Expanding the Kidney Transplant Business in UAE

This business case aims to expand the kidney transplant services in UAE by upgrading the renal transplantation services and promoting kidney transplantation. The focus is on maximizing organ donations to combat end stage renal disease and improve the lives of patients in need.

Running head: EXPANDING THE KIDNEY TRANSPLANT BUSINESS IN UAE
EXPANDING THE KIDNEY TRANSPLANT BUSINESS IN UAE
Name of the Student
Name of the University
Author’s Note

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Executive Summary
Renal transplantation is favorable in contrast to routine dialysis as a treatment of choice for
the patients with end stage renal disease (ESRD). The overall cost for dialysis is much higher
compared to a successful renal transplant. The aim of this business case is to expand the
kidney transplant services in UAE by upgrading the renal transplantation services and
promotion of renal transplantation. Comprehensive digital documentation of the patients on
the waiting list for quick analysis along with health care benefits might be given to the
individuals donating a kidney or discounts for the immediate family members of the deceased
individual from whom organs have been harvested for transplantation. In conclusion,
maximizing organ donations thereby leading to higher number of renal transplants is the key
to combat end stage renal disease and upgrade the life of those patients in need.

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Table of Contents
Introduction................................................................................................................................3
Kidney failure.........................................................................................................................3
Treatments for kidney failure.................................................................................................3
Current service and shortfalls.................................................................................................3
Kidney transplant law in UAE...............................................................................................4
Business objective..................................................................................................................4
Discussion..................................................................................................................................4
Kidney dialysis and kidney transplant...................................................................................4
Kidney transplant procedure in UAE.....................................................................................5
Eligibility for kidney transplant.............................................................................................6
Cost and accessibility.............................................................................................................7
Access and outcomes.............................................................................................................7
Upgrading the renal transplantation services.........................................................................8
Promotion of the kidney transplantation................................................................................9
Conclusion and Recommendations..........................................................................................10
References................................................................................................................................11

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Introduction
Kidney failure
Kidney failure may be of two types, namely acute and chronic, which is categorized
based on the period of the disease’s advance. Acute kidney failure involves rapid progression
of loss of renal function, whereas chronic kidney failure encompasses slow degeneration of
renal functions. Diabetes and hypertension are few causes of chronic renal failure whereas
glomerulonephritis, chemotherapy drugs, multiple myeloma, scleroderma, antibiotics, or
other toxins might cause acute renal failure.
Treatments for kidney failure
Damage to kidney due to disease or injury is generally irreversible. Early
identification of compromised renal function with the aid of elevated blood creatinine levels
might be combated by removing the causal agent such as prescribed drugs or medically
checking hypertension or hyperglycemia. However, after severe progression of renal failure
leading to end-stage renal disease (ESRD) only two options are available, namely dialysis or
kidney transplantation, in which kidney transplantation provides a permanent solution.
Current service and shortfalls
There is a massive shortage of donated organs available for transplantation. Most
patients in need of organ transplantation die while waiting for the matched and screened
organ from another compatible individual. According to a nationwide survey conducted in
2019 in UAE, there are near about 4000 patients with ESRD in need of renal transplant of
which approximately 80% eligible patients do not have any compatible related donor
(Mubadala, 2019).

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Kidney transplant law in UAE
The new organ transplant law declared in September 2016 by the President of UAE,
His Highness Shaikh Khalifa Bin Zayed Al Nahyan, which took effect from March, 2017
decreed that organ transplantation can be from both living people and the deceased, proving
to be a huge relief to patients on waiting lists for organ donation across the UAE (Salama,
2019).
While the new law designated as the Federal Decree Law No. 5 of 2016 on
Regulation of Human Organs and Tissue Transplantation, provided massive respite to the
citizen, there are new list of prohibitory rules around the newly decreed law, to make
minimize illegal transactions and criminalization of the opportunity (Salama, 2019). The law
forbids the sale and trade of any organ or tissue or other human body part, required for
transplantation. It also prohibits unlicensed publicity and advertisement of human organ
transplantation and bars any monetary funding for the same.
Business objective
The aim of this business case is to expand the kidney transplant services in UAE by;
 Upgrading the renal transplantation services
 Promotion of the kidney transplantation, in comparison to the dialysis services
available
Discussion
Kidney dialysis and kidney transplant
Kidney transplantation involves one time solution from the end-stage renal disease
whereas dialysis is a lifelong procedure. Although kidney transplant is comparatively costlier
compared to dialysis, kidney transplantation is the treatment of choice due to the improved

