Although liver transplantation has become widespread and routine in developed world, it is still uncommon in most Middle East (ME) countries. There are many reasons for this but lack or shortage of deceased donors (DD) is a crucial factor in establishing or sustaining a program of liver transplantation.

Deceased Donation in the ME
Only few countries in the ME have viable DD programs, even so, the rate of deceased donors is far below those in western countries. The best in Europe is 35 donors per million population whereas the best in the ME does not exceed 6.

This discrepancy is because there is a lack of donation culture in most ME countries resulting from an eastern culture of respecting the deceased body and misunderstanding the provisions of Islam which dominates the lives of the people in the ME.

Meeting the demand
In Spain, which has the highest DD rate in the world, organ donation has become a national program, receiving support and pride by the population. A similar model should be followed in the ME to increase DD in the long term. This requires a concerted effort by the state, organ procurement organizations, other professional organizations, media and religious authorities in promoting donation. The governments should be made accountable to achieve self sufficiency in organ donation as advocated by the WHO. Iran is one of the countries which has applied this model in recent years and has succeeded in increasing DD year after year.

Providing incentives to donor families
Some Gulf countries managed to achieve good rates of DD by providing financial incentives to donor families. This practice remains controversial especially after the declaration of Istanbul, against commercialism in transplantation, which allows removal of disincentives, by covering the costs incurred by the donors, but rejects providing financial incentives.

This model can be modified to provide humanitarian support to donor families, if needed, within an ethically acceptable framework, not including fixed cash payments. This could be done in the form of educational grants provided to deceased’s children to continue their education or providing long term interest free loan to allow the family start a small business to sustain them. This support can be provided and managed by charities.