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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1998  |  Volume : 9  |  Issue : 2  |  Page : 123-127
Survey of the Current Status of Renal Transplantation in the Arab Countries


Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia

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   Abstract 

To evaluate the current status of renal transplantation in the Arab world, a questionnaire was mailed to prominent renal transplant physicians and surgeons in the Arab countries to get information related to number, donor type, immunosuppressive therapy used and survival of graft and patients who received renal transplantation. Furthermore, data about rehabilitation and legislation in the Arab countries were also included. The cost of renal transplantation was estimated from historical data. There were replies from 14 out of 22 (70%) countries with a total population of approximately 210 million (84%). Renal transplantation started in most of these countries in the late seventies and early eighties. In all but one, the renal transplant programs started with live related donations, and continued over the past 1 5-20 years with this type of donation. There have been 5,680 such operations, performed in a growing number of transplant centers. Legislation organizing donation from cadaveric donors has been established in only seven of the fourteen countries (50%) and, to date, there are only five countries with specialized centers to organize organ donation. The overall average graft survival is 87%, 80%, 60%, while patient survival is 96%, 85%, 70%, during one, five and ten years respectively. Full rehabilitation averaged 50%, partial rehabilitation averaged 40% and complete dependence averaged 10% after renal transplantation in the Arab countries. We conclude that there is still a need for more efforts to increase the number of renal transplantation, passing legislations that organize organ donation, and increase utilization of cadavers in renal transplantation in the Arab countries.

How to cite this article:
Shaheen FA, Souqiyyeh MZ. Survey of the Current Status of Renal Transplantation in the Arab Countries. Saudi J Kidney Dis Transpl 1998;9:123-7

How to cite this URL:
Shaheen FA, Souqiyyeh MZ. Survey of the Current Status of Renal Transplantation in the Arab Countries. Saudi J Kidney Dis Transpl [serial online] 1998 [cited 2020 Aug 5];9:123-7. Available from: http://www.sjkdt.org/text.asp?1998/9/2/123/39283

   Introduction Top


The Arab society for Nephrology and renal transplantation (ASNRT) was established in 1988 as a scientific and social forum of cooperation between of nephrologists in the countries of the Arab League.

The Arab league is composed of 22 countries with a total area of 12,000,000 square km and a total population of 250,000,000. The majority of the population is Muslims followed by Christians and Jews. They all speak the same language and have closely-related cultural and historical bonds. [Table - 1] shows the demographics of the Arab countries, gross national product and annual budget of ministries of health (MOH) per capita in US dollars [1] . Renal transplantation started to become a routine practice in the 1960's [2],[3],[4].

The aim of our study was to evaluate the different aspects of the current practice of renal transplantation in the Arab countries, as one of the functions of the division of renal transplantation in the ASNRT.


   Methods Top


A questionnaire was mailed in early 1997 to prominent renal transplant physicians and surgeons in the countries of the Arab league to provide data of practice of renal transplantation in their respective countries. The questionnaire included queries relating to the date of the first renal transplantation, type of donors, Legislation, approval of religious and legal experts, donation coordinating centers, total number of renal transplants, types of immunosuppression, estimated graft and patient survival, and rehabilitation.


   Results Top


Answers were obtained from 14 out of 22 (63%) Arab countries with a total population of 210 million (84%).

[Table - 2], shows the starting date of transplantation in the study group. Most of the renal transplant programs started in the late 1970's and early 1980's. Except for Jordan, all the renal transplant programs started with live related kidney donations and continued mainly with this source of donation over the ensuing 15-20 years. Some Arab countries are promoting the practice of cadaveric renal transplantation. These are Saudi Arabia, Kuwait, Tunisia, Jordan, Lebanon, Oman, Qatar and United Arab Emirates. Live non-related renal transplants were performed in some Arab countries but this is restricted to spouses, breast milk relatives in Saudi Arabia and Kuwait. However, commercial renal transplantation is being practiced in some Arab countries.

