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Despite the positive aspects of the bill, the EIPR believes that the state must take decisive measures to implement the law after its adoption by the People’s Assembly. If the real intent of the law is to end organ trafficking and provide an adequate legal framework for organ donation, the EIPR recommends that these measures be established by the implementing regulations. Moreover, these measures must be adopted when executing policies, programs and plans connected to the law, after its passage.
A. Definition of death
There is a definite (or an urgent) need for a precise, well-written definition of death to be followed by state institutions and facilities that perform organ transplants. However, we believe that drafting this definition is not the legislature’s job. Rather, the law must lay the foundation and set safeguards that guarantee the competence, integrity and transparency of the process. Nevertheless, the definition itself requires a committee of specialists, commissioned by the state, which will fully research the issue and agree on a definition to apply to all facilities.
We should not forget that citizens in our country die every day and no one asks whether it is brain death. Each country must establish a technical definition of death and isolate the issue from that of organ transplant.
B. Systems for the transfer and transplant of organs and tissue
The bill establishes a higher committee, formed by the Minister of Health, to oversee the administration and organization of organ and tissue transplantation. The committee shall classify donated organs and tissue and register potential recipients by tissue, immunity, blood type etc. The committee shall supervise and inspect hospitals and medical centers that perform organ transfers and transplants as well as issue the requisite licenses.
Clear standards that specify the committee’s role and how it shall discharge all of its mandates, as stipulated by the law, must be established in order to guarantee impartiality and precision, and to enable the committee to fulfill its duties. This is important since the committee will oversee the selection of those hospitals that are permitted to perform transplants. Furthermore, it should have its own budget and adequate financial resources, proportionate to the sensitivity and difficulty of its tasks.
The existence of an independent committee that offers quality medical services and supervision will pave the way for broad public support. Moreover, the independence of the committee will encourage citizens to adopt a culture of donation and propagate it throughout society. Over the years, the lack of trust in the health system has had a detrimental effect on community contribution and on those who have a sincere desire to donate.
The government has issued several statements recently regarding the submission of a new health insurance bill in the current parliamentary session. Organ transfer and transplant must be included in any new health insurance system. Otherwise, it will remain a luxury available only to the wealthy.
C. Conditions for the transfer and transplant of organs and tissue
The bill lays out conditions for the transfer of organs from the living to the living, stressing the need to preserve the life of the recipient without undermining the donor’s right to life. It also emphasizes the necessity for treatment from serious illness when there are no other adequate options, as long as this does not risk the life of the donor.
This, in particular, requires the establishment of detailed medical guidelines which specify the risks to the donor, the specific clinical conditions that must be met for donation and the physical and psychological follow-up care, to be administered based on internationally recognized standards.
As for donations from the deceased, there must be safeguards to ensure that the higher committee, which oversees transplant and transfer, will act without discriminating among potential recipients. A strong system must be established for monitoring and supervising all aspects of the waiting list for patients requiring transplants. Moreover, if any malpractice is proven, existing penalties for fraud and falsification of official documents should be applied to all those involved.
D. Raising awareness
The law establishes conditions for transferring organs from the deceased to the living. For example, consent before death is an important precondition for transferring organs. The rules and procedures of this law will be established by the implementing regulations. In any case, it is stipulated that no payment may be involved, that donations from Egyptians to Egyptians must take priority, and that human dignity must be protected when transferring organs.
Although the culture of organ donation is not prevalent in our society, this article did not consider encouraging post-mortem donation or drafting policies to foster a culture of donation at death. Thus, the state must initiate a broad awareness campaign to change attitudes toward death and organ donation. The Special Rapporteur on the sale of children, child prostitution and child pornography has also recommended “educational programs as well as awareness-raising activities” as “essential in the fight against traffic of organs.”40
40- Report by the Special Rapporteur, 2006, paragraph 86.