Identifier
Created
Classification
Origin
07RIYADH460
2007-03-06 09:55:00
CONFIDENTIAL
Embassy Riyadh
Cable title:  

POTENTIAL ABUSE IN PROPOSED ORGAN DONATION LAW

Tags:  PGOV PREL KHUM TBIO 
pdf how-to read a cable
VZCZCXYZ0000
PP RUEHWEB

DE RUEHRH #0460/01 0650955
ZNY CCCCC ZZH
P 060955Z MAR 07
FM AMEMBASSY RIYADH
TO RUEHC/SECSTATE WASHDC PRIORITY 4595
INFO RUEHJI/AMCONSUL JEDDAH 8413
C O N F I D E N T I A L RIYADH 000460 

SIPDIS

SIPDIS

E.O. 12958: DECL: 03/05/2017
TAGS: PGOV PREL KHUM TBIO
SUBJECT: POTENTIAL ABUSE IN PROPOSED ORGAN DONATION LAW

Classified By: Political Counselor David Rundell
for reasons 1.4(b) and (d).

C O N F I D E N T I A L RIYADH 000460

SIPDIS

SIPDIS

E.O. 12958: DECL: 03/05/2017
TAGS: PGOV PREL KHUM TBIO
SUBJECT: POTENTIAL ABUSE IN PROPOSED ORGAN DONATION LAW

Classified By: Political Counselor David Rundell
for reasons 1.4(b) and (d).


1. (C) SUMMARY: Following imminent approvals from the Saudi
Organs Transplant Center (SOTC),the Prince Salman Charitable
Center for Kidney Diseases, and the Medical Services Council
(MSC),the SAG will implement a new organ donation regulation
allowing for live donors to donate their organs to unrelated
persons. Ministry of Health and King Faisal Specialist
Hospital Organ Donation Coordinator Abdullah al-Enazi
(strictly protect) denounced the proposed law for lacking
proper controls. Based on his recent experience with
donation cases throughout the Kingdom, Al-Enazi stated that
he fears that allowing unrelated persons to donate organs --
including kidney and liver transplants -- may lead to coerced
donations from foreign domestic workers as well as "temporary
marriages" to foreigners in order to secure a live donor.
END SUMMARY.

--------------
Background on Organ Donation in Saudi Arabia
--------------


2. (U) Under current Saudi Arabian law Saudi nationals and
expatriates can donate organs; however, beneficiaries must be
Saudi nationals. If the donor is deceased, then no relation
to the recipient is required. However, recipients must be
related -- either through blood or marriage -- to live
donors. (Note: If a donor is related through marriage, the
marriage must have been legal for at least one year prior to
a live organ donation. End Note.) Transplants occur with
all major organs, except skin and corneas.


3. (U) Several years ago the Ministry of Health partnered
with King Faisal Specialist Hospital (KFSH) -- the leading
organ transplant center in the Middle East, and only one of
three centers in the Kingdom -- to create the Ministry's
organ donation program. The program has several components:
(1) increasing public awareness about the benefits of organ
donation; (2) educating intensive care unit (ICU) hospital
staff on the benefits and processes involved in organ
donations; (3) identifying potential donors in ICUs in dozens
of hospitals throughout Saudi Arabia; (4) maintaining the
list of needy recipients; and (5) coordinating the transport,

hospital access, and operational needs of organ transplant
surgery.


4. (U) This program has a mobile team of staff serving forty
public and private hospitals in Riyadh Province. The mobile
team is responsible for all of the above activities, but
mainly focuses on securing permission from the families of
the deceased or dying to obtain organs for donation. Their
work depends on the cooperation and notification by the
various ICUs-- the reason why increased outreach programs are
critical to their success. The increased number of education
programs in 2006 had a direct effect on the number of
donations-- 73 in 2006 up from 25 in 2005 in Riyadh alone.
Due to the success of the program, KFSH expanded its
resources, including medical staff, operating theaters, and
bed capacity.

--------------
Major Issues in Organ Donation
--------------


5. (C) In a February 11 meeting with PolOff, KFSH Organ
Donation Coordinator Abdullah al-Enazi stated that religious
concerns and ignorance about the process of organ donation
are the leading impediments facing the organ donation
program. Organ donation is a relatively new concept in Saudi
Arabia and many refusals to grant donation stem from
religious concerns. As a general rule, al-Enazi said that
Saudis do not believe in the concept of "brain dead." If a
person is breathing, according to al-Enazi, it is because
Allah wills it -- not the machine breathing for the
individual. As a result, families are often unwilling to
discuss the potential for organ donation until it is too late
to save the organs. Al-Enazi told PolOff in a meeting
several months ago that often when his mobile team is working
with a family to secure an organ donation, religious
conservatives ("Mutaawa'iin") will arrive and effectively
prevent the family from giving permission. According to
al-Enazi, the hospital staff are often the ones to call the
Mutaawa'iin into the ICU. Throughout the past eight months
al-Enazi has witnessed a decline in "Mutawaa'iin" presence in
the ICUs and a decline in the hospital staff opposing the
efforts to secure organ donations. Interestingly, receiving
organs as a recipient has not been a religious concern.


