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EGYPT: Move to End Organ Trafficking
By 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.
(END)
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