Donor Organ Shortage Crisis: A Case Study Review of an Economic-Incentive System

Mohamed Al Sebayel ¹, A Al Enazi , R Sabbagh, T Al Aqeel , M Al Enazi, Hamad Al Bahili ¹, Hussien Elsiesy¹

¹Liver transplantation, KFSH&RC, Riyadh, Saudi Arabia

Introduction and Background: Gross disparity between organ demand and supply created a profound negative impact on organ transplantation.  Organ supply system depends on altruistic non-coercive donation (ADS). Desperate demand for organs and the need to combat organ trafficking, transplant tourism and human exploitation have resulted in the search for effective alternatives. Financial incentives are one of them. Its feasibility is debatable as it relates to medical, ethical and economic dimensions.

In Riyadh, Saudi Arabia, organ shortage was approach by Incentive-based procurement system (IBPS) applied by Mobile Donor Action Team (MDAT). Aggressive approach towards incentives for donors' families and health workers was associated with a threefold increase in donation rate.

The aim  is to provide a qualitative review of a five-year IBPS and to assess medical, ethical, religious, cultural and economic issues that have, and may impact the system and to make recommendations to the transplant community and health authority in KSA and elsewhere regarding the transferability of the system and areas for further research.

Method:  is qualitative. Review of documents was used to create a chronological audit and to shape interview questions. Sampling was purposeful and inclusive of MDAT members. Semi-structured interviews were conducted. Findings were subjected to thematic analysis.

Result: Documents reflected evolution of MDAT. The essence of MDAT is field work and liberal use of financial incentive resulting in 3 fold increase in donation rate.  MDAT members believed that IBPS is the reason behind this increase. Moreover, IBPS has been acceptable from moral, ethical and religious aspects with high degree of professional satisfaction. 

Discussion: Theoretical assumptions doubted the feasibility of IBPS. This real-life experience with IBPS proved the contrary. The findings may be applicable only to the setting in Riyadh, KSA. Further research is needed to explore its transferability to other settings.

Conclusion: IBPS can be an alternative to ADS and should be piloted in different settings.