Evolution of the Concept of Death.

The definition of death remains unresolved. To define death, one has to define the characteristics of a living person and to confirm whether an individual with brain death fulfils any of these characteristics. Although the concept of irreversible cessation of brain function is clear, controversy remains on the treatment of individuals with brain death and beating hearts. An individual with brain death but a beating heart is not breathing on his own and is dependent on medications and machines to maintain respiration, heartbeat, and blood pressure. Muslim scholars remain divided over the issue of whether death also means irreversible cessation of brain function. Questions remain on when it is permissible to remove vital organs for organ transplant. Groups have advocated for uniformity in law and medical practice on the definition of brain death.

The critical pathway for deceased donation: reportable uniformity in the approach to deceased donation.

The critical pathway of deceased donation provides a systematic approach to the organ donation process, considering both donation after cardiac death than donation after brain death. The pathway provides a tool for assessing the potential of deceased donation and for the prospective identification and referral of possible deceased donors.

Postoperative Surgical Complications of Live Unrelated Renal Transplants for Patients of End Stage Renal Disease Needing Renal Replacement Therapy.

OBJECTIVE: To evaluate the postoperative surgical complications of live unrelated renal transplantation (LURRT) done abroad for patients of end stage renal disease (ESRD) who needed renal replacement therapy (RRT) in an organ transplant centre. STUDY DESIGN: Descriptive, observational study. PLACE AND DURATION OF STUDY: Department of Renal Transplantation, Hamed Al-Essa Organ Transplant Center, Kuwait, from January 1993 to December 2015. METHODOLOGY: This is descriptive and observational study in which data was retrospectively collected from medical records of the patients. All patients were selected who had been transplanted in various countries and admitted to this center for post-transplant care and follow-up in the period of 22 years and their surgical complications were noted. Data was analysed by SPSS 21. Nationalities and complications were noted and their percentages were calculated for the variables. RESULTS: A total of 423 patients (288 males (68%) and 135 females (31.9%), having mean age of 43 years) were transplanted in various countries. Most of these were Kuwaiti nationals (n=224, 53%). The post-transplant course was complicated by lymphocele in 25 (5.8%), ureteral stenosis in 22 (5.2%), urinary leak in 15 (3.5%), incisional hernia in 14 (3.3%) rare. CONCLUSION: Due to inadequate living-related organ supply, many ESRD patients go to Third World countries for LURRT. Although, the risk of various complications is well established, this should be documented. Besides the ethical issues, overseas renal transplantation carries a high risk of unconventional complications.

Rabies Acquired Through Kidney Transplantation in a Child: A Case Report.

Rabies is usually transmitted to humans through bites of infected animals; however, it can rarely be transmitted through deceased donor organs or tissues when not suspected. Here, we report a case of rabies transmission in a child. The child was a 5-year-old girl who was admitted to the pediatric intensive care unit with encephalitis of unexplained cause 3.5 months after she received a kidney transplant from a deceased donor. The laboratory and imaging studies did not reveal any explanation for her rapidly declining clinical and neurologic condition, which ended with death 4 days after admission. Death of another recipient from the same donor led to an investigation that revealed rabies as the cause. Both corneas were explanted from other recipients to prevent further death. Polymerase chain reaction sequence analysis of the corneas was consistent with a rabies virus from the same donor's state of residence. Rabies transmission, although rare, should be suspected when a donor comes from or has visited endemic countries. Donors with unclear causes of death should be rejected.

Organ trafficking and transplant tourism: the role of global professional ethical standards-the 2008 Declaration of Istanbul.

