Establishment of Solid Organ Transplantation in the United Arab Emirates

Deceased donor kidney transplant policies in Asia - implications on practice and recommendations for the future

Deceased donor kidney transplantation (DDKT) is common in high income Western countries with high transplantation rates. However, the utilization of deceased organs is suboptimal in Asia, due to a multitude of factors. Coherent policies are integral to the development of DDKT programs and deterrence of commercialization, but most are still at an infancy and formative stage in Asia. This review article identifies the glass ceiling effects of social, cultural, religious, political, and technical factors hampering the progress of DDKT in Asia. Additionally, it reviews the history of policy development in different countries and describes their idiosyncratic barriers and challenges. Lastly, it discusses innovative policy measures that can be undertaken to proliferate DDKT practice and curtail commercialization. The long-term ideal is to achieve regional equity and self-sufficiency, through a shared ethos of social and ethical responsibility that transcends and resonates with the different segments of the Asian community.

Development of a calculated panel reactive antibody calculator for the United Arab Emirates: a proof of concept study

Calculated panel reactive antibody (CPRA) is used to help increase sensitized patient's access to transplantation. United Arab Emirates (UAE) has a diverse resident population hence we developed a UAE-CPRA calculator based on HLA antigen frequencies of the different ethnic groups that represent the UAE population. HLA antigen frequencies at serological split antigen level for HLA-A, -B, -C, -DRB1 and -DQB1 of 1002 healthy unrelated donors were performed. We subsequently compared the performance of the UAE CPRA calculator with the Organ Procurement and Transplantation Network (OPTN) and the Canadian CPRA calculators in 110 Kidney Transplant waitlist patients from January 2016 to December 2018. Lin's concordance correlation coefficient showed a moderate agreement between the UAE and OPTN calculator (Rc = 0.949, 95% CI 0.929-0.963) and the UAE and Canadian calculators (Rc = 0.952, 95% CI 0.932-0.965). While there continued to be a moderate agreement (Rc = 0.937, UAE versus OPTN calculator) in the lower sensitized group, a poor agreement (Rc = 0.555, UAE versus OPTN calculator) was observed in the higher sensitized group. In this study, we provide a template for countries to develop their own population-specific CPRA calculator. Implementation of the CPRA algorithm based on HLA frequencies of the multi-ethnic UAE population will be more fitting to increase access to transplantation and improve transplant outcomes. Our study demonstrates that the CPRA calculators developed using the data from the western population had poor correlation in our higher sensitized patients disadvantaging them in potential organ allocations systems. We plan to further refine this calculator by using high resolution HLA typing to address the problem of a genetically diverse population.

Organ transplantation in Arabian Gulf countries: ethical and legal practice and beyond

Almost half a century ago, organ transplantation was introduced to Arabian Gulf countries. The criteria for diagnosing brain death among these countries is relatively similar, in which the main area of discrepancy is the number of physicians required to diagnose and their required specialties. Regarding the organs and tissues allowed for transplantation, they must possess an intrinsic regenerative ability if they are harvested from a living donor to avoid jeopardizing their health. To donate, Arabian Gulf countries follow an opt-in consent system, requiring the donor's informed consent before organ procurement. Live donors can be related or unrelated to the recipient, although the latter is subjected to variable restrictions among Arabian Gulf countries and prohibition in one of them. This is due to its implication in commercial trade. Furthermore, the Gulf Health Council was established to coordinate different health initiatives and programs between Gulf states, including organ transplantation, in an attempt to improve the health sector of all of its member states. Although organ trafficking is illegal in all Arabian Gulf countries, their penalty systems vary from barring physicians, subjecting them to fines or even imprisonment. As for the attitudes of people towards organ transplantation, the willingness to donate varies among these countries. The rate of organ transplantation remains low. This article aims to cover the history of organ transplantation, brain death diagnosis protocols, organ donation enrollment policies and conditions, as well as the issue of organ trafficking in Arabian Gulf countries.

In death there is life: perceptions of the university community regarding body donation for educational purposes in the United Arab Emirates

Human body dissection is the traditional instructional method for anatomy education worldwide, providing a kinaesthetic learning experience that is often challenging to achieve with other teaching techniques. However, due to lack of body donation programs in Middle Eastern medical schools, dead bodies are imported from abroad. Since literature suggests that the body shortage is influenced by reluctance to donate one's body, this study aimed to determine the perceptions of faculty, staff, and students regarding body donation for educational purposes at a new Dubai-based medical school. An online dually translated questionnaire was administered to the target population (322), of which 150 participants representative of faculty, staff, and students, responded. Although 111 (74.0 %) of participants considered body donation to be appropriate for educational and research purposes, only 44 (29.3 %) of participants expressed willingness to donate their bodies. Reluctance to donate 106 (70.7 %) appeared to be mostly influenced by religion, psychological barrier, and familial reasons. The emergence of four themes (i.e., resource, barrier, humanitarian, and awareness) and the identification of a potential donor group within the group that was willing to donate provided insight into the level of awareness within the university community. Furthermore, such findings may assist to establish future body donation programs and strategize recruitment approaches, especially when there is an ensuing dearth of anatomical donations.

Contribution of Arab world in transplant research: A PubMed-based bibliometric analysis

BACKGROUND

The Arab world consists of 22 countries situated in the Middle East and North Africa, tied together by linguistic and cultural bonds. Over numerous past decades, this region tended to fall behind regarding biomedical research. Organ, tissue, and cell transplantation are life-saving and life-improving treatments for various diseases. Given the positive correlation between research activity and the improvement of the clinical frame of transplantation, this article intended to examine the regional activity of transplantation research between 2005 and 2019.

METHODS

Using the PubMed database, the number of transplantation-related articles published by each country, and regarding 26 different procedures, was assessed. The results were normalized with respect to each country's average population & average Gross Domestic Product (GDP). In addition, the co-occurrence of keywords and the co-authorships were analyzed by VOS Viewer.

RESULTS

Arab countries contributed to 1.25% of total transplantation publications. The number of transplantation publications had an inflection in 2013, with the last six years alone contributing to 65.27% of the overall regional transplantation-related publications. Kuwait and Lebanon ranked first in terms of publications per million persons, while Egypt ranked first in terms of publications per national GDP. Stem cell, bone & kidney transplantations had the highest number of Arab transplantation-related publications. Low levels of collaboration between authors and organizations were observed, besides a modest but increasing trend towards experimental work on animals and newer therapies.

CONCLUSION

Despite the increase in transplant-related research activity in recent years, the Arab world still lags behind in this field compared to the worldwide contribution.