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TRENDING IN HEALTHCARE

A Shot in the Arm: UAE's New Organ Transplantation Law

With the new law, UAE's healthcare industry is now gearing up to assess and meet the organ transplantation requirements of the region

By: Jayata Sharma

UAE recently heaved a sigh of relief when a new law permitting organ transplantation was passed. The law, allowing organ transplantation from living people and the deceased, was decreed by President His Highness Shaikh Khalifa Bin Zayed Al Nahyan last year and has taken effect from March 2017, six months after publishing in the official gazette.
Such a huge law comes with a set of positives while also needing a lot of gearing up from the healthcare industry's side.
Transplants are complex procedures requiring expert hands. In a place where the law is still fresh, how will surgeons be arranged? What are the dos and the don'ts? Are hospital facilities ready to make the necessary changes in their infrastructures?
We try and take an early look into the current scenario in the region and find answers.
Many players that we contacted thought it's too early to speak on the subject. However, we did manage to find a few players that were open to discussing the topic.
While there are a lot of details as to who can be eligible and for what kind of donor or recipient category, in this article we will look at the law from a more 'how is the industry prepared' kind of angle.

The law is good news. Challenges and hurdles will keep coming up and the industry will keep sorting through them. What's important is that UAE has opened its arms to an extensively beneficial medical procedure that will improve the lives of its population

The need

To provide a solution, first a proper requirement check should be done. Same is the case with transplants. The need has to be pin pointed at, first.
"In a country where the concept of organs transplants has been legalised for the first time, we may need to assess the need by studying the percentage of kidney, pancreas, heart and liver failures, which can be treated with transplants that may reflect the demand to some extent only, as not all cases may be treated with a transplant," says Taher Shams, Managing Director, Zulekha Hospital.The hospital is one of the few players equipped to start transplants; however, Zulekha is still in the planning phase where more details cannot be shared at the moment.
True. The industry is still trying to find the right numbers to address.
Dr. Bashir Sankari, Chief, Urology, Surgical Subspecialities Institute at Cleveland Clinic Abu Dhabi,is a veteran of Cleveland Clinic for more than 25 years, and has extensive experience in urology and kidney transplant, having performed more than 1,000 kidney transplants during his career. He says, "There are more than 2,000 patients in the UAE who are currently undergoing regular dialysis treatment for kidney diseases. But the number of transplants needed depends on the availability of suitable organs from donors that match with patients. The change in the law will allow patients to receive lifesaving treatment without the need to travel abroad. Offering these services is a natural step towards our goal of bringing world-class healthcare to Abu Dhabi and supporting the development of a sustainable healthcare sector." Not just Cleveland, the entire healthcare industry is wanting to cease the opportunity to provide the best for their patients.
Dr. Houssain Mustafa, CMO, Saudi German Hospital, Dubai, shares some figures from his facility that give us a further idea, "We have around 6-7 patients as yearly candidates for cardiac transplantation, 10 patients for liver transplantation and 25 cases for renal transplantation and other sporadic cases for different organ transplantation."

Strict governance and assessment of organs before transplants, their storage and transplants' successes over a period of time will iron out the initial doubts and eventually become an easily accessible and affordable medical service


Taher Shams,
Managing Director, Zulekha Hospital

Geared up for transplants

It will take some time for the industry to arrive at more wholesome figures. However, some hospitals are already geared up or are in the process of it.
Cleveland Clinic Abu Dhabi has been developing extensive transplant facilities to support a full range of transplant operations since beginning of operations in March 2015. "Once we are able to offer more transplant services, eligible patients with severe cardiovascular disease, lung disease and liver problems will benefit greatly, as will patients in need of a kidney transplant. Many of these patients will be able to return to their everyday lives as transplants can improve both their quality and quantity of life," says Dr. Sankari.
Physicians at Cleveland Clinic Abu Dhabi successfully completed the hospital's first live kidney transplant operation in April of this year, moving the hospital another step towards providing full transplant facilities that are in line with recent changes in UAE legislation. This was followed by a second successful live kidney transplant between two Emirati sisters in July.
Saudi German Hospital too is getting ready, as Dr. Mustafa says, "We are planning to start liver transplantation and will prefer to build our own unit for the facility."
As per a news report by The National, last year, the Mohammed bin Rashid University of Medicine and Health Sciences successfully carried out the first organ transplant surgery from a dead donor in collaboration with Mediclinic City Hospital. The organ went to a 29-year-old Emirati woman who suffered kidney failure because of diabetes. In addition, only about 200 operations from live donors have been carried out at Sheikh Khalifa Medical City (SKMC) in the past decade – all kidney operations involving donors willing to part with one.
The same report states that more hospitals are now getting equipped to handle organ donations from deceased donors after a change in the law. It listed 5 players, and said that donor hospitals are usually major hospitals with intensive care units, such as Sheikh Khalifa Medical City, Cleveland Clinic Abu Dhabi, Al Rahba, Al Mafraq and Tawam.
As reported, a common process would mostly be that the hospital staff asks the families of patients who die in intensive care if their relative would donate his or her organs after death, as part of a major drive to establish a national transplant programme.
More than 100 doctors and nurses have been trained as part of the process that will begin next month. The hospitals involved are equipped to perform transplants as part of a wider effort to encourage more members of the public to become donors, the report states.
Dr. Ali Obaidli, Chair of the National Transplant Committee, has been quoted in it as saying that having trained medics speak to families of dying patients face to face provides the best chance of a successful donation.
"Across the UAE, 110 experts have been trained in the science of organ donations and will be further trained – this makes us optimistic for when we begin transplants that the UAE will have a sustainable organ donation programme," he added.
"To have a high rate of donations, you need a strong culture of donation among the population, a strong medical infrastructure and a strong insurance system – these are strengths that are both available in the UAE."
"We think that with great partnerships with key organisations like the Cleveland Clinic, the UAE has what it takes to have one of the best organ donation programmes, not just to serve the UAE, but the region," Dr. Obaidli was further quoted.
As per The National, along with direct approaches to families in hospital, officials are also looking at how other countries register donors, including by carrying a donor card or opting into the scheme with their driving license or Emirates ID.
Dr. Obaidli gives an example of Spain here, the world leader in organ donation. Its success in finding organs lies partly in the fact that doctors presume consent unless otherwise stated, although the family of a donor can still object. "Such a scheme is not yet being considered here."


