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Organ Donation. Donor Prevalence in Saudi Arabia Research Paper

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Table of Contents
Introduction
History of Organ Donation
Islam and organ donation
Basic Requirements for Organ Donation
Donor Prevalence in Saudi Arabia
Problems Encountered
A Way Forward
Conclusion
Bibliography

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Introduction

Donating organs does not pose a threat to the life of the donor; however, it can save the lives of many other people who need organ transplants. According to Health care professionals, organ donation is to give an organ or a part of an organ for transplantation into a recipient in need of a transplant. Organ donation can occur with a deceased donor; kidneys, pancreas, liver, lungs, heart, intestinal organs, as well as with a living donor; kidney, or a portion of the liver, lung, or intestine (Glossary of Terms).

According to Marijke Durning, who wrote an article about 10 FAQs on donations and transplantations, on December 23, 1954, Joseph Murray and his coworker had the first successful kidney transplantation. By taking his coworker’s kidney, the receiver body thought this kidney was his kidney and he didn’t feel that this kidney belonged to his coworker. Therefore, the opportunity of acceptance is successfully increasing. This transplant helped Joseph to live well for eight years (Durning, 2009).

Organ donation benefits both patients and their families. We can see the benefit through giving them and their families hope of living longer. But when people volunteer to donate their organs, society is promoting a higher level. Some of the most common types of organ donations are kidney and liver transplants since the human body has two kidneys and he only uses one, and the liver produces itself after splitting a part of it and donating it. These two types of organ donation are allowed by the jurists because they don’t harm the donor body. Also, the jurists allowed the case of donating after death because of the organs that can’t be transplanted during the donor’s life, for example, heart, pancreas, lungs, etc.

Organ donation became a very important topic in Saudi Arabia and the government provides many surveys for it. Nevertheless, people get confused about how the idea works in Saudi Arabia. In the situation of organ donation in Saudi Arabia, 91.1% of participants knew about the need for organ transplantation. On the other hand, 27.5% refuse to donate because they fear that their religion doesn’t allow organ donation. Furthermore, 42% agree to donate their organs after death but 3.5% believe that there’s no benefit for organ donation (Alam, 2007). However, the number of patients who need a donor has increased by 14% per year but the number of donors has increased with the number of 3% (Sunil). For people who want to become lifesavers in Saudi Arabia, all they have to do are to sign the organ donor card. The important organs that people can donate are kidneys, heart, lungs, liver, pancreas, and corneas. Organ donation will not cost your family. According to give life, all the cost of the donation process are paid by the recipients, the donor’s family have to pay for the health care before the death and funeral expenses.

History of Organ Donation

When we think of organ donation we think that it’s a new thing but actually, it’s not. Scientists were working on the organ donation process since the 16th. A 16-century drawing by Fernando del Rincon shows a transplant between a black man’s leg and his diseased leg. In the 17-century, Richard Lower did the first blood transfusion between two animals. After that, Jean-Baptiste tried to transfer the blood of an animal into a man but this caused his death. In 1902, Emerich Ullman and Alexis carrel did the first kidney transplantation between two animals. (Goldstein, 2000). Other more interesting facts include:

The first organ transplantation between two humans was a kidney donation in 1954. The donor and recipient were identical twins (Drs. Joseph Murray and John Harrison, Peter Bent Brigham Hospital)
The first lung transplant was in 1963. (Dr. James Hardy, University of Mississippi)
The first transplanted liver was in 1963. (Dr. Thomas Starzl, University of Colorado)
The first heart transplant was in1967
1968 Uniform Anatomical Gift Act passed by Congress making it legal to donate a deceased Individual’s organs and tissue for transplantation.
1968 First pancreas transplant. (Drs. Richard Lillche and William Kelly, University of Minnesota)
1981 First heart/lung transplant. (Drs. Norman Shumway and Bruce Reitz, Stanford Medical Center)
1983 First successful lung transplant. (Dr. Joel Cooper, Toronto General Hospital)
1984 First heart/liver transplant. (Dr. Starzl, Children’s Hospital of Pittsburgh)
1986 The first successful double lung transplant. (Dr. Joel Cooper, Toronto General Hospital)
1990 Medicare agrees to pay for liver transplants in adults 18 and older at approved sites, excluding cases where patients have liver cancer
1997 Vice President Al Gore, on behalf of the Department of Health and Human Services, announces a national organ and tissue donation initiative to increase donation 20% by 2000.
1999 The Department of Health and Human Services issues the amended “Final Rule” for Organ Procurement and Transplantation. Among the stipulations, it calls for a broader sharing of organs and more consistent medical criteria to be used for allocation. The goal is to make the allocation system fairer and to assure that patients with the most urgent medical conditions receive Transplants
Islam and organ donation

According to Alghamdi, A, Islam is one of the most fastidious religions in protecting the human body. For this reason, the donation was only allowed in the case of a living person if the transplantation process doesn’t harm the donor’s body. For example, the living person could donate hisher kidneys sense the human body contains 2 kidneys and it only needs one. Its liver because can produce itself after splitting a part of it.

