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Saudi Journal of Kidney Diseases and Transplantation
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EDITORIAL Table of Contents   
Year : 1994  |  Volume : 5  |  Issue : 1  |  Page : 3-5
Organ Transplantation in the Kingdom of Saudi Arabia: New Strategies


Director Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia

Click here for correspondence address and email
 

Keywords: Organ transplantation, Saudi Arabia, Cadaveric donor, Living related donor, Regulations, Waiting list.

How to cite this article:
Shaheen FA. Organ Transplantation in the Kingdom of Saudi Arabia: New Strategies. Saudi J Kidney Dis Transpl 1994;5:3-5

How to cite this URL:
Shaheen FA. Organ Transplantation in the Kingdom of Saudi Arabia: New Strategies. Saudi J Kidney Dis Transpl [serial online] 1994 [cited 2019 Aug 25];5:3-5. Available from: http://www.sjkdt.org/text.asp?1994/5/1/3/41353
The greatest impediment to organ transplant programs worldwide is the shortage of donor organs. Waiting lists for organ transplants continue to increase each year but the number of available organs is not keeping pace to meet this demand. By the end of 1992 there were 29,519 people on the waiting list for organ transplantation (75% for kidney transplant) in the United States alone [1] . The number of patients on the waiting list for kidney transplantation in the United Kingdom and Saudi Arabia was 4,343 [2] and 2,500 (SCOT data) respectively. The United Network for Organ Sharing reports that the number of patients on the waiting list is growing steadily by about 19% each year in the United States [3] . The report further adds that the number of donors has remained virtually unchanged for the third straight year. The figures in Saudi Arabia are not too different in proportion, with the number of new patients recruited for dialysis in 1993 being 783 as against a total of 240 renal transplants performed in the corresponding year.

This shortage of organ donors is not due to a lack of potential donors but due to a failure to utilize the potential cadaveric organ donors optimally [4] . It is estimated that in the United States, there are about 28.5 to 43.7 potential cadaveric donors per million population (pmp) annually [5] of whom only 16 to 17 donors pmp are utilized with a procurement efficiency of 37% to 59%. The corresponding figures for Saudi Arabia are 17 potential donors pmp, with a procurement rate of about 20 %. Thus, one of the main issues seems to be how we can increase the number of positive consents for organ donation.

Two major systems are currently in use worldwide to obtain consent for cadaveric organ donation [6],[7] .

  1. Opting-in: This requires explicit consent of the donor prior to death or authorization by an appropriate member of the family at the time of death [7],[8] . This system is currently being followed in Saudi Arabia, the United States, England, Canada and Australia.
  2. Opting-out: Under this system, organs can be procured from brain-dead cadavers without explicit consent unless the deceased has previously expressed his or her wish not to donate [6],[7],[8] . This is being followed in several European countries and has shown to have a higher retrieval rate particularly in countries like Austria.


It is evident that neither system is functioning optimally. To overcome the shortage of donor organs and to streamline organ distribution, new strategies have been laid down in Saudi Arabia under the auspicies of the Saudi Center for Organ Transplantation (SCOT). This center is the central coordinating body for the delivery of medical care to patients with end-stage renal as well as other organ diseases. Several scientific committees have been established comprising of eminent physicians and surgeons working in different parts of the Kingdom. These committees cover various aspects of organ donation including brain-death, transplantation and co-ordination. After convening several meetings these committees have laid down the regulations that govern the various aspects of organ transplantation in Saudi Arabia. No detail is spared and the regulations are applicable to both government and private institutions.

The regulations have been published as a directory in Arabic and English. The English version is published as a special article in this issue of the journal (pp 37 to 98). The salient features of this directory of regulations are:

  1. Various committees have been established in each hospital of the Kingdom, e.g., brain-death committee, family convincing committee and transplant committee. These committees regulate the documentation of brain-death, obtaining consent for organ retrieval and distribution of organs retrieved.
  2. Regulations have been laid down concerning the diagnosis, confirmation and management of brain-death. The steps to be followed for obtaining consent for organ donation from the heritors of the deceased have been spelt out clearly.
  3. Regulations concerning living related donor transplantation have been laid down. Stress is laid on documentation of the relationship between the donor and recipient. The act of donation should be voluntary and the fitness criteria for donors are specified. It is worth emphasizing that living unrelated transplantation is prohibited in Saudi Arabia.
  4. Strict priority guidelines have been laid down for the transplantation of each organ. This will ensure that deserving candidates would not have to wait for too long for life saving transplantation. A unique "urgent waiting list" has been created for each organ and patients in this list would get top priority for transplantation upon availability of a suitable organ.
  5. In order to improve the degree of coordination of cadaver donor transplantation, SCOT has formed a zonal distribution system for the hospitals in the Kingdom. Several medical zones have been made each having an organ transplant center as its nucleus. All the hospitals in this zone are attached to this parent center which in turn offers assistance in diagnosis and management of brain-death as well as performing transplantation. This zonal system is expected to increase the cadaveric pool by increasing the number of brain-death cases reported and harvested. The number of organ donors is expected to increase four fold under this system.
  6. The zonal distribution will further help in ensuring equal and fair distribution of organs so that a given patient with endstage organ failure has an even chance of getting organ transplantation irrespective of where he is located.


These new strategies are always under the close monitoring and supervision of SCOT. All transplant centers ate monitored closely by SCOT through its committees to ensure quality control as well as to assess the level of activity in promoting awareness on the concepts of brain-death and organ transplantation. No center in the Kingdom can ignore these regulations and non-compliance could result in closure of the center.

Preliminary experience with the zonal classification system is encouraging and in the last six months since its application there has been an increase of about 65% in the number of successful organ retrievals in Saudi Arabia. It is hoped that this success is sustained so as to narrow the gap that exists between the number of patients with endstage organ failure and the number of transplantations performed.

 
   References Top

1.Spital A. The shortage of organs for transplantation: Where do we go from here? N Engl J Med 1993;325:1243-6.  Back to cited text no. 1    
2.Williams R. More donor organs for transplantation. Elective ventilation proposals. Journal of the Royal College of Physicians of London,1993;27(3):214-5.  Back to cited text no. 2    
3.Patients waiting for transplants. UNOS Update 1992;8-24.   Back to cited text no. 3    
4.First MR. Transplantation in the nineties. Transplantation 1992;53:1-11.  Back to cited text no. 4  [PUBMED]  
5.Evans RW, Orians CE, Ascher NL. The potential supply of organ donors: An assessment of the efficacy of organ procurement efforts in the United States. JAMA 1992;267:239-46.  Back to cited text no. 5  [PUBMED]  
6.Lee PP, Yang JC, McDonnell PJ, Maumenee AE, Stark WJ. Worldwide legal requirements for obtaining corneas: 1990. Cornea 1992; 11: 102-7.  Back to cited text no. 6  [PUBMED]  
7.Kokkedee W. Kidney procurement policies in the Eurotransplant region:"Opting in" versus "opting out." Soc Sci Med 1992;35:177-82.  Back to cited text no. 7    
8.Sommerville MA. "Procurement" vs. "donation" access to tissues and organs for transplantation: Should "contracting out" legislation be adopted? Transplant Proc 1985; 17:53-68.  Back to cited text no. 8    

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Correspondence Address:
Faissal A.M Shaheen
Director, Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417
Saudi Arabia
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PMID: 18583754

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