Last May, a man who went by the name “Mazzika” started luring homeless street children and teenagers from Ramses Square, a stone’s throw away from Tahrir Square, and convincing them to harvest their organs. He asked for kidneys, liver lobes, or other organs, in exchange for 15,000 Egyptian pounds (about $850). Seduced by the money, the children usually agreed. The man would then take the organs and never pay up. “He takes the kids, lures them with a kidney and then cons them,” one underage victim said in a video.
For almost two months, “Mazzika” and other organ traffickers pursued this scheme out of a rented apartment in the low-income Cairo neighborhood of Marg. Apparently, no one in the neighborhood noticed when the bodies of the victims were dumped in a gravesite. The traffickers were only caught after a street brawl over money drew the attention of a neighbor, who tipped the police off to what he and others suspected was an underground organ trafficking mafia. Their testimonies led to the arrest of four suspects, two of whom were brothers in their twenties.
Incidents like these are not uncommon in Egypt, and offer startling insight into the country’s burgeoning black market in human organs. In 2010, the World Health Organization (WHO) ranked Egypt amongst the five top countries for illegal organ trafficking.
Perhaps surprisingly, Egypt has a law that prohibits trading in organs and also regulates donations. Approved in 2010, the law bans foreigners from receiving organ donations from Egyptians, and, for the first time, legalizes cadaver organ transplants in certified hospitals and centers, under specific conditions. The law was the product of a history of wrangling over the permissibility of organ transplantation and donations in Egypt. Rather than mitigate the crisis, however, the law has lain dormant, with the state unable to enforce its provisions.
Organ Transplants and the Question of Permissibility
In 1962, in the provincial town of Mansoura, a urologist named Mohamed Ghoneim carried out the first renal transplant in Egypt. Surgeons in Cairo also soon began carrying out transplants. The surgical practice quickly raised uncomfortable ethical and legal questions, about body ownership and religious permissibility. Were we cheating death? Did our bodies really belong to us, or were they God’s property?
Al Azhar, Egypt’s governing religious body, initially ruled against organ donations in 1979, citing to scriptural passages in order to forbid the practice. As a result, organ donation rates dropped. An extreme shortage in organs for patients in need developed. Up until the 1990s, the debate continued to intensify over whether it was legal and religiously permissible to donate organs after a person’s death.
According to Sherine Hamdy, an anthropologist at Brown University, a young legal scholar sent an eight-part questionnaire to the then-grand mufti of Egypt, Shaykh Gad al-Haq in 1979. The scholar requested an Islamic legal ruling on taking organs from the living, dead, and brain-dead patients. In response, Haq issued a fatwa ruling that kidneys could ethically be transplanted from living donors and eyes from corpses. Death meant “loss of all signs of life,” meaning that organ donations from brain-dead patients were prohibited.
In the 1980s, public opinion began to shift against organ donation, as the popular, charismatic religious scholar and lecturer, Shaykh al-Sha’arawi, came out against transplantation in all its forms on television. Sha’arawi’s famous refrain was: “How can you give a kidney that you yourself do not own?” Sha’arawi’s reasoning, that our bodies belonged to God, was derived from the Quranic injunction against suicide as haram, or forbidden. According to his biographer, M. Hasan, Sha’arawi’s opinion caused “huge shock and commotion in the public space [over organ transplants].” In her book, Our Bodies Belong to God: Organ Transplants, Islam, and the Struggle for Human Dignity in Egypt, Hamdy argues that Sha’arawi’s words – which, for many patients, meant submitting to God’s divine will – were never intended as a fatwa or Islamic ruling.
In the 1990s, the religious discourse shifted again, this time in favor of organ donation. In 1997, Shaykh Muhammad Sayyid Tantawi, another mufti, announced he would donate his organs after his death. His action was a deliberate refutation of Sha’arawi’s opinion. “I don’t understand why people are afraid of death…and what happens to their body after their death,” he said. “I see that what is taken from a person’s body after his death […] is halal, halal, halal.”
When Organ Theft Accelerated
Despite its existence, the 2010 law has not been enforced and, even when it is, the penalties for illegal organ trafficking have been relatively lax, in practice. The law imposes a punishment of no less than a year and a maximum of five years imprisonment for those found guilty of violating the law. Yet, the harshest sentence handed down has been fifteen months in prison, according to a story in Al-Ahram weekly this week.
The problem of organ theft is also only increasing. Organs are regularly stolen from corpses, even at government hospitals (an organ theft scandal in the 1990s caused the closure of two public eye banks). According to the Coalition for Organ Failure Solutions, a non-profit international health and human rights organization, their report in 2006 showed that approximately 100 to 200 unlicensed transplants occur every year in Egypt. Between 80 to 90 percent of kidney donors in the country have sold their organs for money.
The following deposition in an eye theft case, from last year, underscores the systemic nature of the problem. The deposition was of a morgue worker in Qasr al-Aini hospital [one of the largest teaching hospitals in Cairo]:
Q: What happened after you received the body of Zeinab Mahmoud?
A: The health inspector wrote his report on the status of the deceased and after that the doctor from the eye bank of the hospital took a blood sample from the deceased, wrote something and told me to bring this case to the equipped room inside the mortuary room. Dr. Jamal then took out the cornea from the deceased and I recorded that in the eye bank’s books.
Q: Since when have ophthalmologists from Qasr al-Aini hospital’s eye bank done this procedure?
A: Since I started working in the hospital.
Although no official records are kept, trafficking cases usually involve a wealthy foreigner paying a substantial sum to a donor, who is either a financially desperate Egyptian citizen or, in some cases, a refugee. The British Journal of Criminology recently published a study of organ trafficking practices amongst Sudanese migrants in Cairo – adding this group to the list of vulnerable people who have been coerced into selling their organs in Egypt.
The Human Cost of Organ Trafficking
In April, the bodies of nine Somalis washed up on the beaches of Alexandria, their corpses badly stitched and their vital organs missing. The migrants were allegedly lured onto a boat headed to Italy. In another instance, last December, dozens of arrests were made in what has been called “the largest international network for trading human organs.” The group was made up of forty-one suspects, including twelve doctors and eight nurses, and involved “Egyptians and Arabs taking advantage of some of the citizens’ difficult economic conditions so that they buy their human organs and sell [them] for large sums of money,” according to a statement made by Egypt’s Administrative Control Authority, an anti-corruption body. The arrests not only exposed collusion amongst members of the medical profession, but also provided more evidence of the long-standing, but hidden practice, of commercial organ donation.
While the stigma around organ donation has been lifted, both legally and socially, there is little oversight from the state over this practice. As a result, many of the most vulnerable members of Egyptian society have and continue to fall victim to organ trafficking.