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Saudi Journal of Kidney Diseases and Transplantation
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   1996| April-June  | Volume 7 | Issue 2  
    Online since March 12, 2008

 
 
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EDITORIALS
Islamic Ethics of Organ Transplantation and Brain Death
Mohammed Ali Albar
April-June 1996, 7(2):109-114
PMID:18417922
The Kingdom of Saudi Arabia, the most conservative Islamic country, is playing a major role in formulating ethical Islamic jurisprudence views and rules in the rapidly expanding field of organ transplantation, and in implementing these new rules in its proliferating centers. The Islamic O' Sool or fundamentals of Islamic jurisprudence through which the jurists reach their rulings are discussed briefly. The historical background of the Islamic jurists' views on organ transplantation and the recent Fatwas (decrees) are highlighted. The conditions needed for allowing both cadaveric and living donors are discussed.
  10,799 1,125 -
SPECIAL ARTICLES
Living Organ Donation: Time for a Donor Charter
AS Daar
April-June 1996, 7(2):115-120
PMID:18417923
  4,799 272 -
ARTICLES
Liver Transplantation at King Fahad National Guard Hospital Riyadh, Kingdom of Saudi Arabia
M Al Sebayel, AT Kizilisik, C Ramirez, I Altraif, A Hammad, W Littlejohn, MB de Cordier, G Geldhof, TJ Bhatti, A Abdulla
April-June 1996, 7(2):173-177
PMID:18417935
Liver disease is a major medical problem in the Kingdom of Saudi Arabia and is mostly due to viral hepatitis. Liver transplantation is the only option for patients with end-stage liver disease offering good long-term survival. The first liver transplant at the King Fahad National Guard Hospital was performed in February 1994 and since then, 40 liver transplants have been performed on 37 patients. Immunosuppression consisted of prednisone combined with cyclosporin (Neoral) or FK 506. Maintenance immunosuppression was with the use of cyclosporin or FK 506 as monotherapy. All, but one patient, survived the surgical procedure; there were no cases of primary non-function; acute cellular rejection occurred in 12 patients all of whom responded to steroids. Pneumonia and biliary sepsis occurred in 12 patients each. A total of 10 patients died, with sepsis being the leading cause of death. The overall graft survival was 73%. Donor shortage continues to be a major limiting factor.
  3,756 254 -
ORIGINAL ARTICLES
Knowledge and Attitude towards Organ Donation among Males in Riyadh, Saudi Arabia
Ibrahim H Altraif, Mohammed I Al Sebayel, Hassan Nondo
April-June 1996, 7(2):135-138
PMID:18417927
Organ transplant programs are increasing in Saudi Arabia with the major barrier to transplantation being a shortage of organs. The majority of Saudi Nationals are reluctant and unwilling to donate or consent for donation. This study was undertaken to determine the knowledge and attitude towards organ donation among males in Riyadh, Saudi Arabia. A questionnaire was distributed to 223 men attending the out-patient department of the National Guard Hospital, Riyadh. A total of 205 (92%) individuals answered the questionnaire. Of them, 187 (91%) were Saudis and 18 (9%) were non-Saudis. A total of 187 (88%) had heard about organ donation of whom 80 (43%) each, had acquired this knowledge through television or radio, 16 (8%) through newspaper and magazines, seven (4%) through friends and relatives, and four (2%) through health-care workers. Of the 205 study subjects, 88 (43%) claimed they understood the concept of brain-death, 96 (47%) did not, and 19 (10%) did not respond to this question. One hundred and thirty-eight (67%) were willing to donate, and 156 (76%) were willing to receive an organ. One hundred and fifteen (56%) believed that Islam permits people to donate organs, five (2%) thought Islam does not permit organ donation, 64 (31%) gave a "don't know" answer and 21 (11%) did not attempt to answer the question. In addition, 41 (20%) thought organ donation disfigures the body. In conclusion although 67% of the respondents in this survey were willing to donate, there was a significant lack of knowledge and misconception with regard to Islamic support to, and the mutilating effects of, organ donation. Public educational programs and other measures addressing these issues may help in increasing the rate of organ donation among Saudis.
