Knowledge Exchange Program to Increase the Organ Donation Rates in Saudi Arabia.

The present study presents the results of a collaborative program in Saudi Arabia, aiming to improve deceased organ donation rates. Launched in 2017, the program involved implementing a training program and quality management system in conjunction with the Donation and Transplantation Institute and the Saudi Center for Organ Transplantation. The study summarizes 2 phases of the program, including the implementation of key performance indicators and a continuous improvement plan. Results revealed a 198% increase in potential donor detection and a 44% increase in donation rates in the pilot program. The second phase, applying a 3-level methodology in selected hospitals, led to a 40% increase in utilized organ donors. The creation of in-hospital organ donation units showed the best results, and the program emphasizes the importance of continuous training and quality management to achieve optimal organ donation outcomes.

Attitudes Toward Organ Donation in an Arab-Based Population.

BACKGROUND: Commitment to organ donation may vary among willing younger and older adults. We aimed to understand attitudes toward organ donation among Arab adults. METHODS: We conducted a cross-sectional survey of a representative sample of adults from 13 regions in Saudi Arabia between February 12, 2021, and March 14, 2021. We stratified the analyses by individuals' age (younger, 18 to 39 years old; older, ≥40 years old). RESULTS: Of 4217 individuals contacted, 3120 respondents (1846 younger and 1274 older) completed the survey, with a response rate of 74%. We found that 54% of younger and 47% of older respondents expressed support for organ transplantation, and 49% of younger and 35% of older respondents wanted to donate their organs. However, only 4% of younger and 3% of older respondents had registered in the national donor database. Knowledge sources that most likely to influence attitudes toward organ donation for younger and older respondents, respectively, were physician/health care worker (58% and 55%), family member (29% and 26%), scientist/researcher (29% and 22%), and religious scholar (16% and 23%). CONCLUSION: Though many younger and older adults express a willingness to donate, few are registered to be a donor. Our findings highlight the influential sources of knowledge that can be implemented in future interventions to increase commitment to organ donation.

Knowledge, Attitude, and Behavior Toward Organ Donation and Transplantation Among Medical Students in the Eastern Province of Saudi Arabia.

BACKGROUND: Organ donation is an integral part of medical ethics worldwide, including Saudi Arabia. Although the Saudi community has a positive attitude toward the concept of organ donation and transplantation, several factors prevent people from agreeing to donate organs and tissues. This study aimed to explore and evaluate the knowledge and attitudes medical students in the Eastern Province of Saudi Arabia have toward organ donation and transplantation. METHODS: A cross-sectional study among 722 medical students in the Eastern Province. The questionnaire consisted of 3 parts: sociodemographic questions, organ donation and transplantation knowledge questions, and questions on attitudes toward organ donation and reasons for consenting or refusing to donate. RESULTS: Both men and women had positive attitudes toward organ donation. The level of knowledge of organ donation and related procedures did not differ significantly among men (13.07%) and women (13.60%) (P < .027). The motives for donation were the desire to help others (88.8%) (P = .02) and sympathy (59.8%). The main source of information on organ donation for respondents was television, followed by the internet and relatives and/or friends. CONCLUSIONS: While medical students are generally supportive of organ donation and transplantation, they may lack basic knowledge on organ donation. Due to lack of basic knowledge, they become hesitant to make the decision to donate. It is recommended that additional organ donation modules be included in the student curriculum to increase the knowledge of future health care providers. Most of the participants would not change their attitudes toward organ donation based on the Saudi government initiatives to register for the Saudi Center for Organ Transplantation organ donation program.

Burden of disease: Prevalence and incidence of endstage renal disease in Middle Eastern countries.

