MoH issues decree on ‘declaration of death’, supports organ transplant in UAE

Abdul Rahman Mohammed Al Owais, Minister of Health and Prevention, recently issued Ministerial decree No. 550 of 2017 on the declaration of death.

The decree covers three main provisions, namely death resulting from cardiac-respiratory arrest; death resulting from complete loss of brain functions; and pediatric brain death guidelines.

Dr. Amin Hussein Al Amiri, Assistant Undersecretary for the Ministry’s Public Health Policy and Licensing sector, emphasized that the UAE is keeping abreast of the latest developments in global health legislations and international health standards and is modernizing the state health legislative initiatives to improve local services according to global standards.

This is in line with the UAE Vision 2021 that aims at enhancing the local health system through enactment of health policies in adherence with the highest international standards.
 
Sustainable health solution

Dr. Al Amiri said that the recently issued ministerial decree complements the national program for organ transplantation as embodied in Federal Law No. 5 of 2016, that excludes stem cells, blood cells and bone marrow transplants.

It is a sustainable health solution, especially for individuals suffering from cancer, heart disease, pulmonary failure, hepatic fibrosis, and kidney failure. He reiterated the UAE’s commitment to criminalize illegal organ transplant procedures, saying these violate human dignity.
 
Clinical death

After studying similar regional and global cases, a national committee composed of all local health authorities prepared the latest resolution in consultation with the General Authority for Islamic Affairs and Endowments.

The decree was made in response to the urgent need to enact legislation on the declaration of death in a bid to protect hospitals and enable doctors to stop the suffering of brain-dead patients.

The question of clinical death is a medical and legal problem, while the issue of organ transplants has raised vital ethical issues such as the clear definition of death and the timing and manner of authorizing the transplant procedures.
 
Patient protection from regional and global non-accredited facilities

He said a number of patients diagnosed with kidney and liver failures, among others, will go abroad to seek organ transplants. Out of desperation, however, they fall prey on false promises of non-specialized centers, especially those located in some Asian countries. Worse, they might become infected with AIDS and viral hepatitis as a result of the fraudulent procedure. 

The ministerial resolution, he said, will protect UAE patients from becoming victims.
 
Moreover, the resolution aims to help contribute to the enhancement of the country’s medical tourism. 

Significant investments are expected to pour into the country with the opening of new international centers specializing in organ transplants. It also allows the establishment of a national organ bank and a database to record all individuals who signify their wish to donate their organs upon their deaths.
 
“Our role is to spread this culture and the importance of social and educational awareness within this context. We also hope to establish an environment where people will be motivated to donate their organs to help thousands of patients in need of transplants, reduce the burden on hospitals, lessen the costs on the state and society, and urge insurance companies to cover organ transplants,” he said.
 
An organ donor can save 5 to 8 lives

Dr. Al Amiri explained that organ transplant will take place only in accredited public and private hospitals with Ministry-approved standards and prior approval of competent authorities to ensure patient safety and implementation of correct procedures.
 
According to him, one donor can save 5 to 8 lives. Organs that have been successful transplanted include the heart, kidneys, liver, lungs, pancreas, and intestines, while tissues include bone, tendons, cornea, skin, heart valves, nerves, and veins.

Worldwide, kidney transplantation is the most common, followed by liver then heart. He pointed out the importance of keeping the identity of the donor and his family confidential as well as the name of the beneficiary.
 
Cardiac arrest and loss of brain functions

Dr Al Amiri also noted that the resolution differentiates between the declaration of death resulting from cardio-respiratory arrest and death resulting from complete loss of brain functions.

This serves as a guide to hospitals, especially for those with intensive care units. Brain death is defined as an irreversible cessation of all functions of all parts of the brain.

The decree also explained the conditions and exceptions for the declaration of brain death, including proper diagnosis through clinical preliminary examination, then the brain reflexes test with the visual response to light.

It also covers the observation period, or intervals between clinical tests, and protocols. The results of these tests should be duly recorded along with the electrical brain layout.

The time interval between the tests varies according to the age groups, from 48 hours for infants to 6 hours for adults.

Lastly, confirmation tests should be done either through electroencephalogram (EEG), cerebral vascular imaging, or apnea test with explanation of how it is performed and general considerations. The apnea test is positive if there is no respiratory activity during the separation of the patient from the ventilator.
 
Pediatric brain death

For pediatric brain death, the decree mandates 48- hour observation period for infants aged 7 days to two months; 24 hours for infants aged two months to 1 year; with 2 electroencephalograms separated by a period of 24 hours and both showing the absolute lack of effectiveness of brain or one ECG showing brain inactivity and lack of blood flow to the brain confirmed through CT scan or radioisotope, and children aged 1 year and until puberty, the same adult protocol is followed except the observation period which must be at least 12 hours. After puberty, he same protocol for adults is followed.
 
Sustainable organ transplant program

Dr. Ali Abdul Kareem Al Obaidli, Chair of the National Organ Transplant Committee, praised the completion of procedures allowing the expenditure of the national organ transplant program, including organ donation upon death.

He said that the efforts of the country’s wise leadership and the Ministry of Health and Prevention will lead to the establishment of a sustainable program for organ transplants given that the UAE enjoys modern health infrastructure and the willingness of the citizens and residents to donate their organs as per the results of various surveys and studies in support of the National Organ Transplantation Program.
 
Dr. Al Obaidli pointed out the importance of providing services related to organ transplant in parallel with the intensive efforts preventing kidney and liver failures and other diseases, while highlighting the role of individuals and families in these initiatives. He emphasized the state’s keenness to provide high-quality health care, taking into account safety procedures and ethical standards.

The decree aims to ease the burden on patients suffering from organ failure and protect them from undergoing operations in non-specialized centers abroad that may cause numerous complications.
 
As for the future expansion of the national transplant program, he noted the planned full coordination and periodic meetings among local centers such as SKMC, Cleveland Clinic Abu Dhabi, and Mohammed bin Rashid University for Medical Sciences, and Al Madina Hospital in the coming weeks.
 
Clear criteria to establish credibility in declaration of death process

Dr. Marwan Al Mulla, Director of the Department of Health Regulation of Dubai Health Authority, this Ministerial decree No. 550 of 2017, which set the standards in the declaration of death according to the Federal Law on Medical Liability No. (4) of 2016.

It will lead to the rearrangement of priorities for hospital-based healthcare programs to prevent patients in critical conditions to be moved to less efficient healthcare centers.
 
It also seeks to increase the hospitals’ capacity and capability to receive more emergency cases that require intensive and continuous care.

The decree aims to provide financial support to patients, their families, and healthcare providers, in addition to establishing clear criteria that will lend credibility to the process of death declaration. Lastly, it strives to promote organ donations to help critical patients according to relevant legislations.
 
Enhancing the health system

Dr. Amer Sharif, Vice Chancellor of the Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) and CEO of Dubai Healthcare City Authority's Education Sector, commanded the efforts of the Ministry of Health and Prevention and the national committee for organ transplantation in establishing these standards and he indicated that this development will definitely facilitate organ donation as well as increase awareness of organ transplants in the UAE.
 
Dr. Amer Sharif explained that Mohammed Bin Rashid University of Medicine launched last year an organ transplantation program that aims at relieving the suffering of patients with renal impairment and implemented 2 successful renal transplantation surgeries in collaboration with Mediclinic City Hospital and the support of the Saudi Center for organ transplant, which is considered as a reference in the GCC.

Dr. Sharif expressed his trust in the role of this decree in enhancing the healthcare systems and ensuring highest quality of healthcare services to the residents and citizens of the United Arab Emirates.

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