  3,477 439 -
SPECIAL ARTICLES
What it Means to Die in Islam and Modern Medicine
Yousef Boobes, Nada Al Daker
April-June 1996, 7(2):121-127
PMID:18417924
The objectives of this article is to evaluate whether the concept of brain-death can be examined by modern medicine alone as well as examine the impact of such an evaluation on Islamic views of this subject. Various clinical, philosophical, Islamic, and public-policy literature on the subject of death and brain-death have been examined. We present arguments to support the view that the subject of death (including brain-death) cannot be examined without a philosophical base. Any discussion on death should consist of definition of what it means to die, criteria for determining that death has occurred, and specific medical tests that show whether these criteria have been fulfilled. Medicine has no definition for death based on experimental sciences and death is defined by a philosophical concept. In order to accept the concept of brain-death in Western countries, they had to change first the philosophical definition of death. Also, there is still a debate in modern medicine whether death is an event or a process. Most recent Islamic literature has accepted the concept of brain-death as a medical fact, without discussing its philosophical base. This philosophical definition depends on many subjective factors. In Islam, death has a clear definition: it is the departure of the soul and hence, it is an event. However, the signs of this departure have not been specified and they were left to experts (physicians) to define them. In conclusion, medicine alone cannot formulate a concept regarding death. A philosophical definition of death must be used with it. The Islamic discussion on the concept of death should be focused mainly on its philosophical definition. The definition of death in the concept of "brain-death" does not contradict the concept of death in Islam.
  3,238 419 -
ARTICLES
The Southern Region Renal Transplant Program at Armed Forces Hospital, Khamis Mushayt
Abdalla Sidahmed Mohammed, Ahmed Al-Hashemy, Abdul Jewad Addous, Gamal Ismail
April-June 1996, 7(2):164-167
PMID:18417933
The Southern Region renal transplant program was established in February 1989. The appointment of a transplant co-ordinator and creation of a waiting list for the Southern Region as well as tissue typing of all patients in the region were important early steps. Between February 1989 and December 1995, 155 transplants were performed on 152 patients at the Armed Forces Hospital, Southern Region (AFHSR). Of them, 52 were cadaveric donor transplants and the remaining were from living related donors. The overall five-year actuarial patient and graft survival was 93% and 78% respectively. Of the 152 patients who were transplanted, 79 patients were from other hospitals in the region and 73 were from AFHSR. Maintenance immunosuppression consisted of cyclosporin, azathioprine and prednisolone. Use of the spouse as a donor was an early feature of this program. Our results compare favorably with results published from other centers. To cope with the increasing demand of transplantation in the Southern Region, we have to look into ways of increasing our transplant numbers to match the needs.
  3,335 182 -
The Experience of Bone Marrow Transplantation at Riyadh Armed Forces Hospital
Maadh Al Douri, Magda Wahdan, Akram Al Hilali, M Talal Jeha, Ferdinand Zwaan, Peter Van Dijken, Fatima Batniji, Mohiuddin Qasim, Khalid Al Anazi, Fawzia Al Saghair, Tariq Shafi
April-June 1996, 7(2):199-202
PMID:18417941
This is a report about the program of bone marrow transplantation (BMT), which was established in 1989 at the Armed Forces Hospital in Riyadh, Saudi Arabia. We follow the strict international protocol of pre transplant assessment of the donor and the recipient, BMT conditioning by Cyclosphosphamide and Basulphan or body irradiation, BM harvest and processing, graft versus host disease prophylaxis by cyclosporin and methotrexate, and post-transplant care. Since the start of the BMT programme at the Armed Forces Hospitals in Riyadh in May 1989 and until the end of March 1996, fifty nine allogeneic and one autologous transplants have been performed. Chronic myelocytic and acute myeloid leukemia were the principal indications for BMT in our institute. The acturial five years survival of BMT in these two conditions was 67% and 47% respectively. Besides allografting, we finished the preparations for autologus BMT and peripheral blood stem cells transplantation, which may be used for treating patients with solid tumors and leukemias who are not suitable for allogenic transplantation due to older age or donor unavailability.
