Egyptian law stipulates that an individual is considered to be dead if the brain stem is dead. Yet, even though Parliament’s Health Committee has accepted a draft law approving the legalisation of organ transplantation, article 11 of the draft law is still giving rise to wide debate.
A number of Arab and Muslim countries accept the scientific rule, but some people object on the grounds that the individual whose brain stem is dead should not be considered as dead but as a sick person who needs health care.
Watani contacted Khaled Mukhtar, professor of urology at Ain Shams University, who is calling for the law to be passed as soon as possible.
“The ban of organ transplants forces people to manipulate the law,” Dr Mukhtar says. “A patient who needs a kidney can buy it from someone, but it should be formally registered in the papers that the seller has voluntarily given his or her kidney to the patient and that the two people are relatives, even if they are of different religions.” He believes that the law, if approved and applied in a climate of transparency, would provide a solution for many patients.
Artificially alive
Professor of immunology Abdel-Hadi Mesbah says it is approved worldwide that brain stem death indicates a patient is dead, since the brain cells subsequently deteriorate. In this case, patients remain technically alive but it is advanced devices that keep the heart and lungs working. “Eighty countries, including Saudi Arabia and Iran, consider brain stem death an indication that the patient is dead,” Dr Mesbah says. “Our Parliament should pass the law. The State should establish an organ bank and carry responsibility for the whole process to prevent commercial organ transplantation.
Dr Mesbah said any organ, except the brain, could be transplanted, but the patient would need treatment for the rest of his or her life to prevent the body from rejecting the transplanted organ.
Youssef Abdel-Fattah, a professor at the Cardiology Institute in Cairo, said organ transplantation entailed relatively simple surgery with the only exception of heart transplants.
“What makes the question so complicated is the dominant cultural norms that reject organ transplantation, even from the dead,” Dr Abdel-Fattah says. “Poverty makes poor people resort to selling their organs, a situation that creates a market for organ transplantation and gives it a bad name. But if a law were to be passed and penalties were tightened, it would put a stop to the organ transplant trade,” he says.
About time
Dr Abdel-Fattah stresses that the medical committee authorised to decide on the death of the brain stem should be impartial and transparent.
Hassan Shalabi, a specialist in liver diseases, says partial liver transplants are performed frequently in Egypt. “Complete liver transplants are done outside Egypt where there are deterrent laws that prevent manipulation and illegal transactions. These operations are very successful, and people live normal lives after surgery,” he says.
Hamdi al-Sayed, the head of the Doctors Syndicate, told Watani it was a pity that the organ transplant law had still not been promulgated. “The law should be passed to put an end to the suffering of thousands of patients,” he said.
However he conceded that there was long way to go before this hope became a fact on the ground. “The draft law was presented to Parliament eight years ago, but MPs affiliated to the Muslim Brotherhood presented a memo to the Speaker of Parliament to the effect that the issue needed to be discussed in depth. We had even attached with the draft law a letter from prominent Muslim scholar Youssef al-Qaradawi approving organ transplantation,” he said. Dr Sayed concluded that it was about time to pass that law that was leading many Egyptians to travel to China in seek of transplants.
Further investigation
Abu Srei’ Abdel-Hadi, professor of Islamic jurisprudence and a member of the Islamic Research Academy, says Islamic Sharia allows for organ transplantation if it will save the life of a human being, but that the donor should do this voluntarily, not in return for money. As for dead people, Sharia accepts that their organs could be transplanted, but only under the condition of the heir’s approval or according to the will of the deceased.
Muhammad al-Beltagui, a Muslim Brotherhood MP, said that ‘the group does not oppose the law, but it objects to two articles. The first is related to the measure of death, which the law stipulates as brain stem death. This stipulation should be further investigated since it may suit the interests of certain parties—especially where inheritance is concerned—that someone would be pronounced dead. The other article which the MB is wary about defines the hospitals in which transplantation surgeries could be carried out. These hospitals may very easily turn into organ trade centres in absence of proper regulatory measures. Dr Beltagui called for the formation of a national council for organ transplant to achieve just that.
Born again
Mohamed Fouad, who needs a liver transplant, told Watani he hoped the State would pass the law as soon as possible. “I have been waiting for a new liver since August,” he said. Mr Fouad, who earns only LE350 a month, has sold a plot of land owned by his mother to cover the cost of the surgery. “Up to the present I have paid more than LE250,000, but the State has not given me any support at all,” he complains.
A month after his surgery, partial liver recipient Bissi Nabil said it was like “being born again”, and says he is much better than he was before. However, some people who had been given a partial liver transplant reported that although their lives had much improved they felt a complete liver transplant would be much better for patients.