The government has finally gained Al-Azhar's approval for new legislation regulating organ transplants, reports Reem Leila Sheikh Mohamed Sayed Tantawi, the grand imam of Al-Azhar, has approved organ transplants from individuals sentenced to death even in cases where the families of the deceased object. At the same time Tantawi announced his own intention to donate his organs following his death. "The transplant of human organs is permissible from dead to living people," stated Tantawi. According to a press release issued by the Islamic Research Centre (IRC) clinical death occurs when the soul departs the body, the heart and brain stem die and there is no possibility that the body will return to life. Al-Azhar's approval of the new draft organ transplant law may signal the end of a long running debate. Opponents of organ transplants had long argued that the process violates religious tenets, arguing successfully against four earlier attempts to introduce legislation. "The religious debate stemmed from the medical debate and not vice versa. Once the medical debate was settled it became easier for religious scholars to settle the matter," says Sheikh Ibrahim Negm, official spokesman of the grand imam of Al-Azhar. Under the organ transplant draft law, expected to gain the approval of the People's Assembly (PA) in April, an independent committee of three experts from hospitals that undertake transplants will be charged with pronouncing any potential donor dead after first conducting 14 tests. The same committee members will also be in charge of approving waiting lists of patients requiring organ transplants. The draft law regulates the transplant of human organs between Egyptians, bans commercial trade in human organs, and limits transplants to hospitals authorised to undertake such operations by the Ministry of Health. Muslim Brotherhood MP Akram El-Shaer, a member of the People's Assembly Health Committee, opposes the new law. "Sheikh Abdel-Aziz bin Baz, the former grand mufti of Saudi Arabia, issued a fatwa in Saudi Arabia in 1986 indicating that organ donations were not against Sharia," says El-Shaer. "Yet when he learned from doctors that the heart of the person from whom the organs are taken would still be beating he revoked the fatwa." Under the new law any donor must be a first, second or, in the most serious of cases, a third or fourth-degree relation of the patient. The donor must provide written consent and a statement confirming that no exchange of money is involved. In the case of kidney transplants a doctor must confirm the operation will harm neither the donor nor recipient. Leading hepatologist Mohamed Ghoneim believes that the clause relating to fourth-degree relations might form a loophole through which organ traffickers will slip. "It is very difficult to prove by documents and birth certificates that someone is a fourth-degree relative, especially on the maternal side," argues Ghoneim. He believes that the draft law still needs to be polished. Hamdi El-Sayed, chairman of the Doctors Syndicate and head of the PA's Health Committee, says death can be clinically determined by the complete arrest of the body's circulatory and respiratory functions or by a complete stop of brain functions. In cases of brain death, waiting for other observable signs of death would mean that it is too late to transplant the needed organs. Currently, partial liver, kidney, skin and bone marrow transplants are allowed. Complete liver, heart, lung, pancreas, cornea and other organ transplants are all likely to take place in the near future. Doctors have been pressing for 10 years for such procedures to be allowed. "Doctors are seeking to save lives," says El-Sayed, who denies rumours that the speaker of the People's Assembly, Fathi Sorour, has rejected the draft law. "In Egypt we are dealing with a culture that traditionally has given more care and attention to the dead than to the living," he says, arguing that this cultural ideology still exists among Egyptians, many of whom remain uncomfortable with the idea of organ transplants. "We are one of just four countries that have registered increasing rates of illegal organ transplants. And Egypt is the only one of the four that has still no framework regulating organ transplants," points out El-Sayed. Eighteen Muslim countries, including Saudi Arabia, already have organ transplant laws in place. "I am sure that when the law is passed a major challenge will be changing cultural perceptions," he adds. El-Sayed praised the Health Ministry for "helping the medical community push the organ transplant law," something he said the Doctors Syndicate has been trying to do since 1996. Abdel-Rahman Shahin, official spokesman at the Ministry of Health, has highlighted the role the new law will play in eliminating organ tourism and regulating transplants to benefit those who "need them the most -- not the ones who can pay the most". The draft stipulates that organ transplants be conducted in public hospitals that are affiliated to the Health Ministry so the ministry can monitor the procedures. Participating hospitals have not been named yet. Currently there are at least four hospitals in Egypt equipped to conduct organ transplant operations though the number could be increased to 10 in order not to create waiting lists. Under the new law doctors who perform illegal organ transplants could face up to 25 years in jail, donors and patients a maximum sentence of 10 years. The hospital where the illegal transplant took place will be fined a minimum of LE500,000 and could be shut down altogether. "Currently the maximum penalty is a three- year jail sentence," says Shahin.
