Abu Dhabi: Although the UAE now has its own multi-organ transplant programme at Cleveland Clinic Abu Dhabi, the absence of a nationwide donor registry means that residents must still rely on family members to provide consent for organ donation after their death.
It is this kind of consent from family members that has facilitated the donation of kidneys from the deceased since the UAE’s revised organ transplant law came into effect in March 2017 — as well as the donation of the heart, liver and lungs in the nation’s first transplantation of these organs.
Transplant programme
The Cleveland Clinic Abu Dhabi, an Abu Dhabi Government-owned multi-speciality hospital, announced on February 20 the launch of its multi-organ transplant programme.
It followed the completion of the first full liver and first lung transplant, earlier this month.
Last year, the hospital undertook its first heart transplant in December, and its first kidney transplant from a deceased donor in September.
What's going to change
A top official from the National Transplant Committee has confirmed, however, that this is soon set to change, with plans nearly in place to activate a donor registry.
“We expect to open a donor registry for people across the country within the next month, as well as a national transplant list that includes details of patients in need and the organs they require,” Dr Ali Al Obaidli, chairman of the committee, told Gulf News.
“As has always been the case, anyone in the UAE — regardless of nationality — can become a donor, or receive an organ during a transplant surgery,” he added.
In fact, the committee is expected to make an important press announcement in the capital on February 25 regarding the national programme for organ transplantation.
The UAE passed its first law on organ transplants in 1993.
Under this regulation, transplants were allowed between living donors who were related.
This meant that only kidneys and parts of the liver could legally be transplanted in the country, as organs like the heart and lungs can only be acquired from brain-dead persons.
For years, the Shaikh Khalifa Medical City, a public health care facility in the capital, was the only authorised organ transplantation centre.
In September 2016, President His Highness Shaikh Khalifa Bin Zayed Al Nahyan passed a new law to authorise transplantation from deceased donors, marking the UAE’s acceptance of the Gulf-wide medically agreed-upon definition of brain death.
Brain death defined
But the process of establishing a robust transplant programme began years ago.
The UAE Ministry of Health and Prevention and the National Transplant Committee worked with other transplantation committees, including the Barcelona Transplantation Society and the Saudi Centre for Organ Transplantation, to train physicians at health care facilities across the UAE to accurately identify brain death.
The UAE currently has three certified centres for organ transplantation at the Cleveland Clinic Abu Dhabi, the Shaikh Khalifa Medical City and the Mediclinic City Hospital Dubai, Dr Sankari said.
Each maintains its own waiting list of patients who require organ transplants, including vital details to make a match, such as the patient’s blood type, HLA type (antigens on white blood cells that determine tissue compatibility for organ transplantation), age and weight.
In addition, the National Transplant Committee coordinates with organ transplantation centres across the Gulf countries for organs.
Organ transplant: The logistics
✓ Once a patient is identified as brain-dead, the National Transplant Committee deploys a trained sub-group of professionals to inform the family of the deceased, and obtains the required consent.
✓ The health facility then contacts all organ transplantation centres in the UAE and regionally to see if any of the available organs are required by patients on their waiting list — and if there is a potential match given the donor’s blood type, HLA type, age and weight.
✓ The transplant centre sends out a team of two surgeons and a nurse to recover the organ.
✓ If the facility is more than 40 minutes away by road, the hospital seeks the help of the Abu Dhabi Police air ambulance to hasten the transport of harvested organs.
✓ Meanwhile, the matched recipient is asked to come in to the transplant facility to be tested again, and to prepare for a possible transplant surgery.
✓ Once the organs are harvested, the rush for time begins.
✓ While kidneys remain viable for transplant up to 24 hours after harvesting, a heart must be transplanted within four to six hours, lungs within six to eight hours, and livers within eight to ten hours after harvesting.
✓ After the organs are brought in, surgical teams set to work. The time required for the transplant procedure varies.
For instance, the country’s first liver transplant from a deceased donor involved an eight-hour surgery by a 30-member medical and surgical team, while its first lung transplant was completed in about three-and-a-half hours by 15 professionals.
How donor registry will help
With the establishment of a donor registry, the process of getting consent could become easier because residents will be able to record their wish to donate organs after death.
A national transplant list would also make it easier to identify patients who need urgent organ transplants across the country.
Source: Dr Basheer Sankari, Cleveland Clinic Abu Dhabi
UAE law on organ transplantation: Some key elements
» Current law was passed by presidential decree in September 2016, and took effect in March 2017.
» It provides definition and criteria for brain death, including the requirement for two physicians and a neurologist that the patient does not have blood flow to the brain.
» Transplants are allowed for solid organs including heart, kidneys, liver, lungs, pancreas, intestine, and thymus, and for tissues including bones, tendons, cornea, skin, heart valves, nerves and veins.
» Sale of human organs and tissues and their advertising for transplantation purposes are banned.
» Donation of organs and tissues by a living person can only be made if the donor is legally competent, and to a recipient related within the fourth degree or between couples married for at least two years.
» Bone marrow can be donated by minors if it is transplanted in parents, siblings or children of the donor. Written consent from the donor’s guardian is required.
» People can record their decision about becoming an organ and tissue donor for transplantation after death on the Emirates Identity Card or any other documents. They can also unconditionally backtrack on their decision.
Consent
For a deceased donor who did not register their wish, the consent of a resident relative of the donor is required. This consent is invalid if the deceased expressed a refusal to donate while alive.
A donor may change his mind before removing an organ, a part of it or a tissue, but may not recover a donated organ once it is removed.
The identity of both the donor and recipient must remain confidential by law. Violation of this will invite fines and prison terms.
Surgeons who extract organs or tissues by force or fraud will face life imprisonment and at least a Dh20-million fine if the surgery leads to the death or complete disability of the person whose organ or tissue is removed.
FACT FILE
130,000 solid organ transplants across the world each year
70% of these are kidney transplants, followed by transplants of the liver, heart and lungs.
In a country like the UAE with a population of 8 million,
400 dialysis patients could become eligible for transplants
With adequate supply, the country could see
40 liver transplants per year
20 heart transplants a year
12 lung transplants a year
Sources: Dr Ali Obaidli, National Transplant Committee, and Dr Basheer Sankari, Cleveland Clinic Abu Dhabi
TIMELINE OF TRANSPLANTS IN THE UAE
1993: First UAE organ transplant law passed authorising transplants from living donors
2009: Kidneys transplanted for the first time at Shaikh Khalifa Medical City, the only authorised transplant centre in the country
2013: First organ transplant in the UAE from a deceased donor at Shaikh Khalifa Medical City
2016: Organ transplant law revised by presidential decree to allow donations from the deceased
2017: Revised law comes into effect in March
September 2017: First full heart transplant in the UAE from a deceased donor at Cleveland Clinic Abu Dhabi
February 2018: First full liver transplant and lung transplant in the UAE from deceased donors at Cleveland Clinic Abu Dhabi