Nowadays, and because of medical’s development. And since there are organs that can’t be transplanted from a living donor like heart, lungs, pancreas, etc. The jurists allowed taking these organs from a dead body as long as they won’t be sold.

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Basic Requirements for Organ Donation

The Saudi Arabian Law allows organ transplantation if the donor is a relative of the patient or clinically brain dead. This limitation has forced several patients to go abroad to get transplanted organs. By the year 2006 and because of the increase in the number of organ donations needed, the Saudi government allowed the non-relatives donors (Organ Donation in Saudi, 2006). So, signing the organ donor card and being above the age of 18 are the only required things of becoming a donor in KSA.

Donor Prevalence in Saudi Arabia

Saudi Arabia is a prominent force not only in the Middle East but also in world affairs mostly due to its strategic oil reserves. Furthermore, their stance on controversial issues like organ donation does set precedence for their neighbors in the Arab world. Organ donation in Saudi Arabia like many Muslim countries in the region is a topic that has been mostly swept under the carpet. Most people are not outrightly opposed to it; nor do they completely support it. It is more a question of lack of sufficient information in the public domain to generate an all-inclusive debate that will set the guidelines on how this issue should be handled.

Most of the people who are widely informed on this issue unfortunately are the ones who have been directly involved. Occasionally, they have been informed that a close relative or friend does require an urgent transplant and the first donors that come to mind are other close relatives or friends. This should not be regarded as a weakness in the system; even world leaders in the transplant sectors like the US and UK probably prefer that the recipients try to source organs first from close relatives and friends. What they have excelled in is creating a nationwide database where their citizens have been urged to participate in active organ donation upon their demise. In this system, recipients can post their details in this database and once an organ does become available and they are eligible, then they are received. The whole system works on a first come first serve basis to promote fairness.

Such kind of a system is what some stakeholders in Saudi Arabia are trying to perfect. Organ donation has to move from expecting your kidney or liver transplant from a relative or friend that you know. A patient’s options should be expanded such that he or she can receive these organs from areas as far as in the countryside from donors he has never met. All these can be achieved through increasing public awareness. A study was conducted by the Saudi Centre of Organ Transplantation (SCOT) in 2005. 948 Saudi citizens were studied in the research which was evaluating their knowledge and attitudes with regards to organ donation and transplantation. The research hoped to bring to the forefront issues that directly affect organ donation and transplantation in the kingdom. These include religion, the varied attitudes, and knowledge of the procedures involved in transplantation, and personal experiences of people who have gone through the procedure.

Problems Encountered

Some of the statistics were quoted earlier in the essay but the two major demographics that are of particular interest in this essay are the 27.5% who feared the procedure contradicted their beliefs in Islam and the 36.1% who could not offer their opinion on the issue due to lack of knowledge. Even if the study only focused on 948 citizens, it is quite shocking that 36.1% of them were not well informed on the topic. The 27.5% who had reservations about the procedure are understandable since the nation’s policies and day-to-day functions by its citizens are strongly influenced by Islam. The challenge, therefore, was to increase public awareness on the topic but at the same time also sensitize the public that the procedure does not contravene the beliefs of Islam. SCOT recommended that this could be achieved through strong government support that will be backed by strong recommendations from respected religious scholars.

The situation is quite different when you compare it to the west where the biggest criticism is usually raised when people who have damaged their lungs, livers, and kidneys through excessive consumption of alcohol and cigarettes compete for the same organs with other sick patients who can only blame bad luck for their current predicament. It is highly unlikely such a debate will arise in Saudi Arabia due to the strong anti-drug policy of Islam that its citizens follow. The biggest obstacle to this venture however will prove to be Islam itself. A recent report by Arab News which was trying to drum up support for organ donation in the kingdom stated that senior Saudi clerics have been advocating for the procedure since the 1930s. Adding to this, their stance was also supported by other clerics across the Islamic world which now raises the question; where did all this sense of doubt between Islam and organ donation originate from? The major contributor according to the report was a great deal of ignorance that had existed in the country and still does.

This explains the 36.1% in the SCOT research that did not know the procedure. The ignorance could stem from not only the citizen’s resistance to absorb and accept “new information” but also the type of material being put out there by the broadcasters and editors of the country’s newspapers. Understandably, a lot of the foreign content from the west will be filtered due to the extremely conservative nature of Saudi society. Such a measure has probably proved to be a double-edged sword. It is a problem that has resonated in other Muslim countries in the Middle East. Another factor that has further complicated the issue is the lack of clarity in the definition of death. The exact time of death should be stated before organ harvesting can begin from a donor’s body. A person can be brain-dead whereby his brain is not showing any activity but is only “alive” due to the aid of breathing machines. Then there is the other common definition of death where your lungs, heart, and brain have all stopped functioning. The leaders in Saudi Arabia appear to be sitting on the fence with this issue and therefore a lot of the weight is being carried by the doctors who are directly involved in the procedure. The problem is also common in the west. Most health experts think that a person who is brain dead should qualify to have his organs removed as long as their legal guardians give the consent to turn of the breathing machines. The sooner the organs are extracted within the 4-6 hour window, the better for the recipient who is going to use them. It is understandable why the various policymakers in the kingdom are tossing the issue around like a hot potato. The Muslim religion is quite uneasy with the handling of dead persons instead of preferring the person to be buried whole as soon as possible. Conducting post-terms does raise some storm amongst the family members and this understates how difficult it would be to obtain organs from a person who is brain dead but is still alive due to the aid of machines.

