CAIRO — Kidneys are in high demand. Livers — or part thereof — too. So much so that each organ can fetch a couple of thousands of dollars on the black market.
At those prices, one would guess that we are not talking the bovine, ovine, or poultry variety.
Yes, add to Egypt’s myriad social problems rampant trafficking in human organs for the purpose of medical transplants.
Egyptian authorities have seen a rise in this lucrative trade over the past several years and only now believe they are beginning to get control of the problem.
The problem is symptomatic of Egypt’s extreme poverty.
The price tag on a kidney or part of a liver comes to just a couple thousand dollars, a small fee considering the risks involved. But in a country where 40 percent of the population lives on $2 or less a day, to the most destitute here it’s more money than they may make over the course of several years.
Most of those seeking organs on the black market are Arabs from the region, according to the Ministry of Health. They connect with traffickers who, in turn, source donors from among Egypt’s poorest citizens.
The Ministry first caught wind of the problem in 2006 when a small number of cases were reported to the authorities. The ministry, working with the country's security forces, launched a series of raids on suspected clinics and made a number of arrests.
The unintended consequence of this, however, was to drive the organ trade further underground, which dramatically increased the risk to the patients.
"What we came to as a conclusion: those who used to use hostels in Mohandiseen and Dokki [two central commercial districts in Cairo], then moved their operations underground,” said a Ministry of Health spokesman, Dr. Abdel Rahman Shahin. “This means more danger for the patient.”
Routinely, patients were taken from illegal clinics while still unconscious because the doctors feared getting caught. In some cases patients were dumped back on the street before waking up.
Dr. Adel Hosny, head of liver transplants at Cairo’s Kasr el-Aini Hospital concurred that doctors in illegal clinics often discharged organ donors long before they should. He said that patients need to be in intensive care for at least 12 hours after liver surgery.
Infection was another big risk in the illegal clinics, Hosny said, because there is no way to guarantee the sterility of the operating room.
While organ trafficking has been driven deeper underground, some have begun making more brazen public efforts to buy and sell organs.
“People have begun showing up at hospitals with a family member ... doctors only find out later that they weren’t family,” Hosny said.
To combat commercial organ sales, the Egyptian Parliament is set to consider a new law that will raise the bar on donors to prove the transplant isn’t a commercial venture. At the same time, the law will make more organs readily available through government hospitals.
This legislation, said Shahin, may finally slow the organ trade business in Egypt, which has become one of the biggest markets for the illicit trade of organs. China and Pakistan lead the world, according to the Albany, New York-based Institute for Humanist Studies.
“The regulations are very clear,” Shahin said. “They have to get permission from the medical syndicate. They have to be blood relatives, and if they are not blood relatives, they must appear in front of a committee and prove there is no commercial element.”
This process for gaining approval isn’t new in Egypt, but the proposed law will toughen enforcement standards.
The number of legal transplants in the country is still low in relation to demand.
Government hospitals have reportedly performed 350 partial liver transplants since they were made legal in 2001, 400 bone marrow transplants over the past three years, and 60 to 80 kidney transplants a year.
In another effort to reduce the need for the underground trade, the government is trying to loosen standards on who qualifies as an organ donor, hopefully boosting the number of transplants by increasing the availability of organs.
But as lawmakers debate how best to do this, they have clashed with members of Egypt’s religious establishment and set off a hot debate in the country that centers on the very definition of death.
“You have two types of death,” Hosny said, “the brain death, when the person still has a beating heart. Then there is the death when the heart is not beating anymore. This is where the debate lies.”
Politicians are still haggling over the definition of death with leading religious scholars — among them Sheikh Mohammed Sayed Tantawi, who runs al Azhar Mosque, and Ali Gomaa, Grand Mufti of Egypt. The two are considered to be Egypt's most influential clerics.
The other controversy surrounds the use of organs from executed criminals. Though it is unclear how many executions take place in Egypt each year, legalizing the use of a convict’s organs, with or without their consent, would seriously boost supply on the legal market, Shahin said.
Several religious clerics have recently spoken out in favor of the measure.
“They are saying that when [convicts’] organs are taken, they’re compensating for the bad they did,” said Shahin, paraphrasing some in the religious establishment.
While the new transplant law still hangs in limbo, many medical officials are hoping for any measure that would make transplants more readily available and thus deal a blow to the illegal trade.
For more Dispatches Egypt's poor:
Trash or treasure: Egypt's poorest decide
Cairo on $2 a day
A crumbling city