The World Health Organization has named Egypt one of the world's top “hubs” for organ trafficking. Corneas, kidneys, and liver lobes are especially in demand, owing to the country's unusually high prevalence of diabetes, trachoma (a bacterial infection of the eyes that can lead to blindness), and schistosomiasis or bilharzia (a disease caused by parasitic worms that affects the kidneys and liver). Kidney and liver diseases are also a consequence of the staggering levels of air, water, and soil pollution. Furthermore, a government campaign in the 1960s and 1970s to treat schistosomiasis that reused needles inadvertently spread the liver-damaging hepatitis C virus; as a result, today between 10 and 30 percent of the population has hepatitis C—the highest prevalence in the world. Despite the severity of the situation, only as recently as 2010 did the Egyptian government pass a law banning the sale of organs and regulating the procurement of organs from both living and brain-dead donors. Until then, a major impediment to legislative efforts had been disagreement over whether brain death can be considered “true” death.
Sherine Hamdy's engrossing book, based on nearly two years of ethnographic fieldwork in the cities of Cairo, Tanta, and Mansoura, probes the many facets of the national debate about the permissibility of organ transplantation. Through an introduction, seven chapters, a conclusion, and a brief epilogue, she skillfully analyzes the opinions of doctors, of patients and their families, of religious scholars, and of the media, situating these in a precarious Egyptian social context of little state care or even basic protection. With the exceptions of chapter 3, “From Secret to Scandal: Corneas, Dead Donors, and Egypt's Blind,” dedicated to cornea grafts, and occasional mentions of liver lobe transplants, Our Bodies Belong to God is focused on kidney transplants. Hamdy specifically seeks to explain Egyptians’ general aversion to organ transplantation, despite the fact that “biomedical authority remains the national medicine of Egypt” (43), and despite the fact that Egyptian doctors pioneered transplant medicine in the Arab world. This antipathy, she contends, is not simply due to “Islam” or to a clash between science and religion—after all, governments of other Muslim countries, including Saudi Arabia, have permitted organ transplants for decades. To be sure, several religious scholars have indeed opposed organ transplantation. For example, the enormously popular Shaykh Sha꜂rawi, to whom chapter 4, “Shaykh of the People: Genealogy of an Utterance,” is dedicated, asserted forcefully that organ transplant is not permissible in Islamic law on the arguably simplistic grounds that “our bodies belong to God.” By and large, however, the Egyptian official religious establishment has endorsed the procedure.
If not religion, Hamdy asks, what then explains this antipathy? She argues that it is a function of the social and medical problems faced by both prospective organ donors and recipients, including the substantial risk of kidney graft failure, significant financial investments, and the heavy emotional toll of the process on families—all in the Egyptian social context of vast socioeconomic inequalities that exist in a healthcare system that is inadequate at best and government failures to ensure the protection of the rights and dignity of its citizens. Hamdy concludes that, ultimately, attributing Egyptians’ attitudes to organ transplantation simply to religion or to sociomedical problems is unhelpful because it “misses the ways in which these interrelated factors inform Muslim ethical positions” (246). Rather the patients she interviewed “understood ethical formulations to be contingent upon the specificities of their social circumstances” (247).
I am not an anthropologist, and thus I will leave the assessment of Our Bodies Belong to God's theoretical contributions to the field of anthropology to others better qualified for that task than I am. As a historian with a keen interest in disability, the body, and illness in the Arab world, I found that the book can also be read as a sophisticated and well-documented sociocultural history of organ transplantation in Egypt over the past forty years. Its main shortcoming is the paucity of interviews with kidney donors, whose voices would have added an important perspective, but that is not the author's fault, as the Egyptian government unfortunately did not grant her research permission to conduct those interviews. Besides that, the prose could be tighter in places, the endnotes are at times slightly repetitive, and the first few pages of the conclusion, which present a lengthy and glowing description of the Mansoura Kidney Center, seem somewhat out of place. These are merely minor details; Sherine Hamdy's richly textured book is not only a model of scholarly rigor, but also of sensitivity and empathy.