| Abstract|| |
The reported annual incidence of ESRD in the Kingdom is 100-120 patients per million population. The first dialysis unit in Saudi Arabia was set up in 1971 and since then rapid advances have been made in the Kingdom in the field of renal replacement therapy. There are currently 103 centers offering dialysis to about 4500 patients. The National Kidney Foundation was established in 1985 to implement a cadaveric organ transplant program and to co-ordinate the renal care facilities in the Kingdom. This center was renamed as Saudi Center for Organ Transplantation (SCOT) in 1993 in order to encompass transplantation of organs other than the kidney as well. A real impetus was given in the year 1982 with the approval handed over by Islamic scholars on the concept of brain-death and organ transplantation. From 1979, when the first renal transplant was performed till end of 1994, more than 1600 renal transplants have been performed in 13 transplant centers in Saudi Arabia. Also, 49 liver, 57 heart, 45 heart valve, 121 cornea, 4 pancreas, 4 lung, and 100 bone marrow transplants have been performed in the Kingdom. Despite these achievements, there is still a large gap between demand and supply and efforts are ongoing to improve the donor pool and bridge this gap.
Keywords: ESRD, Saudi Arabia, SCOT, Organ transplantation, Hemodialysis, CAPD.
|How to cite this article:|
Shaheen FA, Souqiyyeh MZ, Al-Swailem AR. Saudi Center for Organ Transplantation: Activities and Achievements. Saudi J Kidney Dis Transpl 1995;6:41-52
|How to cite this URL:|
Shaheen FA, Souqiyyeh MZ, Al-Swailem AR. Saudi Center for Organ Transplantation: Activities and Achievements. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Jun 3];6:41-52. Available from: http://www.sjkdt.org/text.asp?1995/6/1/41/40899
| Introduction|| |
The Kingdom of Saudi Arabia (KSA) is located in the South Western part of Asia and has an area of about 1.5 million square kilometers. The population of the Kingdom as estimated in 1993 is about 17 million, of whom 70% are Saudi nationals. The Kingdom has a well organized health care network including renal replacement therapy. The reported incidence of end-stage renal disease (ESRD) in Saudi Arabia is 100-120 Patients per million population (PMP) per year. The first hemodialysis (HD) unit was started in 1971 in Riyadh. Since then there has been a steady increase in the number of patients on maintenance HD as well as the number of centers offering such treatment. Organ transplantation in the KSA in the early years, was restricted to renal transplantation which started in the Armed Forces Hospital in Riyadh in 1979. Initially, renal transplantation was performed using live related donors and cadaveric kidneys that were harvested abroad. There were no local cadaveric donors. The Jurisprudence of Islamic Ulema (scholars) approving the acts of organ donation and transplantation in 1982 heralded the true era of transplantation programs in the Kingdom.
The National Kidney Foundation (NKF) was established in 1985 by the Government of the Kingdom of Saudi Arabia as a nonprofit organization. The initiative and pa-tronization of His Royal Highness Prince Salman Ibn Abdul Aziz, the Governor of Riyadh Region, helped in this endeavor. Its main responsibility was to co-ordinate a local cadaveric organ transplantation program in the KSA using the brain-dead donors in the Intensive Care Units (ICU) in the different hospitals of the KSA as organ donors. The NKF was upgraded in 1993 and renamed as Saudi Center for Organ Transplantation (SCOT) to encompass transplantation of organs other than the kidney as well. Since its establishment, the center has been successful in implementing an active cadaveric organ donation program including the kidneys as well as other organs such as heart, liver, pancreas, corneas and lung.
Since SCOT co-ordinates the facilities pertaining to renal replacement therapy in the Kingdom, we will attempt in this report to highlight the various aspects of the activities of this organization, and to describe the activities of the different transplantation programs in the KSA.
| Responsibilities of SCOT|| |
There are several sections in SCOT including the medical, the public relations, journal and research and the computer sections, besides the other supportive administrative sections, which work together to carry out the following responsibilities.
a) Co-ordination of dialysis facilities
The annual incidence of ESRD in the Kingdom was estimated to be between 100120 PMP. Treatment of renal failure by replacement therapy started in 1971 in the Kingdom with the establishment of the first HD unit in Riyadh. [Figure - 1] shows the trend with time of the number of patients with ESRD on HD which has now reached 4,542. [Figure - 2] shows the trend with time of the number of HD units in the Kingdom which has reached 103. There is a concomitant increase in the number of HD machines and currently there are 996 machines in the Kingdom. These figures reveal the magnitude of the service being provided for patients with ESRD. Special pediatric dialysis units are also available in four hospitals. Peritoneal dialysis (PD) is also offered in the Kingdom, but constitutes only 3% of the total population on dialysis [Figure - 3]. The SCOT has established an elaborate database about the renal failure patients in the Kingdom through a computer network linking major hospitals in different parts of the Kingdom to the center. This has helped in proper co-ordination of supplies and in predicting the need for newer centers for dialysis.
