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DOI: 10.4103/ijmbs.ijmbs_16_21
Solid organ transplantation medicine in Arab countries: A Narrative Review Focused on Ethical Aspects
Introduction: Ethical issues have been at the center of transplantation medicine for the past 60 years. Arab countries are not without ethical concerns with living donations as the dominant type of organ source. There is no comprehensive review of the ethical consideration evolvement. This narrative review aims to examine the English medical literature over the past 25 years. Materials and Methods: This is a narrative review of the international literature from two online databases (PubMed and Scopus). The combined search term “Ethics and Transplantation” was coupled with the individual names of the countries of the Arab countries. Relevant literature was narrated in a concise thematic account. Results: The themes that emerged from the review process included global concern on transplantation ethics that touched on the Middle East and North Africa (MENA) region. Some reports on transplantation practice status in the MENA region address clinical practice, organization, and ethical considerations. Organ-specific reports focused on renal and liver transplantation. Several other researchers addressed the knowledge and attitudes of health-care professionals of transplantation and posttransplantation care. The ethics of transplantation medicine has focused on the donation and financially motivated provision of organs (mainly kidneys). A few authors have underscored the implications of the Istanbul declaration on the prevention of trafficking of human organs to the practice of transplant medicine. Being a Muslim-majority region, several authors addressed the ethical and medicolegal aspects of transplantation from an Islamic perspective. Conclusions: Ethical issues in transplantation are evolving in Arab countries. They are mostly related to religious and cultural backgrounds. A broader dialog between the medical community, Islamic scholars, and legislators must continue to align concepts such as brain death and donor compensation. Furthermore, a concerted effort is required to inform the public and further the transplant agenda.
Key-words:
Arab countries - ethics - Islamic - kidney - liver - medico-legal - middle east - North Africa - organ donation - organ transplantation - reviewFinancial support and sponsorship
Nil.
Publication History
Received: 22 February 2021
Accepted: 22 February 2021
Article published online:
14 July 2022
© 2021. The Libyan Authority of Scientific Research and Technologyand the Libyan Biotechnology Research Center. All rights reserved. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License,permitting copying and reproductionso long as the original work is given appropriate credit. Contents may not be used for commercial purposes, oradapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Murray JE. The first successful organ transplants in man. J Am Coll Surg 2005;200:5-9.
- 2 GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020;395:709-33.
- 3 Yang CW, Harris DC, Luyckx VA, Nangaku M, Hou FF, Garcia Garcia G, et al. Global case studies for chronic kidney disease/end-stage kidney disease care. Kidney Int Suppl (2011) 2020;10:e24-48.
- 4 Bello AK, Alrukhaimi M, Ashuntantang GE, Bellorin-Font E, Benghanem Gharbi M, Braam B, et al. Global overview of health systems oversight and financing for kidney care. Kidney Int Suppl (2011) 2018;8:41-51.
- 5 Van Biesen W, Jha V, Abu-Alfa AK, Andreoli SP, Ashuntantang G, Bernieh B, et al. Considerations on equity in management of end-stage kidney disease in low- and middle-income countries. Kidney Int Suppl (2011) 2020;10:e63-71.
- 6 Fitzgerald A, Mayrhofer-Reinhartshuber D, Suske M, Fitzgerald RD. Recent thoughts about the ethics of renal transplantation. Saudi J Kidney Dis Transpl 2005;16:540-6.
- 7 Masri M, Haberal M. Solid-organ transplant activity in MESOT countries. Exp Clin Transplant 2013;11:93-8.
- 8 Freeman RB, Bernat JL. Ethical issues in organ transplantation. Prog Cardiovasc Dis 2012;55:282-9.
- 9 Daar AS. Ethical issues a Middle East perspective. Transplant Proc 1989;21:1402-4.
- 10 Abouna GM, Kumar MS, Samhan M, Dadah SK, John P, Sabawi NM. Commercialization in human organs: A middle eastern perspective. Transplant Proc 1990;22:918-21.
- 11 Bakdash T, Scheper-Hughes N. Is it ethical for patients with renal disease to purchase kidneys from the world's poor? PLoS Med 2006;3:e349.
- 12 Chamsi-Pasha H, Albar MA. Kidney transplantation: Ethical challenges in the Arab world. Saudi J Kidney Dis Transpl 2014;25:489-95.
- 13 Chamsi-Pasha H, Chamsi-Pasha MA, Albar MA. Ethical challenges of deactivation of cardiac devices in advanced heart failure. Curr Heart Fail Rep 2014;11:119-25.
- 14 Daar AS. Organ donation—world experience; the Middle East. Transplant Proc 1991;23:2505-7.
- 15 Albar M. Organ transplantation: A Sunni Islamic perspective. Saudi J Kidney Dis Transpl 2012;23:817-22.
- 16 Ebrahim AF. Organ transplantation: Contemporary Sunni Muslim legal and ethical perspectives. Bioethics 1995;9:291-302.
- 17 Daar AS. The body, the soul and organ donation: Beliefs of the major world religions. Nefrologia 1994;14:78-81.
- 18 Paris W, Nour B. Organ transplantation in Egypt. Prog Transplant 2010;20:274-8.
