Doctors call for a donor system

Medical experts say seriously ill patients are forced to turn to illegal transplants on black market or face a lifetime on dialysis.

Ibrahim Baker undergoes dialysis at Tawam Hospital in Al Ain.

Ill patients who desperately need transplants are shopping abroad for black market organs because there is no official donor system in the UAE. Doctors have reported a growing number of people with renal and liver failure turning to illegal transplant brokers, many of whom have focused on the UAE because there is no register.

Patients, however, risk complications from overseas transplants that often go wrong. One consultant in Dubai estimated that one in 10 people buying on the black market will die from infection, while others suffer organ rejection and failure. Doctors say they treat dozens of such cases every year. They believe the number of illegal transplants is much higher because they only see those who develop complications after returning home.

Most of the doctors The National spoke to had been approached by a transplant broker at some point in their career and every one had turned them down. Dr Ron McCulloch, who has worked in the UAE for more than 30 years and has a clinic in Abu Dhabi, said: "Patients come and ask if I know about getting kidneys abroad. I always tell them it is illegal and that organ transplantation is a very serious procedure.

"I have been approached by a supposed doctor acting as a broker. He was not in practice here but obviously found it lucrative enough to travel out here to look for business. He was from a former Soviet Union country and said he was a doctor. "They would come and stay and start approaching doctors here and offer to give them money for business. I made it very clear I viewed this with concern." At least 50 patients are known to have needed emergency treatment this year after paying up to Dh570,000 (US$155,000) for black market transplants in countries such as India and Egypt.

Medical experts say the only solution is a national donor system, which could potentially save hundreds of lives and reduce the financial burden of long-term kidney dialysis. "People are unnecessarily dying because we have no [donor] system in place," said Dr Abrar Khan, the director of transplantation and hepatobiliary surgery at Sheikh Khalifa Medical City (SKMC), Abu Dhabi. While there are no restrictions on cadaver transplants - organs taken from a dead person - none has been done in the UAE because of a legal grey area.

The shortage of donor organs is a problem that experts have warned is only likely to get worse. The UAE has some of the highest rates of diabetes and hypertension in the world, both major causes of renal failure. "We have had four people die this year alone. If we had livers, they would not have died," Dr Khan said. "There is every other medical treatment available in the country except cadaver transplants.

"We have potential donors every week at our hospital. Imagine how many we would have if we went to other hospitals in the UAE." The hospital has up to four potential donors every month. Then there are the patients who arrive at the hospital with liver failure, in need of a transplant. Doctors said there was a potential supply of organs for transplant from the high number of traffic accidents. Last year, 1,056 people died on UAE roads.

If only half of those were viable for transplants, it would provide more than 1,000 kidneys, easily clearing the 500-strong waiting list for new kidneys in Dubai alone. At present, only living relatives of the patient are accepted as transplant donors. Legal transplants of organs from cadavers can cost as much as £150,000 in Britain. For those who cannot afford it, the alternatives are a lifetime of dialysis, two or three times a week, or an illegal transplant.

"Although dialysis can keep people alive, it significantly increases your chance of dying and ages you by about 30 years," said Dr Mustafa Ahmed Kazim, a consultant nephrologist at Welcare Hospital in Dubai. Even when a legal transplant is possible there is a long waiting list. Only a few hospitals perform the procedure. Last year, the Abu Dhabi-based Sheikh Zayed Military hospital performed the first liver transplant in the UAE.

"Transplantation is the gold standard for treatment," said Dr Kazim. "Dialysis is just a bridge to hold people that are not suitable for transplant because they are too ill, or until they can get a transplant. "We have three road or traffic accident deaths every day and if we had a proper scheme here there would be enough organs for everyone." Illegal transplants are usually performed in poorer countries where no questions are asked.

Donors willing to sell a kidney for the right price advertise openly on the internet. Brokers often negotiate the deals and take a percentage of the fee, as do the doctors, while the donors receive a tiny percentage. In the Philippines, slum dwellers are paid as little as US$2,000 (Dh7,350) for a kidney. Organ trafficking rings have been shut down there and in India and South Africa. This year a multimillion-rupee illegal organ racket was uncovered by police in Gurgaon, a suburb of New Delhi, which saw up to 500 kidneys removed from poor labourers and sold to wealthy clients from five countries, including Dubai. In May, the UAE was among 78 countries that signed the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, the first step to making the practice illegal in international law.

Welcare Hospital sees 15 patients every year with complications from illegal liver and kidney transplants. "The livers they usually get from in China from executed people," said Dr Saeed al Shaikh, a consultant hematologist. "If you are having liver failure you go to a certain doctor and they go to the criminals and see who matches your blood group. They execute them and take their liver and other organs."

Dr Kazim warned that poor surgery and aftercare leaves patients highly vulnerable. "Very poor people who are down and out - alcoholics, drug addicts and people with untreated tuberculosis - are the people who are selling their organs. These people forage garbage dumps for their next meal and therefore are full of infection." Dr Kazim described one patient who had an illegal transplant: "They punctured his bowel. He had a colostomy bag. He came to me with a wound the top to the bottom of which was infected. After a week he dropped down, practically dead, with a huge clot on his lung."

SKMC said it has to deal with 25 patients a year with complications from illegal transplants. "On return to the UAE the patients are often in bad health," said Dr Khan. "Patients come back pretty messed up. One person had a bleeding kidney and another had a huge open wound." Doctors say the use of cadaver transplants are hampered by uncertainty over the definition of "brain dead". Organs are delicate and when the heart stops beating many become unusable so transplants can only be carried out when the patient is clinically brain dead.

Doctors argue that allowing cadaver transplants would in the long term save the health service money. Yearly dialysis costs a minimum of Dh140,000 for each patient but a transplant is about Dh60,000, plus an annual bill of Dh6,000 for drugs. A final draft for a new law that would make legal cadaver transplants possible by redefining brain death is being prepared by the Government, says the Health Authority - Abu Dhabi (Haad). Dr Oliver Harrison, the director of the public health and policy division at the Haad, said: "To open up a new source for organ donation is a top priority for the Haad."

Sources say the draft could be presented to the Federal National Council (FNC) for consideration within a month. Dr Ayesha al Roomi, a member of the FNC, said she would welcome debate about a law clarification and the possibility of introducing cadaver transplants as regular practice. "There are a lot of different factors to consider but, overall, this would be a good idea," Dr Roomi said. "However, it may be difficult for people to accept easily. It is a cultural and religious thing. Some people will think this is playing with the body and it may be hard to accept emotionally."

Religious objections to the procedure are based on moral and ethical grounds. Sheikh Mohammed Metwalli al Shaarawi, an Egyptian imam, has condemned transplants because, "organs do not belong to us in the first place, so we can't give them away". The Abu Dhabi Fatwa Centre said it condoned organ transplants but under strict conditions - and money should never be exchanged. "Generally speaking, it is acceptable if all parties involved give consent and there is a mechanism in place to ensure that no one is exploited," the centre said.

Doctors want the law to go a step further and formally establish a national register, where people can state their desire to be a donor on their residents' visa or ID card. "I am very hopeful that as this programme matures and the public becomes more aware of the issues, we can set up a national infrastructure incorporating all the various health agencies," said Dr Laila Abdel-Wareth, the chair of the laboratory medicine department at SKMC, who has been working with a team of medical professionals to assess the legislation. "As long as the process is done with proper structures in place it will be successful." According to Dr Khan it cannot come too soon. "We desperately need help and support to further our programme. People are in desperate need."

[e-mail] * with additional reporting by Mitya Underwood and Matt Bradley