BACKGROUND: End-stage renal disease (ESRD) is one of the leading non-communicable diseases worldwide which at the same time costs immense amount of both financial and human resources. The number of ESRD patients continues to grow, and the need to provide different modalities of renal replacement therapy (RRT) increases. MATERIALS AND METHODS: We conducted a retrospective study on the incidence and prevalence of RRT in the Middle East (ME) and the treatment modality, and correlated the findings with the economic status. RESULTS: The predominant age group of patients receiving RRT in ME countries is 0 - 39, compared with the age group of 25 - 59 in Western countries. The reported prevalence of RRT is directly proportional to the economic status of the country, with low-income countries having low prevalence of RRT and high-income countries having higher prevalence. Diabetes mellitus (DM) as the leading cause of ESRD has a high prevalence in the ME according to the World Health Organization (WHO); the projected prevalence by the year 2035 is 85%. RRT in ME shows 75.81% of patients are on hemodialysis (HD), 3.25% on peritoneal dialysis (PD), and 20.93% were post-transplant recipients. Internationally, 77%, 16%, and 6% were on HD, PD, and post-transplant, respectively, in Europe; 63.1%, 6.9%, and 29.6% in the USA; and 12%, 70%, and 18% in Mexico. HD was the predominant modality of RRT in ME, while PD is underutilized, and transplantation was mostly from living donors; deceased-donor transplantation is not available in many countries. The Ministry of Health (MOH) is the main provider of RRT in ME; next, charitable organizations provide a significant proportion of RRT; and lastly, through private sectors for patients who could afford the cost of the therapy. In our survey, kidney transplantation in ME was mainly from living donors with almost 77.7% of the total kidneys transplanted while deceased donors comprised 22.3%. The overall graft survival was 93.7% and 84.23% after 1 and 5 years, respectively. Internationally, there are 17 accessible renal registries, compared with only 1 in the ME, resident in Saudi Arabia. Of the patients receiving RRT, 80% are on HD; chronic kidney disease (CKD) is found in ~ 10% of the population in the region. CONCLUSION: There is a high CKD burden in the ME countries. There needs to be emphasis on prevention of ESRD and provision of adequate care for the total ESRD patient population. National renal registries are needed to monitor the status of ESRD patients. Health expenditures should be increased to cover all aspects of RRT in ME Countries.

Trends in Deceased Donor Kidney Availability and Utilization in the Kingdom of Saudi Arabia.

OBJECTIVES: We investigated trends in deceased donor kidney availability and utilization in Saudi Arabia, wait list changes, and recipient characteristics. MATERIALS AND METHODS: Ten-year registry data from the Saudi Center for Organ Transplantation were analyzed, including consent/discard rates, numbers of kidneys from deceased donors versus expanded criteria and standard criteria donors, wait list characteristics, dialysis characteristics, and causes of chronic kidney disease. RESULTS: Annual mean number of deceased donor transplants remained almost constant over the 10-year period (mean of 129). Use of kidneys from expanded criteria donors increased (from 16%-28%), which was associated with higher frequency of delayed graft function (36.2% vs 16%; P = .002) and acute rejection (5.4% vs 19.6%; P = .001) versus kidneys from standard criteria donors. Donor consent rate (34%) and cold ischemic time (12.3 hours) remained constant. Numbers of patients on wait lists remained fairly constant (mean of 2825), although those on dialysis on wait lists decreased from 24% to 17% (P < .0001). Overall wait list numbers remained level or even dropped despite increased patients on dialysis (from 7%-10% annually). Between 2008 and 2016, prevalence of patients > 65 and > 75 years rose by 4.2% and 2.4% and prevalence of diabetes mellitus in patients on dialysis increased by 59.2%. Of kidneys consented in 2016, 14.7% were not recovered, mainly because of sudden cardiac arrest (60%). Of total transplanted kidneys, proportion from deceased donors decreased from 51% (2008-2010) to 22.1% (2014-2016). Only 13% of recipients were older than 55 years, although they comprised 25% of the dialysis population, with patients < 18 years (comprising 2.2% of the dialysis population) receiving 15% of kidneys. CONCLUSIONS: Deceased donor transplants remained almost constant; however, their proportion of total transplanted kidneys decreased, while transplants with extended criteria kidneys increased. Wait list totals decreased, with relatively less elderly patients and more children being transplanted.

Organ Donation From Deceased Donors: A Proactive Detection Program in Saudi Arabia.

Several challenging obstacles remain to increasing the number of organ donations from deceased patients in a hospital setting. These include medical, administrative, and ethical issues. Possible medical obstacles include the failure of early recognition of possible donors and inadequate care of potential and actual donors. To maximize the use of donated organs, proper care of the donors and expedited donor consent cannot be overemphasized. The care rendered to patients should ensure appropriate perfusion and nutrition of the organs, with meticulous follow-up until organ recovery. For example, patients involved in accidents are presumed to be healthy, but many have no available medical history on file. At the time of organ recovery, unexpected infections or malignancies can be minimized by raising the index of suspicion of the presence of serious conditions in donors, especially in donors with unknown medical history. A careful physical examination and an appropriate and aggressive laboratory investigation may disclose the cause of suspected clinical conditions in these potential donors. Individuals who work in intensive care units are the main group of health care providers directly involved in the process of organ donation. Appointing a donor coordinator in each intensive care unit could improve all aspects of organ donation. Such coordination could harmonize efforts toward the goals mentioned above and surmount the obstacles encountered during deceased-donor organ donation. Here, we describe the preliminary results of the Proactive Detection Program, a collaboration between the Saudi Center for Organ Transplantation (the national organ donation and transplant supervising center) and intensive care units of donating hospitals. With its success in Saudi Arabia, it is hoped that it will be widely adopted in other regions.

