Showing posts sorted by date for query Germany AND kidney. Sort by relevance Show all posts
Showing posts sorted by date for query Germany AND kidney. Sort by relevance Show all posts

Monday, September 11, 2017

Kidney exchange in Switzerland in 1999, and some early repugnant reaction

Kidney exchange is well established and growing in Europe today, but the first exchange was greeted in some quarters as a repugnant transaction.

The first kidney exchange in Europe was actually an international exchange, involving a German couple and a Swiss couple. It was conducted in Basel on May 23rd 1999, and reported in

G. Thiel, P. Vogelbach, L. Guerke, T. Gasser, K. Lehmann, T. Voegele, A. Kiss, and G. Kirste  ”Crossover renal transplantation: hurdles to be cleared!”, Transplant Proc , 2001

They report that
"The Swiss Health Insurance paid the hospital bill without hesitation. The German insurance, however, refused to pay, despite the fact that the cost (including donor nephrectomy) was lower in Basel than cadaveric transplantation alone would have been in Germany and despite huge savings for the German insurance by being released from further payments for dialysis treatment. The insurance agency argued that crossover transplantation is not allowed in Germany, and that they would not pay for an illegal procedure. …Crossover transplantation is legal in Switzerland”

Following the publication of the paper, press coverage reflected a good deal of repugnance for kidney exchange and criticized the German surgeon Prof Dr. Gunter Kirste (with whom I have discussed these matters prior to my recent talk in Geneva). Muriel Niederle pointed me to this story from Der Spiegel 12.02.2001: “[Opening the] Door to Commerce”



Here's another, from the Suddeutsche Zeitung, also in 2001, kindly supplied by Dr. Kirste, which compares kidney exchange to organ trafficking: "Organs of a Travelling Salesman"



Friday, April 29, 2016

Zurich celebrates Tuomas Sandholm: Symposium on Electronic Market Design

A symposium and more in honor of Tuomas Sandholm:


Location

The symposium will take place at the Department of Education of the University of Zurich (building KAB), at Kantonsschulstrasse 3, 8001 Zurich in room G-01 (interactive map).
A map is available below.

Talks

TimeSpeakerTitle
14:00 - 15:00Prof. Tuomas Sandholm
Carnegie Mellon University, USA
Keynote: Journey and new results in combinatorial auctions, automated mechanism design for revenue maximization, and kidney exchanges
15:00 - 15:45Prof. Martin Bichler
TU Munich, Germany
All models are wrong, but some are useful: About spectrum auction design and challenges in market design
15:45 - 16:15Coffee Break
16:15 - 17:00Prof. Sven Seuken
University of Zurich, Switzerland
Designing better combinatorial auctions: Algorithms, incentives, and bidding languages
17:00 - 17:45Prof. Axel Ockenfels
University of Cologne, Germany
Engineering trust on eBay

Friday, March 25, 2016

Who Gets What and Why at the European School for Management and Technology in Berlin--video

Here's a video of a public lecture followed by a discussion (about half an hour each) about my book Who Gets What and Why, which just came out in German.   The location of the lecture was once an East German government building where the head of state had his office, and is now a business school, the European School for Management and Technology.  I was introduced by Gerhard Caspar, the head of the American Academy in Berlin and former president of Stanford. (My talk begins about minute 11:30 of the video, the discussion begins about minute 41, with Christoph von Marschall, Managing Editor of the newspaper Der Tagesspiegel, which touches on market designers in Germany, the legal barriers to kidney exchange there, and refugee resettlement.)


Thursday, March 17, 2016

Transplants in Germany, further discussion of changing the transplant law, in Der Tagesspiegel

My op-ed in Der  Tagesspiegel yesterday on changing the German transplant law has drawn some prompt further comment in today's paper (as near as I can tell from Google Translate).

Here's the new commentary (English courtesy of GT):

Ärzte und Politiker für mehr Lebendspenden


VON RAINER WORATSCHKA


[Organ transplant
physicians and politicians for more living donations German reservations "no longer fit into the time", criticizing physicians. The exchange between unacquainted pairs should be allowed.]

"The demand of the American Nobel Prize winner Alvin Roth, to facilitate in Germany living donation of organs and to amend the Transplantation Act accordingly, has met with doctors and politicians on consent.

