Soheila, an Egyptian village housewife, traded her kidney for $2,185 to pay off debt -- the best option the desperate mother of three could find to keep food on the family table.
The 32-year-old from the fertile Nile Delta region is one of many people caught up in a thriving trade for illegal organs in Egypt, where there is no legal path to transplants.
Donation is allowed in practice only in very limited circumstances. But conservative Egypt, one of the world's biggest organ trade hubs, is now working on legislation to legalize transplants from brain dead donors and hopes the new law will cut back on demand for illicit organs.
Giving my kidney is better than working in furnished apartments, Soheila told an Egyptian transplant advocacy group, using a euphemism for prostitution. This is against my dignity and I wouldn't want to go and do such things.
I didn't want to do (anything religiously wrong) and steal for money. There was no other way to get such money so I decided still to give my kidney, she told the Coalition for Organ Failure Solution in testimony posted on the group's web site.
Other Egyptians have complained of being tricked into giving up their kidneys, and some have filed lawsuits. In 2008, police arrested a Syrian and Jordanian over organ trade in Cairo.
Eighteen other Islamic countries, including staunchly conservative Saudi Arabia and Shi'ite Iran, are more liberal than Egypt on transplants, allowing operations from dead donors, said lawmaker Hamdy al-Sayed, who drafted the law in Egypt.
Egypt has no transplant laws although in practice living kin can legally donate a kidney and portions of their liver. It also does not recognize brain death, a matter up for debate in Muslim religious circles and among conservatives. But the World Health Organization said Cairo has agreed to the need for both.
Most of Egypt's commercial living kidney donors are young and male, and later regret selling their organs. Nearly four in five face worsening health after the transplant, and the money they earn is gone within five months, according to WHO.
Commercial living donors, mainly the poor and vulnerable, are thought to supply 10 percent of the world's kidneys, WHO says. It has estimated the price of a kidney in Egypt at $1,700-$2,700.
SPARE PARTS FOR THE RICH
Egypt's parliament is due to vote in the next few weeks on a law that would legalize transplants from brain dead donors and regulate organ donations from the living, Sayed said.
We cannot stop organ trading where the poor sell their organs through dodgy people unless there is a law that criminalizes illegal organ trading, said Alaa Ghannam, director of the health program in the Egyptian Initiative for Personal Rights. This law is a positive step forward.
The law, which in previous years has failed to make it onto the parliamentary agenda, now has the blessing of President Hosni Mubarak, who told parliament's opening session that he hoped to reach a resolution on the matter.
The law would establish a formal organ waiting list and would bar financial rewards for organ donations. Doctors caught performing illegal transplants may face up to 15 years in jail.
It would also require living donors to sign consent papers, while organs could be harvested from dead donors based on a will or family consent. Operations would be supervised by the state.
To avoid controversy in Egypt, where sectarian tensions sometimes erupt between Muslims and minority Christians, the law would bar transplants across faiths and between Egyptians and non-Egyptians, said Sayed, the law's author.
If the law passes, the number of legal transplants performed annually in Egypt could surge to roughly 40,000 from just 1,000 now, he said.
Egypt's Mansoura University Hospital, the country's premier transplant center and a top trauma center, says it already has the capacity to perform thousands more transplants a year.
Mansoura, where gleaming halls smell of antiseptic and teams of nurses hover at bedsides, is a far cry from many typical Egyptian hospitals, where patients often sleep on trollies in hallways and must tip nurses to receive standard care.
Once the law is approved, we can start work the next day, said Mohamed Abdel Wahab, a gastroenterologist who works on liver transplants at Mansoura Hospital.
Egypt's state-run Islamic authorities, including the prominent Al-Azhar mosque and university, have given a religious nod of approval to the draft law, controversial among many Muslims because it recognizes brain stem death as ending life.
But the proposed law still faces critics even from within Mubarak's ruling National Democratic Party, who disagree over the definition of death and fear that allowing transplants in any form could exacerbate organ trade.
The law should not leave the matter in hands of doctors to decide if death has occurred and should set a clear definition for death that would guarantee the soul has permanently left the body, ruling party lawmaker Mohamed Khalil Kwaitah said.
As early as 1997, al-Azhar Grand Sheikh Mohamed Sayed Tantawy issued a fatwa, or Islamic decree, allowing organ transplants, and vowing to donate his own organs after death.
Some religious Muslims in Egypt, however, believe that death occurs only when the heart stops beating -- a view that would proscribe viable transplants because organs would deteriorate after the heart stops.
The death of the brain stem is a disease and is not death. said Al-Sayed Abdel Maksoud Askar, a lawmaker from the powerful Muslim Brotherhood, which holds a fifth of the seats in parliament and is the biggest opposition bloc.
He said organs cannot be taken from a person with brain death because in his view life ends with death of all organs.