The Middle Eastern map includes all the Arab countries, Iran, Turkey, Pakistan, and countries of Central Asia. There are common features of organ transplant in these countries such as inadequate preventive medicine, uneven health infrastructure, poor awareness of the medical community and public about the importance of organ donation and transplant, high level of ethnicity, poor government support of organ transplant, and political unrest. In addition, there is inadequate team spirit among transplant physicians, lack of planning for organ procurement and transplant centers, and lack of effective health insurance. Living-donor organ transplant is the most widely practiced type of transplant in the Middle East. Deceased-donor organ donation is not used properly because of continued debate in the medical community about the concept of death according to neurologic criteria (brain death) and inadequate awareness of the public about the importance of organ donation and transplant in many countries in this region. Continuous work is needed to provide solutions to overcome the current obstacles.

Key words : Donation, Organ transplant, Living-donor, Deceased-donor

Introduction

The Middle Eastern map includes all the Arab countries, Iran, Turkey, Pakistan, and countries ofCentral Asia. The population in these countries exceeds 600 million, and the countries have a unique location between Europe, Africa, and Asia. There have been several publications addressing the activities of organ donation and transplant in this region.^1-3

There have been several recent resolutions of the World Health Organization and transplant community that affected organ transplant around the world and in the Middle East. The resolutions included combating transplant tourism (Declaration of Istanbul) and calling on members of the World Health Organization to adopt the principle of self-sufficiency of organ donation and transplant, including preventive measures for diseases that may cause organ failure.⁴

Organ donation and transplant in Middle East countries
There are common features of organ transplant in Middle Eastern countries that include inadequate preventive medicine, uneven health infrastructure, poor awareness in the medical community and public about the importance of organ donation and transplant, high level of ethnicity, poor government support of organ transplant, and political unrest in the region. The lack of team spirit among transplant physicians, inadequate planning for organ procurement and transplant centers, and lack of effective health insurance add more obstacles toward improvement in this field. Therefore, patients in the Middle East seek transplant tourism that has added risk of acquiring infections and other complications and exploitation of donors and recipients. Despite international efforts, transplant tourism has not been abolished, especially in the absence of effective alternatives and weakness of the organ donation and transplant programs.

The waiting lists for organ transplant have increased, and there is a growing gap between supply and demand for organs in Middle Eastern countries. There is an estimated average 200 patients per million population in need of renal transplant. In addition, there is 10% to 15% annual death rate on dialysis and greater death rate for patients on the waiting lists for liver and heart transplant because of the absence of artificial means to support those patients while awaiting an organ.

Sources of organ donation in the Middle East
Living-donor organ donation is the most widely practiced type of donation in the Middle East and includes kidney and partial liver grafts. Living-donor organ donation predominantly is genetically related, but nongenetically related and commercial living-donor organ donation exist.

Deceased-donor organ donation has great potential in the Middle East because of the frequency of accidents. Nevertheless, this source still is not used properly because of continued debate in the medical community about the concept of brain death and inadequate awareness of the public about the importance of organ donation and transplant in many countries in this region. Data about current transplant activities in the Middle Eastern countries were collected in surveys by the Saudi Center for Organ Transplantation and the Middle East Society of Organ Donation and Transplantation (Figures 1-2-3).⁵

In addition, deceased-donor organ donation still is not implemented in 25% of Middle Eastern countries despite supportive legislation. There are 3 major factors that must be fulfilled to organize deceased-donor organ donation. These include religious and social acceptance, the presence of legislation for organ donation and transplant, and government support. There is religious acceptance for organ donation in the entire Middle East, but in some countries, there is no religious acceptance of death according to neurologic criteria and its equivalence to legal death. Therefore, legislation still is unavailable or not fully implemented in some countries such as Egypt, Morocco, Syria, Sudan, Qatar, United Arab Emirates, Yemen, and Libya. There are weak health systems and variable infrastructure in most Middle Eastern countries. Organ transplant and treatment of end-stage organ failure are not a priority in most Middle East countries because of the large expense and high technology equipment required. Furthermore, there is inappropriate allocation of resources because of weak government support in many instances.

There are very few organ procurement centers in the Middle East Society for Organ Transplantation (MESOT) countries to supervise the activities of organ donation and transplant at the national level. The Middle East countries lack an active network of organ sharing except between few countries such as Saudi Arabia, Kuwait, and Qatar.

There are several dominant and distinctive models for practice of organ donation and transplant in the Middle East including the Turkish,⁶ Iranian,⁷ Pakistani,⁸ and Saudi models.^9,10 All these programs have active living- and deceased-donor organ donation and transplant and have national procurement centers to supervise these activities. They all prohibit organ transplant tourism in their countries. These countries can be an example for other countries in the Middle East for proper practice of organ donation and transplant.

Possible solutions to obstacles for organ donation and transplant in middle east countries
The financial issue for treatment of end-stage renal disease is of utmost importance. Therefore, it may be necessary to adopt a funding system similar to the Pakistani model or medical insurance. Furthermore, organization is important to improve organ donation and transplant in any country, and efforts should be directed to establish national organ procurement centers. There should be encouragement to develop a network for organ sharing between Middle East countries and exchange of information about the experience of national programs (coordination of organ donation, scientific expertise, multicenter studies, and registry of organ failure patients). In addition, there should be consideration for a highly regulated new source of organ donation from living-donor nongenetically related donation.

In conclusion, organ donation and transplant programs in Middle Eastern countries have many obstacles. Continuous work is needed to provide solutions. Examples are available in the Middle East to guide new programs to improve performance.

References:

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