The requirement that living donation - this question come kidney or parts of the liver - may come only from the direct family environment, are too strict, the economists had in Tagesspiegel criticizes. As in other European countries and the United States would also in Germany more distant relatives, friends or colleagues may donate writes Roth. In addition, an exchange between unacquainted pairs should be allowed (cross-donation, crossover Donation) at incompatible donor organs."
***************

Here are my two earlier posts on the subject, with links to my earlier op-ed and the one by Axel Ockenfels and Thomas Gutmann

German organ transplant law should be amended or reinterpreted to allow kidney exchange: my op-ed in Der Tagesspiegel

During my recent visit to Germany, I spoke with a number of people about the fact that the German transplant law effectively outlaws kidney exchange.  I was invited to write an op-ed on the subject for the German newspaper Der Tagesspiegel, and it has just appeared:


Normally at this point I would use Google Translate to give a sense of the article, but in this case, since I wrote the op-ed in English, I can give you the original:

German organ transplant law should be amended or reinterpreted to allow kidney exchange
By Alvin E. Roth[i]
Kidney failure is epidemic around the world, and a shortage of organs for transplantation condemns many patients to dialysis, and early death. 

Most transplantable organs come from deceased donors, and there aren’t enough to fill the need. But because healthy people have two kidneys and can remain healthy with one, a healthy person can donate a kidney to a sick person.  A living-donor kidney works better than a deceased-donor kidney.
In the U.S. we now have around as many living donors as deceased donors (although we still have more deceased-donor transplants, since a deceased donor donates both kidneys).

But living donation isn’t always possible, even when a willing donor is available, because a kidney must be well-matched to its recipient. Often the life-saving gift cannot be given, because the donor’s kidney is incompatible with the patient. (It is now sometimes possible to successfully transplant an incompatible kidney, but, like a deceased-donor kidney, this does not keep the patient as healthy for as long as would a compatible living-donor kidney.)

In the U.S., there is a way for incompatible patient-donor pairs to help each other, through what we call kidney exchange, or kidney paired-donation. In its simplest form, two incompatible patient-donor pairs are identified by their doctors such that each patient is compatible with the kidney of the other patient’s donor. Then four surgeries are performed, two nephrectomies and two transplants, so that each donor gives a kidney and each patient receives a compatible kidney. Kidney exchange has become a standard form of transplantation in the U.S., and has saved thousands of lives. (This is one of the “matching” markets I helped design, and wrote about in my recently translated book, Wer kriegt was - und warum?.)

Notice that no money changes hands in this paired donation. It is just an exchange of gifts between two patient-donor pairs, which allows each donor to save a life and see his intended recipient restored to good health.
Laws around the world prohibit buying a kidney for transplantation, because of fear that allowing organs to be sold would exploit the poor and vulnerable. (The single exception is Iran, which has a monetary market for kidneys.) But German transplant law  imposes a severe further restriction: a patient may receive a living-donor kidney only from a member of his or her immediate family. This means that, unless a judge intervenes, kidney exchanges are illegal in Germany. (This law also restricts the number of direct living donations in Germany compared to countries like the U.S., in which uncles, cousins, friends, colleagues, members of the same church, etc., are often living donors.)

I surmise that the reason for this strict limitation in German law is to remove any possibility that a kidney being transplanted has been purchased rather than freely given. But if when you want to give a kidney to your brother there is no suspicion that you are a paid organ-seller, you should remain above suspicion even if your kidney is incompatible with your brother. Kidney exchange allows you to give a kidney and save a life, and have your brother’s life saved. Kidney paired donation is a mutually beneficial exchange of life-saving gifts, not a commercial transaction.

The U.S. law that includes the prohibition on organ sales is the National Organ Transplant Act of 1984.  When American surgeons explored kidney exchange in the first decade of this century, it wasn’t initially clear what its legal status might be, but in 2007 Congress passed an amendment to the NOTA making kidney exchange explicitly legal.  Kidney exchange is legal elsewhere in Europe, and is well developed in the Netherlands and Britain. A similar amendment to the German law, or even instructions to judges that kidney exchanges should be allowed after being examined, could save the lives of many patients in Germany, without opening to door to commercial transactions in body parts.