6. (C) Additionally, al-Enazi said that hospital staff are
often over-worked and do not care for the "brain dead"
patients as much as other patients. He said that this is a
fatal mistake because organs need to be cared for in order
for a successful transplant; if the hospitals do not work to
preserve the organs, then the need to obtain permission for
the donation is moot. Fortunately, increased awareness has
stemmed some of these problems, and on the morning of
February 10 -- the day before PolOff met with al-Enazi -- a
father "pulled the plug" on his "brain dead" son for the
first time in Saudi Arabia. This willingness to "pull the
plug" is a new concept in the Kingdom and potentially
ground-breaking for organ donation purposes. Al-Enazi
expressed hope that this action indicates a new wave of
thinking about the religiously controversial subject of organ
donation.

-------------- -
New Law Brings Progress with Significant Risks
-------------- -


7. (C) In early February the SAG proposed a new regulation
aimed at increasing the overall number of transplants and
access to transplants for all needy recipients. The media
announced this proposed law on February 7, citing its
elements generally -- namely that live donors can donate
their organs to unrelated persons either designated or
anonymous recipients. According to media reports the new law
would provide 200 to 400 kidneys for transplant in the first
year, with the goal of 600 to 700 per year-- an increase of
over 100 percent in the first year alone. The regulation
needs to be approved by SOTC, Prince Salman Charitable Center
for Kidney Diseases, and finally by the Ministry of Health's
MSC. The proposed law includes incentives for the donors;
however, the media interview did not delineate the
incentives. Al-Enazi -- a member of the MSC -- gave more
details on the incentives, including that the SAG will be
authorized to pay amounts of USD15,000 or more to donors in
order to encourage live organ donations.


8. (C) Although the law would provide a significant increase
in the number of kidneys available for donation, al-Enazi
expressed repeatedly that "encouraging live donations only
drives more people to be sick in the future." Further
al-Enazi stated that "paying people for their organs is
unethical." In his experience people already try to abuse
the current regulations by attempting to use "temporary
marriages" as a means of securing a "related" donor; he even
recounted a story of a woman who tried to get his committee
to accept a kidney donation from her Egyptian driver because,
as she told him, "he is like family. Plus, we will pay him
SR 5,000." Al-Enazi expressed strong concern that the new
regulation does not include stringent enough controls to (1)
stop "temporary marriages" for the purpose of organ donation,
and (2) the purchase of organs from foreign domestic workers
living in Saudi Arabia-- or even regulatory mechanisms to
prevent individuals from entering the Kingdom for this
purpose. He said that he would support the law if it was
restricted to Saudi national donors only, thus preventing
potential abuses of expatriate workers, but there are no
plans to amend the law to reflect his concerns. Al-Enazi said
that he has openly opposed this new regulation to the
Minister of Health and as a result of his opposition, the
Ministry of Health has instructed him to only deal with
"brain dead" patients, cautioning him to stay away from
potential live donors and their families. (Note: The
Ministry of Health has engaged him to work on a new organ
donation program with Prince Salman to create a new
charitable center for liver transplants. The new program
will be announced at Kingdom Hospital by Prince Salman and
Minister of Health Hamad Al-Manaa on March 14. End Note.)


9. (C) COMMENT: There is no evidence that properly screened
kidney donations reduce the donors life expectancy. Many
Saudis already travel to India or Pakistan where kidney
transplants can be legacy purchased from non-related donors.
However, the new organ donation system does raise concerns
over the strictness and transparency of Saudi screening
procedures.


10. (C) It is also clear that religious beliefs and customs
continue to be a major driver in every aspect of Saudi life
-- including health care and, more specifically, organ
donation. However, the increase of organ donations --
particularly by Saudi donors -- and outreach programs, the
new proposed regulation, and the decline of "Mutawaa'iin"
interference with the organ donation process are small
indicators of growing religious "flexibility." That some
Saudis are clearly willing to adjust to the opportunities
provided by modern medicine is a promising sign that
development outside the scope of conservative Wahhabiism is
possible. Moreover, the SAG's recent announcement preventing
the "Mutaawa'iin" from entering hospitals without
pre-authorization demonstrates that the progress made in the
organ donation arena can continue. END COMMENT.
OBERWETTER