April 24, 2014

Human Trafficking for Organ Removal: Evidence from Egypt by Debra Budiani-Saberi

Human trafficking for organ removal (HTOR) occurs across the globe and constitutes egregious human rights abuses. The crime is included in the UN Trafficking Protocol and is the subject of the 2008 Istanbul Declaration on Organ Trafficking and Transplant Tourism.  In a recent report, Sudanese Victims of Organ Trafficking in Egypt, the Coalition for Organ-Failure Solutions (COFS) presents an extraordinary set of preliminary findings about the hidden world of human trafficking for organ removal in Egypt. Through its on-the-ground investigation, COFS has uncovered compelling evidence that traffickers have exploited and are continuing to exploit Sudanese refugees and asylum-seekers for their organs in Egypt. These abuses include removing kidneys either by inducing consent, coercion, or outright theft. The victims include men, women and children. Many of the victims came to Egypt seeking refuge from the genocide and armed conflict in their homeland.

The report elaborates its findings of 57 Sudanese refugees and asylum seekers COFS-Egypt identified in Egypt who said they were victims of organ trafficking.  Each case involved the removal of a kidney.  COFS-Egypt conducted in-depth interviews with 12 of these victims who described their experiences in compelling detail.  It arranged ultrasounds and physical exams for five of the victims as part of its follow-up care outreach service. The medical exams confirmed that kidneys had been removed in all five cases.  Four victims also showed the COFS field researchers documents from the hospitals where their organs were removed and the transplants occurred that detail the date, surgeons and organ donor involved in the transplantation.

Of the 57 victims identified, 39 (68%) are from Darfur, 26 (46%) are female and 5 (9%) are children. The twelve victims COFS interviewed ranged in age from 11-36 years with an average of 23.5 years; four (33%) of the victims were 18 years old or younger; and five (42%) were female.  Three of the interviewed victims said people (who turned out to be traffickers) helped them to enter Egypt illegally. Those traffickers worked directly with other traffickers who arranged for the kidney removal.  Some of the victims indicated that some women and girls are simultaneously being trafficked for sex and organs (9 possible cases in the sample of 57), and that the actual number of females in general may far exceed that of males.  Thus, women and children are of special concern.

The case of Dawood illustrates some of the processes involved in targeting Sudanese asylum seekers for a kidney.  Dawood explained that he was smuggled through Egypt with the promise to go to Israel for employment. After being taken to Cairo, he was housed and fed by a friend of the smuggler and then told he had accumulated a debt he must pay in order to be smuggled the rest of the way to Israel. Dawood was told about the option to sell a kidney to clear these debts, was told he would receive 2,000USD, never told about the risks involved and knew no other way to get out of the situation while displaced in Cairo. Although recipients pay between 10-15,000USD for a transplant in Egypt, Dawood (like many other victims of HTOR) never received the full payment and was robbed of the payment he did receive.  Dawood and three other victims elaborate their testimonies in a video clip that COFS prepared of corroborated evidence of testimonies, ultrasounds and some documentation from transplant centers.

One victim told COFS researchers that he was imprisoned in an effort to prevent him from reporting his/ claim of organ theft; this victim escaped during the January 25, 2011 revolution.  COFS-Egypt has confronted other cases where victims were in situations where they were restrained to share their stories before reaching our field researchers.  For example, Abdul, an 11-year old boy whose mother was a victim of organ trafficking and eventually gave in to pressure to broker Abdul’s kidney, waited many months before he could reach a COFS-Egypt field researcher/victim advocate to share his story in the absence of his mother’s presence.  Another example involved a woman who was abducted for a kidney and expressed her suspicion of her husband’s involvement but has not been given sufficient opportunity to speak with our advocates without his presence.

Four of the victims said they met the patients who had received their kidneys. Seven of the victims knew the nationality of the recipients: three were from Sudan, one was from Jordan, one was from Libya, and two were from countries in the Persian Gulf.  Interviewed victims also reported that the broker stole the money they received for the organ.

All of the victims interviewed said they had experienced a deterioration of their health in addition to negative social, economic and psychological consequences as a result of the experience.  These consequences are elaborated in the Report but with regard to effects on health, all of the 12 victims interviewed expressed deterioration in their health. This is likely a result of factors such as insufficient donor medical screening and pre-existing compromised health conditions of this vulnerable population.

Three of the victims interviewed held official “refugee” status from the United Nations High Commissioner for Refugees (UNHCR). One victim’s application for refugee status was under review; another had filed an application; and seven others were illegal and had not yet applied to UNHCR at the time that they said organ traffickers victimized them.