Leading by example

As per our research and the news carried in publications across GCC, it seems that Cleveland is one of the few players that's leading by example here. One reason for it is that they have the expertise to use from across the globe due to the group's far and wide presence.
Their transplant team includes well-established physicians and surgeons in the field of transplantation. Dr. Sankari further informs, "A number of our physicians and staff at Cleveland Clinic Abu Dhabi have attended training courses on transplant management and procurement that meet the same standards used by Cleveland Clinic in the US."
Cleveland Clinic Abu Dhabi had also hosted an event for medical staff including nurses, intensivists and surgeons in association with the UAE National Transplant Committee.
"The hospital is planning follow-up training events as we prepare to begin offering expanded transplant services. Many of them have also been trained on such issues in their previous roles in the United States and Western Europe. We have also trained social workers who will support the families of deceased organ donors through the donation process."
Cleveland Clinic Abu Dhabi brings over 100 years of world-class healthcare experience in the US, and we are very lucky to have highly trained and experienced surgeons on staff who have previously worked on transplant cases in the US and elsewhere," he adds.
The hospital has been working with a lot of partners to give the required push to organ transplant in the region.

A number of our physicians and staff at Cleveland Clinic Abu Dhabi have attended training courses on transplant management and procurement that meet the same standards used by Cleveland Clinic in the US


Dr. Bashir Sankari,
Chief, Urology, Surgical Subspecialities Institute at Cleveland Clinic Abu Dhabi

Benefitting the entire society

A law of this stature sets precedence for generations to follow. There is no doubt that the society will benefit extensively by this step.
"There will be difference made to lives and the healthcare system with greater possibilities of saving lives. The society is going to benefit at large by easing the stress and burden an individual or his family would otherwise go through when they have lost all hopes of an organ being cured completely. The communities learn the value of gifting a life by being a donor. It creates responsible citizens. I myself am a registered donor with MOHAN Foundation, an international non-profit organisation supporting organ transplantation in Nagpur, Chennai, Hyderabad, Delhi-NCR, Chandigarh, Jaipur, Mumbai and USA. One would feel fulfilling during his/her lifetime by promising to donate their organs after they are gone. The concept is a welcome change and we appreciate the move in UAE," says Mr. Shams of Zulekha Hospital.
As the general population sinks in the excitement, the healthcare industry will also witness a sea of change in the coming years. Perhaps medical tourism too will receive a shot in the arm.
Currently, however, the hospitals are more focusing on the task at hand.
Says Dr. Mustafa of Saudi German Hospital, "The image of the healthcare sector will be up to the ruler expectation when organ transplants become a common practice in UAE. About 50 patients in our facility need either cardiac, liver or liver transplantation yearly, and we would like to start attending to them as soon as possible."
The exact number, as mentioned above, is hard to predict as it is highly dependent on the availability of suitable organs from donors that match with patients. "However, patients who choose to have transplant surgery before reaching the dialysis stage typically enjoy better outcomes and survival rates, so the expansion of transplant facilities is another positive development in the UAE's healthcare sector.
We have the expertise and facilities to serve as one of UAE's leading organ transplant centers and we are pleased to see patients choosing to stay within the UAE, rather than taking a long flight for overseas treatment at what is a very difficult time for them physically," says Dr. Sankari of Cleveland.

