Organ Transplantation - RM Solutions

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Organ Transplantation - RM Solutions

Organ Donation & Transplantation

in KSA

BESHER AL ATTAR

Consultant Nephrologist

Medical Director

Saudi Center for Organ Transplantation

Riyadh, Kingdom of Saudi Arabia


Organ Transplantation (FACTS)

It is an established method of organ function

therapy due to:

‣ Better surgical techniques

‣ Better selection of patients

‣ Better pre transplant preparation of patients

‣ Better post transplant care at short and longterm

follow-up

‣ Better immunosuppressive agents


Deceased Organ Donor Rates Compared

Europe

7768 Donors

15.43 pmp

105 Donors

4.5 pmp

KSA

206 Donors

10.6 pmp

United States

Australia

6183 Donors

21.5 pmp

Comparison of the number of cadaveric organ donors and organ

donation rate in Europe, the USA and Australia

Matesanz; Update on organ donation in Europe 2003, Organs and Tissues, (3), 2003


1985

National Kidney Foundation

Established

1986

Start of

Deceased Organ Donation Program

1993

NKF upgraded as

Saudi Center for Organ

Transplantation


General Regulations for Organ

Transplantation in Saudi Arabia

The Saudi Center for Organ Transplantation

(SCOT) is the coordinating and supervising

center for all activities related to organ donation

& transplantation in Saudi Arabia.


SCOT Computer Network

• Data Base –organ failure pts

• Medical Supply -RRT

• National Waiting List

• Urgent Waiting List

• Recipients Follow up (All Organs)

• Brain Death Protocols

82 TERMINALS


Directory of the Regulations of

Organ Transplantation in KSA


Regional Coordinators- 8

Transplant Centers - 25

Intensive Care Units- 88

Dialysis Units- 180

Hospitals with E.R- 325

SCOT


Coordination System

116 Donating

Hospitals

SCOT

25 TX

Centers

Transplantation

Coordinator

Regional

Coordinator


Intensive Care Units and

Emergency Services in K.S.A

Total Active ICUs in Saudi Arabia: 116

Total ICU Beds : 2,276

Emergency Services: 324 Hospitals

Red Crescent: 238 Centers,

681 Ambulances


General Regulations for Organ

Transplantation in the Kingdom

Documentation of brain-death is performed

according to Death by Brain Function

Criteria.

No member of the medical team involved in

the transplantation of organs should

participate in the diagnosis of brain-death.


Death Documentation Form by

Brain Function Criteria


General Regulations for Organ

Transplantation in the Kingdom

Consent for organ donation should be

obtained from the heritors of the

brain-dead person whether they were

inside or outside KSA according to a

Consent Form.


Organ Transplantation Centers

in the Kingdom of Saudi Arabia

Kidney 17

Cornea 10

Heart 3

Liver 4

Lung 2

Pancreas 2


Renal Transplantation Centers

in the Kingdom of Saudi Arabia

RIYADH

JEDDAH

DHARAN

TABUK

MADINAH

TAIF

KHAMIS

MUSHAYAT

-KAAMHT

-KFHM

-KFHJ

-KAAHJ

-KFMHJ

-KFSHJ

-KFMMCD

-KFSH-D

-RAFH

-KFSH

-KAMC

-AHMHT

-KMMH


SCOT

MEDICAL

DEPARTMENT

MEDICAL

COORDINATION

OF BRAIN DEATH

WAITING LISTS OF

POTENTIAL

RECIPIENTS

DISTRIBUTION

OF DONATED

ORGANS

TRAINING

CONSULTATION

FOLLOW-UP


Med.Evac. Services

1986-2010

620

Flights

Armed

Forces


Trend of Brain-Death Cases Reported

1986 – 2010

CASE REPORTED – 8110

615

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

7

24

136

148

146

154

187

210

348

367

374

355

385

427

364

348

337

360

372

410

526

474

533

503

The average cases reported in the last 5 years: 530 (19 PMP)


