When the body becomes an ATM

He sits quietly at the corner cafe, a gold watch flickering on his wrist. If you need a liver, or want to sell a piece of yours, grab a chair and get acquainted with Mustafa Hamed, a 24-year-old ex-bus driver who fell unexpectedly into a life as a broker in human organs.

Hamed’s 4-year-old son, Mohamed, was dying of cancer and needed an artery transplant that cost $5,000. The only savings Hamed had was what he fished from his pockets at the end of the day.

There was another way, one whispered about for those with nothing. A man could wager part of himself, slip into a hospital gown, and wake up with an incision above the gut.

Hamed sold a section of his liver for a bit more than the price of his son’s operation. The boy died in surgery.

With his scar healing and his son buried, Hamed, whose knowledge of anatomy would perhaps fill a single page, decided that driving a bus was not the fate of the man he wanted to be. He brokered his first liver deal four months ago. He earned $900. Four more sales have followed.

“Things shouldn’t be this way, but they are,” he says. “I sold part of my liver to save my son. I had to do it. . . . You cut your body and sell your pieces. But some people who come to me aren’t that desperate. They could find other solutions. Many men I see now want to sell their organs so they can afford to buy an apartment to get married. That doesn’t seem desperate enough to me. I try to tell them: ‘Be patient. You don’t need to do this.’ ”

Patience and desperation move in curious currents in Cairo. Nearly half of Egyptians live in poverty, and although the nation’s economy is privatizing and growing, inflation is crushing the poor and working class. The price of green peppers has risen 90% in the last year.

Thousands have moved to the richer Persian Gulf; many have put off marriage, a delay that in Egypt is the stinging sign of a man’s failure. Others, such as Hamed, have bartered kidneys and livers to pay off debts and reinvent dreams.

Similar tales echo around the globe. Human organs are brokered from Pakistan to China; kidney-theft rings have swept through villages in India. The poor in underdeveloped nations, such as Moldova and the Philippines, are offered “transplant tourism” packages that arrange for them to travel to another country and sell their organs to rich patients. It is a market of desperation and ingenuity in which doctors ask few questions and donors often end up ill, and sometimes dead.

The business has thrived for years in Egypt. The country has no laws and little oversight regarding most transplants. Statistics are unreliable. Medical groups estimate that as many as 500 unlicensed kidney transplants are performed each year, but a legislator investigating the practice indicated that the actual number is much higher.

Donors and patients in Cairo know where to go. There are cafes near clinics and labs where the brokers sit, stirring tea and smoking, cellphones buzzing like insects on the tables.

Those needing organs are easy to spot. They carry X-rays and blood work charts under their arms. Some are ashen, some drawn; they need what they need quickly. They come from Upper Egypt and the Nile Delta, their purses and wallets bulky with borrowed money, and if they’re lucky enough they’ll be able to hire the Japanese transplant surgeon who flies in once a month.

“My doctor told me to come to this place,” says an agricultural engineer from Upper Egypt who was shopping for a kidney near a lab in Cairo’s Dokki neighborhood, where horse carts clatter and puffed bread cools in the breeze.

He will not give his name as he straightens his pressed tunic. “I’m 58 years old. I’m in renal failure and I have no children. I need a donor. Kidneys sell for between 20,000 and 40,000 pounds [about $3,600 to $7,300]. I’m bargaining, but I can’t pay more than 30,000 pounds.”

The donors face hardships of their own. Ayman Abdullah was an accountant in Upper Egypt when he and his brother decided to take their parents’ savings and move to Cairo to open a cellphone shop. In a nation that’s mostly desert, Cairo is a gritty, crowded neon promise of minarets and high-rise banks that attracts those willing to risk what little they have. Others who had left Abdullah’s village had made a fortune in the city, or so went the stories that trickled back home.

Abdullah and his brother trusted a man -- he called himself a partner -- more than they should have. The man vanished with the money, and suddenly the brothers were 75,000 pounds, or about $13,700, in debt.

