Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 761 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 


 
ORIGINAL ARTICLE Table of Contents   
Year : 2007  |  Volume : 18  |  Issue : 1  |  Page : 60-64
Organ Donation after Brain-Death: Experience Over Five-Years in a Tertiary Hospital


1 Critical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
2 Clinical Medicine, University of Missouri Sleep Center, University of Missouri, Columbia, USA
3 Division of Nephrology & Renal Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Click here for correspondence address and email
 

   Abstract 

Organ transplantation is the treatment of choice for end-stage organ failure. The main challenge for organ transplantation continues to be organ shortage. The purpose of our study was to evaluate the success rate of organ donation after brain-death, as documented in a tertiary closed intensive care unit in Saudi Arabia. Data was obtained from a collected database from Jan 2001- Dec 2005. Brain death was documented in 162 patients, most of whom were young (median age was 28 ± 17 years). The group consisted predominantly of males, 149 (92%) and Saudis 109 (67%). Only 24 (17%) positive consents to organ donation were obtained and the majority of them [21 (87%)] were from non-Saudis. Positive consent was obtained from only three percent of Saudi potential organ donors in comparison to the 40% positive rate among non-Saudis (40 %) (p< 0.05). In conclusion, we believe that misconceptions about brain-death are the likely causes behind this unfavorable view towards organ donations among Saudis.

How to cite this article:
Aldawood A, Al Qahtani S, Dabbagh O, Al-Sayyari AA. Organ Donation after Brain-Death: Experience Over Five-Years in a Tertiary Hospital. Saudi J Kidney Dis Transpl 2007;18:60-4

How to cite this URL:
Aldawood A, Al Qahtani S, Dabbagh O, Al-Sayyari AA. Organ Donation after Brain-Death: Experience Over Five-Years in a Tertiary Hospital. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2019 Jun 26];18:60-4. Available from: http://www.sjkdt.org/text.asp?2007/18/1/60/31847

   Introduction Top


As the supply for organs reached a plateau over the years, the demand for organ transplantation has consistently increased, thus creating a major shortage in organs and longer wait times for those critically ill patients registered on the list for transplantation. The waiting list for solid organ transplantation in the United States of America (USA) now exceeds 92,000, of whom 67,000 are waiting for a kidney transplant and only 16,477 kidneys were transplanted (United Networks for Organ Sharing (UNOS) at www.unos.org)

This shortage of transplantable organs is a worldwide phenomenon, but it is particularly obvious in countries like Saudi Arabia where more than 4,200 patients are presently on the waitlist for kidney transplantation.[1],[2] Although an increase has been noted in the rates of organ donation, this has not been adequate to meet the demand. Growing attention is being given to the issue of organ shortage by such governmental agencies as the United States Congress. [3]

The number of patients on waiting lists for organ transplantation has always outpaced that of the supply creating a wide gap between supply and demand. The gap, for example, is wider in the Middle East where the estimated prevalence of end-stage renal disease (ESRD) is 200 patients per million populations (pmp) per year, with a 10-15% annual death rate on dialysis.[4]

To deal with this widening gap, there has been a worldwide increase in live donations, but this is still inadequate. In the USA, 99% of organs used for transplantation are obtained from deceased persons. [2],[5]

Cadaveric organ donation has a great potential in the Middle East due to the high rate of road traffic accidents. Nevertheless, this source is not being utilized properly due to the continued debate in the medical community about the concept of brain-death and inadequate awareness of the public of the importance of organ donation and transplantation in many countries in this region.[4] Thus, it appears that the shortage of transplantable organs is not due to a lack of potential donors per se but likely due to the failure to utilize the potential cadaveric organ donors in an optimal fashion.

The aim of our study was to evaluate the success rates of consent for organ donation among the relatives of the documented brain­dead patients who are deemed candidates for donation.


   Methods Top


Setting

This prospective study was conducted in a 21 bed, medical and surgical intensive care unit (ICU) in an 800-bed tertiary care teaching hospital in Riyadh, Saudi Arabia. This ICU is a closed unit, run by in-house, full-time, board-certified intensivists, with more than a thousand admissions per year.

Patients

All consecutive patients who had documented brain-death between January 2001 and December 2005 were included.

Measurements

Patients were prospectively identified as being brain-dead on the basis of two clinical examinations performed on two separate occasions that were at least six hours apart. Additional confirmatory tests performed consisted of one of the following: brain perfusion study by nuclear scanning, electro­encephalogram or cerebral angiography. After these two steps were performed, the apnea test was conducted and if all of these three steps revealed negative brain stem function, the patient was declared brain-dead.