[i] Alvin Roth, a professor of economics at Stanford University, shared the 2012 Nobel Prize in Economics for his work on market design. His recent book about markets has just appeared in German translation, Wer kriegt was - und warum?: Bildung, Jobs und Partnerwahl: Wie Märktefunktionieren

Monday, March 14, 2016

Promoting kidney exchange in Germany: Axel Ockenfels and Thomas Gutmann

In Germany, kidney exchange isn't legal (German law only permits a patient to receive an organ from a member of his immediate family). Here's an op-ed saying that should change, by Axel Ockenfels and Thomas Gutmann in the Sueddeutsche Zeitung:

Nierentausch in Zeiten des Mangels (kidney exchange in times of shortage)

Google translate makes it pretty clear.


Saturday, September 12, 2015

Ethical issues concerning living donors: a European conference

ELPAT (it stands for Ethical, Legal and Psychosocial Aspects of Organ Transplantation) is organizing a conference on issues involving (chiefly) non-directed anonymous kidney donation in Brussels:


Sunday, 13 September, 09:00 - 12:50

Moderated by: Annette Lennerling, Gothenburg, Sweden and Willem Weimar, Rotterdam, The Netherlands

Antonia Cronin: "Is it unethical for doctors to encourage healthy adults to donate a kidney to a stranger"

Antonia Cronin is Consultant Nephrologist and Honorary Senior Lecturer at the MRC Centre for Transplantation, King's College, London. She is chair of the British Transplantation Society Ethics Committee and appointed member of the UK Donation Ethics Committee. Her presentation will examine the legitimacy of allowing individuals to donate an organ to a stranger and explore the circumstances in which encouraging such a form of donation may be justified.

Willij Zuidema: "Unspecified donors and domino-paired chains"

Willij Zuidema is working at Erasmus MC in Rotterdam, The Netherlands. For years she is involved in the alternative living donation programs. Especially the program of the unspecified donors has her interest. The living donation program in Rotterdam is one of the largest in Europe with an expertise in unspecified donors and domino-paired chains. She will present the data and logistics of the unspecified donations and domino-paired transplants.

Mihaela Frunza: "Acceptability of public solicitation, the role of social media"

Mihaela Frunza is Associate Professor at the Department of Philosophy, Babes-Bolyai University, Cluj, Romania. She will present a presentation where public solicitation of organs is critically assessed from a legal, moral, and practical perspective. Several recommendations are discussed that aim at maximizing the organ donor pool while safeguarding the interests of potential living donors.

Leonie Lopp: "The legal debate on anonymous donation"

Leonie Lopp studied law in Münster, Germany. Afterwards, she wrote her doctoral thesis with the title "Regulations regarding Living Organ Donation in Europe - Possibilities of Harmonisation". She will today present the results of comparing the legal regulations on living organ donation in Europe by focusing on anonymous living organ donation.

Hannah Maple: "Psychological outcomes after unspecified donation"

Hannah Maple is a trainee Renal Transplant surgeon in London, United Kingdom. She will present an overview of the psychosocial issues pertinent to unspecified donation. Additionally she will discuss the results of her UK based study into psychosocial outcomes after unspecified donation.

Linda Wright: "Ethical and practical issues of breaking anonymity"

Linda Wright conducts research on transplantation ethics with the Canadian National Transplant Research Programme in Toronto, Canada. She will discuss the experience of contact between anonymous living donors and their recipients and recommend a strategy to address this, in the absence of evidence to support best practice.

Sunday, September 8, 2013

German kidney transplant surgeon on trial

Prosecutors in Germany have accused a transplant surgeon of attempted murder, for allegedly manipulating the waiting list to obtain organs for his patients, and thus victimizing those who should have been ahead of them in line to receive the organs in question

Google translate renders the headline as "He killed without being a murderer"

"The surgeon Ayman O. is on trial. He is said to have manipulated information to patients to transplant organs to them. The prosecution sees this as attempted murder, he had taken the death of the other into account. The process in Göttingen will make the system of organ allocation to the test."

