Could Egypt witness breakthrough in post-mortemorgan donation?

Official statements, reinforced by interaction with Egyptian celebrities, have brought the “organ donation” issue back to the fore, amid anticipation of the executive steps that the country will take in the framework of legalizing the necessary procedures for donation.

The past few days witnessed a great media spotlight on the difficulties facing those wishing to get this notarized in the Land Registry office. 

The lack of a culture of donation among citizens is due to the fears of some about its religious legitimacy and the warning of others against exploiting the poor to profit from the death of their relatives under the name of donation.

In a government response to the issue, Egyptian President Abdel Fattah El-Sisi directed the government on Monday to “establish the largest regional center for organ transplantation in the Middle East and Africa, in cooperation with major international companies specialized in this field, with the aim of establishing an integrated system that includes a database for transplants, patients and donors.”

A few days before this decision, Presidential Advisor for Health and Prevention Affairs Mohamed AwadTaj al-Din confirmed on Saturday that the addition of the option to donate organs to the national ID card is being studied, which is applicable in many countries of the world.

Individual attempts

Despite her success in documenting the first official power of attorney (for a woman) to donate organs after death in 2018, Dina Reda revealed to Jusoor Post that “she faced great difficulty in doing this because many employees do not know how to write this type of power of attorney and believe that it is an illegal step.”

Reda pointed out that “despite the existence of a law regulating human organ transplantation since 2011, the number of those who were able to document an official power of attorney to donate their organs was only 15 due to the absence of a culture and the difficulty of documentation.”

The idea of documenting the first official power of attorney for organ donation after death came back to a person named Youssef Radi in 2014.

Radi, along with others, launched the “Post-Death Organ Donation” closed group on Facebook, and the number of its members just exceeded 10,000.

The group describes itself as a group of young people who believe in the importance of organ donation after death to save the lives of patients and give them a better life and confront the organ trade.

In statements to Jusoor Post, Radi called for legalizing donations through a presidential initiative such as the stem cell initiative. “The crisis is not in religion, but in societal awareness. This awareness must be properly directed by the state's leaders,” he said.

Donors are based on Article 8 of the Organ Transplant Regulation Act. It permits “due to the necessity of preserving the life of a living person or treating him from a serious disease or completing a vital deficiency in his body, for an organ or part of an organ or tissue from the body of a dead person to be implanted.”

This law is applied “among Egyptians if the deceased had recommended this before his death with a will documented in any official paper or acknowledged it according to the procedures specified by the executive regulations of this law.”

The first law regulating organ transplantation

Egypt passed Law No. 5 of 2010, which was the first law regulating human organ transplantation. It included 28 articles related to general provisions, human organ transplant facilities, transplant procedures, and penalties for violating those articles.

The law stipulated that an organ transplant must be “necessary to preserve the recipient’s life or treat him from a serious disease, provided that the transfer does not expose the donor to a serious danger to his life or health.”

With the aim of blocking the organ trade, the law prohibits “transferring organs from Egyptians to foreigners except for the spouses if one of them is Egyptian and the other is a foreigner.”

It also adds that “it is not permissible to transfer any organ or part of an organ or tissue from the body of a living person to be transplanted into the body of another human being unless it is on the way to donate.”

The law promised that violators would be imposed fines and prison sentences of up to hard labor and life imprisonment if the violation resulted in the death of the donor or recipient.

The World Health Organization praised the law and considered it “a wonderful step that gives hope to thousands of patients who need organ transplants to save their lives. It also eliminates the illegal trade in this field, which was taking place in an atmosphere that harms both the donor and the recipient alike.”

With the spread of the human organ trade, the fine has been doubled and the penalty has been increased to the death penalty in accordance with Law No. 142 of 2017, which amended some provisions of Law No. 5 of 2010 regulating human organ transplantation.

Donation and transplant operations are subject to the supervision of the Higher Committee for Human Organ Transplantation, in accordance with the law, and follow the Prime Minister, who issues a decision to form it, organize its work, and determine the rewards of its members and their assistants based on the proposal of the Minister of Health.

Religious opinion

Egypt’s Dar Al Iftaa permitted organ donation according to specific conditions, the most important of which is the existence of a necessary and urgent medical purpose, the consent of the donor, and the non-payment of any material or moral compensation, directly or indirectly, in Fatwa No. 739 dated October 22, 2003.

In 2009, Al-Azhar Islamic Research Academy authorized in its general conference to donate organs to the deceased. It permitted the transfer of organs, whether between the living or the dead to the living, and prohibited selling.

This was supported by one of Al-Azhar’s scholars, Sheikh Ibrahim Reda, who told Jusoor Post, “In my personal opinion, there is nothing that legally prevents the use of the organs of the deceased that he donated for the benefit of the living person, in accordance with what was stated in the Holy Quran in connection with the right to life, as God says{And whoever saves a life, it is as though he had saved the lives of all mankind}[5:32].”

“We were preceded by the former Sheikh of Al-Azhar, SayedTantawi, who donated his organs had he not been buried in Al-Baqi' in Saudi Arabia,” he added.

The other matter in Sheikh Reda’s opinion is that “establishing organ banks in Egypt, as in a number of neighboring countries, will eliminate the mafia and brokers who trade in human organs under the name of donating and exploiting the need of the poor because organs will be available.”

The trade in human organs is flourishing in major hospitals in Egypt under the name “donation”, which is among the top ten countries with the most popular organ trade in the world. The United Nations ranked Egypt fifth in the world in 2010 due to the fact that thousands of its citizens had to sell their organs, such as kidneys and livers, because of their suffering from destitution, poverty, and debt.

Donors without member banks

Despite what was raised about the issue of documenting organ donation after death, there are no rules or mechanisms to regulate such matters, according to a member of the Egyptian Medical Syndicate Council and a representative of the Federation of Medical Professions Syndicates, Dr. RashwanShaaban.

Shaaban explained in statements to Jusoor Post that “the organ donation process needs capabilities that are not available, and the Egyptian government does not have a database related to the health status of patients and the efficiency of their organs, and we do not know when and where they will die.”

“The lack of special banks to deal with members of the deceased prevents the application of donation in the event of their death, although some Arab countries preceded us in this matter,” he added.

Shaaban praised the recent government measures regarding Sisi's decision to establish a regional center for organ transplantation and to establish an integrated system that includes a database for transplants, patients, and donors.

The Medical Syndicate member ruled out that “the legalization of donation opens the door to organ trafficking because the deceased will have died, whether he was poor or not, especially since the law criminalizes selling them for a fee and therefore not even the heirs will benefit, because the process of organ transfer will be subject to the rules and regulations of the Ministry of Health.”