Surgery unit calls for donor law

Organ shortage prompts doctors to push for legal framework to permit harvesting tissue from brain-dead patients.

ABU DHABI // A pioneering transplant unit which opened in the capital this year is pushing for a change in the law to allow the use of organs from brain-dead patients. The country's first dedicated transplant unit opened in Sheikh Khalifa Medical City in February, allowing the complex surgery to be carried out by locally based doctors for the first time.

However, in order to carry out a wide range of transplants, the centre requires a steady supply of organs and doctors say a change in the law is needed to allow them to harvest livers, hearts and other organs from patients declared brain-dead. They are also calling for a donor registration scheme, under which people prepared to donate organs in the event of their death would carry a donor card. In cases where no card was carried, the decision would be left to the patient's next of kin.

The centre, which is managed by the US-based Cleveland Clinic, has so far carried out four kidney transplants and is preparing to perform its first liver transplant early next year. Within the coming year, the centre will diversify further to include pancreas and heart operations and eventually hopes to establish a multi-organ transplant programme. Until now, transplant patients have either had to travel abroad for surgery or surgeons have had to come to the country to operate on them.

All four kidney-transplant patients operated on so far received organs from family members. All were at home within five days of the operation, although one patient died two months after surgery. His kidney functioned for the first two months but then he subsequently contracted a rare condition called graft-versus-host disease, in which a donor's immune cells attack cells in the patient's body. Dr Abrar Khan, the chairman of the transplant programme, is now in discussions with the Abu Dhabi Health Authority about the possibility of legislation known as the "Brain-death law", to increase the number of patients whose lives can be saved by transplants.

Such legislation is in effect in all GCC countries except the UAE and in countries around the world including the UK, US and Canada. In Saudi Arabia, a decree allowing the use of organs from brain-dead patients was issued in 1982, and 85 per cent of transplants in the GCC are carried out in the kingdom. Between 1982 and 2007, there were 5,366 kidney transplants, with organs taken from brain-dead donors in 1,794 cases.

Death, said Dr Khan, could be defined in two ways. "Either your heart stops and you stop breathing or the other way is if you are brain-dead, in which case, your heart is still functioning, but your brain isn't." In the UK, for example, irreversible damage of the brainstem is accepted as diagnostic of death and, once the condition has been confirmed by an authorised committee and legally valid consent has been obtained, the dead person's organs can be removed for transplant.

Donations from brain-dead patients were the main source of transplant organs around the world, said Dr Khan. "We're moving forward to catch up and trying to implement this law. If we get the law passed, more donors will come forward year by year." If a law is not passed, organs will have to be sourced either from living donors, when possible - in the case of kidneys, for example - or from patients who have died, usually in accidents, with viable organs.

If it is passed, however, Dr Khan envisages there will be between 20 and 40 operations within the first year, rising subsequently to as many as 100 a year. He hopes that, if a law is passed in the UAE, people will be encouraged to carry donor cards. A second transplant surgeon will be joining the centre in September and by the end of the year the team is expected to be 12-strong. "Transplants are very high-maintenance operations with high levels of social and aftercare needed, including three home visits a week by medical staff to check on the patient," said Dr Khan. "It requires a lot of resources but luckily the Government has given us this. In terms of manpower, we need donor coordinators pharmacists and so on. It's a complex programme."

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