CAIRO – The poverty of Cairo's slums forced a young couple to sell nearly everything they had. When that wasn't enough, each of them sold a kidney.
The clandestine pre-dawn operation in a small private hospital ended with the man and wife being dumped semiconscious in taxis — the payment for their kidneys tucked into their clothes, they say.
Now, a year later, penniless once more, they are too weak to even move around their apartment. Unable to afford follow-up care, their health is so fragile they spend much of the day in bed in a dark room.
"If anyone had made clear to me the danger, I wouldn't have done it," said Abdel-Rahman Abdel-Aziz, gaunt and looking older than his 24 years as he lay in bed beside his wife. He pulled up his sweatshirt to show the scar from the operation.
For years, word has spread among Egypt's destitute that selling a kidney — sometimes for as little as $2,000 — can be a quick way out of a debt or to keep from sinking deeper into poverty. At rundown cafes, they are hunted by middlemen working for labs that match donors and recipients, many of whom are foreigners drawn to Egypt's thriving, underground organ trade.
Egypt is one of a half dozen countries identified by the World Health Organization as organ-trafficking hot spots. Under international pressure, other trouble spots like China, Pakistan and the Philippines have outlawed organ sales and barred foreigners from undergoing transplants to stop "transplant tourism."
Egypt, however, has long ignored the problem, experts say. Transplant surgeons working to stop the global trade fear that foreign patients finding it harder to go to Asia could flood into Egypt in search of organs.
Egyptian officials are finally showing signs of action. One key problem has been that Egypt does not have a law regulating transplants, only weak doctors union rules that bar sales but are largely self-policing and ignored.
Now, a draft law is expected to be put before parliament in the next few months. The law would ban the sale of organs, prohibit transplants to foreigners, restrict the operations to public hospitals and impose sentences of up to 15 years in prison and $180,000 fines for violations.
At the same time, Egypt's Health Ministry has begun cracking down. In recent months, authorities closed two private medical centers in Cairo and arrested doctors, middlemen and lab workers for violating doctors union rules or other charges, said ministry spokesman Abdel-Rahman Shaheen.
"They work after midnight," he said. "They do these operations in fact in hospitals that have no facilities to do a major operation like this. They were all closed, and they were all arrested."
"We must admit that we do have a problem with organ transplants," Shaheen said.
Crucially, the draft law also allows deceased donations, limiting the need for living donors. Past attempts at legislation have failed partly because of religious and cultural resistance to taking organs from the dead, though many other Muslim countries allow deceased donation.
There now appears to be consensus on allowing deceased donations, but there remains a strong debate over whether the law should let doctors use brain death in determining whether a potential donor has died, as most other nations with transplant laws allow.
The brain death standard, rather than heart and lung failure, makes more organs available and is necessary for heart and full liver transplants.
Grand Sheik Mohammed Sayyed Tantawi of Al-Azhar, Sunni Islam's pre-eminent institution, last week endorsed a brain death standard. But a powerful group of lawmakers opposes it, saying it opens the door to abuses by doctors.
In the absence of a law, the organ trade has been out in the open.
Many of those looking for kidneys are Saudis paying around $16,000 for a black market transplant, experts say. The donors are plucked from Egypt's poor, often misled about the risks and abandoned after surgery with no follow-up care, said Amr Mostafa, a field researcher for the Coalition for Organ-Failure Solutions, a Washington-based advocacy group that helps donors.
In Cairo's sprawling Muqattam district, Abdel-Aziz and his wife's story began, like most others, with money troubles: He lost his job as a minibus driver and was three months behind on rent.
He was led to a neighborhood woman who worked as an organ broker.
"She said her own son did it (sold a kidney), that it was safe and that I'd get lots of money," he said. She was so persuasive that Abdel-Aziz's wife, Asmaa, agreed to sell a kidney as well.
They were promised $5,400 each. But after surgery, they were stuffed heavily sedated into taxis with just $2,300 each tucked into their clothing.
The money went fast — much of it for debts and medicine. Abdel-Aziz and his wife's health suffered from a lack of post-surgery care. They complain of weakness and pain in their sides.
As destitute as before, the couple moved in with Abdel-Aziz's 70-year-old father, Mohammed, who struggles to earn enough money as a driver to care for them.
"I'm paying for my son's mistake," said the father.
In Egypt, transplant numbers are hard to come by, as there is no official registry. At least 500 doctors union-approved kidney transplants are carried out each year.
The desperate search for organs has intensified around the world, with kidneys in highest demand due to increases in kidney disease. The 66,000 kidney transplants worldwide in 2005 met only 10 percent of the estimated need, according to WHO. The extent of illegal kidney transplants is unknown even to WHO.
Organ trade is also big business — another reason for resistance to change.
"To some extent — and this is not just specific to Egypt — there are vested interests, there is money to be made," said Dr. Gabriel Danovitch, a transplant specialist at UCLA's David Geffen School of Medicine who has been part of efforts to stop the problem.