The moral dilemma of organ donation in Egypt

What would you do if your son needed a kidney transplant and you were not a match to give him your own?

If you were in Egypt, you don't have many choices.

Legally, there is a choice of two options. The most widely practiced is to receive a donation from Egyptian family members, as stipulated in the organ donation law, approved by the Egyptian parliament in 2010.

Foreigners in Egypt are allowed to donate organs to family members, and others of their own nationality.

However, not all family members can be matching donors, and if they are, they would not necessarily be able to donate, depending on their health conditions.

The second legal option is deceased donation - taking an organ from the recently deceased or the brain-dead - the source for the majority of organ transplants around the world. Although this legal option is the most logical and preferable, as it does not risk the health of the donor, it is yet to be applied in Egypt.

Legalising deceased donation was only made possible by the 2010 law after a decades-long theological dispute on the definition of death was settled when Egypt's higher religious authorities, represented by the al-Azhar Islamic institution and the Coptic Church, officially approved it.

According to most interpretations of the Islamic Sharia Law, the heart must stop beating before someone is legally declared dead. Thus, donation from brain-dead patients was not possible before 2010.

Abdel Hamid Abaza, the former head of the Egyptian Health Ministry's Higher Committee on Organ Transplants, which was formed following the approval of the law in 2010, told al-Araby al-Jadeed that the implementation of the law had been hindered by the political unrest in the country over the past few years.

"In the long-run, organ donation from the recently deceased and the brain-dead will hopefully begin by early 2016," he added.

"For that purpose, the Health Ministry has trained medical professionals to diagnose brain-dead cases, with four main hospitals selected for the operations to take place. These are the hospitals in the universities of Cairo, Ain Shams, and Mansoura, as well as the Armed Forces hospital.

In the long-run, organ donation from the recently-deceased and the brain-dead will hopefully begin by early 2016 - Abdel Hamid Abaza

"On the condition they are carried out in public hospitals and from related donors, liver transplants cost about $25,000, of which the state pays roughly $9,600, while the Egyptian Organ Transplant Association contributes with another $9,600," said Abaza.

"As for kidney transplants, the state covers the entire cost of $3,800."

Abaza added that the Health Ministry had finally created a long-awaited national online database of donors and recipients, to come into effect "soon".

However, in 2013, Abaza said that the main obstacle before the implementation of the organ donation law was "public rejection".

Egypt is known, among other things, for its traditional approaches to the idea of the posthumous sanctity of the human body. Ancient Egyptians, for example, used to mummify bodies and preserve the organs for the afterlife.

Traffic chaos

But the main drive behind the rejection of organ donation in Egypt is the claim that it allows for organ trafficking, giving way to fears of the exploitation of the poor as spare body parts for the rich.

The legal hurdles and the high demand and limited supply of organs gave rise to a third option: the organ trade.

This is illegal in Egypt and most, if not all, countries of the world. The ethics of the organ trade remain a topic of debate, and the moral dilemma becomes irrelevant - or of little importance for many families and individuals urgently in need of transplants.

Article six of the 2010 law outlaws financial remuneration for organ donation. It aims to prevent underprivileged Egyptians from selling their organs to wealthy visitors from other countries, such as conservative Gulf states - some of which still outlaw organ donation entirely.

According to humanitarian news website IRIN, a 2010 report by the World Health Organisation described Egypt as a hub for organ trafficking, saying that the country was one of five trafficking hotspots.

But many recipients and donors still find a way to get around the law. Falsifying family relationships in order to arrange for organ transplants is not difficult in Egypt, as officials do not always look thoroughly into the paperwork required to prove kinship.

However, Abaza confirmed to al-Araby that the organ donation law was finally putting an end to such practices.

"The immediate effect of the law included the closure of more than 100 illegal facilities carrying out organ transplantation operations," he said.

"And, according to the Interior Ministry, the law has contributed to the reduction of organ trafficking crimes by more than 80 percent."

Debra Budiani is the executive director and founder of the Coalition for Organ-Failure Solutions, a non-profit international health and human rights organisation.

She told al-Araby there had been cases of organ trafficking in Egypt in the past three to five years - despite the country's legal victories.

We have wasted a lot of time on the counter-productive argument about medical ethics, when in fact organ trade is a human rights abuse - Debra Budiani

Besides outreach programmes working to identify victims of organ trafficking and raising public awareness, COFS collects data with the objective of ending the organ trade and advancing protection for its targets.

Due to clandestine nature of the trade and the unrest witnessed by Egypt in the past few years since the revolution, it is nearly impossible to have an accurate estimate of the number of organ trades in the country.

"But it has been reduced significantly," said Budiani.

Another major reason why organ trafficking victims are difficult to identify is because they do not often report the crimes against them for fear of punishment - as the law also criminalises commercial donors, which Budiani believes to be extremely unjust.

"There are no protection mechanisms to ensure the victims are not prosecuted for selling their organs," she explained.

"We have spent much time referring to the abuses of trafficking in persons for the removal of organs as a medical ethics dilemma," said Budieri. "It is a human trafficking and human rights abuse. Not recognising it as such is counter-productive."

Officials should, instead of prosecution, focus on identifying victims and offering follow-up care and counselling.

"We have to move beyond the ethics," she said.

A UN grant recently received by COFS to carry out further work in Egypt, including follow-up care for victims of organ trafficking, serves as an acknowledgment by the UN that much more still needs to be done in the country to end such practices.

One solution that Budiani hopes will be pushed forward in Egypt in the coming years is paired donation - where patients who failed to find a matching related donor coordinate with other families looking for a cross-match.

"Until deceased donation is developed, paired donation can offer more rapid solutions to patients," she said. "I hope this gets pushed forward in Egypt, even though it would still take years to apply."


Editor's note: This article has been amended since its first publication to clarify the position of COFS, the non-profit human rights charity.