  3,251 256 -
Single Lung Transplantation for Alveolar Micro-Lithiasis: The First Clinical Report
Hassan Raffa, Medhat El-Dakhakhny, Khalid Al-Ibrahim, Mohammed S Mansour
April-June 1996, 7(2):189-193
PMID:18417939
Pulmonary alveolar microlithiasis (P.A.M.) is a rare pulmonary disorder that pursues usually an asymptomatic course and can culminate in severe respiratory failure. We report a 48 year old Saudi female patient with P.A.M. who deteriorated rather steadily after the initial 18 years of asymptomatic course until a frank type I respiratory failure is established. Single lung transplantation (S.L.T.) was performed successfully and the patient returned to full daily activity and has now survived 12 months post S.L.T. The immunosuppression consisted of Cyclosporine-A 10 mg/kg/day, azathioprine (immuran) 2 mg/kg/day and prednisolone 10 mg daily. The bronchial anastomosis was done by telescoping the recipient and donor main bronchus without omental wrap. A significant bronchial stricture of the anastomotic site occurred 4 months post S.L.T. which was dilated endoscopically with good clinical and bronchoscopic result. No episodes of rejection or infection were encountered so far.
  3,115 244 -
Story of the First Liver Transplant in Saudi Arabia
Muaffak Jawdat
April-June 1996, 7(2):178-181
PMID:18417936
Chronic liver disease is common in Saudi Arabia with viral hepatitis and schistosomiasis being the common causes. I herewith describe the experience on the first liver transplantation in Saudi Arabia and the Arab World. The patient was a 23-year old Saudi male who had cirrhosis of the liver secondary to sclerosing cholangitis. He underwent orthotopic liver transplantation on July 30, 1990. The post-operative course was uneventful and immunosuppression comprised of small doses of cyclosporine, azathioprine and prednisolone. The patient continues to be well six years post-transplant and is adequately rehabilitated.
  2,852 233 -
Renal Transplant Experience at King Fahad National Guard Hospital
Sameer Huraib, Waleed Al Khudair, Hesham Saleem, Khawaja Quadri, Saleh Abu Romeh, Ahmed Chaballout, Nabeel Nezamuddin, Riyad Saeed, Ramon Duarte
April-June 1996, 7(2):157-163
PMID:18417932
Between September 1988 and end of 1995, 170 renal transplantations were performed at the King Fahad National Guard Hospital, Riyadh. There were 102 cadaver donor (CAD) and 68 living related donor (LRD) transplants. All patients received triple drug immunosuppression. Patients with delayed graft function received anti-thymocyte globulin instead of cyclosporin until recovery of graft function. The 1,3 and 5 year graft survival was as follows: all transplants 83.5%, 77.6%, 74.7% respectively; LRD transplants, 89.7%, 85.2%, 80.9% respectively; CAD transplants, 81.0%, 72.5%, 70.5% respectively. The commonest cause of graft loss was chronic rejection. The 1,3 and 5 year patient survival was as follows: all transplants, 97.0%, 94.7%, 93.5% respectively; LRD transplants, 98.5%, 97.0%, 95.5% respectively; CAD transplants, 96.0%, 93.0%, 92.0% respectively. The overall results in our center are comparable to those published from other centers in Saudi Arabia and abroad.
