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The Doha Donation Accord Aligned With the Declaration of Istanbul: Implementations to Develop Deceased Organ Donation and Combat Commercialism

Alkuwari, Hanan1; Fadhil, Riadh1,2; Almaslamani, Yousef1; Alansari, Abdalla1; Almalki, Hassan1; Khalaf, Hatem1; Ali, Omar1

doi: 10.1097/01.TP.0000437564.15965.2e
The Transplantation Society Regional Perspective
Free
SDC

1 Hamad Medical Corporation, Doha, Qatar.

2 Address correspondence to: Riadh A.S. Fadhil, M.B.Ch.B., F.R.C.S., Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.

The authors declare no funding or conflicts of interest.

E-mail: rfadhil@hmc.org.qa, riadhfadhil@yahoo.com

H.A. participated in performing the research. R.F. participated in performing the research and writing the article. Y.A. participated in performing the research. A.A. participated in performing the research. H.A. participated in performing the research. H.K. participated in performing the research. O.A. participated in performing the research.

Received 2 October 2013.

Accepted 24 October 2013.

Accepted November 27, 2013

Qatar is a Gulf peninsula country of approximately 1.7 million people, with a multicultural society of more than 80% non-citizen residents, mostly expatriate workers of Middle Eastern and Asian origin. Qatar ranks highly on the Human Development Index, with the highest health index in the Arab world (1). The first kidney transplant in Qatar was performed in 1986. Since then, lack of donors in Qatar has compelled most patients with end-stage renal disease to seek commercial transplantation abroad, returning to Qatar with high postoperative complications (68%) and a high early postoperative mortality of 12% (2, 3).

Hamad Medical Corporation (HMC) is the main tertiary healthcare facility in Qatar. Following the publication of the Declaration of Istanbul (DoI) in 2008 (4), HMC adopted the recommendations of the Declaration by launching the Doha Donation Accord (DDA) in 2010 (5). The DDA has been developed by HMC and the Qatari Supreme Council of Health, in consultation with the Declaration of Istanbul Custodian Group (DICG), so as to meet needs for transplantation locally, thereby discouraging Qatari patients from undergoing commercial transplantation abroad. The DDA is thus intended to develop deceased organ donation and live related kidney transplantation in Qatar, leading to the eventual achievement of national self-sufficiency.

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Principles Underpinning the DDA

The primary objective of transplant policies and programs should be the promotion of health through provision of optimal care to both donors and recipients. Financial considerations or material gain of any party must not override consideration for the well-being of donors and recipients, nor influence the application of relevant organ allocation rules. Consistent with the Qatari Transplant law 21 of 1997 (6) and the World Health Organization Guiding Principles on Human Cell, Tissue and Organ transplantation (7), the DDA prohibits trade in human organs and financial rewards for organ donation. Qatar is notable for the fact that organs for transplantation are equitably allocated within Qatar to suitable Qataris and expatriate patients residing in Qatar alike, without regard to citizenship status.

The acts of heroism by all donors whether living or deceased are acknowledged by a representative of the Qatari government, awarding a medal of honor to the live donor or the deceased donor family in recognition of their gift of life.

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DDA Provisions for Live Donors

A comprehensive health insurance for life while residing in Qatar is provided for the live related donor following donation and irrespective of the medical condition requiring care, regardless of their nationality or employment status.

A medical condition identified before donation that renders a potential donor medically unsuitable will be cared for without cost to the potential donor.

HMC covers expenses incurred during evaluation for donation and surrounding the donation procedure until discharge from hospital.

Disability insurance is provided in accordance with national norms if a disability occurs as a complication of the donation process, inclusive of the evaluation and postoperative periods.

If the live donor develops end-stage organ failure, they receive an allocation priority for transplantation.

Provisions of the DDA are accessible only by related live donors and recipients residing in Qatar (Qatari and expatriates), and not by visitors.

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DDA Provisions for Families of Deceased Donors

Counseling and travel support for families of the deceased organ donor will be provided as necessary at the time of donation. Transfer of the coffin of the deceased to the homeland of an expatriate worker is assured by Qatari regulation. No money is provided directly to the family of the deceased. In the course of their engagement with potential donor families, donor coordinators may also facilitate referral to social support services where needed, irrespective of whether consent is provided for donation. Of note, access to financial and other supports through the hospital social work program and Qatar charities is available to all families of deceased patients at HMC.

