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Cablegate: Poverty, Legal Loophole Fuel Egyptian Organ Trade

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DE RUEHEG #1188/01 1621221
ZNR UUUUU ZZH
P 101221Z JUN 08
FM AMEMBASSY CAIRO
TO SECSTATE WASHDC PRIORITY 9507

UNCLAS CAIRO 001188

SENSITIVE
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E.O. 12958: N/A
TAGS: TBIO KCRM EG
SUBJECT: POVERTY, LEGAL LOOPHOLE FUEL EGYPTIAN ORGAN TRADE

Sensitive but unclassified. Please handle accordingly.

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.
SCOBEY

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