Legislations governing renal transplantation have been established in Algeria, Kuwait, Lebanon, United Arab Emirates, Oman, Saudi Arabia, Tunisia and Egypt. Bahrain and Qatar are in the process of passing legislation. There are five Arab countries, which have moved one step ahead by establishing national coordinating centers for organ donation and transplantation. These are Saudi Arabia, Kuwait, Tunisia, Lebanon and Egypt.

Till the end of 1997, there have been 4,155 renal transplants from living and 1,516 renal transplants from cadaver donors performed inside the Arab countries, [Table - 3]. The average renal transplants per million of population (PMP) per year is estimated as 2.2 renal transplants in the Arab world. [Table - 4] shows the detailed rates for each country in the study.

The total number of transplants performed outside the Arab countries for Arab patients during the same period is estimated as close to 6,000 transplants. This adds 2.5 patients PMP annually. The answers to the questionnaire also show that cyclosporine-based immuno­suppressive therapy is available in all the Arab countries participating in this study.

The overall graft survival was 87%, 80%, and 60% at one, five and ten years respectively.

The patient survival was 96%, 85%, and 70% at one, five and ten years respectively. The estimated average rehabilitation was full in 50% and partial in 40%, while 10% remained dependent on others.


   Discussion Top


This study shows that most of the Arab countries have renal transplant programs for a long time and have satisfactory results in terms of survival and rehabilitation. However, the numbers are very modest (4.7 PMP) compared to the incidence of renal failure of 100-120 patients/million/year [5],[6],[7],[8],[9],[10],[11] . The rest of the patients either end on dialysis or die. This modest profile of transplantation practice is due to several factors related to cost and lack of legislation and/or organization of organ donation programs.

Both dialysis and transplantation have heavy impact on health budget of the Arab countries. The estimated average cost for chronic dialysis is almost 20,000 US dollars/patient/ year [12] . This sums up to a total of six billion dollars per year, considering a projected pool of patients of 30,000 patients still active on dialysis. This has an extra burden on health budgets of 24 dollars on the average health budget per capita (originally 109.6 dollars, [1] . The cost of transplantation is less than dialysis and decreases with time after the first year [13] . Furthermore, rehabilitation is better in transplantation compared to dialysis [14],[15] .

In our study, the countries with active cadaver transplant programs (such as Saudi Arabia, Kuwait) have greater total number of renal transplants. This has also been noticed in other European countries and USA [5],[6] . The latter has a transplantation rate of 44 PMP annually, of which 32 PMP are from cadaveric donors [16] . These models could be used as examples to other Arab countries for establishing successful transplantation programs. We believe that the continued debate in some countries over the ethical or legal aspects of organ donation and transplantation should conclude soon, since there remains no doubt of success of donation and transplantation in countries that have established legislations [17],[18],[19],[20],[21] .

We suggest that all the Arab countries should pass legislations organizing living and cadaver organ donation and organ transplantation at the local as well as the Arab League levels. Also, there should be a network of organ sharing among the Arab countries. Governments should allocate sufficient budget and have more spending to encourage transplantation in their countries. This would decrease hopefully the drainage of funds spent on commercial transplantation abroad, whose known complications and sequellae drain resources.

We conclude that while renal transplan­tation is available in the Arab countries much work is still needed, for effective narrowing of the gap between supply (of organs) and demand (by the many patients with end­stage renal failure).


   Acknowledgement Top


We would like to thank all the following respondents to our questionnaire:

Dr. Hamoud Al-Marhobi (Oman)
Dr. Sameer Al-Aurayed (Bahrain)
Dr. Mohsen Ayad (Tunisia)
Dr. Sameer Mallat (Lebanon)
Dr. Antoine Stephan (Lebanon)
Dr. M. Abdul Quader Sobeh (Egypt)
Dr. Kamel El-Reshaid (Kuwait)
Dr. Yassin El-Shahaat (U.A.E.)
Dr. A. Bourquia (Morocco)
Dr. Omar Abboud (Qatar)
Dr. Mohammed El-Louzi (Jordan)
Dr. Hottam Salah (Algeria)
Dr. Ziad Ayash (Syria)
Dr. Salma M. Sulaiman (Sudan)

