In today’s Egypt, a human kidney can be bought illegally for less than US $5,000. A desperate donor sold his to Fawziya (not her real name) for as much. But even paying that sum of money did not cure the patient.
In Egypt, prior to any transplant, the Doctors’ Syndicate must conduct an investigation and only when a specialised committee has given approval can a transplant take place.
Fawziya from Upper Egypt suffers from kidney failure in both kidneys. With no relatives with matching tissue, Fawziya found herself with two options: to continue undergoing dialysis at run-down government health centres, or seek an unrelated donor willing to give up a kidney in exchange for money. She opted for the latter.
In Fawziya’s case the laboratory managed to bribe a member of the committee to approve the operation. “The laboratory had a contact in the syndicate, and we got the approval that way,” Mohamed said. “The doctors treating my mother were all paid, but my mother’s still sick.”
“Now she’s very, very sick,” said Mohamed, her son. “The transplant failed. Within hours of the operation, doctors discovered that her body had rejected the kidney. She is back on dialysis, and has no intention of undergoing surgery again.”
According to Mohamed, Fawziya had received a kidney from a donor from Cairo. The transplant was arranged by a privately-run clinic that officially operates as a laboratory. “We paid a total of US $15,600 for the entire procedure,” he said. “The kidney alone cost US $4,335.” Much of the family’s life savings, therefore, went to waste as a result of the failed operation.
Strict rules, little enforcement
In Egypt, only live organs can be transplanted, according to one health ministry spokesman speaking on condition of anonymity. “Traditionally, Islam prohibits the transplant of body organs from the deceased,” he explained.
Given the genuine risk of patients paying donors for organs, the syndicate has attempted to apply numerous rules aimed at minimising organ trafficking. In 1996, for example, a decree passed by the syndicate forbade patients from receiving organs from unrelated donors. “Only those who are related up to the fourth degree are allowed to donate organs to a given patient,” said syndicate head Hamdi al-Sayyid.
Additionally, in order to curb the purchase of organs from poor Egyptians by wealthy Arabs, foreigners are not allowed to receive organs from Egyptian donors. “The decree prohibits foreigners from receiving implants from Egyptians,” al-Sayyid explained.
There is, however, no law regulating transplants, rendering it difficult to monitor the situation at every level. According to al-Sayyid, a draft law was recently presented to the People’s Assembly by the syndicate, which is currently being deliberated by the upper house of parliament. “The draft includes provisions allowing for transplants from the recently deceased, which is allowed in numerous other Muslim countries,” al-Sayyid said. He added that the draft law enjoyed the support of the Grand Mufti of Cairo’s Al-Azhar University, the most respected seat of religious jurisprudence in the world of Sunni Islam.
The draft also sets down penalties for doctors involved in carrying out illegal transplants. “We’re hoping for the law to be passed as soon as possible so that doctors and institutions involved in the trafficking can be punished,” said al-Sayyid, adding that the draft will subject offenders to possible prison sentences and licence revocations.
Hard to control
According to al-Sayyid, trafficking is not as widespread as some purport it to be. “The total number of transplants taking place every year ranges from 120 to 130,” he said. “In comparison to India for example, the number isn’t so high.”
Nevertheless, specialists agree that the phenomenon is in bad need of regulation, particularly in light of the vast economic disparities between different peoples in the region. “The syndicate will often approve transplants without knowledge that money might be involved,” said Alaa Fayez, professor of children’s surgery at Cairo’s Ain Shams University. “On the surface, the procedure might seem legal when in fact there’s already an agreement in place involving the recipient, the donor, the hospital and the doctors.”
“It’s very difficult to control the activities of small private clinics, which are very widespread in Egypt,” Fayez added.
In cases where a donor or recipient is not Egyptian, those involved will not even approach the syndicate for a license. “Often, donors will be from Sudan, for instance,” said Fayez, “while recipients may be from the wealthier Arabian Gulf.”
Thus the poverty of the donor is actively taken advantage of for the benefit of the wealthier party. “It’s not unusual for secret agreements to be made with Saudi Arabian patients willing to pay thousands of dollars for a transplant,” said local journalist and expert on the topic Ibrahim Othman. “Such operations totally circumvent stipulations laid down by the syndicate.”
Some of the more marginalised communities have also expressed a fear of organ theft during operations. Among the Sudanese refugee community, for example, this fear is particularly high. “Many refugees in Cairo, particularly the Sudanese, express their self-marginalisation from Egyptian society in terms of their fear of Egyptian doctors and the threat of organ theft,” said Barbara Harrell-Bond, professor at the American University in Cairo, who teaches forced migration and refugee studies.
Harrell-Bond added, however, that, “For the six years that I have been in Cairo, I’ve never found any evidence to justify these fears”.
Giving up health for money
While the poverty of potential donors constitutes a major aspect of the problem, the difficulties of living with kidney failure in Egypt also contribute to the trend. “Dialysis centres are on the whole inhuman and unclean,” said Othman. “There is also the possibility of contracting diseases. Patients undergoing dialysis in poor conditions essentially have their whole lives impaired.”
It is not surprising therefore, that many patients suffering from kidney disease seek alternatives. “Trafficking exists precisely because patients are provided with no other option,” said Othman.