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Another reason for the misinformation or lack of it is the sale and buying of organs is sort of a grey area. While the selling of organs is strongly prohibited, not much has been said about the buying part. It is this “loophole” that has been exploited by desperate relatives and patients who go to countries like India and the Philippines to buy organs. They feel they are morally obliged to do so out of desperation and the fact that the Islamic clerics haven’t vehemently opposed it. Such justification has however not been transferred to organ donation. Awareness being raised in this issue is mostly to discourage the organ trade in South East Asia because of the physical and financial exploitation that is taking place.

A Way Forward

More efforts should instead be directed to changing the mentality of many Saudis who believe that organ donation is a favor instead of an obligation. Most Saudis that are willing to donate organs think that they can do it after death which is not a straight answer since the decision to donate or not to will be up to their legal guardians; not them. Those who say they are willing should instead enter into a contract with the government where doctors will be legally bound to take their liver or kidney upon their demise. In the US, “the citizens are asked if they wish to be organ donors while they are obtaining their driver’s license.”(Alam, 2000) If they agree, then their details are fed into the database and the only bone of contention that should arise when donating these organs will be declaring the official time of death. It is a simple system that takes the pressure of your legal guardians in deciding whether or not to donate your organs. I believe since some of the kingdom’s citizens have already shown willingness in purchasing organs in other countries, a similar system to the one in the US should be adapted and priority should be given to patients who had previously agreed to donate their organs but are now in a position of requiring one. This does not mean that those who never signed up for organ donation should be ignored; they will also receive if they are a match but if the decision comes down to a 50-50 split between two patients, then the one who agreed to donate his organs should receive a higher rating. Such a measure will increase the number of people signing up because most people will be scared of missing out on a transplant due to some technicality. The main reason however is people who have contributed the most to a particular service is should be the ones who benefit from it the most. It’s crude, but it’s fair.

Other efforts by Islamic scholars have been undertaken to educate the public on the importance of organ donation. An Islamic scholar like Dr. Mohammad Haytham Al-Khayat has added his voice in recommending this procedure. He said that organ donation “is a kind of sadaqah jariya,” (Scroff, 2009) which translates to an “act of charity whose benefits continue after a person passes away.”(Schroff 2009). Furthermore “leading Islamic scholars in Kuwait some years ago endorsed organ donation and organ transplantation.”(Schroff, 2009) These scholars however still believe that a person has to be 100% dead before their organs can be taken out; being brain dead does not qualify. The scholars justified their position by drawing on the core beliefs of Islam; which is the saving of life.

Allah will greatly reward those who save their fellow brothers and sisters from death; when they donate their organs. Though the violation of a person’s body, whether living dead is strongly prohibited, an exception can be made. The first is if it is necessary and the second if it is for saving another person’s life. “It is this Islamic legal maxim al-durant tub al-mahurat (necessities overrule prohibition) that has great relevance to organ donation.”(Schroff, 2009) Necessary quotations from the Koran have been given to support this claim. “Whosoever saves the life of one person it will be as if he saved the life of all mankind” – Holy Qur’an Chapter 5 vs. 32 (Schroff, 2009). Sheikh Dr. MA Zaki Badawi, Principal, Muslim College, London further adds by saying “If you happened to be ill and in need of a transplant, you certainly would wish that someone would help you by providing the needed organ.” (Schroff, 2009).

Conclusion

It is clear now that the hiccups in the system that were blamed on religion are really non-existent. It is more a case of ignorance and people making their own assumptions. The Saudi Kingdom could start by asking prospective donors to be carrying their donor cards to ease their identification in case there, unfortunately, pass away and their organs are required urgently. As to the determination of the time of death, this is not a question the Islamic scholars should be asked; that authority should lie squarely with the medical professionals since they are the best judges in this field. I think it is highly unlikely that a doctor will pronounce a person dead just to get their organs if there is a minute chance that they may save his life. In conclusion, public awareness programs should be encouraged to increase organ donation as it is the only way of reversing the misconceptions that exist. “Whosoever helps another will be granted help from Allah.”- Prophet Muhammad. (Schroff, 2009)

Bibliography
Glossary of Terms. Gift of life.
Durning, M. (2009). 10 FAQs on donation and transplantation. Blisstree.
Alam AA. Public Opinion on Organ Donation in Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2009];18:54-9. Web.
Shroff, Sunil Ethical Issues Related to Organ Donation.
Give a Life.

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