b) Co-ordination of organ donation from the brain-dead cases
There are 110 Intensive Care Units (ICUs) in the Kingdom, with a total of 1005 beds distributed between the hospitals of the Ministry of Health and the other health care providing sectors, which are available to share in the organ donation program. All potential brain-death cases from the ICUs are reported to SCOT. Road traffic accidents constitute 60% of the reported cases, while other causes such as brain tumor, cerebro-vascular accidents and fall from height account for about 40%. [Figure - 4] shows the number of major road traffic accidents and the number of the dead individuals in these accidents during the years 1992 and 1993 as reported by the Department of Traffic, Saudi Arabia.
It is well known that in order to succeed in any organ donation program, one must increase the awareness of the medical personnel about the concept of brain-death and organ donation ,,,, . This needs regular training courses for the medical personnel and visits to ICUs in different hospitals. In this context, symposia about organ donation are organized regularly in different hospitals. Medical and legal data related to donation of organs are published periodically. These different strategies carried out by SCOT, have been fruitful. The total number of brain-death cases reported has reached 1360 [Figure - 5] and there has been a regular increase in the number of the reported cases over the years as shown in [Figure - 6]. The number of the ICUs involved in SCOT donation program has also increased over the years and 85 hospitals out of the 110 in the different medical sectors are participating actively.
| Diagnosis of brain-death|| |
Ensuring that the brain-death protocol is strictly followed is an important objective of SCOT in any potential brain-death case  . Hospitals are supplied with the needed equipment for the diagnosis of brain-death. Also, the brain-death protocol is reviewed periodically with the help of neurologists and neurosurgeons. The co-ordinators of SCOT also supervise the diagnosis of brain-death in all the reported cases from medical as well as legal view points.
Consent of the families for organ donation
There are local brain death and family convincing committees in each potentially donating hospital in the Kingdom, They comprise of doctors and coordinators who approach the families of the brain-dead patients for consent for donation. The SCOT co-ordinators always help these committees in this regard, The activities of these committees have been increasing over the years which has helped significantly to achieve successful consent in 40% of the reported brain-death cases [Figure - 5]. The trend over the years of the consented eases for organ donation is depicted in [Figure - 7]-The success rate of convincing the families for organ donation has not been affected by the requests of multiorgan donations as has been reported from other countries  .
Co-ordination with transplantation centers
The SCOT co-ordinators arrange the transportation of the harvesting teams between the donating hospitals and the hospital where transplantation will be performed. They also follow up the results of the operations.
The SCOT has adopted over the last two years a new strategy called the "zonal distribution", where hospitals in each zone are attached to a transplant center in that zone. This has helped in achieving better coordination in reporting of the brain-death cases. The retrieved organs are distributed to the appropriate transplant centers according to pre-arranged lists and according to zonal distribution  .
c) Follow-up of the results of organ transplantation
The different organ transplantations performed in the Kingdom are followed up regularly by SCOT in co-ordination with the treating hospitals.
| Renal transplantation|| |
The total number of renal transplants performed in the Kingdom according to donor source is given in [Figure - 8],[Figure - 9]. [Figure - 10] shows the number of transplantations with the donor source and their relation to the establishment of SCOT. They all show clearly the increasing trend in the number of these operations, which has reached 1621. There were 276 renal transplantations performed in 1994 alone. The centers performing renal transplantation and the year of their establishment are given in [Figure - 11]. [Figure - 12],[Figure - 13] show the graft and patient survival rates of transplants performed in the Kingdom after three years of renal transplantation (SCOT data). These results are compatible with those published elsewhere  . Despite all these efforts, there are still many patients with ESRD who seek commercial transplantation abroad because of the long waiting list which now includes 2,724 patients. There have been more than 2,000 commercial operations performed over the last 15 years, These patients have faced many medical problems because of these operations  .
The first cardiac transplantation in Saudi Arabia was performed at the Armed Forces Hospital* Riyadh in 1986. There has been an increasing trend in the number of these operations over the years, Besides using whole hearts for transplantation, the hearts have also been used as a source for human heart valves in the last two years, [Figure - 14] shows the number of the whole heart transplantations performed and the number of hearts as a source of human heart valves. The survival rate for the whole heart transplantation is between 50-60% after two years of transplantation (SCOT mail survey).