  2,490 246 -
EDITORIALS
Establishment of a Cadaveric Transplantation Program: The Saudi Arabian Experience
Faissal A.M Shaheen, Besher Al-Attar, Mohammed Ziad Souqiyyeh, KS Ramprasad
April-June 1996, 7(2):105-108
PMID:18417921
  2,361 257 -
ARTICLES
Orthotopic Heart Transplantation in the Prince Sultan Cardiac Center
Mohamed R Al Fagih
April-June 1996, 7(2):185-188
PMID:18417938
In this report we attempt to demonstrate the efforts involved in establishing and organizing the heart transplant program at the Armed Forces Hospital in Riyadh, Saudi Arabia. From 1986 to date, 25 orthotopic heart transplants were performed at this center. Patient age ranged from 22 months to 57 years; 4 patients were below 12 years of age and 4 aged 50 years and above. The incidations for transplantation were cardiomyopathy in 15 patients, ischemic heart disease in 6 patients, and valvular heart disease in 4 patients. Fourteen recipients have died. Three of them were classified as hospital deaths, occuring before the patient could be discharged after the procedure; the reminder died from rejection and associated problems. Eight patients of them died within the first year. The longest survival period was almost 8 years. The overall 8 years survival rate was 45%, which is comparable to the international figures. Shortage of donors may affect the future of the transplant programs. Increasing the awareness of the public about the importance of organ donation and transplantation is crucial in this regard.
  2,410 195 -
ORIGINAL ARTICLES
Survey of Opinion of Secondary School Students on Organ Donation
Faissal A.M Shaheen, Mohammad Ziad Souqiyyeh, Besher Al-Attar, Ahmed Jaralla, Abdul Rahman Al Swailem
April-June 1996, 7(2):131-134
PMID:18417926
We conducted a survey of opinion of a sample of senior high school students in Saudi Arabia to evaluate their awareness of the importance of organ donation and concept of brain death. There were 839 students from nine schools, 745 males and 94 females. The participants were not primed about these topics before answering the questionnaire, which was answered at school. The study group declared the level of education of the parents. Twenty three percent knew about the Saudi Center for Organ Transplantation, but 61% could only guess its function. Fifty eight percent could not differentiate between "natural 11 death and brain death and 93% were not aware of how to document it. Elaboration on these questions showed variable explanations. Sixty eight percent agreed to donate organs of relatives in case of brain death, and 91% would donate a kidney to their relatives. However, 38% agreed to donate organs of their own to organ failure patients other then relatives. Thirty five percent knew about the organ donation cards, but only 12% carried them, and only 48% would consent to include the word "donor" on their driving licenses. Forty two percent knew about the opinion of Islamic religion toward organ donation. Thirty one percent agreed to send patients for organ transplantation abroad due to their belief that transplantation technology in Saudi Arabia is lacking, There were no significant differences in the answers according to schools, gender, students of different curricula, having a friend or relative with organ failure, or the level of the education of the parents. This study suggests the great need for education of the new generation about the importance of organ donation and the concept of brain death. We believe that including these topics in the curricula of schools would help disseminating this knowledge to the public in Saudi Arabia.
  2,144 305 -
SPECIAL ARTICLES
Update of Organ Transplantation in the Gulf Co-operation Council Countries
Faissal A.M Shaheen, Nabeel Mohsin Salmeen, Ibrahim Abdul Aziz Al-Muzairy, Abdulazeem Abdul Wahab Hussain, Mahmoud Mohammed Fikry, Ahmed Salem Al-Areedh
April-June 1996, 7(2):128-130
PMID:18417925
  2,167 253 -
ARTICLES
Renal Transplantation at the Jeddah Kidney Center
Faissal A.M Shaheen, Iftikhar Ahmed Sheikh, Abdullah Fallatah, Ahmed Bayoomi Shehab, Lubna Al-Menawy, Abdullah Awad, Nabeel Nezamuddin
April-June 1996, 7(2):153-156
PMID:18417931
Renal transplantation is the optimal treatment for patients with end-stage renal failure. During the period 1991 to 1995, a total of 279 renal transplantations were performed at the Jeddah Kidney Center. They included 115 kidneys from cadaveric donors and 164 living related donor transplants. There were 160 males and 119 females; age of the patients ranged between 4 and 45 years. During the follow-up period, 32 grafts were lost and 26 patients died. The overall 5-year graft and patient survival rates were 79.2% and 90.7% respectively. Sepsis and pulmonary embolism constituted the common causes of death.
