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Volume: 17 Issue: 1 January 2019 - Supplement - 1

FULL TEXT

Living-Donor Organ Donation: Impact of Expansion of Genetic Relationship

In Jordan, the history of organ transplantation started in 1972 with a kidney transplant from a deceased donor. At present, Jordan is in a good position with regard to organ transplantation among developing countries. It remains important to follow through with some decisions and enact laws that would increase the percentage of legal organ donations and transplant procedures. This has involved the expansion of relative degree donation. Until 2013, most relative degree donations involved 1st-degree and 2nd-degree rela-tives. The degree of genetical and legal relatives in living organ donation was then expanded to allow 4th- and 5th-degree relatives. This expansion to a 5th-degree relative came about when it was realized that the percentage of organ transplants in 2nd-degree relatives was high. Therefore, the idea of organ donation in these degrees may be beneficial, as it can lead to significantly higher numbers of organ donations.


Key words : Jordanian Center for Organ Transplantation Directorate, Procurement, Relative donation, Transplant

Introduction

To achieve optimal interest in organ donation, there must be sufficient efforts by medical, legal, and supervisory authorities, such as suspicious material compensation, genetic and legal relationships, financial needs, and issues of age. Interested parties should restrict donations to relatives and the degree that they deem to be appropriate.

There are many ethical concerns raised with regard to regulations and procedures for organ trans-plant--ation in developing countries. These concerns include where to get the organ and how to get it for transplant-ation, as well as the concept of justice in distribution.

Here, we review the history of organ transplant-ation in Jordan, legislation efforts, and achievements over time. We also analyzed 1070 organ donations from January 1, 2013 to June 30, 2018, in Jordan. All age groups, both males and females, and the relative degree between 1st degree to 5th degree, as well as whether these were genetic relatives or relatives by marriage, were included in our analyses.

History of organ transplantation in Jordan
The history of organ transplant in Jordan is as follows: the first (deceased-donor) kidney transplant was in 1972, the first cornea transplant was in 1979, the first heart transplant was in 1985, the first lung transplant was in 1997, and the first liver transplant was in 2004. Regarding transplants involving blood components, the first bone marrow transplant was in 1987, the first peripheral blood transplant was in 1995, and the first cord blood transplant was in 2008.

Legislation
A deceased donation law is a sine qua non condition to start a deceased donation program. Jordan issued a law for use of corneas from deceased donors in 1956. In 1977, the Law of the Usage of Organs and Tissues of the Human Body was issued in and then adjusted in 2000.

Instructions regarding transplantation of human organs and tissues were written in 1999 and adjusted in 2015.

Living-donor organ transplant
Until 2013, most living-donor organ transplants involved 1st-degree and 2nd-degree relatives. The degree of genetic and legal relatives for living-donor organ transplant procedures was then expanded to 4th-degree and 5th-degree relatives.

Creation of a functioning governmental institution
The Jordanian Center for Organ Transplantation Directorate (JCOTD) was established in April 2010 and activated in October 2011.

Living-donor organ donation: impact of expansion of genetic relationship
The expansion of the degree of the genetic and legal relationships in living organ donation from 1st-degree and 2nd-degree relatives to 5th-degree relatives increased organ donation about 6% to 10%. However, this alone does not serve as a substitute of building up a national program for deceased organ donations.

The distribution of kidney and liver organ trans-plants according to genetic and legal relationships from January 1, 2013 to June 30, 2018 (N = 1070) is shown in Tables 1 and 2 and Figures 1 and 2.

Building a deceased-donor organ transplant program: pressure and resistance
Several legislative rules have been added with the aim of increasing public awareness, improving efficiency of the donation process, and conducting training courses and workshops for human resources. Organization transplant meetings, creation of a national wait list system, and no organ transplant service cost are needed.

In September 2018, a decision was made to permit living organ donation (3/Sha’ban/1439H), which corresponded to an earlier date (April 19, 2018).

For donation of organs without any material compensation, there must be sufficient efforts for investigations by medical, legal, and supervisory authorities, including suspicious material compen-sation, genetic and legal relationships, and financial needs. Interested parties should restrict donations to relatives and the degree they deem to be appropriate.

Chairman of the Fatwa Council
The Chairman of the Fatwa Council is the Grand Mufti of the Kingdom/His Eminence Sheikh Abdul Karim.

Regional cooperation
The 1st Symposium on Organ Donation and Procurement of JCOTD in collaboration with Saudi Center For Organ Transplantation (SCOT) and the Jordanian Society for Organ Donation occurred on February 23 and 24, 2015 (Figure 3).

The Second Symposium on Organ Donation and Procurement of JCOTD in collaboration SCOT occurred on March 30 and 31, 2016 (Figure 4). In 2016, the Middle East Society for Organ Trans-plantation was held in Amman, Jordan (Figure 5).

On October 23, 2015, a campaign for organ donation encouragement was held for entry in the Guinness Encyclopedia (4863 donation cards were collected) (Figure 6).

General provisions were made to regulate the process of organ, tissue, and cell transplant from living donors (Figure 7). These provisions stated that donors should be genetically related, as confirmed and authenticated by official authorities, with relationship from a 1st-degree or 2nd-degree relative or in according to fatwas issued from the Jordanian Iftaa Council. The exception is transplantation of renewable organs such as bone marrow.

Questionnaires were also distributed to the Jor-danian population from April 2014 to August 2018 (N = 2971 participants). The results of the ques-tionnaires are shown in Figure 8.

Barriers to establishment of a deceased-donor program
The barriers to establishment of a deceased-donor program include the following: lack of public knowledge about brain death even in educated sectors; lack of trained transplant staff, including surgeons, physicians, coordinators, and nurses; lack of qualified supporting units (eg, gastroenterology, radiology, and immunopathology); and lack of trust and confidence in success among governmental officials, especially for complicated procedures such as liver and heart transplant.

Overcoming barriers and present achievements
Barriers have been overcome because of negotiations with Ministry of Health officials to allocate a special budget for transplant centers. In addition, charities for kidney and liver diseases have been established for fundraising to help patients.

Achievements have so far included the following: increased cases of brain death diagnosis; increased cases of family approach; establishment of national training programs for numerous transplant teams; free cost in governmental institutions and marked decreases in cost of procedures in private centers; progress against unethical/illegal issues in trans-plantation; and establishment of laparoscopic donor nephrectomy. Table 3 lists potential deceased donors from March 2015 to August 2018.



Volume : 17
Issue : 1
Pages : 1 - 5
DOI : 10.6002/ect.MESOT2018.L24


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From the Jordanian Center for Organ Transplantation Directorate (JCOTD)/Ministry of Health, Amman, Jordan
Acknowledgements: The authors have no sources of funding for this study and have no conflicts of interest to declare.
Corresponding author: Saleh Hammad, Jordanian Center for Organ Transplantation Directorate (JCOTD), Ministry of Health, Amman, Jordan
Phone: +96 2795488803
E-mail: dr_salehhammad@yahoo.com