| Abstract|| |
The Gulf Co-operation Council (GCC) which has six member-countries was established in 1981 to promote mutual co-operation on various aspects including health care. Efforts are ongoing to have active co-ordination among the member-countries in the field of organ transplantation. Islamic scholars in these countries have approved organ donation from living related and cadaveric donors after obtaining consent from the families concerned. This has paved the way for the implementation of successful renal transplantation programs in many of the GCC countries. The results of the operations performed locally in these countries are encouraging and similar. However, the demand for organs is still high and only 30% of the need is being met at present. Commercial organ donation is strictly prohibited in all these countries. In Saudi Arabia, the Saudi Center for Organ Transplantation (SCOT), erstwhile National Kidney Foundation, was established in 1985. The main objective was to coordinate organ transplantation program in the Kingdom and in the last ten years, the center has gathered remarkable experience in this field. Other GCC countries need to establish cadaveric renal transplantation programs in their countries on similar lines as SCOT.
Keywords: Renal transplantation, GCC countries.
|How to cite this article:|
Shaheen FA, Salmeen NM, Al-Muzairy IA, Hasan MJ, Fikry MM, Al-Areedhf AS. Renal Transplantation in the Gulf Co-operation Council Countries. Saudi J Kidney Dis Transpl 1995;6:5-8
|How to cite this URL:|
Shaheen FA, Salmeen NM, Al-Muzairy IA, Hasan MJ, Fikry MM, Al-Areedhf AS. Renal Transplantation in the Gulf Co-operation Council Countries. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Apr 4];6:5-8. Available from: http://www.sjkdt.org/text.asp?1995/6/1/5/40891
| Introduction|| |
The Gulf Co-operation Council (GCC) was formed in 1981. It has six member-countries, namely, Bahrain, Kingdom of Saudi Arabia, Kuwait, Qatar, Sultanate of Oman and United Arab Emirates. Ail these countries have an organized health care system and have established a Supreme Executive Committee comprising the Ministers of Health in each country to supervise the co-ordination of health care facilities among the member countries. A special committee to co-ordinate efforts in the field of organ transplantation has stemmed from this with the task of implementing strategies to improve the performance of the GCC countries in this field. Two meetings of this committee have been held so far, first in 1992 and later in September 1994. Representatives of all the GCC countries participated in these meetings and reports of the existing status of the renal transplantation programs were presented. In this article, we will summarize the activities of the renal transplantation programs in these countries.
| Organ transplantation guidelines in the GCC countries|| |
The GCC countries have similar cultures and traditions and are all Islamic countries. This makes the unification of the laws of organ transplantation in these countries an easy task. The scholars of Islam in these countries have earlier discussed the issue regarding organ donation and transplantation and issued a "Fatwah" wherein they approved organ transplantation and donation from both living and brain dead donors, provided proper consent of the families for donation was obtained in each case. At the same time they cautioned against commercialization of organ transplantation. They prohibited selling of organs to unrelated Recipients. The GCC countries have formed their guidelines concerning organ transplantation according to these "Fatwahs", and the programs of organ transplantation were established accordingly. The basic guidelines are similar and this enhances the chances of success of future efforts for their unification.
| Basic information about renal transplantation programs in the GCC countries|| |
[Table - 1] shows the details concerning renal transplantation programs in the various GCC countries. The Kingdom of Saudi Arabia and Kuwait have been the leaders in this field and the first operations were performed in 1979 in both these countries. Subsequently, the other GCC countries also followed suit. Bahrain does not have a local renal transplantation program as yet, and is about to start one soon. [Table - 1] also shows the number of transplantation centers existing in each of the GCC countries. Saudi Arabia has 13 centers and in addition has many centers that carry out follow-up of patients after renal transplantation.
| Local renal transplantation in the GCC countries|| |
The number of renal transplantations performed has been steadily increasing from the time the GCC countries initiated their transplantation programs. [Table - 2] shows the number of such operations performed in each country. Saudi Arabia heads the list having performed 1,570 such operations of which 906 are with living related donors and 604 with cadaveric donors, the latter having been performed both before and after establishing the Saudi Center for Organ Transplantation (previously, The National Kidney Foundation) in 1985. Varying number of transplants have been performed in the other GCC countries also both from living and cadaveric donors as shown in [Table - 2]. It may be noted that living unrelated donor transplantations are virtually not performed in the GCC countries and the few that have been performed were after close scrutiny and that too only from spouses or very close friends. The immunosuppressive therapeutic protocols used after renal transplantation are similar in all GCC countries comprising prednisolone, cyclosporine and azathioprine, in both living related and cadaveric renal transplants ,,, . The results of these operations, in terms of the graft survival and the patient survival both for living related and cadaveric renal transplantation are similar in these countries ,,, .