  2,185 202 -
Bone Marrow Transplantation in Children: The King Faisal Specialist Hospital Experience
Hassan El Solh, Abdallah Al-Nasser, Reem Al-Sudairy
April-June 1996, 7(2):194-198
PMID:18417940
The results of the Pediatric Bone Marrow Transplant Program at The King Faisal Specialist Hospital and Research Center (KFSH & RC) from June 1993 to October 1995 were reviewed for a preliminary report on the outcome of children undergoing bone marrow transplantation (BMT) particularly in relation to mortality and morbidity. A total of 64 bone marrow transplants were performed on 60 patients during this period of time. The study patients included 28 with acute leukemia, 10 with severe combined immune deficiency, five with chronic myeloid leukemia, four with Fanconi's anemia and 13 others with miscellaneous disorders. The average hospitalization period was six weeks per patient. Forty three of these patients (72%) were alive and disease-free after a median follow-up of 14 months (range 1-27 months). Eight patients died from transplant-related toxicity within 100 days of BMT. One patient died of chronic graft versus host disease (GVHD) of the liver. Eight patients with acute leukemia relapsed within one year after BMT. Further details regarding the preparative regimens, toxicity of BMT, GVHD and disease-free survival are reviewed in this report.
  2,145 225 -
Orthotopic Liver Transplantation at King Faisal Specialist Hospital and Research Center: 1994-1995
Mohammed Rezeig, Nabeel Nezamuddin, Abdulmajeed Abdulkarim, Timothy Pruet, Ashraf Ali, Riaz Ahmed, Mohammed Al Quaiz, Souhail Shabib
April-June 1996, 7(2):182-184
PMID:18417937
Over the last decade, orthotopic liver transplantation (OLT) has become an established therapy for end-stage liver disease of various etiologies. The early experience with orthotopic liver transplantation in the Kingdom was in 1990 in the Military Hospital when a man with sclerosing cholangitis received a new liver successfully. Intensive effort was done at King Faisal Specialist Hospital and Research Center (KFSH & RC) to start liver transplantation and that was achieved in March 1994 when a man with an end-stage liver failure secondary to hepatitis C was transplanted successfully. Since then, forty four (44) more liver transplantations were done at KFSH & RC. The age of the patients transplanted ranged from 9-65 years old; there were more males than females, (26 males, 15 females). The waiting time until transplantation was up to one year. All patients received a combination of cyclosporin and prednisolone as an induction therapy ± Azathioprime. The majority of patients developed minor complications like wound infection and acute mild cellular rejection. In the second year, 3 out of 18 patients also developed primary non­function. Also in the first year, the majority of the patients developed primary dysfunction; however, this decreased significantly in the second year. The majority of the patients who were transplanted for hepatitis C had mild recurrence. None of them lost their livers because of recurrence of hepatitis C. Several patients developed biliary complications including bile leak and stricture at duct-to-duct anastomosis.
  1,935 208 -
Initiating a New Renal Transplant Program: Problems and Results
Hatim Mansy, Zain Al-Shareef, Saud Shlash, P Filobbos, Saad Al-Dusari, Saad Ghasib
April-June 1996, 7(2):145-148
PMID:18417929
Patients from the North-West area of Saudi Arabia had to travel to Riyadh or Jeddah for renal transplantation and post-transplant follow-up. The administration of the North-West Armed Forces Hospitals Program provided medical expertise and financial support to set up a renal transplant program in this area. Suitable staff members including nephrologists, transplant surgeons, staff nurses social workers and laboratory personnel were recruited. A strong link was established with the Saudi Canter for Organ Transplantation in Riyadh. At the end of two years since establishment, 25 renal transplants (11 cadaver donor and 14 living donor) have been performed. During follow-up, nine patients developed serious infection including pneumonia, wound infection and tubercu­losis; all were managed successfully. Three grafts were lost necessitating graft nephrectomy and there were four deaths. The two-year graft survival is 83.3% and patient survival, 84%. These results are highly satisfactory taking into consideration the fact that our transplant program is new.
