3 UAE hospitals gear up for cadaver

The first transplant to be done in the UAE after recent regulations that allow for a cadaver transplant would be a kidney because of the biggest chunk of people requiring such a transplant in the country and worldwide.

Kidney transplantation is the highest performed transplant among other types of organ transplant.

The new transplant law is in place and in the coming days, the required details and protocols will be finalised through a formal communication, said Dr Ali AbdulKareem Al Obaidli, Chairman of the UAE National Transplant Committee, in an exclusive interview with Khaleej Times.

"The UAE is also planning to do kidney and pave the way for other type of organ transplants in a stepwise fashion as other type of organ transplants are more demanding and require additional preparations and collaborations between stakeholders," he said.

Three centres across the UAE have been finalised for transplants including Sheikh Khalifa Medical City, Cleveland Clinic Abu Dhabi and Mohammed bin Rashid University in collaboration with Mediclinic.

He said that in essence, all patients on dialysis were potential recipients. "Those who have kidney failures and are about to start dialysis are potential recipients of a kidney transplant unless they have a medical condition that prevents them from receiving a transplant," said Dr Ali.

* At least 79,950 kidney transplants done in 2014. Kidney transplants are done in 99 countries.

* 27,397 donations were reported from dead persons in 2014. Currently there are 77 countries worldwide with deceased donation programmes

* About 119,900 solid organs were transplanted worldwide in 2014, an increase of 1.8 per cent since 2013

*26,150 liver transplants were done worldwide in 2014. Liver transplants are performed in 74 countries

* 119,873 organs transplanted annually (2014)

* 27,397 actual deceased organ donors in 2014

* 13.6 transplants per hour done in 2014

* In 2012, the UAE did 19 kidney transplants from living donors and 28 in 2013 - Data from Global Observatory on Donation and Transplantation

However, there are no exact numbers of how many people are on dialysis and require a transplant. "If we start a federal registry for all patients on dialysis in the country and establish a close collaboration between dialysis units and transplant centres, then we can track how many people can be potential recipients," said Dr Ali.

"In any case they have to go through a rigorous process to make sure that transplantation is suitable to them. So depending on the age and co-morbidity of the patients, the process of clearing them to be listed could either be lengthy or faster as the key to having a successful transplantation programme is that patients are reviewed thoroughly by multidisciplinary medical groups to make sure that they unlikely to face complications." It would also be important for transplant patients to receive regular care from the transplant team, he added.

Dr Ali said that transplant of organs such as liver, lungs or heart could take time before it happens in the country depending on the level of preparedness of the setups and the initial start of the cadaveric programme.

"Transplant programmes start in phases. Earlier, we only had the option of have a kidney from a live donor, now we will have cadaveric kidney transplant, so it's an ongoing process," he explained.

"Because there are a lot of procedures for hospitals to complete before they are fully prepared, I'm sure once we start the kidney transplant, all preparedness will also be aligned to start other organs."

The proposed transplant centres already have a list of prospective transplant patients. "There are some lists with each of the transplant centres," he said. However, the list of potential recipients is currently small.

"Because there was no transplant programme earlier, there was no reason for many people to get ready and be listed. Effectively, there are only smaller numbers who are fully ready but with time, this list will grow," said Dr Ali.

Explaining how the process will work, he said that those people who need a kidney transplant will communicate with these three transplant centres through their kidney specialists taking care of them.

"Effectively, nephrologists working at dialysis units and renal departments can refer their patients to transplant centres depending on their level of preparedness to facilitate and make sure everything is ready."

Dr Charles Stanford, Senior Director, VPS Healthcare welcoming the new decree said it will have a great impact on patients here.

"Patients, who by international medical standards are brain dead and hence, it is not possible for them to have an independent life, will meet the criteria for this decree," he said.

He said that the international criteria for recognition of brain death will be used in a careful and scientific manner. "It will also be essential that medical personnel help family members of patients understand the condition."

