Muscat: Organ donation after brain death can bring forth life amidst a tragedy but that opportunity is being squandered, say medics citing almost zero response in Oman.
Kidney transplants that can be carried out after taking the organ from dozens of people declared brain dead can save the lives of people on dialysis in Oman.
Similarly, other organs taken from such people can bring a new hope to many more.
Despite the fatwa of the Grand Mufti of Oman, His Eminence Sheikh Ahmad bin Hamad Al Khalili, which allows organ donation from a brain dead patient, and the endorsement by the Ministry of Health, the number of such transplants taking place in Oman is practically nil.
Dr Issa Salim Al Salmi, senior Omani consultant in medicine/nephrology at the Royal Hospital, believes the main reasons are that many people are not aware about this issue, or about the Grand Mufti's fatwa, and are confused by the conflicting messages of other religious figures.
Speaking to Times of Oman, Al Salmi said around 150 people were declared brain dead in Muscat Governorate last year but not even one family agreed for organ donation despite the fact that brain death is 'irreversible.'
This when kidney transplant from brain dead patients can save the lives of some of the 1,500 people who are on dialysis in Oman, he added.
Irreversible death of brain
According to him, brain death is 'irreversible cessation' of all brain activities which is confirmed through a rigorous and accurate procedure by several experienced specialists, who are not part of the transplant team.
There are two types of brain death. It may happen while the heart is still beating or after the heart stops beating.
Dr Issa Salim Al Salmi, senior Omani consultant in medicine/nephrology at the Royal Hospital.
Al Salmi said that the issue of organ donation after brain death has been rarely endorsed by the local community while Western families have a more open approach to the issue.
"One per cent of the population has severe kidney failure. Nine per cent have moderate renal failure and almost 30 per cent have mild renal failure," said Al Salmi, who has a Masters in international public health and a PhD in medicine.
Dialysis
According to him, more than 1,500 people are on dialysis in Oman and some of them have been in this situation for several years and are receiving this treatment three times a week.
At least 50 per cent of the patients on dialysis will need kidney transplant, added Al Salmi, a fellow of the Royal College of Physicians, UK, the Royal College of Physicians of Ireland, and American Society of Nephrology.
Al Salmi said that the average age of the patients receiving dialysis in countries like Australia, the United States, the United Kingdom and some other European countries is 60 to 65 while it is 40 in Oman.
A large number of patients undergoing dialysis in Oman are in their 20s and 30s, which are the most productive years of life, and the whole situation is negatively affecting the productivity of the country, he added.
Live donor
Kidney transplant from a live donor is an established practice in Oman for decades and around 20 such transplants are carried out at the Royal Hospital every year, mainly from foreign donors, Al Salmi said.
In Oman, there are about 1,200 to 1,500 people living with donated kidney, and there are 150 individuals living with donated liver, he noted, adding that all the liver transplants had been done outside the country.
He explained that over the past years the main focus of organ transplant had been on kidney transplant but now the technology for liver transplant is also available and many Omanis are being trained in this field both inside the country and abroad.
Cheaper and legal
Some families have to take their patients to other countries because of the non-availability of organs for donation inside the country but the promotion of the organ donation culture can resolve this issue and eliminate commercial TRADE in human organs, Al Salmi said.
"If such surgeries are performed inside the country, it will be cheaper and safer and will be within the context of the law," he said, adding that Oman has signed several agreements, including with the World Health Organisation which forbids any commercial transplantation.
"We strongly advise our patients against engaging in such activities, but still some people do it."
Promotional efforts
On the efforts underway to promote organ donation, he said that the Ministry of Health, the Royal Hospital and the departments concerned are seeking to raise awareness about the issue through various workshops and seminars.
Also, the ministry will launch an 'electronic answering machine' system to answer queries of the citizens. It is expected to be launched early next year.
"We want the citizens to be aware that if they have any question, any concern, we are available," he said, adding that with the launch of the helpline, the questions will be answered 24 hours a day, seven days a week, 365 days a year.
Donor cards
However, the most important initiative is a plan to distribute donor cards recording the citizens' consent for organ donation if they are declared brain dead.
Al Salmi explained that the aim is to distribute these cards and then obtain the consent information and ensure that it is printed on the individual's ID card or their driving licence so that when they are brought to the hospital, the medical team can act accordingly.
He added that people can agree to donate certain organs or all.
This initiative requires a joint effort by Royal Oman Police (ROP), health authorities and other officials concerned, he said.
"For example, in Singapore, the concept of 'presumed consent' exists, which means everyone is a donor unless stated otherwise," he said, adding that Oman has a long way to reach that level.
"We will hopefully distribute the donor cards across the country and see how the people respond."
Al Salmi said that he believes any driver should be presumed a donor for a number of reasons from humanitarian point of view, from a religious point of view, and from a national point of view.
Cooperation
Asked about Oman's cooperation with other countries in the area of organ transplantation, he said that there is collaboration between the health officials of the Gulf Cooperation Council (GCC) countries and their meetings focus on issues related to organ donation.
Al Salmi said that the GCC's main and best organ transplant centre is based in Saudi Arabia, where they help in retrieving and providing organs for GCC citizens.
"Also, other Gulf citizens can send their organs to this centre if they are not utilising it," he said, adding that Oman is enhancing its cooperation in this field with other countries, and Iran, which is an advanced country in organ transplant, is a potential partner.
Community is like a body and if one member is suffering, it affects others and they should feel the responsibility to ease the pain, Al Salmi said, expressing the hope that everyone will look at this issue with more 'open eyes, open heart, and an open mind.'
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