Trend of Brain-Death Cases Consented

1986 – 2010

CONSENT OBTAINED - 13 – 1444

20

6 10 13 17

88 7 15

91

80

3 10

42 43 52 54 54 50 43

31 34

41 46 46 51

33 31

23

0 10

19

66

18

100

9

73

14

1986

1987

1988

1989

1990

1991

101

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010


Brain-Death Cases Possible, Eligible,

Consented and Actual

8110

1986 – 2010

54%

4352

33 % 92 %

1444 1311

POSSIBLE ELIGIBLE CONSENTED ACTUAL


Kidney Transplantation from Deceased

Donors

TOTAL: 2227

59 57

74

154

131

95

83 88 84 76

62 65 59

89

57

71

151

122

88 95

166

111

156

2 4 0

28

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010


Deceased Liver Transplantation

1990 – 2010

TOTAL: 572

44 45

49

54

59

51

62

28 26

20 18

10

29 28

19

10

15

1 2 2

1990

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010


Heart Transplantation

1986 – 2010

WHOLE HEART – 187

HEART FOR VALVES – 517

52

38

36 39 26 23

33 35 19

1 1

3

8 9

5 6

12 12

9

7

5 5 4

6

32

27

22

17

8

3 3

5

2

4

31 29 29

19 19 20

13 15

12

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010


Deceased Organ Donation Program

Total Number of Deceased Organs Transplanted

1986 –2010

2227

257

187

517

18 45

632

KIDNEYS LIVER WHOLE

HEART

HEART FOR

VALVES

PANCREAS LUNGS CORNEAS


Comparison on Possible, Potential, Eligible, Consented

and Actual Cases

2000-2004 vs 2005-2009

1781

2446

37%

1104

1550

920

1242

2000-2004 CASES

2005-2009 CASES

464 417

238 218

95 %

Possible Potential Eligible Consented Actual

Percentage on Conversion of the Critical Pathways of Organ Donation

Period Possible Cases Potential Eligible Consented Actual

2000-2004 T = 1781 62 % 83 % 26 % 92 %

2005-2009 T = 2446 63 % 80 % 37 % 90 %


Deceased Organ Transplantation in KSA

2000-2004 vs 2005-2009

645

2000-2004 CASES

2005-2009 CASES

364

83

241

67

17 10 14 2 8

179

147

117 120

Kidney Liver Whole Heart Lungs Pancreas Heart for

Valves

Cornea


SCOT

as Referral Center for the

GCC Health Council

2007


SCOT Achievements

Over 25 years :

Consideration for organ donation has

become a routine practice in almost all ICU

equipped hospitals.

Increase in the transplant centers and

number of organ transplantations.


New Dialysis Versus Renal Transplant Patients in

KSA (1985 -2009)

85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Dialysis 586 1,0481,1311,2081,0781,1871,1321,2681,4331,2641,6501,7001,6701590 2084 1733 1918 2042 1718 1958 2080 2389 2518 2500 2600

Transplanted 40 49 99 142 139 137 126 193 240 276 267 230 262 244 264 254 317 308 299 296 316 371 382 399 380


Transplants or Awaiting /Year (1000's)

90

80

70

60

50

40

30

Living Donor

Deceased Donor

Total Donors

Waiting List

77.987

20

10

0

88 89 90 91 92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006

17.091

10.659

6.432


Waiting for a Transplant in USA

More than 80 percent of people awaiting organs need a kidney

Source: OPTN/Scientific Registry of Transplant recipients Annual report,

– Feb. 24, 2011


The Limiting Factor in Organ

Transplantation

NO DONOR

NO GRAFT

NO TRANSPLANTATION


Brain Death Incidence

Hospital Type

BD/Total

Hospital

Deaths

BD/ICU

Deaths

BD/100

Hospital

Beds

BD/100

ICU Beds

BD/ICU

Patients

admitted

Global

2.4%

13.9%

3.6

95.8

1.0%

Hospital with

Neurosurgery

3.0%

16.4%

4.4

109.8

1.2%

Hospital with no

Neurosurgery

1.3%

8 %

2.0

90

0.8%

ONT, Quality Assurance Program 1999-2003 Data


In-hospital Death in KSA and Possible

Organ Donation

In-hospital death from

MOH 40,101*

Estimated Possible B.D.

in MOH (810)

Reported Possible B.D from

MOH 371 (45.8%)*


Challenges to Organ Donation

Program

The Public at large

The Medical Community


Inter-relation are intimate between

Society and Transplantation

TRANSPLANTATION

& ETHICS

RELIGION

LEGISLATION

CULTURE


Facing Public at Large

LEADERS OF RELIGION

PRESS AND MEDIA

ATTITUDE OF PUBLIC


Medical Community

EMERGENCY SERVICES

INTENSIVE CARE SERVICES


Emergency Services

Number and Quality of Paramedics

Emergency Management

Awareness of Paramedics and Doctors in ER

to the importance of transplantation and of

Brain-Death.


Average Time in ICU for

Possible Deceased Cases 2009

Admission to Reporting

5.8 6.

Reporting to

Documentation

1.8

Documentation to

Harvesting/Cardiac Arrest

3.4

3.6

Admission to

Harvesting/Cardiac

Arrest

11

0 1 2 3 4 5 6 7 8 9 10

(Days)

11


What do you need from I.C.U

services?

Early Recognition of Brain-Death

Early Diagnosis of Brain-Death

Adequate Maintenance of Brain-

Death


Comparison of Rates of Deceased Organ

Donation

Possible

Deceased

Donor

Procurement

Rate

Saudi Arabia

(SCOT Data 2008)

22 PMP

20%

United States

(UNOS Registry)

43.7 PMP

37-59%

Europe

(EDTA Registry)

30-40 PMP

30-40%


Future Plans

Connect all ICU hospitals to SCOT .

Provide more certified Transplant coordinators to

cover all regions in KSA.

Provide recognized educational and training

program in organ donation and transplant.

Prepare the new generation of transplant physicians

and surgeons.


Conclusion

Organ donation & transplantation is a well

established modality of therapy for end stage

organ failure in KSA.

Self sufficiency of organ donation and

transplantation should be the aim of all

countries world wide.


Thank you…

We are Online !

www.scot.org.sa

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