Organ donation and transplantation activities are increasing worldwide.1 In parallel, national and international regulations have improved.2,3 The World Health Organization (WHO) has been active in protecting the welfare of living donors while preventing commercialisms and organ trade.4 The WHO's call for self-sufficiency of all nations worldwide for organ donation and transplantation has emphasized on the need for every country to organize and supervise transplantation practices.5 Moreover, there is a consensus to denounce and fight commercial transplantation.6
Organ transplantation started in the Kingdom of Saudi Arabia (KSA) in 1979 with a kidney transplanted from a living donor. Deceased donor transplants were started in the 1985 with the inauguration of the Saudi Center for Organ Transplantation (SCOT), a governmental agency that supervises all national transplant activities in KSA.
In 2015, close to 17 000 patients required dialysis provided in 190 hospitals in the KSA. Currently, 3715 patients (22% of all dialysis patients) are waiting for renal transplants with an additional close to 3500 patients being tested for eligibility (representing 20% of dialysis patients).7
The Saudi Center for Organ Transplantation
Initially, transplantation in the KSA had been restricted to kidney transplantation; cardiac transplantation was introduced in 1986 followed by deceased donor liver transplantation in 1990. With advancements in organ transplantation worldwide, transplant programs in the KSA picked up pace. Currently, there are 12 kidneys, 3 livers, 2 pancreases, 2 lungs, and 1 cardiac transplant programs throughout the Kingdom. In addition, tissue transplants such as cornea, bone, and heart valves are being offered.
The scope of the SCOT is broad. Saudi Center for Organ Transplantation (encourages all types of donations from living and deceased brain dead donors; SCOT meticulously collects data on patients with end-stage organ failure, supervises the allocation of organs, and emphasizes on ethical practices. Saudi Center for Organ Transplantation facilitates the process of organ donation between donor hospitals and transplant centers by providing coordinators, procuring teams and assuring consent). Moreover, SCOT applies strategies to increase awareness in both, medical and public community communicating the importance of organ donation and transplantation while providing education for medical staff in intensive care units (ICUs) and emergency rooms. Saudi Center for Organ Transplantation facilitates also general education and awareness for organ transplantation that starts, for example, with frequent school visits. Saudi Center for Organ Transplantation always communicates with experts around the world and is actively involved in various international initiatives concerned with organ donation and transplantation including the world health organization advisory committees. Furthermore, SCOT participates in a network of organ sharing with other countries in the gulf region and has established regulations for the process of organ donation and transplantation with the input from national scientific committees. Moreover, SCOT has published a directory that regulates the practice of organ donation and transplantation in the KSA.
Features of Organ Donation and Transplantation in the KSA
Deceased organ donation improved remarkably through the activities of SCOT. Currently, 74% (52/140) of all ICUs in the KSA participate in the program. Indeed, organizing the practice of organ transplantation in the KSA through the SCOT has granted the success of organ transplantation and deceased donations have become a regular feature in ICUs all over the KSA during the past 30 years.
By the end of 2015, a total of 11 220 possible deceased donors have been reported to SCOT. In 2015, a total of 620 possible deceased donors were reported by 104 intensive care units throughout the KSA (Figure 1).
From 1986 to 2015, a total of 6969 living and 2838 deceased donor kidney transplants have been performed inside the KSA. In 2015 alone, 779 renal transplants were performed in 12 active renal transplant centers. Moreover, 936 living donor and 857 deceased donor liver transplantations have been performed inside the KSA, in addition to a total of 310 heart transplantations; 30 cardiac transplants have been transplanted at a single heart transplant center in 2015 (King Faissal Cardiac Transplant Center, Riyadh). In addition, a total of 183 lungs and 35 pancreata were transplanted since 1985. On 2015 alone, 39 lung and 8 pancreas allografts have been performed. (Figure 2).
Kingdom of Saudi Arabia has also had increasing numbers of tissue donors: In 2015, consent for corneal donation was obtained in 51 eligible deceased organ donors. Since 2009, bones were retrieved in 267 cases in addition to 105 cases, in which musculoskeletal tissues were retrieved.
Challenges and Obstacles and Future Plans
With an increasing demand for transplantation, organ shortage represents a major obstacle preventing a further increase of transplantation in the Kingdom. Achievements of the organ transplantation program in Saudi Arabia during the year 2015 reflected the continued success in increasing numbers of organ donations and transplantations. The supply of organs, at the same time, has not kept up matching with the increasing demand reflected by an increasing waitlist (Table 1).
Clearly, measures need to be put in place to receive information on all possible donors while improving rates of consent and utilization to provide support for greater than 3000 patients currently actively waiting for transplantation. The SCOT has started an ambitious program aiming toward 15 donors/million populations annually within 3 years by improving the communication with donor hospitals. Initiatives include a geographically broader representation of SCOT in all regions of the KSA, appointing organ donation coordinators in all ICUs and aiming for a close team effort between SCOT and donating hospitals. An alert electronic system has been developed to support this task. Advice from successful initiatives in other countries such Spain and the United States where a close team work between ICU and Organ Procurement Organization staff has contributed to increasing donor rates have been discussed and implemented.8-10
The SCOT continues its efforts to communicate the awareness of donation to the medical and general community. Saudi Center for Organ Transplantation has also developed close cooperation's with several charitable societies that support public educations. Moreover, SCOT has also cooperated with local universities that have implemented organ donation into their curricula.
Certainly, there is much work remaining on the way to achieve self-sufficiency of organ donation and transplantation. At the same time, we are proud of significant achievements toward this goal in the recent years.
1. Global Observatory on Donation and Transplantation (GODT). Organ donation and transplantation activities 2012. http://issuu.com/o-n-t/docs/2012ad
. Published 2012. Accessed July 2, 2015.
2. U.S. Department of Health & Human Services. Organ Procurement &Transplantation Network. Donors recovered in the US by donor type. Donors recovered January 1, 1988–March 31, 2015.
4. World Health Organization Web Site. The Sixty-Third World Health Assembly, Resolution WHA63.22. WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation
. Geneva, Switzerland: World Health Organization; 2010.
5. Delmonico FL, Domínguez-Gil B, Matesanz R, et al. A call for government accountability to achieve national self-sufficiency in organ donation and transplantation. Lancet
6. Budiani-Saberi DA, Delmonico FL. Organ trafficking and transplant tourism: a commentary on the global realities. Am J Transplant
7. SCOT Data. Organ donation and transplantation in the Kingdom of Saudi Arabia 2013. Saudi J Kidney Dis Transpl
8. Maccarone D, Parzanese I, Torlone N, et al. The registry of brain deaths in quality control program: evaluation of potentiality of each hospital in Abruzzo and Molise regions. Transplant Proc
9. Manyalich M, Mestres CA, Ballesté C, et al. Organ procurement: Spanish transplant procurement management. Asian Cardiovasc Thorac Ann
10. US Department of Health & Human Services, Health Resources and Services Administration. Organ Procurement and Transplantation Network (OPTN). Goal 1: Increase the number of transplants. http://optn.transplant.hrsa.gov/governance/strategic-plan/goal-1
. Updated 2016. Accessed July 2, 2015.