5EXPANDING THE KIDNEY TRANSPLANT BUSINESS IN UAE
quality of life and life expectancy. Post renal transplant, patients claim to feel more energetic
and active compared to being hooked to the dialysis. Patients with end stage renal disease
have to be under constant dialysis with no other treatment available. Renal transplant presents
an increased energetic life and liberty from dialysis, and from limitations on liquid and solid
dietary intake, however kidney transplant does require a lifetime of proper care and
management. Hence, renal transplantation is preferred to dialysis as it increases the chance of
survival by a huge margin.
Kidney transplant procedure in UAE
Any individual of any nationality, residing in UAE, is able to donate organs through
the permitted official and legal process in the UAE (Mubadala, 2019). The procedure for
kidney transplant in UAE is discussed below.
 When the patient is medically identified as brain dead or dead, the UAE National
Transplant Committee organizes a trained task force of professionals who will
approach the concerned family to acquire the consent.
 The medical facility gets in touch with three certified organ transplantation centers of
UAE, namely Cleveland Clinic Abu Dhabi, Shaikh Khalifa Medical City and the
Mediclinic City Hospital, to enquire about a potential match and organ requirements
at those centers and provides the donor’s HLA type, blood type, weight and age. Each
transplantation center maintains a list of waiting patients, who need organ transplants,
as well as vital details required for a match.
 Once potential match is confirmed, the transplant facility sends a team comprising
two surgeons and one nurse to the donor, to recover organs to be donated.

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 The Abu Dhabi Police hastens the transport of the harvested organs by providing air
ambulance in case of long distance travel or traffic congestions as following the organ
harvest, the kidney remain viable up to 24 hours only for transplant.
 In the interim, the matched receiver is tested and screened again, and prepared for the
transplant procedure.
Eligibility for kidney transplant
For every donated organ, there are around five compatible patients enrolled in the
waiting list. Therefore, setting the criteria which decides the eligible recipient is very crucial.
An old ethical belief has been resurrected in the UAE to facilitate the organ transplant law
based on reciprocal altruism to set the priority in choosing the right candidate for the organ
transplantation (Salama, 2019). The reciprocal altruism in religious belief states that each
person in the community must help another as it will in turn help himself. The altruist
benefits because in time he, in turn, is helped. The law intends to eradicate the "free-riding"
occurrence of potential candidates for transplantation of organ who would not acknowledge
deceased organ donation and therefore objects organ donation after brain death or death yet
would not give up his place in the waiting list or refrain from such possible donations
(Boobes et al., 2015). The ethical morality of that type of action is questioned, along with
moral appraisals of the solutions by the law, signifying it as ethically right and just.
In accordance with the principles laid down, patients who positively believe in organ
donation from brain dead patients must be prioritized for receiving such organ donations
(Mubadala, 2019). Candidates who are senior individuals with chronic disease or dementia or
mentally ill along with severe obesity and is prone to drug or alcohol abuse should not be
prioritized. Patients lacking proper compliance with dialysis or prescribed medications or
deficient of health insurance along with recently diagnosed with HIV or hepatitis C are also

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not eligible for organ transplantation (Boobes et al., 2015). Younger candidates with
indisputable medical causes which have lead to renal failure must be prioritized.
Cost and accessibility
Evidences through recent studies have shown that overall cost effectiveness of a
successful renal transplantation is much higher and convenient compared to regular dialysis
of patients diagnosed with end stage renal disease (Jarl et al., 2017). Renal transplantations
are the preferred treatment of choice for ESRD patients due to the reduced number of
contraindications than before with enhanced patient-graft outcomes (Heldal et al., 2019).
However, the accessibility of the donated kidneys has always constantly fallen short of the
predicted requirement as well as the authentic demand noted for transplantation. As a result,
apprehensions over the equitable circulation of the donate kidneys amongst the potential
receivers have been raised over the recent years.
Access and outcomes
Since 2015, Cleveland Clinic Abu Dhabi alone has performed 19 successful kidney
transplants till March 2019 (Cleveland Clinic News, 2019). Such paramount outcomes may
be attributed to the massive governmental interventions along with high quality care available
at the organ transplantation medical centers namely Cleveland Clinic Abu Dhabi, Shaikh
Khalifa Medical City and the Mediclinic City Hospital (Mubadala, 2019). Although with the
new law passed, access to donated kidneys have increased, however, the dearth in the number
of kidneys required to treat the ESRD patients waiting on the list still remain (Sebugwaawo,
2019). There is a significant discrepancy between the numbers projected as kidneys available
and the final number of kidneys used for renal transplantations.

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Upgrading the renal transplantation services
The ever growing list of patients in need of renal transplant is the fundamental reason
behind the urgent need of upgrading the renal transplantation services. The upgrade of the
renal transplantation services has to be focused into four main categories of society and
individual, the doctors and staff handling donation, the medical team handling transplantation
and the government health departments and commissioners.
Category Those who need to be involved Call of Action
1 Society and individuals  Attitude towards organ donation must be
changed.
 Promotion of organ donation to make people
feel proud to donate.
 Registering and pledging organ donation
2 Doctors and staff handling donation  Ensuring excellent care.
 Must be in support of organ donation.
 Must be routinely available.
 Ensuring maximum number of organs
retrieval from each donor.
3 The medical team handling
transplantation
 Well equipped infrastructure to ensure best
transplant outcome.
 Proper management of the donated organ to
maintain its viability for transplantation
 Details of patients on the waiting list must be
well documented for fast matching and
screening