- 19 Hamdy S. Not quite dead: Why Egyptian doctors refuse the diagnosis of death by neurological criteria. Theor Med Bioeth 2013;34:147-60.
- 20 Daar AS, Salahudeen AK, Pingle A, Woods HF. Ethics and commerce in live donor renal transplantation: classification of the issues. Transplant Proc 1990;22:922-4.
- 21 Hamdy S. Our Bodies Belong to God: Organ Transplants, Islam, and the Struggle for Human Dignity in Egypt. Berkeley: University of California Press, 2012. ISBN 9780520271760.
- 22 Muliira RS, Muliira JK. A review of potential Muslim organ donors' perspectives on solid organ donation: Lessons for nurses in clinical practice. Nurs Forum 2014;49:59-70.
- 23 Alwadaei S, Almoosawi B, Humaidan H, Dovey S. Waiting for a miracle or best medical practice? End-of-life medical ethical dilemmas in Bahrain. J Med Ethics 2019;45:367-72.
- 24 Daar AS, Salahudeen AK, Pingle A, Woods HF. Ethics and commerce in live donor renal transplantation: Classification of the issues. Transplant Proc 1990;22:922-4.
- 25 Almaslamani Y, Almalki H, Fadhil R, Khalaf H, Asim M. Transplantation in Qatar. Transplantation 2016;100:2487-8.
- 26 Asim M, Al-Maslamani Y, Al-Malki H. Safe and ethical living kidney donation in Qatar: A national health system's approach. Qatar Med J 2017;2017:3.
- 27 Abdeldayem H, Kashkoush S, Hegab BS, Aziz A, Shoreem H, Saleh S. Analysis of donor motivations in living donor liver transplantation. Front Surg 2014;1:25.
- 28 Wahab MA, Hamed H, Salah T, Elsarraf W, Elshobary M, Sultan AM, et al. Problem of living liver donation in the absence of deceased liver transplantation program: Mansoura experience. World J Gastroenterol 2014;20:13607-14.
- 29 Al-Khader AA, Al-Sulaiman M. How to recognize an unwillng kidney donor. Saudi Med J 1992;13:1-3.
- 30 Daar AS. Living-organ donation: Time for a donor charter. Clin Transpl 1994;13:376-80.
- 31 Al-Khader AA. A model for scoring and grading willingness of a potential living related donor. J Med Ethics 2005;31:338-40.
- 32 AlBugami MM, AlOtaibe FE, Alabadi AM, Hamawi K, Bel'eed-Akkari K. Transplant tourism following the declaration of Istanbul: Poor outcomes and nephrologist dilemma. Nephrology (Carlton) 2018;23:1139-44.
- 33 Physicians attitudes toward living non-related renal transplantation (LNRRT). The Living non-Related Renal Transplant Study Group. Clin Transplant 1993;7:289-95.
- 34 Tebourski F, Jaouadi N, Ben Alaya D, Benamar-Elgaaied A, Ayed M. Attitude of health personnel to organ donation and transplantation. Tunis Med 2003;81:482-7.
- 35 Alsultan M. The perception of organ donation among health-care providers in the intensive care units at a tertiary center. Saudi J Kidney Dis Transpl 2012;23:724-8.
- 36 Hammami MM, Abdulhameed HM, Concepcion KA, Eissa A, Hammami S, Amer H, et al. Consenting options for posthumous organ donation: Presumed consent and incentives are not favored. BMC Med Ethics 2012;13:32. https://doi.org/10.1186/1472-6939-13-32.
- 37 Hachicha J, Yaich S, Charfeddine K, Masmoud M, Jarraya F, Kharrat M, et al. Living and cadaver donor transplant programs in the Maghreb. Saudi J Kidney Dis Transpl 2013;24:150-6.
- 38 Flayou K, Kouam N, Miara H, Raoundi O, Ouzeddoun N, Benamar L, et al. Attitudes toward organ donation among personnel from the University Hospital of Rabat. Saudi J Kidney Dis Transpl 2016;27:758-61.
- 39 Alashek W, Ehtuish E, Elhabashi A, Emberish W, Mishra A. Reasons for unwillingness of libyans to donate organs after death. Libyan J Med 2009;4:110-3.
- 40 Hammad S, Alnammourah M, Almahmoud F, Fawzi M, Breizat AH. Questionnaire on brain death and organ procurement. Exp Clin Transplant 2017;15:121-3.
- 41 El Hangouche AJ, Alaika O, Rkain H, Najdi A, Errguig L, Doghmi N, et al. Knowledge, attitudes, and practice of organ donation in Morocco: A cross-sectional survey. Saudi J Kidney Dis Transpl 2018;29:1358-65.
- 42 Alam AA. Public opinion on organ donation in Saudi Arabia. Saudi J Kidney Dis Transpl 2007;18:54-9.
- 43 Tarzi M, Asaad M, Tarabishi J, Zayegh O, Hamza R, Alhamid A, et al. Attitudes towards organ donation in Syria: A cross-sectional study. BMC Med Ethics 2020;21:123.
