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EGYPT: Selling Kidneys to Pay the Bills

CAIRO, Jul 20 2009 (IPS) - Karim borrowed money to expand his bakery. When the money ran out, and facing the prospect of imprisonment if unable to repay his debts, the 36-year- old Egyptian baker sold his kidney.

His case, among hundreds documented by the Coalition for Organ-Failure Solutions (COFS), a Washington-based NGO working to end organ trafficking, reveals an alarming trend: poverty is driving Egyptians to sell their organs.

Experts say the absence of legislation regulating human organ transplants has made Egypt an international “hotspot” for kidney trafficking. Up to 95 percent of the 3,000 legal kidney transplants per year, and hundreds of illegal ones, involve a commercial transaction.

A nationwide ban on organ transplants from cadavers means all kidneys must be harvested from live donors. Most are sourced from destitute young Egyptians, who are coerced into selling their kidney to pay off debts or meet rising living costs.

“They call them ‘commercial living donors’, but the name is misleading as really they are more victims than donors,” says Kabir Karim, COFS’s Egypt programme director.

A kidney can be purchased for as low as 15,000 dollars on Cairo’s black market, though the donor only receives about 2,500 dollars of this. The rest goes to hospitals, laboratories and agents.

Brokers lurk in the coffee shops of Cairo slums, targeting the poor. “Over 90 percent of donors don’t have a regular job, and are either in debt because of their circumstances, or have gotten married and can’t pay the rent,” says Amr Mostafa, a field researcher for COFS. “Brokers approach them and promise a way out of debt, if they agree to donate their kidney.”

The donors are misled about the risks and talked into taking examinations at hospitals and private labs. The results are used to match donors to clients, often wealthy Gulf Arabs, who use forged documents to circumvent a ban on transplants to unrelated or non-Egyptian recipients.

“If a hospital has its paperwork in order including signed donor consent forms, it can pretty much operate with impunity,” a clinic doctor told IPS. Only if a patient dies does it become felony.

About 80 percent of donors suffer deterioration of health after surgery, according to a COFS study. “Most of the time people complain of tiredness,” says Karim. “A lot of these donors have a job that requires physical labour, but (after the operation) they get tired quickly and can’t do their work. That of course affects their job, and they soon get fired.

“It’s a vicious circle for them,” he says. “They sell a kidney because they are in debt and spend the money within about six months. They are still in debt, but now they are less capable of working than before, so they are in a worse situation.”

COFS offers counselling, peer support and post-operative health care services to commercial living donors, but Mostafa says patients are often reluctant to come forward. “They are very ashamed of what they have done and don’t want anyone else to know.”

Police reports often result from disputes over payment. Donors are promised a sum, but feel duped when brokers fail to deliver the promised amount. Stories of people being abducted or waking up after a routine check-up to find their kidney missing appear little more than urban myths. But one popular ruse does come close.

“There is a well-known broker who works with several hospitals and targets all his victims in cafes,” Mostafa says. “He drives up in a BMW, promising unemployed men that he can secure them a job in the Gulf or Europe – all they need is a routine medical exam for the application. They do the tests, but at the hospital they discover a problem, usually kidney stones.”

The broker agrees to cover the cost of the treatment, which he will deduct from the patient’s first pay cheque. But when the doctors operate, the kidney is found to be “damaged” and needs to be removed. Desperate for the job, the patient agrees to the operation. The victim only discovers the ruse when the job fails to materialise and the broker stops returning his calls. “In this case, he doesn’t even get paid for his kidney,” Mostafa says.

A report issued by the World Health Organisation (WHO) in 2007 named Egypt as one of five international hotspots for organ trafficking along with China, Pakistan, the Philippines and Colombia. The health ministry’s periodic crackdowns on hospitals and clinics performing transplants for foreign clientele have done little to deter so-called “transplant tourism”.

Egypt needs clear legislation with heavy penalties to combat organ trafficking, says Dr. Mahmoud El-Meteini, a prominent transplant surgeon. “Until now, these criminal acts have been treated by the law as malpractice.”

A draft law to regulate organ transplants was rejected by parliament last month. The bill had proposed to ban the sale of organs, prohibit transplants to foreigners, and impose sentences of up to 15 years in prison and 180,000 dollars fines for violations. It also sanctioned cadaveric organ transplants, which would have alleviated the pressure on live donors.

Proponents expect the bill to pass when the legislature convenes in the fall, but admit the anti-trafficking legislation will come as bitter medicine. Its enactment would effectively shut down all transplants from non-related living donors, while it could take several years for people to be convinced of the merits and transparency of the cadaveric programme.

“The one who will pay for this is the patient, as we will not be doing the number of transplants we do now, at least for the first few years,” says El- Meteini. “But this is a price we should be willing to pay to fix things that are not in order.”