Liver donation and transplantation in Saudi Arabia.

OBJECTIVES: The aim of the study was to evaluate and analyze the results of liver transplants from living and deceased donors in Saudi Arabia. MATERIALS AND METHODS: We performed a retrospective study from the National Registry reported to the Saudi Center for Organ Transplantation on 616 living donors and deceased donors between 2004 and 2010. Data included donors ' characteristics and acceptance rates of livers from deceased donors, recipient's status posttransplant, follow-ups, and patient survival. RESULTS: A total of 612 cases from deceased donors consented for liver donation of whom 402 cases (65.7%) were retrieved; 332 of them (82.3%) were transplanted. The mean age of the deceased donors was 33.2 years. Regarding living-donor liver transplants, 285 transplants were performed mostly from parent to offspring or offspring to parent. The mean age of the donors was 26.6 years and male/female ratio was 3/1. The mean follow-up was 745 days, and the mean posttransplant stay in hospital was 28.2 days. There were 11 cases with primary nonfunctioning grafts. At the end of the follow-up, 532 patients were alive (88%) and 58 patients died (10%). The patient survival at 3 years and the estimated 5-year survival were 87.2% and 77.1%. CONCLUSIONS: The outcome of liver transplanting in Saudi Arabia is comparable to international levels. However, the need to increase the acceptance rate and the use of procured livers requires more effort in managing deceased donors. Both living-donor and deceased-donor liver transplants should be continued in Saudi Arabia to meet the ever-increasing demand of patients with end-stage liver disease.

Comparison of expanded criteria kidneys with 2-tier standard criteria kidneys: role of delayed graft function in short-term graft outcome.

OBJECTIVES: To compare transplant outcomes between expanded criteria donor kidneys and standard criteria donor kidneys. MATERIALS AND METHODS: All adult renal transplants from deceased donors performed in Saudi Arabia over a 24-month period were included. Donor and recipient factors were recorded, and their effects on outcomes with expanded criteria donor and standard criteria donor kidneys were compared. Standard criteria donor kidneys were further subgrouped into optimal and suboptimal groups, and outcomes were compared. RESULTS: A total of 280 deceased-donor kidney transplants were performed during the study period. Of these, 61 (21.8%) involved expanded criteria donor kidneys. Cold ischemia time and prevalence of delayed graft function were similar between expanded criteria and standard criteria kidneys (P = .7 and P = .8). Graft survival rates at 2 years were also similar (93.3% vs 94.6%; P = .8). Delayed graft function exerted a negative effect on 2-year graft survival in both the expanded group (hazard ratio, 4.9; 95% CI 3.2-7.5; P = .001) and the standard group (hazard ratio, 4.6; 95% CI 3.24-7.5; P = .001). No difference was found between the 2 standard criteria subgroups with respect to serum creatinine value at the end of follow-up (P = .8), delayed graft function prevalence (P =.5), or 2-year graft survival (P = .8). The only independent factor affecting graft survival was delayed graft function (P = .001). No independent effect was seen for expanded criteria donor versus standard criteria donor, donor serum creatinine level, or recipient age. CONCLUSIONS: Similar short-term outcomes were found for expanded criteria and standard criteria kidney recipients. Delayed graft function was associated with significant risk of graft loss in both groups, with decreases in 2-year graft survival of 33.3% and 18.3%. No difference was seen between the 2 subtypes of standard criteria donor kidneys.

Prevalence of anemia in predialysis chronic kidney disease patients.

