Realizing Equity in Organ Donation and Transplantation in a Society of Immense Multicultural and Socioeconomic Diversity, a Report from Qatar

Abstract

Introduction Qatar is a small prosperous gulf country with vast oil and gas resources that made it one of the largest GDP per capita worldwide, it is populated by 2.6 million including 12% indigenous population and 88% expatriate workers mostly from South East Asia and the Middle East. The inability to meet transplant needs safely and effectively within Qatar prompted the development of the Doha Donation Accord (DDA) in 2009. The DDA is an ethical framework developed in conjunction with the Declaration of Istanbul Custodian Group to increase organ donation and combat transplant commercialism. Methods The DDA and the evolved strategies (the Doha Model of organ donation) are distinguished by equity of access to dialysis, living donation program, donor registry, waiting list, deceased donor organs and the free transplantation facilities regardless of the nationality, religion or financial status. Results Current statistics revealed that The National Donor Registry, has more than 100 nationalities totaling 179,000 registrants including 4.25 % citizens. More than 50% (418/790) of all patients on maintenance dialysis are noncitizen residents of Qatar. Similarly, deceased donation transplant activity from 2011 to 2017 shows that the kidney transplant waiting list include 38%(27/71) citizens and 62%(44/71) non citizens residents, and those who received deceased donors' kidneys are 80.5%(33/41) noncitizen residents Vs. 19.5% (8/41) citizens, similarly for the liver transplant waiting list 95%(19/20) non citizen residents and 5%(1/20) citizens, those who received deceased donor livers were 5.8%(1/17)citizens and 94.2%(16/17) noncitizen residents. As compared to 2009 the living kidney donation increased 20 folds and deceased donation 8 folds.the active kidney waiting list dropped between 3-9% every year, and the commercial kidney transplantation abroad dropped by 65%. Thus, commercial transplantation abroad has largely been replaced by ethically approved living-donor or deceased-donor organ transplantation in Qatar. Conclusion The respect of dignity and equity and the resultant improvement in organ donation and transplantation in Qatar, demonstrate that progress towards true self-sufficiency will be achieved where solidarity and trust are successfully fostered in a resident population. The Doha Model provides a comprehensive strategic framework underpinned by an ethos of inclusion that offers the best chance to unite a diverse society in pursuit of a common goal: meeting needs for transplantation together.