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The Deceased Donation Program

As all Qatari and expatriate individuals register for healthcare at the HMC, there will be an opportunity to register as a deceased organ and tissue donor. Because of a nationwide campaign, the donor registry has now more than 19,000 registrants in the year since its launch. Since January 2011, the deceased donation consent rate has gradually increased to one consent per month on average in 2013 compared with one per year before 2011. Because more than 80% of the potential donors are expatriate workers living alone in Qatar with their families abroad, the multicultural and multilinguistic team of donation coordinators and social workers develops a supportive relationship with the donor family independent of the intensive care unit team.

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Qatari Transplantation Currently

Since the deceased donation program launched in January 2011, 25 organs have been retrieved and transplanted from 10 deceased donors, including 16 kidney and 4 liver transplants in Doha, with the remaining organs shared with Saudi Arabia. Of the 20 transplants performed in Doha, 3 were allocated to Qataris and 17 to non-citizen residents. The introduction of liver transplantation in Doha (8) has made it possible for patients to receive care locally, avoiding the medical and ethical hazards of transplant travel. Furthermore, the number of related living donor kidney transplants has quadrupled over the last 12 months. The proportion of Qatari citizens in need of transplantation who choose to be waitlisted in Qatar has risen from 21% in 2010 to 73% this year, consistent with international findings that strengthening national programs discourages transplant travel (9).

With the endorsement of Her Highness, Sheikha Moza bint Nasser, a meeting involving 70 members of the DICG was held in Doha, from April 12 to 14, 2013, to mark the fifth anniversary of the Declaration and to evaluate progress in implementing its principles and recommended proposals (10). Participants noted the encouraging development of organ donation in Qatar, recognizing that for the DDA to achieve its goals, a sustained progress in the deceased donation program is essential. The DDA is poised with the alliance of the DoI to establish a legacy of transplantation that is a celebration of the gift of life from one individual to another, regardless of race, ethnicity, or gender.

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ACKNOWLEDGMENTS

Hamad Medical Corporation is appreciative for the support and leadership of Professors Francis Delmonico and Jeremy Chapman in collaboration with the Declaration of Istanbul Custodian Group in the development of the national organ donation program.

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REFERENCES

1. United Nations Development Program. International Human Development Indicators. Country profile for Qatar. 2013. Available at: http://hdrstats.undp.org/en/countries/profiles/QAT.html [Accessed September 19, 2013.]
2. Riadh AS, Fadhil R, Moslemani Y, et al. The outcome of commercial kidney transplantation: a Qatari study on preoperative and post-transplant follow-up records of patients having commercial renal transplantation abroad. Transplantation 2008; 86: 292.
3. Riadh AS, Fadhil R, Althani H, et al. Trichosporon fungal arteritis causing rupture of vascular anastamosis after commercial kidney transplantation: a case report and review of literature. Transplant Proc 2011; 43: 657.
4. Participants in the International Summit on Transplant Tourism and Organ Trafficking convened by The Transplantation Society and International Society of Nephrology in Istanbul, Turkey, 30 April to 2 May 2008. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism Kidney Int 2008; 74: 854.
5. The Doha Donation Accord. 2010. Available at: http://organdonation.hamad.qa/en/images/Doha_Donation_Accord.pdf [Accessed September 19, 2013.]
6. Qatari Organ Donation and transplantation Law 21/1997. Available at: http://www.gcc-legal.org/MojPortalPublic/LawAsPDF.aspx?opt&country=3&LawID=2838 [Accessed September 19, 2013.]
7. World Health Organization. Guiding principles on human cell, tissue and organ transplantation. Transplantation 2010; 90: 229.
8. Khalaf H, Derballa M, Elmasry M, et al. First liver transplant in Qatar: an evolving program facing many challenges. Exp Clin Transplant 2013; 11: 423.
9. Padilla B, Danovitch GM, Lavee J. Impact of legal measures prevent transplant tourism: the interrelated experience of The Philippines and Israel. Med Health Care and Philos 2013; 1.
10. Danovitch GM, et al. Organ trafficking and transplant tourism: the role of global professional ethical standards—the 2008 Declaration of Istanbul. Transplantation 2013; 95: 1306.
Keywords:

Doha accord; Donation; Commercialism

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