- 44 Al-Labadi L, Gammoh Y, Shehada R, Shahin R, Jbarah W, Amro M, et al. University students' knowledge of corneal donation and willingness to donate corneas in the occupied Palestinian territory: A cross-sectional study. Lancet 2018;391 Suppl 2:S22.
- 45 Budiani-Saberi D, Mostafa A. Care for commercial living donors: The experience of an NGO's outreach in Egypt. Transpl Int 2011;24:317-23.
- 46 Al Rahbi F, Al Salmi I. Commercial kidney transplantation: Attitude, knowledge, perception, and experience of recipients. Kidney Int Rep 2017;2:626-33.
- 47 Shimazono Y. The state of the international organ trade: A provisional picture based on integration of available information. Bull World Health Organ 2007;85:955-62.
- 48 Participants in the International Summit on Transplant Tourism and Organ Trafficking. The declaration of Istanbul on organ trafficking and transplant tourism. Exp Clin Transplant 2008;6:171-9.
- 49 Danovitch GM, Chapman J, Capron AM, Levin A, Abbud-Filho M, Al Mousawi M, et al. Organ trafficking and transplant tourism: The role of global professional ethical standards-the 2008 Declaration of Istanbul. Transplantation 2013;95:1306-12.
- 50 Martin DE, Van Assche K, Domínguez-Gil B, López-Fraga M, Budiani-Saberi D, Lavee J, et al. Prevention of transnational transplant-related crimes-what more can be done? Transplantation 2016;100:1776-84.
- 51 Domínguez-Gil B, Danovitch G, Martin DE, López-Fraga M, Van Assche K, Morris ML, et al. Declaration of Istanbul Custodian Group working group on ethical travel for transplantation. Management of patients who receive an organ transplant abroad and return home for follow-up care: Recommendations from the declaration of Istanbul custodian group. Transplantation 2018;102:e2-9.
- 52 Delmonico FL. The implications of Istanbul declaration on organ trafficking and transplant tourism. Curr Opin Organ Transplant 2009;14:116-9.
- 53 Alsharif MJ, Labonté R, Lu Z. Patients beyond borders: A study of medical tourists in four countries. Global Soc Policy 2010;10:315-35.
- 54 Commercially motivated renal transplantation: Results in 540 patients transplanted in India. The Living Non-Related Renal Transplant Study Group. Clin Transplant 1997;11:536-44.
- 55 Qunibi WY. Commercial renal transplantation: Clinical and ethical issues. Ann Saudi Med 1994;14:1-4.
- 56 Ben Hamida F, Ben Abdallah T, Goucha R, Hedri H, Helal I, Karoui C, et al. Outcome of living unrelated (commercial) renal transplantation: Report of 20 cases. Transplant Proc 2001;33:2660-1.
- 57 Abdeldayem HM, Salama I, Soliman S, Gameel K, Gabal AA, El Ella KA, et al. Patients seeking liver transplant turn to China: Outcomes of 15 Egyptian patients who went to China for a deceased-donor liver transplant. Exp Clin Transplant 2008;6:194-8.
- 58 Al Riyami MS, Al Saidi S, Al Ghaithi B, Al Maskari A, Lala S, Mohsin N, et al. Pediatric renal transplantation in Oman: A single-center experience. Oman Med J 2018;33:7-14.
- 59 Mohsin N, Al-Busaidy Q, Al-Marhuby H, Al-Lawati J, Daar AS. Deceased donor renal transplantation and the disruptive effect of commercial transplants: The experience of Oman. Indian J Med Ethics 2014;11:153-6.
- 60 Budiani-Saberi D, Columb S. A human rights approach to human trafficking for organ removal. Med Health Care Philos 2013;16:897-914.
- 61 Al Sebayel M, Alenazi AM, Sabbagh R, Al Ageel T, Al Enazi M, Al Bahili H, et al. Donor organ shortage crisis: A case study review of a financial incentive-based system. Transplant Proc 2014;46:2030-5.
- 62 Shaheen FA, Souqiyyeh MZ, Attar B, Ibrahim A, Alsayyari A. Organ donation from deceased donors: A proactive detection program in Saudi Arabia. Exp Clin Transplant 2015;13 Suppl 3:1-3.
- 63 SCOT Data. Organ transplantation in Saudi Arabia-2013. Saudi J Kidney Dis Transpl 2014;25:1359-68.
- 64 Khedmat H, Taheri S. Ethical disputes in living donor kidney transplantation: What should we do to save lives? Saudi J Kidney Dis Transpl 2010;21:971-4.
- 65 Yacoubian AA, Dargham RA, Khauli RB. A review of the possibility of adopting financially driven live donor kidney transplantation. Int Braz J Urol 2018;44:1071-80.
- 66 Khetpal V, Mossialos E. An ethical appraisal of living-anonymous kidney donation using Adam Smith's Theory of Moral Sentiments. Health Policy 2018;122:1212-21.
- 67 Zamperetti N, Bellomo R, Ronco C. Defining death in non-heart beating organ donors. J Med Ethics 2003;29:182-5.
- 68 Zmerli S. History, law and ethics of kidney transplantation through my experience of 60 patients. Tunis Med 2009;87:3-5.