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IV. National Legislation to Regulate Organ Transfer, Transplant and Prevent Organ Trafficking

Organ Transplant Legislation: From Trade to Donation
The Report
I. Organ and Tissue Transplant: The Rights to Health and Life
II. International Standards Established by Organizations for Organ and Tissue Transplantation
III. Organ and Tissue Transfer, Transplantation and Procurement
IV. National Legislation to Regulate Organ Transfer, Transplant and Prevent Organ Trafficking
V. Preliminary Observations on the Bill
VI. Basic Steps Needed to Implement the Law
Because of the lack of national legislation criminalizing organ trafficking and regulating the donation of organs from the deceased, there is an almost complete reliance on living organ donation in Egypt, without strict supervision. As a result very few transplants are performed due to the shortage of organs.  This situation relieves the state of its obligation to provide for such operations on a broad basis and allocate the basic financial resources to support them within a system of comprehensive, universal insurance. Thus, the major problem is that a great number of people who need transplants are without a solution. At the same time, the present situation permits organ trafficking because of the absence of deterrent legal statutes.

To take only one example, an organ transplant law will have an enormous positive impact on the lives of liver patients in Egypt, which has one of the highest rates of hepatitis C in the world. According to the most recent study, the first national survey of citizens aged 15-59, 9.8% of the population has the virus.18  Chronic hepatic viruses bring increased risk of grave complications, first and foremost, cirrhosis, which can lead to liver failure or cancer. Thus far, there is no treatment for these cases except for liver transplantation, which is only for those able to survive the operation.​19

From 2002 to 2007, official reports indicated that 430 liver transplants were conducted in Egypt.20  On 20 March 2007, Minister of Health Hatem al-Gabali announced the first successful liver lobe transplant from a living donor at a government hospital, the Sahel Teaching Hospital in Shubra. According to a news report, the patient fully recovered.​21

While a liver lobe transplant costs nearly LE 600,000 in private hospitals, (an amount which most Egyptian patients cannot afford) it costs only LE 250,000 at the Sahel Teaching Hospital. For the needy, financial support of LE 50,000-200,000 is offered directly from the Ministry of Health or the Misr bi-Kheir Program in conjunction with the ministry and Dar al-Ifta’, which supports the neediest patients with funds from the alms. The Sahel Hospital also has private funding to supplement the costs of such operations.​22

Nevertheless, there is a major reliance on charity to fund these operations at the Sahel Hospital, which greatly limits them.23  Clearly, ameliorating the situation requires the creation of a national program as well as the political will to pass the organ transplant bill and guarantee adequate funding for implementation.

It should also be noted that the health consequences of organ transplantation require lifelong treatment, the costs of which the poor have difficulty meeting.24 The costs of a transplant operation are not limited to the surgery, but also include post-op treatment and follow-up, as well as drugs that the patient must use for a long time (the cost of which is nearly LE 2,000 per month).25 The donor might also suffer complications, which is why some countries do not allow living donations and rely on deceased donations.​26  There are no precise numbers on the number of successful transplants carried out by the Sahel Hospital, but it is rumored that 7 out of 19 patients did not survive the transplantation.​27
At the same time, organ trafficking and transplant tourism are widespread in Egypt, although there are no accurate figures on the scope of the phenomenon, or the number of beneficiaries. Ministry of Health officials admit to the existence of trafficking, carried out with the participation of some medical personnel and treatment facilities.28 Dr. Hamdi al-Sayyid, the president of the Egyptian Medical Syndicate and the chair of the Health and Environmental Affairs Committee in the People’s Assembly, estimates that one-third of liver transplants conducted in Egypt are illegal. 29The Ministry of Health has intensified inspections of facilities that perform organ transplants in recent months after heavy media coverage of the phenomenon and of a WHO report naming Egypt as a site for the trade in organs.30  This report shows that 78% of commercial donors in Egypt faced adverse health consequences as a result of the operation due to several factors, including the lack of a comprehensive medical examination of donors prior to the operation to assess their health.31  A report issued by an international organization that monitors and documents organ trafficking (the Coalition for Organ-Failure Solutions), adds that those who agree to these donations, in return for money, are motivated largely by poverty.  Moreover, 78% of them spend the money they receive for the operation in the subsequent five months to pay off debts rather than to improve their health.32  Finally, research shows that 94% of paid donors regret undergoing the operation.​33

Legal frameworks regulating donation in the absence of national legislation

Given the inexcusable lack of legislation, the only legal framework that exists to regulate organ transplantation in Egypt was, until last year, the professional code of ethics and conduct of the Egyptian Medical Syndicate.​34 In addition, since the code is simply a set of ethical principles endorsed by the syndicate, it naturally does not address criminal liability or civil rights.  Moreover, it does not contain deterrent penalties for those in breach of the code.
The professional code of ethics states that the syndicate should be informed of any organ transfer to ensure the integrity of both the donation and the transplant, in accordance with the ethical guidelines contained in the code. No transfer may be performed without the prior consent of a special committee. Articles 49, 50 and 51 of the code, established by Minister of Health decree 238/2003 (5 September 2003), state the following:
Article 49: The human organs and tissues transplant operations shall be subject to the moral criteria and guidelines stipulated in the legislation and regulations organizing the foregoing.