The first liver transplantation in Saudi Arabia was performed at the Armed Forces Hospital, Riyadh, in 1990. Only five operations were performed till the beginning of 1994. There are four liver transplantation centers at present. [Figure - 15] shows the escalated number of operations in 1994, Liver failure due to hepatitis C virus is still the main indication for these operations followed by hepatoma and idiopathic liver failure, A survey carried out by SCOT showed that the estimated need for liver transplants was around 50 livers per million population per year, The SCOT is in the process of collecting more data about end-stage liver and end-stage heart disease patients, in order to know the exact magnitude of the need for transplantation of these organs,
The first corneal transplantation was performed at the King Khaled Bye Specialist Hospital in Riyadh in 1983 using imported corneas. The SCOT started providing corneas from cadaveric donors in 1990, [Figure - 16] shows the trend of these operations from corneas harvested locally and abroad,
Lung and pancreas transplantation
The first pancreas transplantation was performed in the Kingdom in 1990 and the first lung transplant was performed in 1991, Till the end of 1994, four pancreas transplantations (three combined kidney and pancreas, and one pancreas alone) and four single lung transplantations have been performed in the Kingdom, The centers performing pancreas transplant are Al Shaty Teaching and King Abdul Aziz Hospitals in Jeddah. Lung transplant is being performed in King Fahd Hospital, Jeddah. However, the number of these operations is still smaller than required and there are plans to increase the same in the near future.
Bone marrow transplantation
Bone marrow transplantations started in 1983, and they cover about 60% of the need of the Kingdom of such operations.
d) Scientific activities of SCOT
The center organizes many training courses to increase the awareness of the medical personnel about the concept of brain-death and the importance of organ transplantation. These courses are directed towards the workers in the ICUs, nephrologists, cardiologists, hepatologists, etc. Similar meetings are held with the public for the same purpose. Books, booklets, bulletins and posters about transplantation and organ donation have been printed and widely distributed. A quarterly publication, The Saudi Journal of Kidney Diseases and Transplantation is published from SCOT disseminating knowledge on the kidney and its diseases. The SCOT coordinates many research projects in conjunction with some of the major hospitals. Some of salient projects include; the incidence of ESRD in Gizan and Madinah areas, prevalence of hepatitis C among dialysis population in the Kingdom and prevalence of aluminum toxicity among patients on dialysis. All means of media are also used to increase awareness of the public about organ donation and the concept of brain-death. An annual plan is devised and reviewed regularly by SCOT in this regard. The SCOT also participates in many conventions and congresses, locally and abroad, highlighting the activities of the various transplantation programs in Saudi Arabia.
e)The Scientific Committees of the SCOT
There are 26 scientific committees working through SCOT which comprise of distinguished consultants in different medical fields. There are some basic committees of hemodialysis, renal, liver, and heart transplantations, who meet regularly to evaluate the activities. Proposals and suggestions of these committees aid considerably to improve performance in the related fields.
f) Other services
SCOT handles the medical supplies (drugs, disposables and machines) for the HD units in the Kingdom through a dedicated department called medical supplies department.
Shortage of organ donation
There is an increasing gap between supply and demand for organs in many areas in the world ,, . The same is noticeable in the KSA as well according to the statistics of SCOT in the last 10 years [Figure - 17]. More donors would be needed in the coming years to narrow the gap between supply and demand. Otherwise, we would expect more patients to be on dialysis indefinitely, die, or seek commercial transplantation using their own resources and thereby face numerous ethical and medical problems.
| Conclusion|| |
Significant advances have been made in the field of renal replacement therapy in the KSA. The SCOT has been playing a major role in achieving self sufficiency of the donated organs in the Kingdom thereby decreasing the cost of the operations without the need for the patients to travel away from home. The full capacity of the donation from the cadaveric source of organs has not yet been achieved. Increasing the awareness of the medical personnel and the general public about the concept of brain-death and the significance of transplantation are essential in order to increase the number of donations and to decrease the gap between demand and supply of organs.
| Acknowledgment|| |
Thanks to Mr. M.A. Taher, Mr. Pedly F. Atienza and Mr. Atef Nouman Saleh for their excellent secretarial assistance.
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Faissal AM Shaheen
Consultant Nephrologist and Director, Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11], [Figure - 12], [Figure - 13], [Figure - 14], [Figure - 15], [Figure - 16], [Figure - 17]