| Renal transplantation outside the GCC countries|| |
Due to the long waiting period of the endstage renal failure patients awaiting renal transplantation, many patients seek transplantation outside the GCC countries. Despite the well known risks and complications of these operations such as transmission of tuberculosis, AIDS and viral hepatitis, infectious complications of the surgical wounds and related urological complications, we still see many patients travelling abroad for renal transplantation. Many such operations are performed for profit, severely compromising on proper health care supervision. Some of them are performed despite the presence of contra-indication(s) for transplantation such as advanced age, irreversible urological problems and chronic infections. Though accurate statistics are hard to obtain, the morbidity and mortality of such operations are generally believed to be relatively high ,,, . [Table - 2] shows the number of the patients who had transplantation outside the GCC countries.
| Organ shortage in the GCC countries and strategies for remedy|| |
The shortage of donor organs, whether cadaveric or living related, all over the world is well known. Niemcyk et al, have recently analyzed the United Network of Organ Sharing (UNOS) statistics and put their predictions for the situation in the year 2000 in the United States of America  . They reached the conclusion that there would be a large gap between demand and supply of organs. They gave four major reasons for this, namely:
(i) not making enough efforts to increase the awareness of the health care workers about the significance of donation,
(ii) not making enough efforts to increase the awareness of the public about the importance of donation and the concept of brain death, besides not mastering the best way of approaching the families for consent for donation,
(iii) not having enough funds for organ donation programs from the Federal Government, and,
(iv) the increase of number of patients to be included in the waiting list for organ transplantation.
Accordingly, a large number of patients are expected to be waiting for organ transplantation in the year 2000, and many patients may die while waiting for the same. This group recommended increasing efforts to improve the cadaveric organ donation programs and also to improve upon the number of transplantations from living related donors to decrease the gap between demand and supply.
The situation in GCC countries is not different from the rest of the world, and many of the problems they face are similar to the above problems discussed by Niemcyk et al in their study. [Table - 3] shows the ratio of the number of the renal transplant operations to population in the various GCC countries. It shows that there is a big gap between demand and supply. The estimated incidence of endstage renal failure in these countries ranges between 75 to 120 new cases per million population (PMP) per year. Presuming that about 60% of these patients would need renal transplantation, we would need between 50 to 100 renal transplants PMP annually. [Table - 3] shows that the GCC countries are doing not more than 30% of the operations needed to cover the gap.
In conclusion, the GCC countries should take benefits from all the sources of donor organs whether living or the cadaveric. Organizing active organ donation programs in these countries is required in order to meet the demand. The Saudi Center for Organ Transplantation has long experience in this field and the experience gained by this center will be of help to the other member countries of the GCC in order to reach the goal of establishing a successful organ donation program soon.
| Acknowledgement|| |
We wish to express our sincere gratitude to Dr. M.Z. Souqiyyeh, Consultant Nephrologist, SCOT or his contribution in compiling data and preparation of this manuscript.
Thanks also are due to Mr. M.A. Taher and Mr. Pedly F. Atienza for their excellent secretarial assistance.
| References|| |
|1.||El-Shahat YI, Shakuntala RV, Bari MZ, et al. Treatment of end-stage renal failure in Abu-Dhabi, United Arab Emirates. Saudi J Kidney Dis Transplant 1994;5(3):384-95. |
|2.||Masri MA, Shakuntala RV, Dhawan IK, et al. Transplantation in the United Arab Emirates. Transplant Proo 1993;25:235-8. |
|3.||Shaheen FAM, Souqiyyeh MZ, AlSwailem AR. Saudi Center for Organ Transplantation: Activities and Achievements. Saudi J Kidney Dis Transplant 1995;6:41-52. |
|4.||El-Reshaid K. Renal Replacement therapy in Kuwait. Saudi J Kidney Dis Transplant 1994;5(4):493-7. |
|5.||Niemcyk SJ, Aronoff R, Maconi KM, Bowen GS. Projections in solid organ transplantation and waiting list activity through the year 2000. J Transplant Coordination 1994;4:23-30. |
Faissal A.M Shaheen
Consultant Nephrologist and Direcor, Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417, Kingdom of Saudi Arabia
[Table - 1], [Table - 2], [Table - 3]