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DE RUEHRH #0460/01 0650955
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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). 
 
¶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