Fewer illicit organ transplants in MENA, problem persists in Egypt

Sunday 30/04/2017

The international media frequently present provocative and sensational stories on the trade of human kidneys in the MENA region, a charge to which doctors and government officials in those countries vehemently deny. So why do these stories appear and how much of what is claimed is based on hard, unequivocal evidence?
As an investigator of human organ trafficking, I have come to know many individuals and organisations involved in this lurid trade. I regularly come into contact not only with the buyers and sellers of human organs but also the fixers and middlemen who broker the deals, the doctors who perform the transplant surgery and the hospital officials who provide facilities and nursing support.
I should acknowledge first that many countries in the MENA region have been at the forefront of the international effort to combat global human organ trafficking. As an example, representatives from Saudi Arabia and Kuwait have taken leadership roles within the Declaration of Istanbul Custodian Group, the principal organisation recognised by the World Health Organisation for monitoring and reporting global organ trafficking. These representatives have enforced some of the strictest measures against human organ trafficking within their own countries.
In the MENA region, however, Egypt stands out as the country in which illegal and unethical kidney transplants are per­formed, in large numbers, with impunity. As such, Egypt has become an international hub of human organ trafficking. With the effective closure of organ markets in the Philippines and China to foreigners, Egypt is likely to be the most popular destination for transplant tourists from overseas. From 2008-17, I made contact with more than 250 people who purchased a kidney in Cairo and, given that I am only able to reach out to a fraction of the total, the true number is likely several times that I have discovered.
While Egypt is the only country in the MENA region that appears to have a systemic problem with illicit organ transplantation, other countries have become complicit in the migration towards Egypt of those who become victim to the Egyptian organ trade. The kidney sellers are rarely Egyptian citizens and most often originate from nearby MENA countries. I have discov­ered Syrian victims who were recruited by brokers in Lebanon and Sudanese, Eritrean and Somali victims who were recruited by brokers in Libya.
Unlike the myths perpetuated by some commentators, these victims are not physically forced into having a kidney removed. They are individuals who find themselves in dire financial circumstances who decide to sell a kidney to raise urgently needed funds. Recently I encountered Syrian victims who each sold a kidney so they could pay a people smuggler to transport their families to the European Union via Turkey.
Organ buyers descend on Egypt from all over the world. I have met brokers in Cairo who special­ise in specific buyer nationalities. These buyers will typically pay as much as $100,000 for a kidney purchased from a seller for less than $5,000. A massive profit indeed.
Added to this, the clinical outcomes for both buyer and seller are generally very poor and many die from infection and other complications following these clandestine procedures. Sellers are routinely underpaid and buyers are typically required to make additional payments well in excess of the originally agreed sum. It is just bad news all around.
The solution to the problem can be found on both the demand and supply side of the equation. If more countries would develop and administer a robust deceased organ donation system, then demand for organs on the black market would decrease. If countries in the MENA region developed more rigorous border control and cooperation, then perhaps the continuous flow of organ sellers into Egypt could be reduced and limit the extent of organ trading.
Overall, there are major improvements taking place in ethical organ donation through­out the MENA region. However, the apparent unwillingness of Egypt to engage with the interna­tional transplant community and take urgent and appropriate action will inevitably lead to the international media continuing to unfairly brand the MENA region as a centre of human organ trafficking.