Introduction: Liver transplantation (LT) in the Middle East remains confined to a few countries and relies heavily on living donation. Passage of the landmark brain death law in May 2017 enabled the establishment of deceased organ donation in the United Arab Emirates (UAE). Moreover, the scarcity of established programs in deceased organ donation in the Middle East Gulf region highlighted the potential for regional organ sharing agreements to meet demand.
Methods: We summarize the growth and success of LT in the UAE, supported by increase in deceased organ donation rate, the establishment of a successful organ sharing agreement with Kuwait and present an interim status report after the first six operational years.
Results: Solid organ transplantation in the UAE was established in accordance with provisions of the 2016 Federal Decree on Regulation of Human Organs and Tissue Transplantation, followed by passage of the brain death law in 2017. Subsequently, considerable progress in LT was made possible by seamless collaboration between numerous stakeholders. Key initiatives included establishment of an organ procurement organization, a national center for regulation of organ donation and transplantation and launching of ‘Hayat’, a registry of donors linked to Emirates identification card. This resulted in a significant increase in deceased organ donation rates in the country (Figure 1).

A successful regional organ sharing agreement was initiated with Kuwait in October 2021, that has since grown significantly and provided timely access to Kuwaiti nationals in need of LT, while promoting awareness of deceased organ donation in Kuwait. Recipients from both countries are listed on a common wait-list with prioritization based on MELD-based organ allocation policy. We have thus far successfully transplanted 57 Kuwaiti nationals as part of this ongoing collaboration.Since the first deceased donor LT in February 2018, we have completed a total of 259 LT in the first six operational years, including 32 LDLTs (Figure 2).

Even though Cleveland Clinic Abu Dhabi (CCAD) remains the only multi-organ transplant center in the nation, more recently a second LT center was established in late 2023 at King’s College Hospital London in Dubai that has performed 3 LTs thus far. One and 3-year graft survival at CCAD were 92% (95% CI: 87.2 - 95.0) and 85% (95% CI: 77.2 - 90.1), while 1- and 3-year patient survival were 94% (95% CI: 89.6 - 96.5) and 88.3% (95% CI: 81.4 - 92.8) respectively. Ongoing initiatives to facilitate the continued growth of LT include a proposed federal mandate to include transplant coverage in all insurance policies and a draft proposal to legalize donation after circulatory death LT.
Conclusions: Six years after initiating LT, the UAE has emerged as a regional leader in deceased organ donation and LT. Enhanced regional collaboration has helped meet the needs of patients needing LT in the Middle East Gulf region, while also promoting awareness of deceased organ donation.