HT: Rosemarie Nagel

Tuesday, June 25, 2013

Summer School on Matching Problems, Markets, and Mechanisms: going on now in Budapest

(And don't miss the link to ruin pubs at the bottom...)

the first summer school of the COST project on Computational Social Choice


Monday, 24 June 2013

8:00-8:45 Registration

8:45-9:00 Opening

9:00-10:30 First tutorial of David Manlove

Hospitals / Residents problem and its variants

10:30-11:00 Coffee break

11:00-12:30 First tutorial of Tamás Fleiner

Two-sided problems with choice functions, matroids and lattices

12:30-14:00 Lunch break

14:00-15:30 First tutorial of Atila Abdulkadiroglu

School choice - Theory

15:30-16:00 Coffee break

16:00-17:30 Invited talk 1

Marina Nunez: Introduction to assignment games

18:30-21:30 Poster session with welcome reception

In the main building of Corvinus University of Budapest. Address: Budapest, Fővám tér 8., main hall. 33 posters will be presented.

Tuesday, 25 June 2013

9:00-10:30 Second tutorial of Tamás Fleiner

Generalised stable roommates problems

10:30-11:00 Coffee break

11:00-12:30 Second tutorial of Atila Abdulkadiroglu

Market design and recent issues in school choice

12:30-14:00 Lunch break

14:00-15:30 Second tutorial of David Manlove

The House Allocation problem (with applications to reviewer assignment)

15:30-16:00 Coffee break

16:00-17:30 Invited talk 2

Tamás Solymosi: The nucleolus and other core allocations in assignment games

Wednesday, 26 June 2013

9:00-10:30 Third tutorial of Atila Abdulkadiroglu

From design to evaluation to redesign

10:30-11:00 Coffee break

11:00-12:30 Third tutorial of David Manlove

Kidney exchange

12:30-14:00 Lunch break

14:00-15:30 Third tutorial of Tamás Fleiner

Stable allocations and flows

16:00-18:00 Facultative social program

Hiking to the Citadella (top of Gellért hill), or going to Gellért bath. Meeting after at 18:00 at the fountain in front of hotel Gellért.

18:30- Conference dinner

Thursday, 27 June 2013

9:00-10:30 Invited talk 3

Ildikó Schlotter: Parameterized complexity of some stable matching problems

10:30-11:00 Coffee break

11:00-12:30 Invited talk 4

Katarína Cechlárová: Computational complexity of competitive equilibria in exchange markets

12:30-14:00 Lunch break

14:00-15:30 Invited talk 5

Francis Bloch: Dynamic matching problems

15:30-16:00 Coffee break

16:00-17:30 Invited talk 6

Joana Pais: Experimental studies in matching markets

Friday, 28 June 2013

9:00-10:30 Invited talk 7

Szilvia Pápai: Matching with priorities

10:30-11:00 Coffee break

11:00-12:30 Invited talk 8

Estelle Cantillon: Preference formation in matching mechanisms

12:30-14:00 Lunch break

14:00-15:30 Invited talk 9

Lars Ehlers: Strategy-proofness in markets with indivisibilities

15:30-16:00 Coffee break

16:00-17:30 Invited talk 10

Dorothea Kuebler: University admissions in Germany: empirical and experimental evidence

Facultative social program

Visiting ruin pubs, meeting from 18:00 in Szimpla Kert

Wednesday, February 29, 2012

From repugnant, to legal, to mandatory?

The Telegraph reports on the intersection of prostitution law (it's now legal) and unemployment law (you can lose your benefits if you turn down a job) in Germany: 'If you don't take a job as a prostitute, we can stop your benefits'

"A 25-year-old waitress who turned down a job providing "sexual services'' at a brothel in Berlin faces possible cuts to her unemployment benefit under laws introduced this year.

"Prostitution was legalised in Germany just over two years ago and brothel owners – who must pay tax and employee health insurance – were granted access to official databases of jobseekers.

 "The waitress, an unemployed information technology professional, had said that she was willing to work in a bar at night and had worked in a cafe.

 "She received a letter from the job centre telling her that an employer was interested in her "profile'' and that she should ring them. Only on doing so did the woman, who has not been identified for legal reasons, realise that she was calling a brothel.

 "Under Germany's welfare reforms, any woman under 55 who has been out of work for more than a year can be forced to take an available job – including in the sex industry – or lose her unemployment benefit. Last month German unemployment rose for the 11th consecutive month to 4.5 million, taking the number out of work to its highest since reunification in 1990.

 "The government had considered making brothels an exception on moral grounds, but decided that it would be too difficult to distinguish them from bars. As a result, job centres must treat employers looking for a prostitute in the same way as those looking for a dental nurse."
...
"Tatiana Ulyanova, who owns a brothel in central Berlin, has been searching the online database of her local job centre for recruits.