 
   References Top

1.Annual report of World Health Organization, Regional Office for the Eastern Mediterranean: Demographic and health indicators for Countries of the Eastern Mediterranean 1996. WHO Regional Office P.O. Box 1517, Alexandria 21511, Egypt.  Back to cited text no. 1    
2.Wilkinson AH, Rosenthal JT; Danovitch GM. Developments and dilemmas in renal transplantation. Adv Ren Replace Ther 1994;l:32-48.  Back to cited text no. 2    
3.Suthantliiran M. Strom TB. Renal Transplantation. N Engl J Med 1994;331;36.  Back to cited text no. 3    
4.Holley JL, McCauley C, Doherty B Stackicwicz L, Johnson JP. Patients' views in the choice of renal transplantation. Kidney Int 1996;49:494-8.  Back to cited text no. 4    
5.EDTA report on management of renal failure in Europe XXIV, 1993. Nephrol Dial Transpl 1995;10:Suppl 5.  Back to cited text no. 5    
6.Excerpts from US renal data system, 1993 annual data report, National Institute of diabetes and Digestive and Kidney Diseases, The National Institute of Health, Bethesda 1993;22(Suppl2):l-118.  Back to cited text no. 6    
7.Niclson GW, Nielson B. On the prevalence of kidney diseases in Southern Arabia (abstract). Kidney Int 1984;26(4):487.  Back to cited text no. 7    
8.Veberbrants E, Said R, Hussain M. Four year experience with end-stage renal disease in Saudi Arabia (abstract). Kidney Int 1985;27(1):173.  Back to cited text no. 8    
9.Ayash Z. Renal replacement therapy in Syria. Saudi J Kidney Dis Transplant 1997;8(4):436-7.  Back to cited text no. 9    
10.Barsoum R. Renal replacement therapy in Egypt. Saudi J Kidney Dis Transplant 1997;8(2):145-7.  Back to cited text no. 10    
11.Suliman SM; Beliela MH, Hamza H. Dialysis and transplantation in Sudan. Saudi J Kidney Dis Transplant 1995;6(3):312-4.  Back to cited text no. 11    
12.Eldrees A, Paul TT, Abu-Aisha H, et al. A cost evaluation of hemodialysis in Ministry of Health hospitals, Saudi Arabia: an NKF Study. Saudi Kidney Dis Transplant Bull 1991;2(3)125-33.  Back to cited text no. 12    
13.Chugh KS, Jha V. Differences in the case of ESRD patients worldwide: required resources and future out look. Kidney Int Suppl 1995;50:S7-13.  Back to cited text no. 13  [PUBMED]  
14.Ifudu O, Paul H; Mayers JD, et al. Pervasive failed rehabilitation in center­based maintenance hemodialysis patients. Am J Kidney Dis 1994;23:394-400.  Back to cited text no. 14    
15.Agodoa LY? Eggers PW. Renal replacement therapy in the United States: data from the United States Renal Data System. Am J Kidney Dis 1995;25:119-33.  Back to cited text no. 15    
16.Takomoto S, Terasaki PI, Gjertson DW5 Cecka JM. Equitable allocation of HLA compatible kidneys for local pools and minorities. N Engl J Med 1994;331:760-4.  Back to cited text no. 16    
17.First International Congress on Ethics, Justice and Commerce in Transplantation: A global view. Transplant Proc 1990;22:891.  Back to cited text no. 17    
18.Singer PA. A review of public policies to procure and distribute kidneys for transplantation. Arch Intern Med 1990;150:523.  Back to cited text no. 18  [PUBMED]  
19.Evans RW, Orians CE,AsdierNL. 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. 19    
20.Kokkedee W. Kidney procurement policies in the Eurotransplant region. "Opting in" versus "Opting out". Soc Sd Med 1992;35:177-82.  Back to cited text no. 20    
21.Spital A. The shortage of organs for transplantation. Where do we go from here? N Engl J Med 1991;325:1243-6.  Back to cited text no. 21    

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Correspondence Address:
Faissal A.M Shaheen
Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417
Saudi Arabia
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PMID: 18408286

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    Abstract
    Introduction
    Methods
    Results
    Discussion
    Acknowledgement
    References
    Article Tables
 

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