, told
the IRIN news service, a unit of the UN Office for the Coordination of
Humanitarian Affairs, that it hasn’t been easy to find donors even
though a law regulating cornea transplants has been in effect since