Ethical and cultural dimensions of deceased organ donation consent in a multinational trauma ICU: A five-year experience from the United Arab Emirates

Deceased organ donation in culturally and socioeconomically diverse societies presents significant ethical challenges related to consent, equity, and protection of vulnerable populations.
In the United Arab Emirates (UAE), centralized trauma care and a predominantly expatriate population place trauma intensive care units (ICUs) at the center of the national deceased organ donation pathway.
Cultural and religious interpretations of brain death, language barriers, migration status, and family accessibility may influence consent processes and outcomes.
This study examines ethical, cultural, and socioeconomic determinants of deceased organ donation consent in the largest trauma ICU in Dubai, which provides the majority of deceased donors to the UAE national donation program.
Methods: A retrospective descriptive analysis was conducted of all potential brain-dead referrals managed between January 2021 and March 2025.
Demographic data, nationality (UAE national versus expatriate), family consent outcomes, and progression from referral to actual donation were collected from institutional registries. Data were analyzed descriptively. Findings were interpreted using an ethics and equity framework focusing on voluntariness of consent, cultural sensitivity, language and communication barriers, migration-related vulnerability, and institutional safeguards ensuring transparency and autonomous donation pathways.
Results: A total of 346 potential brain-dead referrals were identified during the study period. Patients were predominantly males (77.5%), reflecting regional trauma epidemiology. Expatriates constituted 94.8% of referrals, while UAE nationals accounted for 5.2%.
Overall family consent for organ donation was obtained in 22.5% of cases, resulting in 78 actual deceased donors.
Consent rates differed markedly by nationality, with no consent obtained among UAE national referrals and a consent rate of 23.8% among expatriates.
Key ethical challenges included language barriers, variable understanding of brain death, and limited in-country availability of next-of-kin among migrant populations, frequently necessitating cross-border family engagement.
Despite these barriers, standardized ICU protocols, structured family discussions, interpreter support, and strict separation between clinical care, death determination, and transplant coordination supported ethically robust consent processes.
Conclusion: Five-year data from a multinational trauma ICU demonstrate that deceased organ donation consent is strongly shaped by gender, migration status, and family accessibility.
Transparent, culturally responsive, and ethically grounded consent frameworks are essential to promote equity, protect vulnerable populations, and sustain public trust in centralized national transplant systems.