"Why shouldn't I look for employees through the job centre when I pay my taxes just like anybody else?" said Miss Ulyanova."
**************


So we have here a situation in which a formerly repugnant transaction became legal and might, under some circumstances become mandatory (at least for those seeking unemployment benefits). This reminds me of one of the better arguments against legalizing kidney sales and other payments to organ donors: once they were legal, some future Congress might want to make unemployment benefits available only to people who had already utilized their kidney resources, for example… See my posts on the fraught debate about compensation for donors.

HT: Itay Fainmesser

Update from the comments: no women have been forced into prostitution by this potential legal technicality...http://www.snopes.com/media/notnews/brothel.asp

Thursday, December 15, 2011

Organ donation in Wales

Will Wales change from opt-in to opt-out on deceased organ donation? The discussion continues...

Presumed consent organ donation to be Welsh law by 2015
"The Welsh government says it plans to have a new law in place for presumed consent of organ donation by 2015.

"The legislation would require people to opt out of donating their organs when they die, rather than opting in by signing the donor register.
...
"Opponents say they do not believe it will work and it will hit trust in the system but supporters claim it will save more lives.

"The Welsh government has told the BBC Wales Politics Show that it is planning a system of "soft" presumed consent where family members would still be consulted after a person's death."
******************

Drop organ law says Archbishop of Wales Dr Barry Morgan
"The Archbishop of Wales is urging the Welsh Government to ditch plans for presumed consent for organ donation."
*****************

A call has been made for more research into presumed consent for organ donation as Wales is poised to become the first part of the UK to adopt it.
"A University of Ulster team has found Wales consistently supplies more donors and donations than other UK nations.

"But they say that laws on presumed consent across Europe show mixed results and need further research.

"Presumed consent campaigners say they have raised awareness of the issue, but opponents warn that it could backfire.

"The Ulster team analysed data from NHS Blood & Transplant for all four UK countries between 1990 to 2009, and compared data on registration and donation from other European countries.

The research found that Wales "consistently outperformed" its UK neighbours, both in terms of the percentage of people registered and its organ donation rate, which had been higher than the UK average for most of the past 20 years.

"The authors recommended more research on the issue of presumed consent, which would mean people would have to opt out of becoming donor, or their organs may be used.

The Welsh government is proposing to introduce the system with a proviso that family members should be consulted.

"The idea has the support of bodies like the Kidney Wales Foundation, but it has been criticised by some, such as the Archbishop of Wales, Barry Morgan, who said organs should be donated as a gift and not as an "asset of the state."

"Spain was found to have doubled organ donation rates with a such a system of "soft" presumed consent, but Sweden - which presumes consent - had a similar rate to Germany and Denmark where informed consent operates, as in the UK.

"Further exploration of underlying regional differences and temporal variations in organ donation, as well as organisational issues, practices and attitudes that may affect organ donation, needs to be undertaken before considering legislation to admit presumed consent," the report says.

"Comparison of EU nations, and particularly Spain, indicates that improvement of organ donation rates is unlikely to be achieved by introducing new legislation alone."

Sunday, December 4, 2011

Kidney sales and trafficking

There have been a number of recent stories about criminal organ-trafficking rings around the world.  Here's a long quote from the one that seems most credible, from Bloomberg (in which Frank Delmonico is among those quoted), followed by links to two related stories.

Organ Gangs Force Poor to Sell Kidneys for Desperate Israelis
"Aliaksei Yafimau shudders at the memory of the burly thug who threatened to kill his relatives. Yafimau, who installs satellite television systems in Babrujsk, Belarus, answered an advertisement in 2010 offering easy money to anyone willing to sell a kidney.
He saw it as a step toward getting out of poverty. Instead, Yafimau, 30, was thrust into a dark journey around the globe that had him, at one point, locked in a hotel room for a month in Quito, Ecuador, waiting for surgeons to cut out an organ, Bloomberg Markets magazine reports in its December issue.
...
"Organ trafficking is on the rise, as desperate people seek transplants in a world that doesn’t have enough donors. About 5,000 people sell organs on the black market each year, according to Francis Delmonico, an adviser on transplants to the World Health Organization.
It’s against the law to buy or sell an organ in every country except Iran, says Delmonico, who is president-elect of the Montreal-basedTransplantation Society, which lobbies governments to crack down on illicit procedures.

