Faissal Shaheen - Kingdom of Suadi Arabia - Monday 28 - Financing the Donation and Transplantation Process
1. Faissal A.M. Shaheen
Consultant in Medicine
and Nephrology MBBCH, Facharzt, FRCP
Director General
Saudi Center for Organ Transplantation
and
Jeddah Kidney Center
Kingdom Saudi Arabia
2. 1985
National Kidney Foundation
Established
1986
Start of
Deceased Organ Donation Program
1993
NKF upgraded as
Saudi Center for Organ Transplantation
7. Dialysis Population: Current and
Projected
1995 - 2015
16000
14000 14855
13738
12000 12633
12040
11168
10000
10280
9533
8000 8482
7833 7526 7809
7383
7029
6000
6008
5206
4000 4861
4322
3869
2000
0
Average Net Annual Increase = 584 Patients
Average Percentage of Annual Increase = 8.3%
8. Counts of Kidney Transplants
and Waiting List in USA
Transplants or Awaiting /Year (1000's)
90
80 Living Donor
77.987
Deceased Donor
70
Total Donors
60 Waiting List
50
40
30
20
17.091
10 10.659
6.432
0
88 89 90 91 92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006
UNOS DATA 2006
9. Process of Consenting for Organ Donation
from the next of Kin of the Deceased donors
Convincing
Families to Study family
donate organs status
from their
beloved
socially
deceased donor
Coordinators do Pay incentive
not mention In need by government
incentives
unless asked by
the family Approval
Pay to
Not in charity on
Interview need behalf of the
family
No Abort
approval donation
10. Organ Donation Is Mandatory
for Organ Transplantation
Live
Recipients
Deceased
12. Education Has Many Methods Which
May Have a Positive Long-Term
Effect on Society at Large
Community
Schools Media
Centers
• Under • Public not in • All levels of
graduates the education society
• Post system
graduates
13. Is a Financial Incentive a Good
Method for Education?
We apply it in schools
• Scholarships
We apply it in business
• Overtime
14. Should Financial Incentives Be Applied
for Organ Donation?
Yes, they help the process of educating the society to donate organs
• Disseminating the idea that good acts and volunteering are appreciated
Yes, due to variability of cultures in the education levels and values that
should be respected
• Some may appreciate a certificate or a medal, others appreciate a
financial incentives ( When stopped , some programs went into a standstill
such as Qatar, Bahrain)
Yes, governments can be the source of the financial incentives not the
recipients, which may antidote commercialism
Government s control natural resources and compensate in disasters ( floods
and earthquakes) and society trust them for future planning
15. Principals for Compensation for
Organ donation
Should preserve the concept of organ as a gift
Should convey gratitude for the gift
Should not be an excessive inducement that would undermine the personal values
and alter decision making solely to receive money
Should preserves voluntariness
Should not lead to a slippery slope that fosters the sale of live human organs
Ref.=Gruessner and Benedetti, Living donor Organ Transplantation ; Mc growhill -Page 96-2010???
16. Principals for Compensation for
Organ Donation
Should honor the deceased by not assigning a monetary value for individual’s
organs
Should respect the sacred nature of the human body by not tampering or
intruding without a specific permission
Should serve the public good by maintaining the current public perception of
organ donation as good
Should maintain the public trust by not altering patient care by premature life-
support withdrawal from a person who might donate and also not placing the
transplant recipients at increased health risk by jeopardizing the integrity of the
organ pool
Gruessner and Benedetti, Living donor Organ Transplantation ; Mc growhill -Page 96
17. Slippery Slope for Compensations
• Though no risk of death
Family may withhold
information that may affect
recipients ( cancer in
donors) to get the payment
Deceased
Donation
• Family may consent to
prematurely withdraw life-
support from patient who
do not fulfill brain criteria
for death
18. Guarantees to avoid slippery slope
Establishing National Organ donation Centers
• Supervises organ donation activities nationwide
National protocols for organ donation process
including diagnosis of death and allocation of
organs
• The diagnosis of death should follow a strict protocol for the
purpose of organ donation and executed by personnel
different from those in charge of transplantation
19. Types of Compensation for
Deceased Organ Donation
Direct Payment
Income Tax Credit
Reimbursement for Funeral Expenses
A Contribution to a Charitable
Organization determined by the Family
20. Arguments for Compensation for
Deceased Organ donation
Other than the families everybody receives
incentives
• Doctors, OPO Coordinators, charges of
transplant centers for hospitalization
Different cultures need different approaches
for education. One size does not fit all
• America is different from Saudi Arabia
21. Arguments against Monetary
Compensation for Deceased Organ
Donation
Charges for services rendered to recipients are ethically different
from payments for consents for organs recovered from donors
Payments to OPOs and Physicians are exercises of their responsibilities
Payments introduce an unacceptable commerce to the value
for human life ( variable value from place to place)
22. ASTS meeting in 2001 to Address
Ethically Acceptable Methods to Increase
Organ Donations
Conclusion of the committee =
• There is a risk that financial incentives can undermine the
public trust of the transplant system
. Of the Types of compensation =
• Payment for funeral expenses was the most ethical
The ASTS issued a statement opposing payments to
deceased and living donors
23. We May Need Financial Compensation for the
Deceased Organ Donation Program
Education of the public
• Incentives helped education about importance of dialysis for
replacement of end-stage renal disease in Saudi Arabia 1980-1995
Pay for expenses such as funeral and hospital bills
rendered by families as an approach may have a
similar effect on our culture
• We prefer the direct payment as a government in Saudi Arabia, since
the administrative system is not mature enough to have accurate
follow-up of the real expenses. Hopefully, with time this incentive
can be cancelled
24. Conclusions
• May be a good tool for Education for Organ
Donation.
Incentives • Will remain controversial.
• Has several different ways and should respect
culture.
• Living donation is different from the deceased in several
aspects and direct comparisons do not apply properly.
Deceased • Can be controlled by governmental supervision through a
Donation • National Center, which insures appropriate
• implementation of the protocol for diagnosis of
death, consenting and allocating of organs.
• Differences do exist and affected by education.
Culture • One size solutions may not fit all.
