Sunday, April 5, 2009

Egypt pressured to end underground organ trade

CAIRO - The poverty of Cairo's slums forced a young couple to sell nearly everything they had. When that wasn't enough, each of them sold a kidney.

The clandestine predawn operation in a small private hospital ended with the husband and wife being dumped semiconscious into taxis - the payment for their kidneys tucked into their clothes, they say.

A year later, penniless once more, they are too weak to even move around their apartment. They cannot afford follow-up care, and they spend much of the day in bed in a dark room.

"If anyone had made clear to me the danger, I wouldn't have done it," said Abdel-Rahman Abdel-Aziz, gaunt and looking older than his 24 years as he lay in bed beside his wife. He pulled up his sweat shirt to show the scar from the operation.

For years, word has spread among Egypt's destitute that selling a kidney - sometimes for as little as $2,000 - can be a quick way out of debt or to keep from sinking deeper into poverty. At rundown cafes, they are hunted by middlemen working for labs that match donors and recipients, many of whom are foreigners drawn to Egypt's thriving, underground organ trade.

Egypt is one of a half-dozen countries identified by the World Health Organization as organ-trafficking hot spots. Under international pressure, other trouble spots such as China, Pakistan, and the Philippines have outlawed organ sales and barred foreigners from undergoing transplants.

Egypt, however, has long ignored the problem, experts say. Transplant surgeons working to stop the global trade fear that foreign patients finding it harder to go to Asia could flood into Egypt in search of organs.

Egyptian officials are finally showing signs of action. One key problem has been that Egypt does not have a law regulating transplants, only weak doctors' union rules that bar sales but are largely self-policing and ignored.

Now, a draft law is expected to be put before parliament in the next few months. The law would ban the sale of organs, prohibit transplants to foreigners, restrict operations to public hospitals, and impose sentences of up to 15 years in prison and $180,000 fines for violations.

Egypt's Health Ministry has also begun cracking down. In recent months, authorities closed two private medical centers in Cairo and arrested doctors, middlemen, and lab workers for violating doctors' union rules or other charges, said Abdel-Rahman Shaheen, ministry spokesman.

"We must admit that we do have a problem with organ transplants," Shaheen said.

Crucially, the draft law also allows deceased donations, limiting the need for living donors. Past attempts at legislation have failed partly because of religious and cultural resistance to taking organs from the dead, though many other Muslim countries allow deceased donation.

There appears to be consensus on allowing deceased donations, but debate continues over whether the law should let doctors use brain death in determining whether a potential donor has died, as most other nations with transplant laws allow.

The brain death standard, rather than heart and lung failure, makes more organs available and is necessary for heart and full liver transplants.

Grand Sheik Mohammed Sayyed Tantawi of Al-Azhar, Sunni Islam's pre-eminent institution, last week endorsed a brain death standard. But a powerful group of lawmakers opposes it, saying it opens the door to abuses.
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