Data were collected on patients' age, gender, nationality, and the cause(s) of the death. All patients were closely monitored until discontinuation of mechanical ventilation or organ harvesting. The ICU intensivists were exclusively responsible for the brain stem death confirmation process. Discussion with relatives about organ donation and the process of obtaining consent was the sole responsibility of the staff from the Saudi Center for Organ Transplantation (SCOT), based in Riyadh which has personnel available 24-hours a day, who are specifically trained in such discussions. Each case was assigned to a specific staff member based on a monthly preset schedule. The assigned staff continued working on the case until final conclusions were drawn. Success in this study is defined as acceptance of next of kin to organ donation with subsequent harvesting.


   Results Top


During the study period, 4,347 patients were admitted to the ICU in our hospital. Brain-death was documented in 162 patients, most of whom were young (median age 28 ± 17 years), males (149, 92%) and Saudis (109, 67%). 101 (62%) brain-death cases were due to road traffic accidents; 161 (99%) cases were reported to SCOT, while one case was not reported due to legal issues. In 139 (86%) of the cases, relatives were approached; only 24 (17%) consented to organ donation, of whom the majority were non Saudis (21, 87%) [Figure - 1].

Positive consent was obtained from only three percent of Saudi potential organ donors in comparison to the 40% positive rate among non-Saudis (40 %) (P < 0.05).


   Discussion Top


In our study, the overall percentage of relatives that consented to organ donation was 17%. This is similar to an earlier report by Al-Sebayal et al, who in a study conducted in three hospitals of the Ministry of Health in Riyadh over a nine-month period, showed similar rates of obtaining consent. However, in that study, the documentation of brain­death was clearly less than that seen in our study (47%). [6] This lower rate of documented cases was also the main finding of another study. [7] That study was conducted in four hospitals in Riyadh between 2001 and 2002 and showed the rate of complete documentation of brain-death and reporting to SCOT as only 33 and 20% respectively. We believe that the high documentation and reporting rates at our center are due to our closed unit system, around-the-clock availability of consultant-level board certified critical care intensivists, as well as the availability of transplant coordinators who facilitate the process of documentation and reporting to SCOT.

The most striking finding in our data is the extremely low rate of positive consent among Saudi potential organ donors in comparison to the relatively high rate among non-Saudis (3% vs. 40 %. P < 0.05). On the contrary, Shehri and his group reported higher rates (39%) in their survey conducted in 1998. [2]

Saudi Arabia is an Islamic country and the home to two of Islam's holiest cities. In this context, the concept of brain-death and organ transplantation received a real impetus in the year 1982 with the approval given by Islamic scholars. However, it seems that there has been a decline in the rate of organ donations in Saudi Arabia in early 2000 compared to the 1990s. One of the reasons for this decline could be a local fatwa from few scholars in Saudi Arabia that discouraged organ donation, or at least did not favor it.

Islam has a great concern and respect for human life and promotes the preservation and prolongation of life. In this respect, organ donation has become acceptable to most jurists and is practiced in many Muslim countries. [8] On this note, improving the understanding of brain-death is essential, as there is considerable doubt still in the minds of not only the lay public, but also some medical personnel. All means of media including radio, television, newspapers, magazines, and posters should be utilized to disseminate information that brain-death means death and this concept has been universally accepted. It is also essential to organize periodic workshops and symposia to educate medical personnel, particularly ICU staff, on the diagnosis and management of brain-death.

All these factors are not beyond the reach of many developing countries. What is required is a constant strive and tireless dedication to make the launching of cadaveric donor transplantation program feasible. This will help in increasing the number of kidneys and other organs available for transplantation, thereby helping many patients in need.

There are some major factors that are crucial in organizing an organ donation program in any country. Among them, religious and social acceptance of organ donation and transplantation are of prime importance. [9] Improving the awareness of the public at large due to the importance of organ donation and transplantation is essential. This can be achieved through education of the public by arranging regular visits to schools, organizing public debates in different regions and public meetings, optimal use of media such as television, press, booklets and pamphlets, use of organ donor cards and conducting public surveys of approval to organ donation. SCOT has adopted these tools in Saudi Arabia. There have been regular visits to primary and high schools, and in return, visits of these students to SCOT from 1996. Public debates have been organized in conjunction with medical conferences in different regions in the Kingdom. SCOT also publishes booklets and pamphlets geared to the public. [9],[10]

Among the main obstacles to organ donation, inadequate awareness of some of the leading Islamic jurists, the public in general, and the lay press of the concept of brain-death need to be addressed. Additionally, the medical community is a key factor for the community at large. Educating both the public and the medical community, besides an efficient organ procurement center, are the major strategies for success of organ donation and transplantation in any country. [11 ]Convincing families, including parents of the deceased, to give consent to the donation of organs is a sensitive issue and adequate training should be imparted to people involved in this field.

In summary, our data show significant improvement in documentation and reporting rates of potential organ donors. Unfortunately, there still exists very low rates in obtaining consent, especially among Saudis. We believe that misconceptions about brain-death are the likely causes behind this, particularly among Saudis. An aggressive social, educational and religious campaign is necessary to impart and disseminate knowledge about the concepts of brain-death and organ transplantation.