Some such patients may already have made a declaration when alive to the effect that their organs may be used for transplant in the event of their death. "If covered by the terms of the decree, patients who die in hospital and, perhaps from accidents outside a hospital, may become suitable donors," he added.

Suggesting an organ bank Dr Charles said, "If the cell/immunology type of a deceased patient is not suitable for current patients on the waiting list (which hopefully will be UAE and GCC wide), their organs may be used elsewhere."

Current options for patients seeking transplants

Currently patients from the UAE needing transplantation may be able to get one in the UAE from live donors - mostly renal (relating to the kidneys).

About 150-200 patients have received this to date, mostly in Abu Dhabi.

"With this decree, many patients requiring renal, liver and other transplants will be able to receive them in a timely manner and here in the UAE," he said.

This will help improve health outcomes and reduce the need to travel abroad, which can be risky when an organ transplant is required, he added.

"Our hospitals are currently in discussion about the relevance of the decree to our respective practice groups and the ability to meet the requirements, in full or partially."

We expect the regulators - HAAD, DHA and the MOHAP - will be forwarding guidelines and permissions, in due course, he added.

For the general public who would like to become potential donors, Dr Ali said that a suitable process to register to become a potential donor was being prepared.

A survey done in the UAE last year showed that 68 per cent of those surveyed said they would willingly donate after their death which reflects a strong culture of donation that exists between people living in UAE.

"Soon after we start the programme and when we are doing the first initial cases, hand-in-hand, there will be details of how to register on the deceased petition, the details of which are currently being laid down," he said.

Strong message of solidarity

He said that signing up for the registry as a potential donor is a strong message of solidarity from the public to those who need the organs and that many people who live in UAE have already registered their wish to become organ donors on driving licences of their home countries.

"In any society, statistically the majority of people who die and lose their life are not suitable organ donors and that's why some believe that donation after death is a huge form of charity as one individual can save the lives of many others. The good deeds of these individuals should be considered and they people should be termed heroes since they want to help other people survive," said Dr Ali.

However, statistically only a very small percentage (less than one per cent) of people who lose their life, have organs that are viable and useful to others.

The committee is now preparing a national registry model on experiences of other countries and will announce the details when prepared.

The deceased's donation wishing from the public list could be very simple process. it could be a talk during a family dinner table saying that in case of my death, if my organ were useful to others then I want to donate my organs and contribute to save the lives of others."

He said that usually families respect the decision of their loved one who made a wish before dying. "Even before the donor registry is formalised, when people have this dialogue they are expressing their willingness to contribute and their support to all patients who suffer from organ failure," he added.

"We have a strong medical infrastructure in UAE and we have strong medical teams. We have three transplant centres and they have all the expertise to initiate a strong programme," he added.

Statistically speaking, Spain is country with the highest organ donation rates. "We measure organ donation as a donor per million of population. Spain had the highest number of organ donations standing at 39.7 in 2014."

Currently, 110 individuals from the UAE have trained through the Spanish model of organ donation. "We are trying to get good practices from different countries."

Since the UAE is already part of the GCC transplant programme, three cadaver transplants have already been carried out in the country - one in Abu Dhabi and two in Dubai.

"Those segments of the population who do not wish can and still have kidney transplant from their relatives as live donors.

Dr Ali stressed that the solution was not only focusing on transplantation but also on prevention of organ failure to decrease the number of patients needing transplantation as prevention is always better than cure and many forms of organ failures could be successfully prevented.

"If we look into the causes of kidney failure, a lot of programmes are there to prevent these failures so that we can have less people with organ failure," he said, adding organ donation campaigns and support by many stakeholders are great opportunities to achieve great goals as on one hand that raises awareness about the importance of organ donation to support those who need it (as transplant patients) and on the other, it's an opportunity for people to learn about prevention about organ failures.

Source: Khaleej Times