table of contents report 2014 en.pdf4 dr. a. al mishari hospital- riyadh 5 demas dialysis center 6...

Table of Contents

Page Preface (Renal Replacement Therapy) 1

Hemodialysis 2

Hemodialysis Hospitals Region Wise 3

HD Data in KSA 14 Peritoneal Dialysis 35

PD Data in KSA 36

Prevalence and Incidence of Dialysis Patients 43

Preface (Deceased Organ Donation and Transplantation) 44 Deceased Donors after Brain Death & Organ Donation 45

Hospital Sharing in Organ Donation Program 52

Organ Transplantation 60

Kidney Transplantation 61 Liver Transplantation 65

Heart Transplantation 68

Lung Transplantation 70

Pancreas Transplantation 72

Corneal Recovery 74 Bone Banking 75

Organ Sharing between KSA and GCC Countries 76

Appendices

Responsibilities of SCOT 78 Regulations of Organ Transplantation in KSA 79

Memorandum by the Minister of Health on Deceased Organ Donation

80

Official Statement of the National Committee for the Diagnosis of Death by Neurological Criteria and Ventilator System

81

Purport of the Senior Ulama Commission 82

Resolution of the Council of Islamic Jurisprudence on Resuscitation Apparatus

83

Glossary 84 Abbreviations 85

Index

Tables 86

Figures 87

Health Statistics Annual Book, p.18; www.moh.gov.sa

http://www.moh.gov.sa/

1

ANNUAL REPORT 2014

Renal Replacement Therapy

Preface

The Annual Report of 2014 highlights the present status of ESRD patients in Renal Replacement

Therapy in the Kingdom of Saudi Arabia. SCOT as the central coordinating body in renal

replacement therapy have taken all necessary steps to ensure accuracy of all the information

and data in this annual report.

The incidence rate of patients suffering from ESRD in the kingdom has been consistently

increasing. Currently, 136 incidences of ESRD patients per million populations (PMP) were

recorded and were expected to grow to the upcoming years. From 1971 since the first dialysis

center was erected in the Kingdom, rapid advances have been made in the field of renal

replacement therapy to cater the growing numbers of patients with ESRD. Currently, Hemo-

dialysis (HD) and Peritoneal Dialysis (PD) were the most prepared modality of treatment for

patients with renal failure, with 187 HD & 35 PD hospitals and dialysis centers in the Kingdom

catering to 15,782 of patients.

2

ANNUAL REPORT 2014

Hemodialysis Introduction

In 2014, a total of 187 hospitals and dialysis

centers Units from Ministry of health, Gov’t

Non-MOH & Private sector hospitals were

catering the needs of ESRD patients,

utilizing 5732 hemodialysis machines with

4428 number of outlet connections

combined.

By the end of 2014, a total of 14366 patients

on Hemodialysis were recorded by SCOT, of

these 3687 were new patients. Blood group

among dialysis patients were also noted

with type O group averaging 52% and the

least were those of blood group AB with

4%. Age Distribution of patients reveals

that most were in the productive age group

of 26-65 years with a total of 75%. Sexes

were also recorded showing that male

patients composed 57% of patients and

female with (43%). By nationalities, Saudis

on HD are 84% compared to Non-Saudi

counterparts with 16%. Vascular access

among dialysis patients shows that AVF or

arteriovenous fistulas were the most

preferred site with 67% of the patients

having them.

Hepatitis B and C infection has been a

constant challenge among health care

provider in stopping the contamination

amongst patients undergoing Hemodialysis.

Hepatitis B infections were in good control

averaging 3.4% per year, while patients

diagnosed with Hepatitis C it is worth

mentioning that it has been contained for

the last five years with the current average

of 15.5% this year. Among Patients on

Hemodialysis, 59% were found to be

hypertensive, while 44% are diabetic.

The proportion of hemodialysis patients

treated with Erythropoietin ranges from 10

and 100% with average of 86%. Vitamin D’s

were also used with 51% given orally while

13% of the patients are receiving via

injectable route. Other medications such as

insulin and oral hypoglycemic were also

utilized with 21% of patients receiving

insulin, 9% on oral hypoglycemic and 11%

were put on diet control.