“I have two choices: Pay my debts or go to jail,” says Abdullah, a heavyset man in a sweater, who sits in a cafe hoping to negotiate part of his liver for 40,000 pounds. “I can’t find any other solution. It’s either the operation or I lose my freedom. . . . I started looking for ads where kidney patients look for donors, but I realized that the maximum amount of money I could get for a kidney is 20,000 pounds. Then in the same newspaper, I found an ad by a liver patient.”

Abdullah’s brother found a buyer whose blood type and tissue type match his. Abdullah says it’s funny in a way -- back home he and his brother never earned enough to be rich, but they made just enough to imagine they could be. But now, he just wants to creep away from the shame of being made a fool.

“If God allows me to live after the operation, I won’t stay in this country. I want to go work as a schoolteacher or salesman or do any kind of job in any gulf country,” Abdullah says. “After one undergoes this operation, he feels inferior to the rest of his people. I want to go somewhere with new people. I want people who don’t know anything about me.”

Mohamed Queita, a member of the Egyptian parliament and the ruling National Democratic Party, has been working for 12 years to pass a law to regulate organ transplants and stop an expanding black market that draws patients from across the Middle East and as far away as Europe.

“It’s the worst kind of business in Egypt. It’s worse than slavery,” says Queita, who has no comprehensive statistics but notes that one Cairo clinic had a waiting list of 1,500 people willing to sell their organs. “I don’t want the poor turned into spare parts for the rich. . . . People are coming from all over to buy organs in Egypt. They’re mainly gulf Arabs. If you’re a rich man from the gulf, you go to a private Egyptian hospital that has contacts with organ brokers. Serious cases of poverty in this country are causing an increase in the theft and sale of organs.”

Queita’s bill proposes that transplants be limited to family members or to donors who accept no money. The legislation has been stalled by disagreements between Islamic clerics and doctors. Physicians support the harvesting of organs from patients who are clinically brain-dead, but clerics regard the practice as haram (forbidden).

The issue is a strand in a legal and spiritual debate over the definition of death that dates to Pharaonic times. Most clerics agree with Queita that the selling of body parts violates Islamic law.

“But there’s no punishment,” the lawmaker says. “Nobody goes to jail.”

Ahmed Abdel Halim was a fishmonger with a load of debt when he tried to sell part of himself. Creditors were closing in, but the lab told Halim his liver was laced with fat and unusable. So he became a broker instead.

He says clerics advised him that his new job did not violate Islamic tenets as long as he didn’t negotiate price. He must accept what is offered. His first commission earned him $900.

“I used to go to popular neighborhoods where young men have [financial] problems,” says Halim, who sits, dressed in a windbreaker, as a waiter hurries by. “I’d spend time in a cafe for a few days until customers got to know me, trust me and started to talk with me. After the person would tell me about his problems, I’d suggest that he do the procedure. Some used to get frightened and walk away; others used to accept and started to ask me questions about the details of the operation.”

He has brokered 45 deals over five years. The money is good, but his wife views him as a mercenary, a man who has made a moral gray area out of his religion. To please her, he says, he stopped brokering for a time. But he could never make it as a fishmonger and returned to the organ business.

“I am an intermediary,” he says. “I care about the donor’s interest and I guarantee the obligations of each, the donor and the patient, because they don’t know each other and have no mutual trust.”

Mustafa Hamed feels much the same way. He was 11 when his father taught him leather craft. He quit school. He tanned hides until his hands were stained, but the most he ever earned was 30 pounds, or about $5.50, a day. He found a job driving a bus, but he was illiterate and didn’t take the test for his license, so things got risky. He tenses a bit when he talks about his son; his fingers press together in his lap; he looks down.

The money he was paid for a piece of his liver is gone, but he says he’s been building up a reputation in the organ business. People call him. One day he might buy his own bus, or open a cellphone shop. His sneakers are dusty, but he keeps his shoulders straight in his suit jacket. He sees himself as a man of consequence.

“On the eve of my operation, I stayed in my room reading the Koran,” he says. “I was afraid, but not to the extent of changing my mind. Even if something bad had happened to me during the operation, I would not have minded as long as the objective was to rescue my son. If one dies for the sake of his son, he gets rewarded by God.”

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jeffrey.fleishman@latimes.com