We have around 6-7 patients as yearly candidates for cardiac transplantation, 10 patients for liver transplantation and 25 cases for renal transplantation and other sporadic cases for different organ transplantation


Dr. Houssain Mustafa,
CMO, Saudi German Hospital, Dubai

Tackling cultural and mental barriers

Organ transplantation is a topic that has the tendency to face resistance, even in places where it has been legalised since long. It takes some efforts in the right direction to make people see and understand the benefit of either being a donor or giving consent for organ donation and transplant.
UAE too is in an early stage now and still figuring out how to deal with the new law. It may tend to have some mental and cultural barriers.
"Alike any new change facing resistance, the myths and misconceptions of possible infections, failures and disbelief in another's organ reviving an individual are some hurdles the medical service providers will face. The limited authorisation of organ transplantation by certain authorised centers only is essential for stringent regulation purposes and helps gain public confidence. Strict governance and assessment of organs before transplants, their storage and transplants' successes over a period of time will iron out the initial doubts and eventually become an easily accessible and affordable medical service," opines Mr. Shams.
Dr. Mustafa also agrees that there would be certain hurdles initially and expresses concern over the current non-availability of donors in the entire region.
Dr. Sankari from Cleveland is hopeful that the barriers will not last too long, "Emirati culture is very much focused on the well-being of the family and the good of the community. Our recent experiences with a living donor kidney transplant leads us to believe that families will likely be willing to consent to organ donation as it represents a generosity that is at the core of local culture."
He believes that Cleveland Clinic Abu Dhabi is set up to avoid many of the potential challenges, largely as they have a highly-experienced medical staff, many of whom have worked on transplant cases before moving to the region. "As such, we are in a position to leverage their experience as well as draw on the knowledge of our colleagues from Cleveland Clinic Ohio."


Summing it up

The law is good news. Challenges and hurdles will keep coming up and the industry will keep sorting through them. What's important is that UAE has opened its arms to an extensively beneficial medical procedure that will improve the lives of its population.
The law needs to be given the required impetus and the industry is all set to provide it.
Donors need to be added, increased and along with the government, hospitals are willing to work in this direction too.
"As the program will start, concomitant with it, the campaign for society will start as well," says Dr. Mustafa.
Cleveland Clinic too will look to support the government in donor outreach activities.


A change in marketing plans

Adding organ transplantation will also change the marketing plans of hospitals, forming a major part of their activities.
"Although our project might be not rentable but just to serve the society and complete the scope of service and save more lives, our marketing plans will be modified more with the aim of attracting patients for liver transplantation from abroad," says Dr. Mustafa from Saudi German Hospital.
While Cleveland Clinic Abu Dhabi says that transplant will be a part of their routine marketing activities. "The hospital comprises 13 institutes, which are designed to put patients first and align with the region's specific healthcare needs. In all, more than 30 medical and surgical specialties are represented at Cleveland Clinic Abu Dhabi and integrated to offer coordinated, multidisciplinary care for adult patients, which includes transplants," shares Dr. Sankari.


Safeguards against fraud

• Surgeons who extract organs or tissues by force or fraud will face life imprisonment and at least a Dh20 million fine if the surgery leads to the   death or complete disability of the person whose organ or tissue is removed.
• The court may also order blacklisting an offending medical practitioner for up to three years, confiscating money and medical equipment used in   the crime and shutting down the hospital or a ward of it where the crime is committed for not less than two months and not more than a year.   The closure will be for good in the case of recurrence.
• The penalty will be a prison term of not less than five years and not more than seven years, a fine ranging from Dh500,000 to Dh3 million for   businesses which trade or act as an intermediary in selling of an organ or tissue.
• A person who sells, buys, offers for sale or acts as an intermediary in selling a human organ or tissue will face a prison term and a fine ranging   from Dh30,000 to Dh100,000.
• Doctors performing organ or tissue transplantation while knowing the surgery involves commercial trade of organs or tissues will face a prison   term of not less than six months, a fine of up to Dh1 million, or both.
• Performing transplantation of organ or tissues outside licensed hospitals will carry a prison term of not less than a year, a fine of not less than   Dh1 million or both.
  Source: The Gulf News


Disclosure

• Disclosing the identity of the donor or the recipient will incur a prison term of not less than six months, a fine of up to Dh50,000 or both.
• A pardon may be granted to people who inform authorities before committing the crime. The court may also grant pardon if the crime is     reported to the authorities before investigation starts. The penalties may be commuted if offenders facilitate arresting accomplices during     investigation or trial.
• The Cabinet will set up a national center for preservation and transplantation of organs and tissues. Committees at the national center will study     cases of patients who need organ or tissue transplant and submit recommendations.
• This law annuls Federal Law No 15 of 1993 concerning human organ transplantation.
• Hospitals must adjust their legal status within a year from March next year. The grace period may be extended for a similar period by the     Cabinet on request from the Minister of Health and Prevention.
    Source: The Gulf News