Abstract
BACKGROUNDThe Saudi Center for Organ Transplantation (SCOT) is the sole supervising, regulating and coordinating body for organ donation and transplantation inside the Kingdom of Saudi Arabia. It is also the referral center for Gulf Cooperation Council (GCC) Countries and adopted the uniform law on regulation on organ sharing among GCC countries as guidelines. In deceased organ donation, kidneys from deceased donors is the most utilized organ in the kingdom, helping patients suffering from ESRD and improving their quality of life by means of kidney transplantation; Thus, we studied the distribution and allocation of these kidneys from the zonal distribution system to kidney allocation and its utilization.
METHODS & MATERIALSA retrospective review was done during the period of 2014‐2016, using the Critical Pathway of Organ Donation comprising the potential, eligible, actual and utilized deceased kidneys inside the kingdom of Saudi Arabia.
RESULTSIn 2014 to 2016 a total of 1,160 Potential Deceased Donors (DD) were recorded by SCOT, of which 944(81%) donor’s next of kin were approached for organ donation after declaration of death, and 313 (33%) had given their consent to donate the organs. A total of 626 kidneys were consented, of these 400 (65%) kidneys were transplanted (utilized) in KSA, 106 (17%) kidneys was also utilized by GCC countries including 2 kidneys shared by KSA to UAE, non-recovered kidneys were 96 (15%), while 24 (4%) kidneys were not utilized. In 400 kidneys transplanted in KSA, kidney donors were categorized using the Standard and Extended Criteria (SCD, ECD) and the Donors Kidney Donor Risk Index (KDRI). A total of 290 (72%) SCD kidneys and 110 (28%) ECD kidneys were transplanted while the kidneys transplanted from deceased donors with KRDI index of less than <0.8 were 17 (4%) kidneys, 0.8-1.15, 163 (41%), 1.15-1.45, 113 (28%) and >1.45, 107 (27%) with mean KDRI of 1.25. SCOT allocation protocol allotted 20% of SCD deceased kidneys to Pediatric recipients; in which, 70 kidneys were transplanted; wherein, 69 (99%) SCD kidneys including, 15 kidneys for urgent pediatric was transplanted, and 1 (1%) kidney from ECD donor. Kidneys transplanted for urgent recipient was implemented by SCOT through zonal distribution which amounted to 28 kidneys transplanted mainly due to loss of vascular access. The cold ischemia time (CIT) Ranges from 2 hrs – 34 hrs. with mean CIT of 12 hrs. Discarded kidneys inside the kingdom were 22 kidneys with most reasons are due to kidney related disease. Non-recovered kidneys 96, were mostly due to donor’s sudden cardiac arrest 52 (54%), followed by causes due to medical reasons 38 (40%) and technical reasons 6 (6%).(Figure is included in full-text article.)(Figure is included in full-text article.)
CONCLUSIONKidney allocation and distribution is a vital role performed by SCOT. It assures, fair distribution of deceased kidneys to transplant centers based on recipient priority criteria and zonal distribution system following the Guidelines in the Directory of Regulations of Organ Transplantation. The SCOT constantly and closely monitor the kidney allocation for pediatric and patients on urgent waiting list were always given the priority. ECD kidneys were also used optimally by offering it to transplant centers thus, increasing the kidneys being utilized.