How red tape ties up life-saving organ donations

organ donation
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AMMAN — “Alive, but not quite living.” Three times a week for the last 15 years, 45-year-old Raed Al-Omari has spent over five hours on kidney dialysis machines, which cumulatively account for at least an entire year and three months of life taken away from him.اضافة اعلان

Despite his exhaustion after each five-hour session, “he is obliged to go to work, (so as) not to lose his job” that his family depends on, said his wife, Rania Shaiab, in an interview with Jordan News.

Omari is one of 5,000 potential kidney failure patients in Jordan who are waiting, along with their families, on a long list for organ transplants from donors suffering from brain death, as they failed to find matches from living relatives.

As the Omari family encountered compatible non-relative friends and neighbors willing to donate a kidney to Raed, the family started to consider why living donors, as compared to deceased donors, are restricted by blood-relation, requiring them to be up to fifth-degree relatives.

Finding a matching organ for transplants is not easy. “Except for corneas, an organ needs to be compatible with the recipient body as part of it,” said ophthalmologist Othman Al-Abbadi.

According to the Jordanian Benefiting from Human Organs Law of 1977 and a fatwa by the Ministry of Awqaf, organ donation is permitted in Jordan under certain regulations, such as the five-degree rule.

Because organ donations are life-saving, there is fear that the urgent need might inspire crime. “The fifth-degree relative law is to prevent organ trade, human trafficking, or materialistic exploitations,” said Anwar Al-Neweiri, consultant general surgeon and director of the Jordanian Center for Organ Transplantation Directorate (JCOTD), in an interview with Jordan News.

Kinship regulations are based on international laws of the World Health Organization and League of Arab States, according to Neweiri.

“People are emotional. Families owe special feelings to their distressed beloved, considering donation as a way to reciprocate. In such cases, sacrifices seem justified,” Neweiri explained.

Stressing that Jordan is free of organ exploitation, Deputy President of Jordan Society for Organ Donation Ahmad Jamil Shaker shed light on the deterrent penalties the law imposes on the trade of organs. “A minimum sentence of six months is the penalty for any doctor taking part in illegal organ transplants,” he explained.

Shaker stated that there are a total of 6,000 people suffering from organ failure in the Kingdom, many of whom are in need of transplants but are still on the waiting list.

According to the JCOTD director, the organization has made its measures more flexible. “We also allow for sixth-degree relatives” with the permission of a specialized committee, Neweiri said, adding that “even (a) non-blood (relative) up to the fourth or fifth degree is allowed for wider options.”

When it comes to friends and non-relatives willing to donate an organ to an ill patient, Neweiri suggested “seeking marriage connections” between the two families “to dispel any suspicion of intentions.” However, the director said, they are sometimes able to donate with permission from the relevant committee. “It is the committee’s decision based on priorities of the national (waiting) list,” he said.

‘Why does organ donation matter?’

“Most organs cannot be repaired except by organ transplant. Once an organ like the heart or the liver fails, no regenerative therapies are effective,” the JCOTD director said.

Neweiri added that even in cases of kidney failure, “artificial kidneys and kidney dialysis are temporary alternatives with suffering.”

In addition to saving lives, organ transplants also reduce costs on the Treasury. “While each patient’s dialysis costs around JD1,200 per month — that is, over JD14,400 annually — a kidney transplant surgery costs JD4,000 to JD5,000,” and provides a lasting solution, according to Neweiri.

Transplants “not only reduce the financial burden but also ease patients’ confinement to machines, which results in more active members of society who can return to normal life and minimize (their) dependency on others,” Neweiri added.

Beyond the fifth-degree relative rule, there is another barrier limiting the number of successful organ donations in the country. In 2020, living donors provided 200 donations. By comparison, of the 48 cases of brain death, only one resulted in an organ donation last year, according to Neweiri. Additionally, “since 1972, only 30 organ donations resulted from brain deaths,” he added.

As a surgeon, Neweiri explained that living donors have limited contributions. “A living person can donate a kidney, part of a liver, or bone marrow, which help cure blood patients, leukemia, and anemia.”

However, brain-dead donors can provide much greater donations. Brain-dead donors are recognized as legally dead in many countries. Brain death describes a lack of oxygenated blood that leads brain cells to stop functioning and die, resulting in the patient losing all brain function. Although the patient is unrevivable, essential bodily functions may be artificially maintained using life support.  Keeping the patient’s body alive with life support provides an ideal opportunity for organ donation.

Those who have suffered brain death currently account for only 1 percent of organ donations. Deputy president Shaker argued that if the deceased donate their organs, a wide range of solutions will be possible for patients.

“In traffic accidents, around 700 people pass away annually, of whom at least 200 are brain deaths” whose organs could be used to save others, Shaker said.

According to Neweiri, a family can take the initiative and donate their deceased’s organs if the individual is brain dead. If the deceased signed an organ donation testament prior to their death, their family is not obliged but encouraged to respect their will. Becoming an organ donor is not compulsory or obligatory.

He added that for an individual suffering from brain death to donate their organs, three conditions have to be met: be officially diagnosed as brain dead by a specialized committee, consent from the deceased’s guardians, and healthy organs.

Neweiri explained that “at least six to seven people can benefit from a single brain dead death,” in which almost all healthy organs can be used. By contrast, he explained, the only organs regularly taken from deceased donors are the corneas, “which can be transplanted even after 24 hours of heart cessation.” As soon as a patient’s heart stops beating, their organs rapidly begin to degrade, making donation challenging.

‘Give the gift of life’

According to officials, the regulations around organ donation are not intended to limit but to guide and direct donors and recipients. “Our ultimate goal is to ensure a decent, healthy life for citizens. We greatly encourage people to donate organs, and that’s why we created regulatory systems and laws,” the JCOTD director said.

Both experts call on citizens to sign an organ donation testament either at the JCOTD site at Al-Bashir Hospital’s Administration Building on the second floor, or through the Jordan Society for Organ Donation’s website or WhatsApp number (+962 79 555 5582).

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