 
   References Top

1.Shaheen FA. Organ transplantation in the Kingdom of Saudi Arabia: new strategies. Saudi Kidney J Dis Transpl 1994; 1:3-5.  Back to cited text no. 1    
2.Al Shehri S, Shaheen FA, Al­Khader AA. Organ donations from deceased persons in the Saudi Arabian population. Exp Clin Transplant 2005; 3(1):301-5.  Back to cited text no. 2    
3.Shafer TJ, Ehrle RN, Davis KD, et al. Increasing organ recovery from level I trauma centers: the in-house coordinator intervention. Prog Transplant 2004; 14(3):250-63.  Back to cited text no. 3    
4.Shaheen FA, Souqiyyeh MZ. How to improve organ donation in the MESOT countries. Ann Transplant 2004; 9(1):19-21.  Back to cited text no. 4    
5.Salahudeen AK, Haider N, May W. Cold ischemia and the reduced long­term survival of cadaveric renal allografts. Kidney Int 2004; 65(2):713-8.  Back to cited text no. 5    
6.Al-Sebayel MI, Al-Enazi AM, Al­Sofayan MS, et al. Improving organ donation in Central Saudi Arabia. Saudi Med J 2004; 25(10):1366-8.  Back to cited text no. 6    
7.Al-Sebayel MI. The efficiency in the utilization of potential donors for organ transplantation in Riyadh, Saudi Arabia. Saudi Med J 2003; 24(7):758-60.  Back to cited text no. 7    
8.Golmakani MM, Niknam MH, Hedayat KM. Transplantation ethics from the Islamic point of view. Med Sci Monit 2005; 11(4):RA105-9.  Back to cited text no. 8    
9.Shaheen FA, Souqiyyeh MZ. Factors influencing organ donation and transplantation in the Middle East. Transplant Proc 2000; 32(3):645-6.  Back to cited text no. 9    
10.Daniels DE, Smith K, Parks­Thomas T, et al. Organ and tissue donation: are minorities willing to donate? Ann Transplant 1998; 3(2):22-4.  Back to cited text no. 10    
11.Grenier CE, Joseph AS, Jacobbi LM. Perceptions and attitudes toward organ procurement and transplantation: a medical community survey analysis. J Transpl Coord 1996; 6(2):69-74.  Back to cited text no. 11    

Top
Correspondence Address:
Abdulaziz Aldawood
Program Director, Critical Care fellowship Program, King Abdulaziz Medical City, P.O. Box 1132, Riyadh 1149
Saudi Arabia
Login to access the Email id


PMID: 17237893

Rights and Permissions


    Figures

  [Figure - 1]

This article has been cited by
1 Transcranial Doppler in brain death assessment: Perspective and implications in the Saudi Arabian health system
Al-Jehani, H.M. and Sheikh, B.Y.
Neurosciences. 2013; 18(2): 122-125
[Pubmed]
2 Brain death: Criteria, signs, and tests
Kasule, O.H.
Journal of Taibah University Medical Sciences. 2013; 8(1): 1-6
[Pubmed]
3 Islam, brain death, and transplantation: Culture, faith, and jurisprudence
Arbour, R. and AlGhamdi, H.M.S. and Peters, L.
AACN Advanced Critical Care. 2012; 23(4): 381-394
[Pubmed]
4 Part 2: Reports from the working groups
Transplantation. 2011; 91(11 SUPPL.): S67-S114
[Pubmed]
5 The effect of shortening confirmed brain death diagnosis time on organ donation rates in the intensive care unit [Yoǧun baki{dotless
Kirakli, C. and Uçr, Z.Z. and Anil, A.B. and Özbek, I.
Journal of Medical and Surgical Intensive Care Medicine. 2011; 2(1): 8-11
[Pubmed]
6 Human organ and tissue transplantation in Pakistan: When a regulation makes a difference [Transplantation dćorganes et de tissus humains au Pakistan: Lorsque la loi fait la diffĂ©rence]
Bile, K.M. and Qureshi, J.A.R.H. and Rizvi, S.A.H. and Naqvi, S.A.A. and Usmani, A.Q. and Lashari, K.A.
Eastern Mediterranean Health Journal. 2010; 16(SUPPL.): S159-166
[Pubmed]
7 Assessment of brain death of organ donors in Iran
Nozary Heshmati, B. and Tavakoli, S.A.H. and Mahdavi-Mazdeh, M. and Zahra, S.
Transplant International. 2010; 23(5): e7-e9
[Pubmed]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Methods
    Results
    Discussion
    References
    Article Figures
 

 Article Access Statistics
    Viewed4028    
    Printed138    
    Emailed0    
    PDF Downloaded530    
    Comments [Add]    
    Cited by others 7    

Recommend this journal