Our Bodies Belong to God: Organ Transplants, Islam, and the Struggle for Human Dignity in Egypt by Sherine Hamdy (review)

In the late 20th century, organ transplants became a widely practiced medical technology not just in Western cities like Boston, London, and Geneva but across much of the globe to also include urban centers such as Bogota, Istanbul, Calcutta, Shanghai, Singapore, Manila, and Cairo. In Our Bodies Belong to God, Sherine Hamdy provides a stimulating in-depth analysis of transplants in Egypt. She explores the discourse on organ transplants in the Egyptian media, courses on Islamic jurisprudence, and through her interviews with physicians, hospital workers, practicing Islamic scholars, journalists, and organ-failure (particularly kidney-failure) patients.

A central aim for Hamdy is to reconstruct bioethics in an attempt to “unbind” categories of science, ethics, and religion towards a “bioethics rebound” that will “expand the field to better promote social justice advocacy” (8) and “find a better way to meet its original goals of improving health, justice and medical benefit to the most people” (9). In so doing, Hamdy provides an illustrative ethnography of the experiences of organ-failure patients in Egypt and the complex familial, social, economic, political, and religious considerations that shape their contemplations about an organ transplant. She also admirably interrogates the ways in which religion and medicine have been juxtaposed and argues for the recognition of the hybrid nature of these traditions in Egyptian discourse and decision making about transplants.

Such an analysis provides a richly nuanced discussion for considering the complexity of policy responses to the epidemic proportions of renal failure and the limited options to increase kidney supplies for transplants. Ultimately, Hamdy references proposals for a regulated market in organs and suggests that “allowing for paid organs is sometimes the most ethical course of action” (236). Considering my own involvement as an anthropologist exploring transplants in Egypt since 1999, and committing to a grassroots movement to disrupt the organ trade, it is this focus of Hamdy’s analysis that caught my attention and is bound to captivate the attention of academics, activists, and policy-makers confronting this issue.

In seeking practical solutions, Hamdy recommends that “increased transparency, rather than criminalization, would better ensure that all donors—whether paid or not—are thoroughly medically screened, can be ensured proper surgical care and receive follow-up medical treatment” (236). All of us concerned with the well-being of organ-failure patients and organ donors agree on the importance of transparency in transplant processes as well as commitments to standards of care for the organ recipient and donor (TSEC 2005, Barr et al. 2006, WHO 2008, Declaration of Istanbul 2008). Although Hamdy does not endorse organ sales, she would condone them if they were made transparent. Yet, she does not elaborate her recommendation to address 1) how “allowing for paid organs” could be structured and administered in Egypt, and 2) how this would promote social justice advocacy.

With regard to the first question, Hamdy’s explanation of a “crisis of authority” (of religious, medical, and state figures) in Egypt raises particular concern with how paid organ donation would work in this context (21–45). Would it continue via the loosely structured system of the Doctors’ Syndicate? Alternatively, might it adopt the Iranian model (the only country that permits organ sales) of state-funded compensation for a kidney? Would it involve cash payments or other forms of material gain/reward as an incentive for organ donation?

The continuation of licensing transplants via the Doctors’ Syndicate would be unlikely to eliminate brokers and would probably continue to “turn a blind eye” to commercial transactions for organ “donations.” Furthermore, this system has been officially replaced with a new national transplant law (which I discuss further below). The Iranian model has been commended for its aim to provide equity in satisfying the waiting list via state-sponsored compensation to solicited organ donors. Yet, this system has been unable to curb corruption that enables patients to pay extra to...