HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Friday, March 14, 2008

Egyptian Organ Donors: Unfortunately It's All About the Money

The LATimes has an eye-opening and rather depressing piece on organ donors in Egypt. Jeffrey Fleishman and Noha El-Hennawy write,

He sits quietly at the corner cafe, a gold watch flickering on his wrist. If you need a liver, or want to sell a piece of yours, grab a chair and get acquainted with Mustafa Hamed, a 24-year-old ex-bus driver who fell unexpectedly into a life as a broker in human organs.  Hamed's 4-year-old son, Mohamed, was dying of cancer and needed an artery transplant that cost $5,000. The only savings Hamed had was what he fished from his pockets at the end of the day.  There was another way, one whispered about for those with nothing. A man could wager part of himself, slip into a hospital gown, and wake up with an incision above the gut.  Hamed sold a section of his liver for a bit more than the price of his son's operation. The boy died in surgery.   With his scar healing and his son buried, Hamed, whose knowledge of anatomy would perhaps fill a single page, decided that driving a bus was not the fate of the man he wanted to be. He brokered his first liver deal four months ago. He earned $900. Four more sales have followed.

"Things shouldn't be this way, but they are," he says. "I sold part of my liver to save my son. I had to do it. . . . You cut your body and sell your pieces. But some people who come to me aren't that desperate. They could find other solutions. Many men I see now want to sell their organs so they can afford to buy an apartment to get married. That doesn't seem desperate enough to me. I try to tell them: 'Be patient. You don't need to do this.' " . . . .

Similar tales echo around the globe. Human organs are brokered from Pakistan to China; kidney-theft rings have swept through villages in India. The poor in underdeveloped nations, such as Moldova and the Philippines, are offered "transplant tourism" packages that arrange for them to travel to another country and sell their organs to rich patients. It is a market of desperation and ingenuity in which doctors ask few questions and donors often end up ill, and sometimes dead. . . .
Donors and patients in Cairo know where to go. There are cafes near clinics and labs where the brokers sit, stirring tea and smoking, cellphones buzzing like insects on the tables.  Those needing organs are easy to spot. They carry X-rays and blood work charts under their arms. Some are ashen, some drawn; they need what they need quickly. They come from Upper Egypt and the Nile Delta, their purses and wallets bulky with borrowed money, and if they're lucky enough they'll be able to hire the Japanese transplant surgeon who flies in once a month.

"My doctor told me to come to this place," says an agricultural engineer from Upper Egypt who was shopping for a kidney near a lab in Cairo's Dokki neighborhood, where horse carts clatter and puffed bread cools in the breeze.  He will not give his name as he straightens his pressed tunic. "I'm 58 years old. I'm in renal failure and I have no children. I need a donor. Kidneys sell for between 20,000 and 40,000 pounds [about $3,600 to $7,300]. I'm bargaining, but I can't pay more than 30,000 pounds."

The donors face hardships of their own. . . .  "I have two choices: Pay my debts or go to jail," says Abdullah, a heavyset man in a sweater, who sits in a cafe hoping to negotiate part of his liver for 40,000 pounds. "I can't find any other solution. It's either the operation or I lose my freedom. . . . I started looking for ads where kidney patients look for donors, but I realized that the maximum amount of money I could get for a kidney is 20,000 pounds. Then in the same newspaper, I found an ad by a liver patient." . . . .

Mohamed Queita, a member of the Egyptian parliament and the ruling National Democratic Party, has been working for 12 years to pass a law to regulate organ transplants and stop an expanding black market that draws patients from across the Middle East and as far away as Europe.  "It's the worst kind of business in Egypt. It's worse than slavery," says Queita, who has no comprehensive statistics but notes that one Cairo clinic had 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. . . . People are coming from all over to buy organs in Egypt. They're mainly gulf Arabs. If you're a rich man from the gulf, you go to a private Egyptian hospital that has contacts with organ brokers. Serious cases of poverty in this country are causing an increase in the theft and sale of organs."

Queita's bill proposes that transplants be limited to family members or to donors who accept no money. The legislation has been stalled by disagreements between Islamic clerics and doctors. Physicians support the harvesting of organs from patients who are clinically brain-dead, but clerics regard the practice as haram (forbidden).

The issue is a strand in a legal and spiritual debate over the definition of death that dates to Pharaonic times. Most clerics agree with Queita that the selling of body parts violates Islamic law.

"But there's no punishment," the lawmaker says. "Nobody goes to jail."   . . . .

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