Ammannet-Etaf Roudan and Mohammad Ersan Amman- The black market of organ trade is growing in Jordan. Brokers prowl the streets of impoverished cities looking for new victims to lure into selling their kidneys to patients from neighbouring countries for a trivial sum of money.When the victims realize that they had paid too high a price with their health, it is usually too late. However, more young people will probably continue to fall victim to traffickers as long as laws and regulations neither define brokers nor stipulate harsh penalties for such violations in clear language, according to lawyers and jurists.Jordan’s “Human Organ Donation and Usage Law” bans selling organs or receiving money for donated organs (Article 4) and regulates organ transplants on the basis of a “fatwa” or religious decree.However, lawyers and jurists find the current law inadequate because it does not impose heavy penalties on brokers who play a big role in arranging the sale of human organs. The law treats the broker as an inciter and not as an essential participant in organ trafficking.“To curb this phenomenon, the law should clearly categorize organ trafficking as a criminal act and impose heavy penalties on violators,” says Amman’s Attorney General, Hassan al-Abdallat.According to the Ministry of Health (MoH), 81 cases of kidney trafficking were discovered in the kingdom over the last three years. But the president of the Jordanian Association for Kidney Diseases, Dr. Mohammad Ghneimat, says that those figures represent only those cases recorded by the police, while, in reality they are likely to be much higher.Between 100 to 120 Jordanians underwent kidney removal operations outside the country last year, as a result 35 of them died, according to Dr. Ghneimat. The first recorded law suits related to kidney selling, dates back to 2004; the year electronic documentation was introduced to the court system. Eleven cases were registered in 2005, and three between 2006 and August 2008.Since 2005, Jordanian courts have issued verdicts in six cases in compliance with the Human Organ Donation and Usage Law that recommends a minimum of one year jail time and/or a fine. More recently, in June 2008, a case related to organ selling was rejected for being beyond the court’s jurisdiction.Judiciary records show that courts sentenced donors who sold their kidneys, to jail terms ranging from one month to one year, after they pressed charges and demanded compensation. Only two brokers, who played key roles in closing the deals, were sentenced. Investigators did not reveal the identities of the remaining involved parties.
All those involved were unemployed males aged between 20 and 30, except for one case that goes back to 2005, where a woman in her thirties was sentenced to four months in prison for selling her kidney.In 2007, a young man was prosecuted and sentenced to one month in prison, while “others involved in the case” were each sentenced to three months in jail.
Between 2005 and 2007, the courts charged four young men individually for selling their kidneys, and sentenced them to jail terms ranging from one month to one year.
The recorded cases of kidney trade do not reflect the real situation probably because affected people are afraid of pressing charges against the traffickers. They don’t feel protected by a law that does not clearly define traffickers or brokers, nor one that stipulates penalties against them.
Referring to a survey conducted by the High Committee for Organ Transplant, former Minister of Health, Mr. Saad Kharabsheh, says that most kidney transplant operations were carried out outside Jordan. Of those, 67.9% were performed in Iraq, and 13.5% in Egypt.
As for the “donors” who sold their kidney, the majority of them came from the governorate of Balqaa, especially from the Palestinian Refugee Camp in Baqaa– some 15 miles to the north of Amman, with apopulation of about 120,000 people. Fifty five percent of kidney vendors were males, less than 31-year-olds, 46.9% of them were married, 60% had attended primary school, and 43.2% came from very poor families. Most of them had no criminal records.
According to the survey, all of them voluntarily accepted to travel to Egypt, Iraq or Pakistan. Following the collapse of Saddam Hussein’s regime in 2003 and the ensuing war, Egypt became an attractive market for the kidney trade, according to concurring sources at the Ministry of Health, and the general prosecutor’s office. Before 2000, Jordanians would travel to Baghdad to undergo a kidney removal in Khayal Private Hospital, according to the same sources that preferred not to be named.
General Director of the National Centre for Forensic Medicine (NCFM), Dr. Momen Hadidi, says that “the kidneys are sold outside Jordan as Jordanian laws forbid human organ trade.”
Illegal brokers “seek commission and prey on the poor for whom they facilitate travel abroad for the kidney removal operation,” he adds.
In its annual report, the National Center for Human Rights, an NGO, states that in March 2005, security services uncovered a network for organ trafficking that was exporting kidney donors to Egypt. Buyers were mostly rich citizens from the Gulf region and Libya.Dr. Mahmoud Harzallah, a forensic doctor at the NCFM, says that “patients are transferred to us to determine if they had a kidney removal.”
“Most of those young people we examined had filed a suit against a person posing as a broker and promising them a job in Iraq. They claimed, however, that on arrival in Iraq, they were coerced into undergoing surgery to remove one of their kidneys,” he adds.
