Recent disclosures of illegal kidney transplants may smooth the path for a new draft law regulating organ transplants, reports Reem Leila A black market connecting those in need of money to others in need of organ transplants is thriving in Egypt. If you cannot find a kidney donor in your own country it is now possible to find one in Egypt, at a knock down price. With a quarter of the population living beneath the poverty line and some estimates of the number of homeless children placing the figure as high as two million, Egypt is a lucrative market for those who trade in human organs. Kidneys can be bought for as little as $3,500 though the donor only receives 10 per cent of the amount. The rest is divided among doctors, mediators and hospitals. The Ministry of Health is currently investigating several cases of malpractice following a series of illegal transplant operations which included six patients from Saudi Arabia and one from Palestine. The ministry, assisted by leading nephrologists, has confirmed that transplant patients are returning home with false documents listing hospitals and surgeons that do not exist. "These reports are nonsense. The patients' names, the hospitals and doctors cited in the medical reports cannot be traced. Even the dates of the transplants are fabricated," says Saad El-Maghrabi, head of the Health Ministry's Central Administration for Non-governmental Organisations and Licences. It is illegal to operate on foreign transplant patients or for patients to receive organs from unrelated donors. Lack of regulation, though, means the prohibitions are easily by-passed, and an estimated 500 illegal transplants take place in Egypt every year. "No one knows the exact figure," says El-Maghrabi, who is leading the investigation into illegal transplants. "We probably uncovered less than a quarter of the operations that take place." Numbers have been increasing, he says, since April 2008, when the Philippines banned foreign patients from seeking transplant surgery in response to international pressure. Abdel-Rahman Shahin, spokesman at the Ministry of Health, says that work on drafting a new organ transplant law, scheduled to be presented to the People's Assembly (PA) for approval during its current session, began in May 2006. The draft law will restrict organ transplants to government hospitals and only between family members. While in the past doctors were fined or disciplined by their hospitals, "they will soon face jail sentences for periods ranging between 10 and 25 years and fines ranging between LE100,000 and LE500,000," reveals Shahin. While living-related transplants of partial liver, kidneys and bone marrow are allowed under the current law, complete liver, heart, lung, pancreas, cornea and other organ transplants will take place in the future. Doctors have been pressing for 10 years for such transplants to be allowed. "Doctors are seeking to save lives," says Shahin, who denies rumours that the People's Assembly Health Committee has rejected the draft law. In the past a small but vociferous group of doctors has refused to accept the notion of clinical or brain-death, while the Doctors' Syndicate banned live-donor transplants from Egyptians to foreigners in 1987, along with newspaper advertisements seeking kidneys and livers. Hamdi El-Sayed, chairman of the Doctors' Syndicate and head of the People's Assembly Health Committee, has been pushing for parliament to adopt new legislation. "In the United States selling organs is a criminal offence and can incur a fine of up to $50,000 and five years in jail. Laws are also very tough in Europe," says El-Sayed. Yet in Egypt mediators cannot be prosecuted and the most severe punishment doctors currently face is to have their licences to practice removed. Some doctors have even gone to court and had bans by the Doctors' Syndicate overturned. "The situation is intolerable. Not only does it feed a booming black market but victims are sometimes dumped after the transplant," says El-Sayed. The draft law will limit donors to those over 21 years of age. "This will put an end to the phenomena of organs being from street children." The draft has already been presented to the State Council which returned it to the Doctors' Syndicate and Ministry of Health for amendment. "The law has not yet been presented to the Health Committee. But we are determined to stop human organ trafficking and the only way to do this is to pass the legislation which regulates the organ donation," argues El-Sayed. "It's the worst kind of business in Egypt. It's worse than slavery." He notes that one Cairo clinic has a waiting list of 1,500 people willing to sell their organs. "I don't want the poor turned into spare parts for the rich. Now, though, if you're wealthy you go to a private Egyptian hospital that has contacts with organ brokers." The draft law, says Shahin, will be re-submitted to the State Council before being presented to the People's Assembly. "A delegation from the ministry and the Doctors' Syndicate will work on explaining its provisions in order to help the State Council issue the right ruling." Private laboratories and transplant centres often act as brokers, sending recruiters to the slums of Cairo to entice prospective donors in for tissue tests. Patients needing kidneys go to the laboratories where they are matched with a donor and sold an organ. The sale of organs evolved into an organised business in 1987, 11 years after the first kidney transplant took place in Egypt. Doctors have been repeatedly criticised for profiting from the illegal buying and selling of organs. Those who sell organs find themselves briefly lifted from the poverty they dream of escaping. They complain of being weak and sluggish after the loss of a kidney, though a single kidney is capable of cleansing the blood if it is functioning well. "The removal leaves the donor vulnerable to future problems if the remaining kidney is damaged or if its filtering abilities decline, as often happens with ageing," explains El-Maghrabi.
