Is there a disconnect between Islam and organ transplantation in Egypt?

An anthropology professor talks to Mitya Underwood about the religious, medical, social, economic and legal issues surrounding organ transplantation in Egypt

Sherine Hamdy: "Imagining that Islam and culture is the single cause of obstacles to organ transplantation is wrong." Fatima Al Marzooqi / The National
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For the last three decades, Egypt has been procrastinating over introducing an official national organ transplant law, citing conflicts between Islam and science as the main reason for stalling.

It's clear the topic throws up complex issues because it forces a blurring of the lines between Islam, the law and medical ethics and the arguments of how to best serve the health of the population.

Although transplants from live donors are permitted, the state recently banned the buying and selling of organs, instead asking people to look to their immediate family for donations.

But despite a thriving illegal trade, the authorities have stopped short of setting up a donor list or a national law regulating the trade of organs, citing Islam as the main obstacle.

Sherine Hamdy, an assistant professor in anthropology at Brown University, says this excuse greatly oversimplifies the issue and is unhelpful to the debate.

"Imagining that Islam and culture is the single cause of obstacles to organ transplantation is wrong," says Hamdy, who recently gave a talk on the subject, hosted by the NYU Abu Dhabi Institute.

"People are looking to Islam for the answers, but looking at a far too simplistic view of it, and the answers are too simplistic for what organ transplantation now means."

Hamdy, who grew up in the US with her Egyptian parents, says the narrative of the clash between Islam and science is usually introduced when the costs of organ transplantation start to outweigh the benefits.

She adds that the rub between religion and science began in the West, but has since been debunked through research. But the problem is reintroduced when the philosophy is exported to other places where the relationship dynamics between science and religious authorities are different.

When the benefits of transplantation aren't obvious, she argues, it's all too easy for people to turn to religion and say something isn't permissible under Islam, regardless of what science says.

"We hear about the gift of life and [what] a great a thing it is to be given a second chance at life," she says. "But there are very specific conditions under which that particular discourse can emerge and these conditions aren't present everywhere.

"In Egypt, when people have organ transplants it's not always clear that it's a beneficial practice, so people look for reasons why it is not allowed, and fall on Islam.

"Particularly in private hospitals, and when physicians take on cases that maybe they shouldn't, the graft survival rates aren't always so compelling. And it's a huge investment of financial resources and family resources, and sometimes it's a relative donating so it has an impact on the social relationship.

"It's not always clear that the benefits outweigh the risks and costs. This is when it creates problems."

Over the past 30 years, Egypt has developed a complex but thriving illegal market in kidneys - which can be taken from a living donor.

In 2006, the World Health Organisation identified the country as one of the world's hotspots for organ trafficking, at which point the authorities clamped down on the kidney trade and banned the buying and selling of organs.

But once the monetary aspect was outlawed, the market was driven underground, Hamdy says, having a detrimental effect on the cost-to-benefit ratio and therefore reinforcing the religious argument against transplantation.

Hamdy recently published her first book, titled Our Bodies Belong to God: Organ Transplants, Islam, and the Struggle for Human Dignity in Egypt, which took 10 years to research.

For Hamdy, the biggest surprise during her research came when she found herself not only acknowledging, but appreciating the benefits of monetary transactions for organs.

"Recently they arrested a criminal gang that was using street children and selling their blood. And there are a lot of allegations of street children also being used as organ donors.

"I started thinking, of course selling [organs] is wrong, but I saw the effects of criminalisation - it just buries it further."

Many countries have legislation to stop the illegal trade of organs, but it is only Iran that allows the legal buying and selling of organs for profit.

It regulates it to a point, stipulating that foreigners are not allowed to buy from Iranian nationals, in an effort to avoid transplant tourism. Iranian citizens are also banned from buying organs from foreigners.

This at least, Hamdy says, keeps the trading "above board".

"If you allow monetary compensation and it's all above board at a good hospital, it won't be pushed underground at a shoddy hospital."

Over the years, Hamdy's studies led her to seriously question why Islam plays such a big role in certain areas of medicine while having very little, if any, impact on other areas.

If the concept of organ transplantation is seen as haram because our bodies belong to God, she says, why are kidney dialysis and many other medical treatments OK?

She also raises the issue of how society looks for answers in a very limited school of Islam, often choosing to ignore the wealth of knowledge coming from different Islamic scholars, and focusing on just one or two points of view instead.

"I find the media would say, 'This liberal mufti says yes, and this conservative mufti says no'. These are not helpful terms. What is helpful is finding out what these muftis have based their points of view on," Hamdy says..

Like Egypt, the UAE also struggles to expand the field of organ transplantation. Both countries have very high numbers of people on dialysis (because of the diabetes rates) and neither do cadaveric transplants, instead relying on family members of patients to donate.

One of the key misconceptions, Hamdy says, is the idea that allowing a trade in organs would somehow be the answer to a population's health problems.

This point is particularly relevant in this part of the world, where chronic diseases such as diabetes are so prevalent in what is a relatively small population.

"To imagine that organ transplantation can address something like the hepatitis C epidemic or the very high proportion of diabetes is wrong," she says. "There will never be enough organs in the world for that.

During her time in Egypt, Hamdy visited Kafr el-Zayat, an industrial city in the north of the country, and found this problem to be endemic.

"They have built a chemical pesticide company whose discharge goes into the water and there's a very high percentage of people in that village with kidney failure.

"That's an example where it doesn't make sense to take a kidney from one and give it to another."

Taking a more preventive approach to reduce the number of people needing organs, including primary care, environmental regulations and labour conditions is also critical, Hamdy says.

"There won't ever be enough living donors without significant risk to them. We are asking too much from a single law. It needs to be a multi-pronged programme."

Mitya Underwood is a senior features writer for The National.