Article 50: It shall be imperative upon the physician prior to carrying out an organ transplant operation, pursuant to the legislation organizing the foregoing, to notify the donor of the medical consequences and the risks to which he may be exposed to as a result of the transplant operation. It is also essential to compile the necessary documents which confirm the donor’s knowledge of all the consequences in this matter prior to carrying out the operation.

Article 51: It shall be prohibited to trade in the human organs, tissues and cells and human embryos. Under no circumstance shall the physician be allowed to take part in these operations. Otherwise he shall be subject to disciplinary accountability.

The terms “legislation” and “regulations” appear twice in the above-mentioned articles, although there is no Egyptian law that criminalizes organ trafficking and regulates donations from the deceased.

The Minister of Health has announced that until an organ transplant law is issued, no transplantation will be permitted except with the approval of the Minister and the Egyptian Medical Syndicate. To regulate transplantations, Ministerial Decree 70/2009 was issued on 22 February establishing a central registry of organ transplants in the Central Administration of Non-Governmental Treatment Facilities and Licenses. The decree requires medical facilities that perform transplants to submit the relevant documentation on the patient and the donor. It also sets general conditions, such as the need for the donor’s informed consent. It also requires donors to sign an affidavit to that effect before a specialized committee established by the decree in order to obtain approval for the transplant. The specialized committee contains an unspecified number of technical and legal experts. The decree specifies that any facility found in violation of the decree faces a one-year closure and medical personnel involved in the violations may have their licenses suspended for one year as well. The decree states that “all private and public hospitals shall be directed to have no interactions with the [facility] during this period, and it shall also be announced in the press that there are to be no interactions with the medical personnel. If the violation is repeated, whether by the facility or the medical personnel, both of their licenses will be revoked.”​35

There are specific objectives in passing legislation that regulates organ transplantation and criminalizes organ trafficking. These include the following:  putting an end to the spread of human organ trafficking, which has flourished in Egypt because of widespread poverty, unemployment, corruption, illiteracy and the absence of regulation; establishing a framework to guarantee the intelligibility and integrity of organ procurement from those who decide,  either before or after their death, to donate their organs; and reforming  as well as  integrating the Egyptian health system to guarantee the basic rights to life and health care in the field of organ transfer and transplant. The Egyptian health system must provide quality health services without discrimination, in such a way that does not undermine citizens’ ability to access such services.
18- El Zanaty and Associates, Egypt Health and Demographic Survey 2008, Ministry of Health and Population.
19- Ahmad Shahin, “Zira’at al-a’da’ bayn al-tibb wa-l-qanun wa-l-din,” al-Qahira, Sept. 2007, pp. 37-8 and 60.
20- Faruq ‘Abd al-Majid, “‘Amaliyat  zar’ kabid jadida bi-mustashfa al-sahil khilal ayyam,” al-Ahram, 11 April 2007, p. 8.
21- Egyptian State Information Service, “Minister of Health: Liver Transplant Operations To Be Performed at Sahel Hospital,” 23 April 2007.
22- “Life Is Not a Luxury,” Egypt Today, Feb. 2008, vol. 29, no. 2.
23- Faruq ‘Abd al-Majid, “Markaz jadid li-jirahat al-kabid bi-mustashfa al-sahil,” al-Ahram, 24 June 2008, p. 9.
24- Hiba Farfali, “Marda zira’at al-kabid fi khatar,” Ruz al-Yusuf, 17 Aug. 2008, p. 2.
25- Amal Ibrahim, “Zira’at al-kabid wa hisad al-hashim,” al-Ahram, 15 Nov. 2007, p. 27.
26- Ibid.
27- Muhammad Hamdi, “Ijabat min mustashfa al-sahil,” Ruz al-Yusuf, 20 June 2008, p. 9.
28- See for example, Hifni Wafi, “Sa’d al-Maghrabi wakil wizarat al-sahha: hunak mafiya munazzama li-tijarat al-a’da’ al-bashariya fi Misr,” al-Badil, 24 Aug. 2008, p. 13.
30- Yosuke Shimazono, “The State of the International Organ Trade: A Provisional Picture Based on Integration of Available Information,” Bulletin of the World Health Organization, vol. 85, no. 12, Dec. 2007, pp. 901-80.
31- D.A. Budiani-Saberi and F.L. Delmonico, “Organ Trafficking and Transplant Tourism: A Commentary on the Global Realities,” American Journal of Transplantation, 2008, pp. 925-29.
32- Shimazono.
33- Budiani-Saberi and Delmonico. 
34-The code is available on the website of the Egyptian Doctors’ Syndicate.
35- Minister of Health Decree 70/2009, Official Gazette, no. 56, 8 March 2009.
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