  1,881 255 -
Experience with Renal Transplantation in the Eastern Province of Saudi Arabia
Adel Al-Dayel, Mamun Ezzibdeh, Maged Daoud, Siddiq Egail, Adnane Guella, Ibrahim Al-Oraifi, Essam El-Sayed, Ali Abu Zallat
April-June 1996, 7(2):149-152
PMID:18417930
We evaluated our experience with renal transplantation to determine its safety and efficacy. Of the 47 renal transplants performed at our institution from June 1992 to December 1995, 29 were performed from living related donors and 18 from cadaveric donors. The age of the patients ranged from 17 to 65 years with a mean age of 32.2 years. Patient survival, allograft survival and the incidence of complications were used as determinants of successful outcome. Patient survival was 100% for both groups. The allograft survival was 100% for living related donor recipients, with 90% of the cases having normal graft function and 96% for cadaveric recipients with 78% of the cases having normal graft function after a mean follow-up of 24 months (range 3 to 42 months). The incidence of complications encountered was similar to that reported from European and North American renal transplant centers. Our study shows the safety and efficacy of the renal transplantation program in the Eastern Province of Saudi Arabia.
  1,767 180 -
Complications in Kidney Transplant Recipients: A Single Center Experience
Magdi Hussein, Jacob Mooij, Haysam Roujouleh
April-June 1996, 7(2):168-172
PMID:18417934
A total of 147 kidney transplant recipients are on regular follow-up in our center including 12 who were transplanted in our hospital since the start of the transplantation program in June 1994. Fifty eight patients received cadaveric kidneys (mainly in the United States), 13 received living-related transplants (of which seven were performed in our hospital), and 76, received living non-related transplants abroad. The follow-up period ranged from 0-228 months. Fifty eight (39.5%) patients continue to be followed with functioning kidneys, 26 (17.7%) patients lost their grafts, 19 (12.9%) patients died, and 44 (29.9%) were lost to follow-up. Six patients converted to HIV-positive after transplantation, of which five had received living non-related transplantation. Four of these patients died. Other significant infectious complications during follow-up period included pneumonia (n = 37; 25%) and tuberculosis (n = 9; 6%). Hypertension was present in 86% and diabetes mellitus in 30% of the patients. Hepatitis developed in 24% of the patients. Eight patients had pregnancy followed by successful delivery (two of them twice). Twenty seven patients had significant post-operative urological complications, including 12 lymphoceles and three urinary leaks. When the influence of different factors such as type and place of transplant, immunosuppression, infections, and occurrence of acute rejections, hypertension, diabetes, hepatitis and urological complications, on outcome were analyzed, only history of acute rejections and chest infections had a significant independent effect.
  1,699 237 -
Some of the Lessons Learnt from Renal Transplant Recipients Cared-for at the Riyadh Armed Forces Hospital
Abdullah A Al-Khader, Mohamed H Al-Sulaiman, Dujana H Mousa, Fahad Al-Hawas
April-June 1996, 7(2):139-144
PMID:18417928
The first-ever renal transplantation in Saudi Arabia was carried out at the Riyadh Armed Forces Hospital in March 1979. Since then, 480 renal transplants have been performed in our institution and we have also followed-up many patients who have been transplanted outside the Kingdom. Over 85% of our patients are on cyclosporin-based immunosuppression and the mean follow-up was 3.4 years. In this paper, we summarize our experiences and findings in the field of renal transplantations.
  1,641 184 -
LETTER TO THE EDITOR
The Role of Women in Consenting for Organ Donation in Saudi Arabia
Saleh Al-Shehri
April-June 1996, 7(2):203-203
PMID:18417942
  936 176 -
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