Organ trafficking "hotspots"

1. (SBU) Summary: Recent years have seen increased Egyptian and international media reports of both the consensual sale and theft of human organs in Egypt, earning the country a spot on the World Health Organization's 2007 list of the world's top five organ trafficking "hotspots". Rising poverty rates are leaving many Egyptians desperate for money, which can be earned quickly by selling, stealing or brokering organs. Yet continued disputes among legislators have prevented the passage of a law to criminalize any aspect of the organ trade. These circumstances contribute to an ever-growing black market in organs, in which brokers can earn more money than those dealing in drugs, without fear of legal ramifications. This market has attracted both rich organ-buyers and poor organ-sellers from neighboring countries, making Egypt a regional hub for the illicit trade in organs.End summary. --------------------------------- True Scope of the Problem Unknown --------------------------------- 2. (U) There are no official statistics gauging the scale of organ trafficking in Egypt. The Egyptian Physician's Syndicate stated in late 2007 that its Medical Ethics Committee reviews about 500 to 1,000 organ sale cases annually. Yet a number of indicators point to a much higher figure: frequent local press coverage of new cases and a new Ministry of Health crackdown, which has resulted in the closure of numerous clinics and hospitals. However,as an Egyptian journalist who went undercover in the organ trade emphasized, the number of cases actually reported to either the press or the police will remain unrepresentatively low as traffickers use a combination of bribery and violence to prevent their victims from speaking out. 3. (U) Much of what is known about the organ trade in Egypt has come from those who have come forward after willingly selling an organ or falling prey to organ theft. From these sources, two scenarios have emerged to explain how organ traffickers operate. In March 2008, the LA Times reported on the first scenario, in which people desperate for money are approached by brokers who openly offer up a tempting trade ) an organ (usually a kidney or part of a liver) for an amount between 10,000 LE and 40,000 LE (1,870 USD and 7,570 USD). Knowing this sum (a veritable fortune by Egyptian standards) would take many years to earn otherwise, many agree to undergo the procedure, often under sub-standard conditions which seriously jeopardize the donor,s health. A World Health Organization study indicates 78% of paid kidney donors in Egypt experience a significant deterioration in their health status after the procedure. 4. (U) The second scenario, detailed in the current affairs publication Egypt Today, involves traffickers posing as businessmen who approach people looking for work and offer them lucrative jobs abroad. For the ostensible purpose of obtaining work permits and visa approval, the fictional employer requires a series of medical examinations during which the unsuspecting victims are sedated and their kidneys or parts of their livers are removed. Afterwards, the victims are typically told the procedure was necessary for their own health and are coerced into remaining silent. Despite the recurrence of organ theft stories in the Egyptian media, an Egyptian representative of the Transplantation Society told embassy representatives experts attribute most of the organ trade to voluntary donation driven by poverty, while elaborate organ theft schemes are less common. --------------------------------------------- ------ No Legal Regulations for Organ Transplants or Trade --------------------------------------------- ------ 5. (U) The willing sale and theft of organs are facilitated by a legal loophole. The only laws explicitly concerning organ transplants forbid transplants from deceased donors and regulate cornea transplants. The law does not regulate legitimate transplants in which a close relative is the donor and no compensation is involved. Dr. Refaat Kemal, Egypt's leading liver transplant surgeon and an advisor to Egyptian lawmakers on transplant issues, has been pushing for the legalization of cadaveric transplants to be included in any law concerning organ transplantation and trade. Dr.Kemal says many Egyptians remain morally opposed to the practice; even though it is accepted in 19 Muslim countries and would significantly increase the availability of organs for transplantation. 6. (U) As a consequence of this legal vacuum, the Center for Organ Failure Solutions reports the investigation and prosecution of organ traffickers is exceedingly difficult. Egypt's leading professional association for medical doctors, the Physician,s Syndicate, has assumed the responsibility of defining ethical transplants as those utilizing organs from close relatives without any form of compensation. The Syndicate enforces these regulations by suspending or revoking the medical licenses of physicians caught performing unethical transplants. According to a ministry spokesman, the Ministry of Health stepped in recently to support the Syndicate's work by raiding hospitals and clinics involved in organ trafficking. Since the guilty parties cannot be prosecuted for the actual transplant procedures or even the sale of the organs, the Ministry is forced to come up with other charges, such as falsification of documents, in order to hold them accountable. In rare cases, if the donor is proven to be an unwilling party in the procedure, the physician can be charged with misdemeanor assault. Dr. Kemal claims it is unlikely that anyone charged for involvement in organ trafficking will face more than light fines and six months to a year in prison. ---------------------------------- A Regional Hub for the Organ Trade ---------------------------------- 7. (U) Given the conduciveness of the Egyptian legal framework to organ trafficking, Egypt is emerging as a regional hub for the illicit trade in human organs. Dr. Hamdi al-Sayyed, head of the Physician's Syndicate, acknowledged that wealthy Arabs came from the Gulf to Egypt to acquire organs at low prices. On the supply side, an Egyptian Society for Medical Ethics report indicates desperate Egyptians are not the only ones offering up their organs for sale. From Sudanese to Syrians, poor people from across the region are making the trek to Egypt to trade their organs for a chance at a better life. In many instances, traffickers identify these donors in their home countries and facilitate their transport to Egypt for the procedure. The Transplantation Society representative confirmed sellers, buyers, brokers and corrupt physicians of many nationalities are converging in Egypt as the black market in human organs grows. --------------------------------------------- - Passage of Draft Law May Require International Pressure --------------------------------------------- - 8. (U) Dr. Kemal hopes that a new draft law permitting cadaveric transplants will be passed in the next session of parliament (November 2008 - June 2009). Increased public demand for ethical transplants, the personal involvement of the Minister of Health and an apparent compromise on the cadaveric transplant issue are fueling these predictions after more than ten years of fruitless Parliamentary debate concerning transplantation. Dr. Kemal claims the new law, if passed, will codify the Physician's Syndicate standards for ethical transplantation and impose a 20-year minimum prison sentence for anyone involved in organ trafficking. 9. (U) Potential obstacles remain as some continue to use religious pretexts to oppose the law. Dr. Kemal believes the passage and enforcement of this law could depend on whether or not the international community decides to pressure Egypt to crackdown on organ trafficking. Such pressure has previously met with positive results in other organ trafficking "hotbeds" like China, Pakistan and the Philippines. In these countries, efforts by the World Health Organization (WHO), the Transplantation Society (TTS) and various health and human rights organizations have contributed to the development of stricter laws and enforcement measures. The WHO and the TTS are expected to issue an Istanbul Declaration highlighting the importance of international action to combat the illegal organ trade. Statements of USG support for this declaration and specific mention of Egypt and other major organ trafficking markets could serve to demonstrate USG concern and facilitate further dialogue with relevant governments and NGOs.