To evaluate the prevalence of anemia in a large cohort that comprises patients in different stages of chronic kidney disease (CKD) in the kingdom of Saudi Arabia (KSA), we conducted a multi-center cross-sectional study of a cohort of CKD patients who have not started dialysis. The study patients were recruited from the nephrology clinics in 11 different medical centers distributed all over the regions of the KSA. For the estimated glomerular filtration rate (GFR), we used the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation. There were 250 study patients who fulfilled the criteria for the study. The patients were stratified according to their GFR as follows: stage 1: 19 patients, stage 2: 35 patients, stage 3: 67 patients, stage 4: 68 patients, and stage 5: 61 patients. The composite of proteinuria and abnormal imaging in stages 1 and 2 was satisfied in 100% of the cases. The prevalence of anemia was elevated for the hemoglobin levels below 12 g/dL (the level at which the evaluation of anemia in CKD should be initiated) in the different stages of CKD, that is, 42%, 33%, 48%, 71%, and 82% in the stages from 1 to 5, respectively. The prevalence was also elevated for the hemoglobin levels below 11 g/dL (the minimum hemoglobin level at which therapy should be initiated with erythropoietin), that is, 21%, 17%, 31%, 49%, and 72%, respectively for stages from 1 to 5. In conclusion, we found a large prevalence of anemia among the CKD population in Saudi Arabia, and the burden of patients who require treatment with erythropoietin is considerably large. However, the response to therapy will not require large doses according to the availability of long-acting erythropoiesis stimulating agents, which will render the therapy more convenient and less expensive.

Implications of ICU stay after brain death: the Saudi experience.

OBJECTIVE: The interval from brain death (BD) to organ harvesting is critical to the success of transplantation. We evaluated the time from BD onset to harvesting and analyzed sources of delay. MATERIALS AND METHODS: This retrospective study was conducted from January 1999 to December 2003. Time intervals analyzed to determine the causes of delay were: time of admission to the intensive care unit (ICU), to the report to the Saudi Center for Organ Transplantation (SCOT), to the documentation of BD, to organ retrieval and/or cardiocirculatory cessation without organ retrieval. RESULTS: During the 5-year analysis, 1834 people were reported to the SCOT. Of those, more than 1511 (80%) were reported during their first week of treatment in the ICU, and BD was documented in 1099 (59.9%). The mean interval from ICU admission to organ retrieval or cardiac arrest was 10.3 days and that from admission to the report to the SCOT was 5.6 days. In the consensual group, the mean interval from the documentation of BD until harvesting was 2 days, and that from documentation until cardiocirculatory cessation without organ retrieval in the nonconsensual group was 5 days. All subjects demonstrated a significant decrease in systolic blood pressure and a significant increase in plasma sodium and serum creatinine levels. The body temperature, serum plasma levels of sodium, and kidney function (measured by the serum creatinine level) of potential donors were compared, and patients with hypothermia, hypernatremia, or renal failure had a shorter stay in the ICU. CONCLUSIONS: Fewer than 30% of the patients could be maintained on mechanical support for more than 1 week after the declaration BD. It is crucial that we increase hospital-staff awareness about the importance of organ donation and transplantation, improve the identification of BD candidates, and enable the early reporting and documentation of BD.

Comparative psychosocial analysis of patients on maintenance hemodialysis and transplanted patients.

OBJECTIVE: Many previous studies have shown that renal transplantation is associated with superior psychosocial rehabilitation than patients on dialysis. Our objective was to test if the same findings apply in Saudi patients. PATIENTS AND METHODS: Questionnaires probing demographic data, income, mental status, literacy and unemployment rates, family support, home ownership, satisfaction with previous transplantation and views and preferences about different types of transplantation were distributed to transplanted patients (n= 150) and patients on maintenance hemodialysis (HD) (n=210) at the Jeddah Kidney Center, King Fahd Hospital, Jeddah, Saudi Arabia. Illiterate patients were helped in completing the questionnaires by the social worker. RESULTS: We found that the male to female ratio in the transplanted group was 1.7:1 whereas it was 1:1 in the HD group. It was also found that more people in the transplant group owned houses than in the HD group (52% vs. 36.7%). Twice as many transplanted patients earned more than 7000 Saudi Riyals monthly. The unemployment rates were equal in the two groups (25-26%). Interestingly, the rate of illiteracy in the transplant group was almost half the rate in the HD group. More transplanted patients were assessed as being mentally balanced and, rational (92%) as compared to 66.2% in the HD group. Gratifyingly, however, both groups reported solid family support in the majority of patients (>80%). Of particular interest was the finding that well over one third (37%) of the patients on dialysis preferred to have live-unrelated transplants. This is far higher than those wishing for live-related (16.7%) or cadaveric (17.1%). CONCLUSION: Many of our findings coincide with what has been reported earlier. More patients with higher income were transplanted and there was no detected improvement in the employment rate associated with transplantation. Moreover, the vast majority of patients (92.7%) had no objection to receiving a living unrelated kidney and, in fact, as many as 37.6% actually felt preference for a living unrelated kidney over other types of transplantations.