Strategies for increasing transplantation: the Saudi experience.

THE STRATEGIES adopted in the Kingdom of Saudi Arabia for increasing organ transplantation are in general terms similar to those adopted elsewhere, ie, increasing awareness among public and doctors, establishing a central body to coordinate transplantation activities (ie, the Saudi Centre for Organ Transplantation), and obtaining the support of the government. However, relatively unique in this experience are the religious dimensions and the fact that advanced medical application is relatively recent in the Kingdom. The people of Saudi Arabia are devout Moslems. Their daily actions are governed by Islamic teachings, even in mundane matters. To accept organ donation, be it in life or after death, the Islamic view had to be ascertained. To fulfill this objective one of our early strategies was to urge our Islamic scholars to discuss this subject. Religious opinions (fatwas) were obtained permitting both living related and cadaveric donation as well as approving the concept of brain death. Until now, for wide consent for organ donation to be successful, the religious aspect of permission to donate must be stressed and fatwas must be cited to the relatives of the deceased. The advanced and state-of-the-art medical facilities existing in the Kingdom are relatively recent, as compared to the West. The populace and our practicing doctors were not familiar with brain stem death, transplantation, etc, when we started transplantation. This necessitated a sustained and persistent education process. Until 30 years ago, many patients were admitted to the hospital in a terminal status and died. The people did not trust doctors very much and this lack of trust then made it difficult to convince the people that “we know what we are doing,” a difficult task initially. As within any other country, increasing public awareness is an integral part of the strategy. This was undertaken through a sustained media campaign. News of transplantation activities are projected continually. Television programmes are devised including live question and answer sessions with religious scholars as panelists. Public debates are organised, usually in association with scientific conferences. Supportive newspaper columnists write on the topic usually from humanitarian point of view. Financial donation campaigns are organised, including marathons. For establishing awareness among medical personnel, regular meetings are held for intensive care unit (ICU) doctors, coordinators, hospital managers and nurses. A total of 80 such meetings were held for 2010 attendees. The topics discussed are tailored to the group involved, but generally cover religious and ethical aspects, diagnosis of brain death, method of reporting, methodology of obtaining consent, methods of increasing organ donation, and preservation of organs. Pamphlets are published on these and other topics. Sometimes ICU doctors are reluctant to get involved. Support is provided for them at all stages of organ donation (diagnosis, reporting, preservation, harvesting). The hospitals involvement is also encouraged by the policy of giving priority to patients for transplantation from the donor hospitals. For all these activities to be effective, a central coordinating body had to be established with full goodwill of the policy makers. By this support, the National Kidney Foundation was established in 1985, which was later renamed the Saudi Centre for Organ Transplantation (SCOT) in 1993, as the need for a multiorgan programme became evident. This body acts to coordinate and establish all activities related to transplantation. Policies are made by committees comprising experienced physicians and others in the Kingdom. It follows up organ donation from the stage of reporting to transplantation. The airborne Medivac system of the Ministry of Defence lends its support for transportation of the retrieved organs as the Kingdom has a vast area (2.5 million km). Recently, SCOT started coordination with the countries of the Gulf Cooperation Council (Oman, United Arab Emirates, Qatar, Bahrain, and Kuwait). Organs are now being exchanged through this programme. Saudi Arabia is the leading Islamic country in organ donation. The number of organs harvested so far are 950 kidneys, 165 hearts, and 163 livers, and patient and graft survival rates are excellent.