By 2005, human organ trafficking, commercialization, and transplant tourism had become a prominent and pervasive influence on transplantation therapy. The most common source of organs was impoverished people in India, Pakistan, Egypt, and the Philippines, deceased organ donors in Colombia, and executed prisoners in China. In response, in May 2008, The Transplantation Society and the International Society of Nephrology developed the Declaration of Istanbul on Organ Trafficking and Transplant Tourism consisting of a preamble, a set of principles, and a series of proposals. Promulgation of the Declaration of Istanbul and the formation of the Declaration of Istanbul Custodian Group to promote and uphold its principles have demonstrated that concerted, strategic, collaborative, and persistent actions by professionals can deliver tangible changes. Over the past 5 years, the Declaration of Istanbul Custodian Group organized and encouraged cooperation among professional bodies and relevant international, regional, and national governmental organizations, which has produced significant progress in combating organ trafficking and transplant tourism around the world. At a fifth anniversary meeting in Qatar in April 2013, the DICG took note of this progress and set forth in a Communiqué a number of specific activities and resolved to further engage groups from many sectors in working toward the Declaration's objectives.

The Declaration of Istanbul--early impact and future potential.

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism was adopted at an international meeting held in 2008. The Declaration has been published globally and consists of a preamble, a set of principles and a series of proposals to improve the ethics and expand the benefits of the international organ transplantation endeavor. To promote and monitor the implementation of the Declaration, a Declaration of Istanbul Custodian Group (DICG) has been created. The DICG has provided support for official efforts to ban the sale of organs, restrict transplant tourism and prosecute those who persist in violating the law. Substantial progress has been made thus far in countries that have been the source of transplant tourists and in countries that have been the source of donor organs for trafficking. In China, however, the use of organs from executed prisoners for transplantation purposes continues despite widespread condemnation of this practice.

Tuberculous tracheo-esophageal fistula in a renal transplant patient.

The incidence of mycobacterial infection (TB) is significantly higher in patients with end-stage renal disease and renal transplant recipients than in normal individuals. Tracheoesophageal fistulas (TEF) resulting from Mycobacterium tuberculosis infection are uncommon. We describe a 44-year old renal transplant recipient with such a lesion that had typical clinical presentation and radiological appearance of TEF and was successfully treated conservatively.

Inferior long-term outcome of renal transplantation in patients with diabetes mellitus.

OBJECTIVE: To retrospectively review the long-term outcome of renal transplant in diabetics at Mubarak Al-Kabeer Hospital and Hamad Al-Essa Organ Transplant Center, Kuwait from 1983 to 1998. METHODS: There were 631 renal transplant patients, comprising 79 (12.5%) patients with pretransplant diabetes mellitus (pre-TDM), 117 (18.5%) patients with post-transplant diabetes mellitus and 435 (69%) nondiabetics (ND). Subjects with post-transplant diabetes mellitus were excluded from the comparative analysis. Distribution of sex, source of donors and mode of immunosuppression were similar in pre-TDM and ND groups. RESULTS: Fifty-three (67%) recipients in pre-TDM and 90 (20.5%) in the ND group (p < 0.01) were above 45 years of age. However, 26 (33.3%) pre-TDM and 345 (79.5%) ND were below age 45. Among those who died, coronary artery disease led to death in 36% of pre-TDM and 27% in ND. Hyperlipidemia requiring drug therapy was observed in 37% pre-TDM and 6% ND. The incidence of severe infections was nearly twice in pre-TDM over ND recipients (1.9 vs. 1.0 per patient, p < 0.001). Acute rejection episodes were more frequently seen in pre-TDM (43%) than ND (33%), however the difference was not statistically significant. The patient survivals at 1, 5, 10, 14 years were significantly lower in pre-TDM (84, 65, 58 and 58%, respectively) than in ND (97, 93, 86 and 82%, respectively). The major contributory factors were severe infections and coronary artery disease. The cumulative graft survival showed a similar pattern (52% in pre-TDM, 73% in ND at 10 years). However, when death is excluded, the 10-year pure graft survival probability was similar for the pre-TDM and ND groups (76% vs. 80%). CONCLUSION: Our study indicates poor patient survival in pre-TDM due to coronary artery disease and infections, whereas the pure long-term graft survival was equally good in pre-TDM and ND transplant recipients.