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EGYPT: Move to End Organ Trafficking

Cam McGrath

CAIRO, May 18 2009 (IPS) - Egypt's parliament is set to review a long-overdue draft law to regulate organ transplant operations. If passed, the legislation could make more human organs available for transplant, and curtail the country's booming organ trade.

"We've been operating for 30 years in Egypt without any organisation, relying on local and personal efforts to regulate organ transplants," says Dr. Mahmoud El-Meteini, head of the Liver Transplant Unit at Wadi El-Nil Hospital. "Things cannot continue like this. We need a law to organise all transplant centres, and shut down the bad ones."

Egypt currently has no legislation regulating organ transplants, only doctor union rules and health ministry guidelines that have proven difficult to enforce. An unconditional ban on transplants from deceased donors means all transplant organs must be harvested from living donors. Transplant procedures are permitted under certain criteria, and provided no exchange of money between the recipient and donor is involved – though violators are rarely punished.

The World Health Organisation (WHO) has identified Egypt as one of five organ trafficking hot spots. Over 95 percent of all kidney transplants, and at least 30 percent of all partial liver transplants, are between non-related donors and recipients – which experts say is a strong indication that a payment is involved.

Brokers, laboratories and hospital staff have also been incriminated in the black market organ trade, either taking a cut to procure commercial living donors, or forging documents to circumvent a rule prohibiting transplants to foreigners.

Proposed legislation headed for parliament this month aims to tightly regulate organ transplant operations and introduce harsh criminal penalties for violations. The Organ Harvesting and Transplant Act would also permit, for the first time, transplants from deceased donors.

"Until now we've been doing the most difficult procedure – live donor transplants – instead of the easiest way to transplant, which is the cadaveric programme," El-Meteini told IPS.

The 18-article draft law envisions the creation of an independent body to manage a national organ bank, screen potential organ recipients and donors, and monitor all transplant operations. Where live transplants are involved the law would require that the donor is over 21 years of age and a close relative of the recipient – restrictions aimed at discouraging the exploitation of minors and transplant tourism.

Cadaveric transplants would require a confirmation of death by an independent team of medical specialists, with each organ going to the best- matched recipient on a national waiting list.

"The main part of this law is that you would recognise death, and if you have consent from the patient before he died, or if you have consent of his relatives, you can proceed and can take the organs and transplant them to a needy person," says Dr. Hamdy El-Sayed, head of the Egyptian Medical Syndicate and one of the bill's most vocal proponents.

Importantly, he says, the proposed legislation introduces clearly defined and severe criminal penalties for organ traffickers. Donors and recipients who engage in the sale of organs face up to 10 years in jail. Hospitals involved in the trade can be shut down and fined up to 200,000 dollars, while doctors performing illegal transplants can be fined up to 100,000 dollars, have their licence revoked, and receive up to 15 years in prison.

For over a decade, attempts to pass organ transplant legislation have been blocked in parliament by a small but influential group of lawmakers who argue that humans cannot sell or donate what they do not own. "You have no right to donate your organs because you are only a keeper of your body, which belongs to God," Sheikh Mohamed Metwali Al-Shaarawi said before his death in 1998. The revered cleric's fatwa still carries weight among many devout Muslims.

By contrast, Sayed Tantawi, Grand Sheikh of Al-Azhar, Egypt's highest Islamic authority, has declared that donating one's organs after death is permissible in Islam because it is an act of charity for the benefit of other human beings. Most lawmakers have accepted Tantawi's ruling, though some have raised concerns about the draft's legal definition of death.

The draft law takes the conventional medical position that death occurs upon the irreversible cessation of all brain activity, since advances in medicine have made it possible for the body's circulatory and respiratory functions to continue with the aid of a life support machine. For transplants of vital organs to be successful, brain death must be considered the measure, as many organs are rendered unfit for transplant once the heart stops beating.

"There is a minority in this country, including not more than 10 doctors, who say that brain death is not death and we should wait until the heart stops," says El-Meteini. "They are saying this rubbish on television, but they cannot say it in one respectable medical conference in the world. Over the past 20 years they've won, but…I think now the arena is more prepared to accept our concept, rather than theirs."

El-Sayed is optimistic the legislation will be adopted as the ruling National Democratic Party (NDP) has emphasised its intent to push the law through parliament, where it has a majority. "Because the government is the caretaker of the (proposed) law we are more optimistic than any other time that the law has a good chance of passing," he says.

El-Sayed anticipates a temporary decline in the number of available organs following the legislation's passage as authorities shut down commercial organ trading, while working to convince the public of the merits of donating organs after death.

"We think the number of available organs will come down for the next three or four years because it's going to take some time before we can convince people to donate after death," he says. "But consider this: in Egypt road accidents alone claim 7,000 lives each year. If just half of these casualties were organ donors, each with six to eight vital organs, we could save an additional 20,000 lives a year."

Amr Mostafa, a field researcher for the Coalition for Organ-Failure Solutions (COFS), says organ traffickers target poor and vulnerable Egyptians by offering money for their organs. The introduction of cadaveric transplants could reduce the demand for these commercial living donors. "We are hoping this law will shift the burden from the poor to the dead," he says.