A long-overdue draft law to regulate organ transplant operations is set to be reviewed by the Egyptian Parliament. The proposed legislation, if passed, is bound to make more human organs available for transplant. This is also thought to be a move against the country’s booming organ trade.
Dr. Mahmoud El-Meteini, head of the Liver Transfer Unit at Wadi El-Nil Hospital said that “We’ve been operating for 30 years in Egypt without any organisation, relying on local and personal efforts to regulate organ transplants. Things cannot continue like this. We need a law to organize all transplant centres, and shut down the bad ones.”
Egypt currently has no organ transplants legislation: regulation of this so peculiar field is left to doctor union rules and to a set of health ministry guidelines.
Lack of certain legislation, loosen enforcement of existing rules and regulations, an unconditional and somewhat hard to understand ban on transplants from deceased donors – which means all transplant organs must be harvested from living donors – have brought to the explosion of organs black market and trafficking. Indeed, Egypt has been identified by the World Health Organisation (WHO) as one of five organ trafficking hot spots. Over 95 percent of all kidney transplants, and at least 30 percent of all partial liver transplants, are between non-related donors and recipients – which experts say is a strong indication that a payment is involved.
If approved, the proposed legislation – The Organ Harvesting and Transplant Act – headed for parliament this month, would tightly regulate organ transplant operations and introduce harsh criminal penalties for violations. It would also permit, for the first time, transplants from deceased donors.
Attempts to pass organ transplant legislation have been blocked in parliament for over ten years by a small but influential group of lawmakers who argue that humans cannot sell or donate what they do not own.
“You have no right to donate your organs because you are only a keeper of your body, which belongs to God,” Sheikh Mohamed Metwali Al-Shaarawi said before his death in 1998. Muslim clerics are not unanimously siding against organ donations. Sayed Tantawi, Grand Sheikh of Al-Azhar, Egypt’s highest Islamic authority, has declared that donating one’s organs after death is permissible in Islam because it is an act of charity for the benefit of other human beings. Most lawmakers have accepted Tantawi’s ruling, though some have raised concerns about the draft’s legal definition of death.
Debate has arisen about the definition of the time of death. The draft law takes the conventional medical position that death occurs upon the irreversible cessation of all brain activity, since advances in medicine have made it possible for the body’s circulatory and respiratory functions to continue with the aid of a life support machine. For transplants of vital organs to be successful, brain death must be considered the measure, as many organs are rendered unfit for transplant once the heart stops beating.
“There is a minority in this country, including not more than 10 doctors, who say that brain death is not death and we should wait until the heart stops,” says El-Meteini. “They are saying this rubbish on television, but they cannot say it in one respectable medical conference in the world. Over the past 20 years they’ve won, but…I think now the arena is more prepared to accept our concept, rather than theirs.”