Since the release of the report, COFS-Egypt field researchers have leads to 13 more recent cases of Sudanese victims and two of their stories have so far been confirmed by ultrasound.  COFS estimates that there are at least hundreds of Sudanese victims of organ trafficking in Egypt as well as numerous other victims from Jordan, Eritrea, Ethiopia, Somalia, Iraq and Syria.  The total number of victims of organ trafficking in Egypt is estimated to be in the thousands.[i]

The findings presented in the COFS report are based only on living victim-survivors of the organ trade that COFS was able to identify.  The report does not speak to claims that many other people have died as a result of an illegal commercial organ removal.  This has special significance considering recent reports about the kidnapping and abuse of sub-Saharan African migrants smuggled into the Sinai Peninsula en route to Israel.  The reports include claims of torture and removal of organs that have resulted in death. (Key reports can be accessed at: http://www.cofs.org/sinai.html )

In light of the extensive evidence uncovered in Egypt, COFS calls upon the medical professional community in Egypt, the transitional and future Government of Egypt, the United Nations, including the UN Human Rights Council, UN High Commission for Refugees, UNICEF, UNIFEM, and other organizations that provide assistance to refugees and asylum seekers in Egypt, as well as human rights organizations, to work together to bring an end to organ trafficking in Egypt and elsewhere.  The present instability in Egypt and the region presents conditions conducive to all forms human trafficking.  It is therefore critical that this matter receives urgent attention.

Significant progress has been made in recent years to strengthen laws intended to curb organ trafficking in key countries that host the organ trade such as India, China, Pakistan, the Philippines and Egypt. However, in these and many other countries, renal (kidney) failure is now reaching proportions similar to that of tuberculosis, in large part because the astounding growth in diabetes worldwide. With transplants as the preferred therapy for renal failure, demand for kidneys will continue to outpace supplies. Until nations can build transparent, reliable systems of organ donation through altruistic donations from healthy individuals and deceased donors, poor and vulnerable individuals are at risk for being targeted to supply organs to privileged patients.

Financial or material incentives for donation are inherently flawed as they necessarily target the poor by providing inducements for their organ “donation.” (Budiani and Golden 2009).  Legal frameworks must continue to be enhanced and enforced to combat organ trafficking/ HTOR.  Countries that have ratified the UN Protocol on Trafficking in Persons must also include HTOR in their trafficking laws.  This includes that the United States, which should add HTOR to the federal trafficking law.

Further, countries must make it illegal for citizens to purchase an organ abroad.  For example, it is not illegal in the United States for a patient from the United States to undergo transplantation in China even though transplants to foreigners are illegal in China. It is also illegal for a patient in the United States to participate in organ trade within the United States; however, neither China nor the United States is preventing the illegal activity in China.  The United States should extend the extraterritorial jurisdiction of the National Organ Transplantation Act (NOTA) to ban U.S. citizens or legal residents from engaging in organ tourism.  These and related recommendations are elaborated in a recent briefing on HTOR to the United States Senate Foreign Relations Committee as well as the Tom Lantos Human Rights Commission.

Debra Budiani-Saberi, Ph.D. is a Medical Anthropologist, the Executive Director and Founder of the Coalition for Organ-Failure Solutions (www.cofs.org) and a Visiting Research Associate at the Center for Bioethics at the University of Pennsylvania.   She has conducted extensive research related to organ trafficking beginning in 1999 as a part of her study on refugee health. Dr. Budiani-Saberi has also worked more broadly on health and human rights in various parts of the Middle East and Northeast Africa (Egypt, Eritrea, Morocco, Somalia, Qatar, United Arab Emirates) as well as in India.  Questions and inquires can be sent to Debra Budiani-Saberi at debra@cofs.org


Budiani-Saberi, D. and Golden, D., Advancing Organ Donation Without Commercialization: Maintaining the Integrity of the National Organ Transplant Act -An Issue Brief, American Constitution Society June 10, 2009.

Budiani, D.,  Facilitating Organ Transplants in Egypt: An Analysis of Doctors’ Discourse, in Islam, Health, and the Body, edited by Diane Tober and Debra Budiani, London: Sage Publications Series in Body and Society, October 2007 13(3): 125-149.

Barsoum, R. and M.A. Bakr, The Egyptian Renal Transplant Experience. Clinical Transplants 2000; 359–60.

[i] Estimates suggest that Egypt performs approximately 500–1000 licensed transplants per year, that there are an additional 100-200 of unlicensed transplants conducted annually (source: personal communication Dr. Hamdy Sayed, Director of the Medical Syndicate, November 2009), and that between 80 percent and 90 percent of living kidney donors in Egypt are commercial living donors. (Barsoum et. Al 2000, Budiani 2007)

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