Reforming Deceased Organ Donation in Pakistan: Lessons from UAE

Abstract: Background:Pakistan faces a severe organ shortage, relying on living donors despite 150,000 annual deaths from organ failure. Deceased organ donation (DOD) remains rare due to misconceptions, legal gaps, and weak infrastructure. The UAE’s opt-in system demonstrates how legal clarity, investing in public awareness and religious support can improve deceased donation rates. Objective:This study compares the deceased organ donation (DOD) frameworks of the United Arab Emirates (UAE) and Pakistan, focusing on legal systems, religious rulings, and public engagement strategies, and identifies actionable reforms to strengthen Pakistan’s DOD system. Methodology: A comprehensive literature review was conducted using PubMed, the Transplantation journal, and official government health portals, with the search term “deceased organ donation” AND “UAE.” Data were also extracted from the International Registry in Organ Donation and Transplantation (IRODaT) and reports from UAE health authorities. Studies were selected based on their policy relevance and availability of full-text in English. The findings were then organized into three thematic categories: legal frameworks, religious perspectives, and public attitudes. Results: The UAE’s opt-in system, established by the 2016 transplant law and 2017 brain death decree, boosted deceased organ donation (DOD) rates from 0.32 to 9.16 pmp between 2019 and 2023.1 Key reforms included standardized protocols, hospital-based Organ Procurement Units (H-OPUs), Transplant Procurement Management (TPM) training, and the Hayat National Program, which centralized donor data via Emirates ID and improved brain death referrals by 35%. ICU reforms raised early donor identification by 38% and reduced referral times from 10 to 3 days.2 In contrast, Pakistan’s weak enforcement of the 2010 Transplantation Act led to only 10 deceased donors in a decade, with no national registry, brain death protocols, or centralized coordination between provinces and tertiary hospitals in the same city, despite minor updates in 2023 allowing donor status on driving licenses. Religiously, the UAE’s Fatwa Council rulings clarified that brain death equals actual death and positioned organ donation as Sadaqah (charity), gaining 74.6% public support. In Pakistan, only 28% are aware Islam permits organ donation, and despite the 2025 approval of deceased donation with family consent, weak religious dissemination and misconceptions persist.3 UAE awareness campaigns increased public willingness to donate by 60–68%, supported by private organizations like Pure Health.4 In Pakistan, only 51.5% of healthcare professionals endorse DOD, with significant gaps in knowledge: 54% of ICU doctors cannot define brain death, and 47% would not withdraw ventilator support, hindering donation.5 Conclusion: Pakistan must strengthen brain death enforcement, establish a national donor registry, and standardize donor identification to improve deceased organ donation. Religious endorsement through fatwas, public awareness campaigns, and TPM training for ICU staff are essential to change perceptions and streamline donor management. Adopting these reforms, modeled on the UAE’s success, can build a sustainable DOD system in Pakistan.