The shortcomings of organ donation in the Arab world

More than three-quarters of Tunisians asked said they accept the principle of post-mortem organ donation but don’t do it.
Sunday 07/04/2019
In need of hope. A Palestinian man undergoes kidney dialysis at al-Shifa hospital in Gaza City. (Reuters)
In need of hope. A Palestinian man undergoes kidney dialysis at al-Shifa hospital in Gaza City. (Reuters)

Sociologists in the Middle East and North Africa have said reluctance to participate in organ donation in the Arab world is because the culture of donating organs is lacking.

This is different from Western societies where great effort is devoted to promoting organ donation, resulting in high levels of social acceptance of the principle. In Germany, for example, 84% of the population accepts to donate organs.

In the Arab world, however, in addition to poor health services and infrastructure and less of an effort to raise awareness, there is an absence of social solidarity and a serious regression in humanitarian generosity, with deteriorating economic conditions and rising cost of living. Amid economic crisis conditions, governments often relinquish their educational duties in this domain.

Abdessattar Sahbani, a Tunisian professor of sociology, said: “The root cause of the problem is the absence of an organ donation culture. In addition, the authorities have done little to incentivise citizens to donate organs while media outlets do not give this matter any importance.”

Sahbani said that there is no clear stance on the issue, either from political or religious authorities.

“There is another reason,” he added, “and that is corruption, which was behind cases of theft and fraud and that has led people to mistrust the whole system. Examples of this are many, so organ donation is mostly perceived as a commercial rather than humanitarian action.”

Habib Riahi, another sociologist, agreed that the near absence of organ donation in Tunisia is because of the absence of a social culture of donation. “Society operates according to cultural models and patterns rooted in religious beliefs that do not accept the principle of organ donation,” he said.

In this respect, opinions of religious scholars about organ donations vary from totally rejecting it, because it is a form of disrespecting the dead, to allowing it because it is a humanitarian act.

“The issue of organ donation should not be looked at from a traditional angle or from a purely religious angle,” said Tunisian religious scholar Sheikh Badri Madani. “Rather, it must be addressed from legislative, humanitarian, medical and financial perspectives.

“Scholars don’t agree on this matter. Some have allowed it, while others refused to decide and still others have banned it in its totality while some have allowed it when the transaction is from a live person to another live person, especially in kidney transplants that do not put donors at risk.”

Madani said that banning organ donations stem from the belief that it is a form of tempering with a cadaver, which is not allowed in Islam. Some scholars, however, argued that it was acceptable if the dead person had left instructions to that effect.

Despite these constraints and general confusion surrounding organ donation in the Arab world, there have been positive developments in some Arab countries, such as Kuwait, the United Arab Emirates and Morocco, where the governments are expanding efforts to promote the culture of organ donation.

Media in Kuwait reported that the Kuwaiti Ministry of Health announced last year that Kuwait was ranked first in the Arab world in the number of post-mortem donors. In February 1979, Kuwait became the first Gulf country to undertake a kidney transplant. Kuwait leads the Middle East in terms of the number of kidney transplants, with 80-100 operations performed annually.

Morocco recorded 43% of the total of transplant operations in the region in recent years. The country has made progress in the area of tissue and organ transplants but despite this effort, the number of donors remains insufficient to meet the need for organ and tissue donors.

In a country like Sudan, financial hardship represents the biggest obstacle to building a culture of organ donation, Sudanese author Usama Al Nour Abd El Sayyed said. He said kidney dialysis centres do operate in Khartoum and in a few other cities but they are hardly sufficient.

Sayyed said that organ donation practice in Sudan was limited to the patients’ immediate family members and relatives. That is why many Sudanese patients seek treatment abroad, especially in neighbouring Egypt.

There are also widespread rumours in the Arab region of organ trafficking and organ trading scams. People often mention hearing of cases in which potential donors are lured by criminals and their organs harvested and sold. In Tunisia, the group Doctors against Corruption said it had received several complaints from citizens who lost organs in private clinics.

Organ trafficking is widespread. Estimates released by the World Health Organisation (WHO) in 2015 state there were more than 10,000 illegal human organ trading operations and 5-10% of all kidney transplants worldwide were conducted through cross-border trafficking and smuggling.

Human organ trafficking produces $600 million-$1.2 billion annually, the WHO said. Other sources estimate profits are as much as $8 billion dollars a year.

Fadhel Bedhiefi, vice-president of the Tunisian League of Human Rights, described human organ trafficking as “a criminal act that deprives needy patients from the chance of having their lives saved, harms humanitarian action, and tarnishes the image and spirit of organ donation in societies.”

Statistics in Tunisia indicate people are reluctant to accept the concept of organ donation. More than three-quarters of Tunisians asked said they accept the principle of post-mortem organ donation but don’t do it. About 90% of Tunisian families said they are against donating the organs of their dead and heart transplants have completely stopped since 2011 because no appropriate donor was found.

These numbers were confirmed by Tahar Gargah, head of the National Centre for the Promotion of Organ Transplant (CNPTO), a public institution. Gargah said: “We have found that 90% of Tunisian families rejected organ donation and this number is alarming.”

“We can provide everything to ensure the success of surgery but what’s the use if we can’t find a donor,” he added.

He noted that there are 10,500 patients undergoing dialysis and in need of organ transplants. CNPTO alone has 1,500 patients on the waiting list for a kidney transplant. The situation is even more critical when it comes to patients suffering from heart diseases because of the risk of dying quickly if they do not receive new organs.

Gargah said the Tunisian Ministry of Health needs to perform 50 heart transplant operations annually and 200-300 liver transplants. Every year, there are 20-30 patients on the waiting list for a lung transplant. However, the number of donors is almost nil.

The number of patients on the kidney transplant waiting list reached 1,416 in 2018 but the number of transplants performed the previous year was only 78.

The picture is not as gloomy when it comes to corneal transplants. The number of such operations performed in 2018 reached 994. This is considered a positive result, especially when the number of patients on the waiting list is at 1,270.

Gargah said Tunisians’ resistance to organ donation can be attributed to a lack of awareness and encouragement campaigns. He pointed out that the Ministry of Health is setting up a new strategy involving civil society and all government agencies and ministries.

This is not just a health issue, he said, adding that society as a whole must be engaged and that much needs to be done to promote the culture of organ donation among younger citizens.

Gargah added that it is necessary to improve the means of awareness raising through greater involvement of the media to build confidence in the health sector through the improvement of services offered to the public.

However, the public health sector, like many other public sectors, suffers from poor services and inadequate infrastructure, in addition to a shortage of medical doctors in hospitals in rural areas. This has led to mistrust of local public health institutions, negatively affecting organ donation in Tunisia.