9EXPANDING THE KIDNEY TRANSPLANT BUSINESS IN UAE
 Surgeons must be routinely available
4 Government health departments
and commissioners.
 Better support systems
 Enhanced processes to enable more
donations
 Government assistance with easily available
helicopters and air ambulances for
minimizing the time required to get the organ
from the donor to the recipient.
Promotion of the kidney transplantation
Dr. Obaidly highlighted that approximately 68% of the population was ready for
deceased organ donation as noted by the survey conducted by Mohammad Bin Rashid
University (Sebugwaawo, 2019). The donation of organs from cadavers has the potential to
save almost eight lives. Cadavers can be utilized with the donation of kidneys, eyes, liver,
lungs, heart, pancreas, skin, small intestines and other viable tissues.
To match up to the requirement of organ donors, His Highness Sheikh Mohammad
Bin Rashid Al Maktoum, the Vice-President and the Prime Minister of the UAE and the
sovereign ruler of Dubai, had launched the ‘Hayat’ app registry for all smart device platforms
at the Ministry of Health and Prevention pavilion (MoHP) of the Arab Health Forum in
January, 2019 (Chaudhary, 2019). All the residents of UAE can install the Hayat app and can
easily register online with their personal details along with signing a pledge for donating the
organs after death (Chaudhary, 2019).
To further promote kidney donation and transplantation, initiatives can be taken for
free medical care for the individual donating a kidney. In case of donation from deceased

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individual medical benefits and discounts for the immediate family members can be ensured
to encourage people to join and pledge organ donation after death.
Conclusion and Recommendations
Kidney transplantation is much more beneficial in comparison to routine dialysis as a
treatment of choice for patients with end stage renal disease. The overall cost for dialysis is
much higher compared to a successful renal transplant. Therefore, the following
recommendations can be incorporated to upgrade and promote the renal transplantation
services.
1. Comprehensive digital documentation of the patients on the waiting list for quick analysis
and screening with the donated organ, as the donated organ remains viable for transplantation
for a short while only.
2. Health care benefits might be given to the individuals donating a kidney or discounts for
the immediate family members of the deceased individual from whom organs have been
harvested for transplantation.
3. Promotion of the ‘Hayat’ app so that all citizens are encouraged to pledge their body for
organ donation after death (Chaudhary, 2019).
4. To enhance government involvement and intervention so that the entire process is
facilitated and maximum benefits can be gained from kidney donations that will uplift the
health and lifestyle of many.
In conclusion, maximizing organ donations thereby leading to higher number of renal
transplants is the key to combat end stage renal disease and upgrade the life of those patients
in need.

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References
Boobes, Y., Bernieh, B., Hussain, Q., Al Omary, H., Al Hakim, M. R., Abayechi, F., ... &
Ahmed, M. (2015, May). Prevalence of polyomavirus among United arab emirates
kidney transplant recipients: results from a single center. In Transplantation
proceedings (Vol. 47, No. 4, pp. 1143-1145). Elsevier.
Chaudhary, S. (2019). Digital registry launched in UAE for deceased organ donors. Retrieved
from https://gulfnews.com/uae/health/digital-registry-launched-in-uae-for-deceased-
organ-donors-1.61770596
Cleveland Clinic News. (2019). Cleveland Clinic Abu Dhabi Establishes Organ Transplant
Program. Retrieved from https://newsroom.clevelandclinic.org/2018/02/21/
cleveland-clinic-abu-dhabi-establishes-uaes-first-comprehensive-organ-transplant-
program.
Heldal, K., Midtvedt, K., Lønning, K., Iversen, T., Hernæs, K. H., Tsarpali, V, & Bernklev,
T. (2019). Kidney transplantation: an attractive and cost-effective alternative for older
patients?—a cost–utility study. Clinical Kidney Journal.
Jarl, J., Desatnik, P., Peetz Hansson, U., Prütz, K. G., & Gerdtham, U. G. (2017). Do kidney
transplantations save money? A study using a before–after design and multiple
register-based data from Sweden. Clinical kidney journal, 11(2), 283-288.
Mubadala. (2019). Cleveland Clinic Abu Dhabi Celebrates Transplant Successes in the Year
of Tolerance. Retrieved from https://www.mubadala.com/en/news/cleveland-clinic-
abu-dhabi-celebrates-transplant-successes-year-tolerance

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Oniscu, G. C., Ravanan, R., Wu, D., Gibbons, A., Li, B., Tomson, C, & Watson, C. J. (2016).
Access to Transplantation and Transplant Outcome Measures (ATTOM): study
protocol of a UK wide, in-depth, prospective cohort analysis. BMJ open, 6(2),
e010377.
Rouchi, A. H., & Mahdavi-Mazdeh, M. (2016). Kidney transplantation in the Middle
East. Clinical nephrology, 86(7), 101.
Salama, A. (2019). Passed: UAE organ transplant law — and what it means. Retrieved from
https://gulfnews.com/uae/health/passed-uae-organ-transplant-law--and-what-it-
means-1.1896013
Sebugwaawo, I. (2019). Hospital in UAE celebrates 35 transplant surgeries. Retrieved from
https://www.khaleejtimes.com/news/uae-health/hospital-in-uae-celebrates-35-
transplant-surgeries