‘Exploit Shortages’

“There have been successes fighting organ trafficking around the world,” Delmonico says. “But organ trafficking continues to flourish because criminals exploit shortages of organ donors.”
Bloomberg Markets reported in June that U.S. citizens and others from the Americas suffering from kidney failure were going to Nicaragua and Peru to buy organs in a shadowy trade that injured and killed donors and recipients.
That U.S.-Latin American connection is dwarfed by a network of organ-trafficking organizations whose reach extends from former Soviet Republics such as Azerbaijan, Belarus and Moldova to Brazil, the Philippines, South Africa and beyond, a Bloomberg Markets investigation shows.
Many of the black-market kidneys harvested by these gangs are destined for people who live in Israel.
...
"Delmonico, a professor of surgery at Harvard Medical School, has spent the past six years lobbying governments and doctors around the world to combat organ trafficking. He says Israel’s government is cracking down.
The Knesset, Israel’s legislative body, passed the Organ Transplant Law in 2008, setting penalties, including imprisonment of up to three years, for buying and selling organs and requiring hospitals to scrutinize transplants by nonrelatives and foreigners.

Breaking up Gangs

In an effort to draw more legal organ donors, the law also offers volunteers compensation for lost wages and travel expense and provides them with additional health insurance. Israeli police have been among the most aggressive in the world against organ traffickers, breaking up three international gangs since 2008.
The government has also banned insurers from funding most transplants outside Israel.
The dearth of available organs in Israel has spawned a new class of criminals, mainly immigrants from the former Soviet Union, says Jerusalem Police Superintendent Gilad Bahat.
Investigators on five continents say they have uncovered intertwining criminal rings run by Israelis and eastern Europeans that move people across borders -- sometimes against their will -- to sell a kidney.
“The criminal here is the middleman who profits from the sick and the poor,” says Bahat, who investigated an organ- trafficking ring in Jerusalem. “It touches my heart that people will sell part of their body because they need money to live.”
...
"The Brazilian case is still wending its way through international courts. In November 2010 in Durban, Netcare Ltd. (NTC) -- South Africa’s largest hospital company -- pleaded guilty to violating the Human Tissue Act, which prohibits buying and selling organs.
Netcare paid 7.8 million rand ($848,464) in fines and penalties. It admitted to allowing 92 transplants in which donors from Brazil, Israel and Romania sold kidneys to Israeli patients. Four doctors are awaiting trial on trafficking charges.
In Brazil, 12 people connected to the Netcare case were convicted and jailed, with sentences from 15 months to 11 years.
In Kosovo, Ratel, who has dual citizenship in Canada and Great Britain and was appointed by the European Union to help restore the country’s criminal justice system, is overseeing a pivotal organ-trafficking case. It includes participants and victims from Belarus, Moldova, Turkey and four other countries.

Center for Trafficking

The EU has administered the courts in Kosovo since 2008, the year the country the size ofConnecticut declared independence from Serbia after a civil war. Ratel, who arrived in March 2010 as part of the European Union Rule of Law Mission in Kosovo, says the country has become a center for organ trafficking.
Ratel built a case against nine doctors, hospital administrators and recruiters on charges of buying and selling kidneys for patients in Georgia, Germany, Israel, Poland and Ukraine, as well as Canada and the United States.
...
"“This is organized crime,” Ratel says. “There is significant coercion and threats of violence.”
Organ traffickers search the world for hospitals willing to perform illicit transplants. Sometimes, sellers are flown to cities just to wait for procedures, and then traffickers move them to other parts of the globe when they find a recipient and a hospital willing to cooperate.
While the illegal organ trade may be run by seasoned criminals, it depends on the complicity of doctors and hospitals, says Oleg Liashko, a member of Ukraine’s parliament.
“I doubt this could happen without the hospital and doctors knowing about it,” says Liashko, who has investigated organ trafficking and is calling for more-severe criminal penalties in organ transplant laws. “They either know or look the other way because of the money involved. This is corruption, pure and simple.”
********
Here's a story that follows up on the U.S. side: Kidney Broker Said to Use Johns Hopkins in Organ-Traffic Case
********

And here's a graphic (but probably less credible) story from Egypt: Refugees face organ theft in the Sinai