Stories of misery
Ammannet, an independent news website, met some of those victims in the center of Amman.
Jamil, 42 years old, was working in construction and enjoyed good health until two years ago when he sold his kidney because he needed the money. Since then, he has been living on the streets. He is unemployed and looks extremely frail.
“I met a young man in Al-Hashimiya Square who offered me JD 5,000 for selling one of my kidneys. He took me to Egypt where it was removed,” says Jamil.
“It was a big amount of money, but it soon disappeared,” adds Jamil who used to earn JD 8 a day.
“The broker convinced me that selling one of my kidneys will save the life of a patient without causing me any harm. However, soon after the operation, my health deteriorated. Today, I am very weak and unable to earn my living,” Jamil explains.
Jamil got part of the money when the compatibility tests proved there was a match with the recipient. “I got the rest after the transplant. I was sharing the same room with the Egyptian patient in hospital,” he remembers.
Jamil says he didn’t press a charge against the traffickers because he was afraid of being sentenced to jail.
“Why would I sue them?” asks Jamil. “The law does not punish them. They move around freely, everyone knows them,” he adds.
Victims are entitled to seek compensations if they suffer from material or moral damages after undergoing an operation to remove the organ, according to civil law regulations. They can press charges against those who caused the damages even if the kidney was sold with the donor’s consent.
Naim Raddad, unemployed in his thirties from Baqaa, seemed luckier than Jamil at first. He had agreed to sell one of his kidneys for 10,000 JD.
“My neighbour Omar asked me to accompany him to Baghdad on a business trip to buy clothes. Since I didn’t have enough money, he persuaded me to sell one of my kidneys. For this purpose, he introduced me to an Iraqi trader called Abu Firas,” he says.
Naim who lives in Baqaa, became another victim of kidney removal: he had to undergo an additional operation on his bladder. Now, he can only sit in a crouching position.
Khaled, 24 years old, sold his left kidney in Egypt for JD 4,000 after his friend introduced him to a broker. Four months later, he started to feel unwell, suffering from low blood pressure. Then doctors told him his right kidney was not getting enough blood and the level of minerals in his blood had dropped. He is suffering from obstruction of urine flow. He has spent all of the money he received from selling his kidney on medical treatment and is now afraid of developing renal failure.
“Islamic law is clear in forbidding the selling of human organs and considers it illicit,” says the director of the Cultural Islamic Centre, Ahmad Awaysha. Mr. Awaysha explains that “donating a kidney to save a patient’s life must not threaten that of the donor.”
“Any patient is subjected to complications during and after surgery that range from simple infections to death,” says Dr. Talal Tahbawi, a urologist and kidney surgeon. “Kidney removal must not be performed unless the donor’s medical history is thoroughly examined and all the necessary tests are conducted and show he is not taking any risk on his health,” he stresses.
“A donor must be in good health and not suffering from diabetes, hypertension or heart failure”, Dr. Tahbawi adds.
“A person can live normally with one kidney, if the operation is carried out under ideal conditions,” he says. When a person loses one kidney, the other one should function normally. However, if the donor suffers from certain diseases, such as chronic infections or kidney stones, he may experience medical complications that may cost him his life,” he warns.
About 2,600 Jordanians suffer from kidney failure, according to the Jordanian Association for Kidney diseases (JAKD). This number increases by 330 every year. These patients need 562 dialysis units and cost the government JD 34 million a year.
About 200 patients need kidney transplants every year in Jordan, according to Dr. Hadidi who encourages families to donate the organs of children who die in road accidents or who are clinically declared as “brain dead”.
Such efforts are jeopardized by the multitude of official bodies that deal with this matter, the ambiguity of their relationship with each other and the lack of a common database.
JAKD president, Dr. Mohammad Ghneimat says that the first kidney transplant was performed in Jordan 37 years ago. Since then, all transplanted organs were taken from local donors who are often relatives of the organ receivers, or those who were declared “brain dead”.
The public prosecutor’s office is often incapable of determining that a donor had received money for a donated organ. Without proving that money has been exchanged for an organ, the court is unable to prosecute either the seller or the broker. A donor can deny any relation to the organ receiver. This worsens the problem and allows traffickers to act with impunity.
All of those who have admitted to selling one of their kidneys said they did so for money. Difficult socio-economic conditions that result in unemployment among the young, together with the deterioration in moral and cultural values, encourages the trade of human organs. Jurists, doctors, and security officials insist on the need for reforming the criminal law to impose strict penalties on violators. They also demand awareness campaigns to stop the aggravation of the situation.
This investigative report was prepared under the support of Arab Reporters for Investigative Journalism, ARIJ (www.arij.net) under the supervision of Saad Hattar.