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Saudi Journal of Kidney Diseases and Transplantation
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Year : 1999  |  Volume : 10  |  Issue : 2  |  Page : 161-162
Commercial Living-Unrelated Renal Transplantation: Is there a Place for it in Saudi Arabia?


Associate Professor of Internal Medicine and Nephrology, College of Medicine and Medical Sciences, King Faisal University, Dammam, Saudi Arabia

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How to cite this article:
Al Muhanna FA. Commercial Living-Unrelated Renal Transplantation: Is there a Place for it in Saudi Arabia?. Saudi J Kidney Dis Transpl 1999;10:161-2

How to cite this URL:
Al Muhanna FA. Commercial Living-Unrelated Renal Transplantation: Is there a Place for it in Saudi Arabia?. Saudi J Kidney Dis Transpl [serial online] 1999 [cited 2020 Sep 27];10:161-2. Available from: http://www.sjkdt.org/text.asp?1999/10/2/161/37223
Saudi Arabia is an Islamic country where religion has a very strong influence on the social, cultural and ethical values of the society. It was, therefore, necessary to clarify aspects pertaining to organ retrieval, transplantation and brain death by leaders of religion. In 1982, religious aspects of organ transplantation were resolved through the support of the senior Ulama (Scholars) Commission when both cadaver and voluntary living related organ donation were approved. [1] In 1986, the Council of Islamic Jurisprudence considered brain death equivalent to legal death. These approvals have considerable helped, consequently, renal transplantation in Saudi Arabia. [2]

Between 1979-1998, two thousand and fifty three (2560) transplants had been performed in the Kingdom. Kidneys were obtained from live related donors in 1574 operations, and from cadaver donors in the remaining 986 transplants. Cadaver organ donation is being pursued vigorously under the auspices of Saudi Center for Organ Transplantation established in 1985.

In Saudi Arabia, the major form of donation for kidney transplantation is still from living related donors. However, special categories of emotionally related donation, where the donor can be a wet nurse or her children (so-called mild-kinship) or the recipient's spouse is legally acceptable. Such relationships, however, have to be attested by an official specialized organization. [3]

Some Saudi patients go abroad seeking commercial living unrelated renal trans­plantation.[4],[5] The operations are commonly done in substandard conditions under the cover of secrecy. Many such patients return to Saudi Arabia within two weeks of transplantation. There is often no communi­cation between the doctors who follow up these cases. Proper medical reports are not given to most of the patients. Infection is the most frequent complication in such patients. [6],[8] Recipients are exposed to risk of infection such as HIV infection and hepatitis. The results of renal transplantation is such cases have been far from satis­factory. One-year patient survival in such cases in the Middle East was 81.5% according a report published in 1990. [7]

The proponents of commercial living unrelated donor kidney transplantation advocate the argument that such practice would solve current shortage of organs and that payment would be beneficial to the poor donor and his family. This argument has to be weighed against the view that such practice predisposes ultimately to the sale of all transplantable organs. The Council of Ulama, who stated that selling one's organs is strictly prohibited, formulated the Islamic position on this issue. [1] A justification may be made for a potential recipient in dire need of a donor but must conform to the prevailing law as well as societal norms and acceptance. Saving a loved one may be regarded as sufficient reason; a desire for cash con not be consi­dared as a worthy motive. [9] Furthermore, there is a legal controversy over the issue of whether a poor rewarded donor can give an unbiased voluntary consent. Financial incentive may mount to coercion.

Reddy at al [10] stated that it is far better to accept and regulate living non related renal transplantation rather than legislate against it because the latter might only drive the business underground to the ultimate detriment of both the donors and patients. [5] In Iran, Where is social, culture, religious and economic constraints against the adoption of renal transplantation from cadaveric donors, and where a large number of patients with ESRD have no live related donors, a controlled living unrelated renal transplant program was established to regulate the practice.[11]

The public, media and professional organizations in Saudi Arabia, [12] and the rest of the world [13],[14] have condemned the sale of kidneys. The Council of the Transplant­ation Society, commenting on donation of kidneys by unrelated living donors, has stated that active soliciting of living unrelated donors for profit is unacceptable. [13] It is gratifying to note that no transplant surgeon/team is involved in commercial transplantation is Saudi Arabia.

 
   References Top

1.Qatan MK. Kidney donation in Islamic Law (Arabic). National Kidney Foundation Publication. Riyadh, Saudi Arabia. Al­Alamia Press 1984.  Back to cited text no. 1    
2.Al-Muhanna FA, Saeed I, Malhotra KK, Prospects of renal transplantation in Saudi Arabia. Saudi Kidney Dis Transplant Bull 1990;1:164-7.  Back to cited text no. 2    
3.SCOT Protocol. The directory of the regulation of organ transplantation in the Kingdom of Saudi Arabia. Saudi J Kidney Dis Transplant 1994;5(1):37-98.  Back to cited text no. 3    
4.Living related kidney donors (Editorial). Lancet 1982;2:37-98.  Back to cited text no. 4    
5.Qunibi W. Physicians attitudes toward living non-related renal transplantation (LNRRT). Clin Transplantation 1993;7:289-95.  Back to cited text no. 5    
6.Al-Khader AA, Sulaiman MH, Dhar JM. Renal transplantation in the Kingdom of Saudi Arabia, a look back at the first decade. Saudi Kidney Dis Transplant Bull 1990;1:63-8.  Back to cited text no. 6    
7.Salahudeen AK, Woods HF, Pingle A, et al. High mortality among recipients of bought living-unrelated donor kidneys. Lancet 1990;336:725-8.  Back to cited text no. 7  [PUBMED]  
8.Daar AS, Organ donation-world experience; the Middle Eat Transplant Proc 1991;23:2505-7.  Back to cited text no. 8    
9.Thiagarajan CM, Reddy KC, Shumugasundaram D, et al. the practice of unconventional renal transplantation at a single centre in India. Transplant Proc 1990;22:912-4.  Back to cited text no. 9    
10.Reddy KC, thiagarajan CM, Shunmugasundarm D, et al. Unconventional renal transplantation (UCRT) at a single center in India. Transplant Proc 1990;22(3):910-11.  Back to cited text no. 10    
11.Ahad J. Ghods, Freedom S, et al. Renal Transplantation in Iran. Asian Nephrology Proc 1997;701-7.  Back to cited text no. 11    
12.Aswad S, Paul TT, Edrees A, et al. The role of National Kidney Foundation in cadaveric renal transplantation in Saudi Arabia. Saudi Kidney Dis Transplant Bull 1990;1:145-54.  Back to cited text no. 12    
13.Brahams D. Kidney for sale by live donor. Lancet 1989;1:285-6.  Back to cited text no. 13  [PUBMED]  
14.Dosetor JB, Manickavel V. Ethics in organ donation: contrasts in two cultures. Transplant proc 1991;23:2508-11.  Back to cited text no. 14    

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Correspondence Address:
Fahd Abdulaziz Al Muhanna
Vice-Dean for Higher Studies, CMMS, King Fahd Hospital of the University, P.O. Box 40085, Al-Khobar 31952
Saudi Arabia
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PMID: 18212426

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