By Heba Saleh in Cairo
At 48, Emad Salama, an Egyptian computer engineer, has already had two kidney transplants and his latest medical tests suggest he will soon require a third.
Mr Salama, a father of two young boys, was a student in 1987 when his kidneys failed and he had to have his first transplant. The organ he bought from an indebted school teacher lasted until 2000, when it started to fail. This time, the donor was a switchboard operator, and the price was around $4,500.
“The second time I had to go with the donor to the doctors’ syndicate where he had to sign a paper saying he had taken no money,” says Mr Salama. “Even so, they knew, and we knew, that money was changing hands.”
With 40 per cent of Egyptians living below or just above the poverty line, finding a kidney has not been difficult. Medical laboratories carry out tissue matching tests, mediate between sellers and buyers, and often send brokers to poor neighbourhoods to recruit would-be donors.
But the outlook for patients such as Mr Salama has just become more
After almost two decades of medical and religious debate and failed attempts in parliament, Egypt has in recent weeks adopted a law criminalising the sale of organs. Doctors hope it will put an end to trafficking and open the hitherto closed door of donations from brain-dead bodies – the norm in developed countries.
“What had been going on up to now was a mess,” says Dr Mahmoud al-Meteini, the head of the liver transplant unit at the Ain Shams university hospital and an architect of the law. “If a patient with a failing organ is lucky he will have a family member who could be a suitable donor. If not, then either he can afford to buy or he is doomed.”
The World Health Organisation considers Egypt one of the top five “host” countries for organ trafficking, alongside China, Pakistan, the Philippines and Columbia. It estimates that up to 10 per cent of all transplant operations in the world use traded organs, almost always sold by vulnerable people in the developing world. Studies show that, for the most part, donors are predominantly males in their 30s, with the exception of India, where more women sell their kidneys, under pressure from their husbands. The United Nations has been pushing for a binding international treaty banning the sale of organs.
No one knows the exact size of the organ trade in Egypt, but experts estimate that, every year, at least 1,000 Egyptians sell kidneys, accounting for up to 90 per cent of transplant operations in the country. Until a few years ago, when the state banned donations to foreigners, Egypt was also a thriving destination for “transplant tourists” from rich Gulf states.
The law restricts donations to relatives up to the fourth degree and imposes stiff punishments on doctors and anyone else involved in the sale of organs. It also lays down rules for donations from brain stem-dead bodies.
But in the country that invented mummification in pharaonic times, the dead body is considered sacred and many expect Egyptian society will find it hard to accept the removal of organs from the deceased. One reason for the long delay in adopting a law has been resistance on religious grounds to the concept of donating a body part. Some scholars have argued that people do not own their bodies, and therefore cannot give away their organs.
Another argument that raged until recently concerned the definition of death – whether it only occurs when the heart stops beating or, as doctors have now accept, when the brain stem has died, which allows organs to be removed when they are still in good condition for transplantation.
“We will have a hard time [finding transplant organs] and there will be a drop in numbers,” said Dr Meteini. “But this is the price of reform. We will introduce something like a donor card, maybe with driving licenses. At the beginning there will be rejection, but we will use the media. We are starting from zero, but with time, transparency and good results, it will improve.”
The prospect of a shortage of organs chills patients such as Mr Salama. But even he agrees that using the poor for spare parts is not an ethical solution.
Researchers say Egyptians who sell organs get no post-operative care and are often unable to go back to their jobs, especially if it involves physical labour.
“It is odd to pretend that there are no health consequences to donors, especially when there are no criteria for selection,” says Debra Budiani, director of the Centre for Organ-Failure Solutions, an international medical ethics charity. “When financial incentives play a role, standards of who is healthy enough to donate are ignored.”