Kidney Donation: When public policy needs to be more responsive

Just back from Dubai: here is an interesting article in a major Gulf (UAE) newspaper. The tension between the need of recipients for transplantation and tardiness of government policy.

The rules on organ donation [in the UAE] are strict. Donors must be living relatives and require extensive psychological testing before 
approval is given.

As a result, there is a long list of people waiting for organ transplants. Dr Al Zaabi said there were about 1,000 people on dialysis, although not all of them required a transplant.

Saeed Al Shaikh, a consultant haematologist at Welcare Hospital, said many people from the UAE travelled abroad for black-market transplants. 

"The number of people who do this is huge," he said. "People travel to Pakistan, India, the Philippines and China.

"There's a lot of problems from people who are returning with those kidneys. They are done on the black market, in suboptimal conditions. There are people who have died under our care because of serious infections."

Dr Al Shaikh said he knew of at least two cases of patients who died while taking immuno-suppressants after a botched transplant.

"If they get an infection from a dirty kidney and their immune system has been suppressed, of course they'll get serious infections and die," he said.

The UAE is working on a law that would allow transplants from corpses. Dr Ali Al Obaidli, consultant nephrologist at Sheikh Khalifa Medical City, said the new law, which he is helping to draft, will go some way to removing the temptation to seek organs from overseas.

"When something is not allowed in this country, we need to give viable options for people," Dr Al Obaidli said.

Dr Luc Noel, head of transplantation at the World Health Organisation, said transplants from cadavers were a more viable option than the current arrangement.

"It's never innocuous to remove an organ from someone who's alive," Dr Noel said.

Dr Al Shaikh also welcomed the proposal, and said it would go some way to meeting the demand for organs.

"There are plenty of people who are dying every day and their valuable organs are buried with them, with no use to anybody," he said. "This law will help a lot of sick people.

"If even 10 per cent of people who die in road accidents donated their organs that would be sufficient to get a good programme going."

What's surprising is the relatively limited penetrance of cadaveric (deceased) donor kidney transplantation in the developing world. Countries have been slow to create the legal framework. And, even when there is a legal framework, it isn't easy to set up a program. For example, in India even though cadaveric transplantation is legal it is limited to only a handful of centers.