Active HD patient’s blood levels such as

Hematocrit, albumin and calcium were also

monitored. In which, 21% of HD patients

have Hct level of < 30%, 14% have albumin

of <30 g/dl, 27% have phosphorous levels

greater than 1.9 µmol/L and 22% have

calcium levels of less than 2.1 µmol/L.

Of the 14,366 patients on HD, 20% are in

the active waiting list or those patients

evaluated and are ready for renal

transplantation. While, the mortality rate

among HD patients by the end of 2014 were

11%

It was estimated that the numbers of

Dialysis patients will be increasing

continuously and numbers are expected to

climb up to 20,000 patients by the end of

2020.

3

ANNUAL REPORT 2014

HD Hospitals Region Wise by Sector

Central Region

MOH Hemodialysis Centers in Riyadh Region

N Hospital

1 Childrens Hospital (RMC)

2 Dawadmi General Hospital

3 Shagra General Hospital

4 Thadiq General Hospital

5 Afif General Hospital

6 Al Aflaj General Hospital

7 Al Ghat General Hosptal(PNSSH)

8 Al Iman General Hospital

9 Al Muzahimiya General Hospital

10 Al Qawaeyah General Hospital

11 Al Sulayel General Hospital

12 Al Zulfi General Hospital

13 Artawiya General Hospital

14 Hotat Bani Tamim General Hospital

15 Hotat Sudair General Hospital

16 Huraimala General Hospital

17 King Khalid Hospital- Al Kharj

18 King Khalid Hospital- Majma'ah

19 King Salman for Kidney Disease Riyadh

20 King Salman Hospital Riyadh

21 Nafee General Hospital

22 Prince Salman Bn Mohd- Delim

23 Rumah General Hospital

24 Ruwaidah Hospital

25 Sajir General Hospital

26 Tumair General Hospital

27 Wadi Dawasir General Hospital

28 King Saud Medical City- Riyadh

29 Prince Mohammad Bin Abdulaziz Hospital Hospital-Riyadh*

*Diaverum

4

ANNUAL REPORT 2014


Central Region

Govt. Non-MOH Hemodialysis Centers in Riyadh Region

N Hospital

1 Al Kharj Military Industrial Corp. Hospital, Riyadh

2 King Faisal Specialist Hospital- Riyadh

3 King Abdulaziz Medical City, Riyadh (KFNGH)

4 King Khalid University Hospital- Riyadh

5 Prince Sultan Military Medical City - Riyadh

6 King Abdullah Hemodialysis Project-Riyadh South Center*

7 Security Forces Hospital – Riyadh**

*National Guard

**Diaverum

Private Hemodialysis Centers in Riyadh Region

N Hospital

1 Al Khawalid kidney & dialysis Center- Riyadh

2 Arab Medical Dar Dialysis Center- Riyadh

3 Dar Al Shifa Hospital- Riyadh

4 Dr. A. Al Mishari Hospital- Riyadh

5 Demas Dialysis Center

6 Dr. Ali Lahibi Dialysis Center, Riyadh

7 Dr. Suleiman Al Habeeb Medical Center- Riyadh

8 Riyadh Care Hospital

9 Riyadh National Hospital

10 Saudi German Hospital- Riyadh

11 Specialized Medical Center Hospital- Riyadh

12 Sultan B.A. Humanitarian City- Riyadh

13 Al Hammadi Hospital- Riyadh

14 Kingdom Hospital- Riyadh

5

ANNUAL REPORT 2014


Central Region

MOH Hemodialysis Centers in Qassim Region

N Hospital

1 King Fahd Specialist Hospital- Buraida

2 King Saud Hospital Unaiza*

3 Al Asyah General Hospital

4 Al Bukariya General Hospital

5 Al Midnab General Hospital

6 Al Rass General Hospital

7 Ayun Al Juwah General Hospital

8 Buraida Central Hospital**

9 Dhariyah General Hospital

10 Oklat Al-Sugour General Hospital

11 Qiba General Hospital

12 Riyadh Al Khabra General Hospital

*Diaverum

**MOH Outsourcing Dialysis Program Davita

6

ANNUAL REPORT 2014


Western Region

MOH Hemodialysis Centers in Makkah/Jeddah/Taif Region

N Hospital

1 Adhum General Hospital

2 Al Laith General Hospital

3 King Abdul Aziz Hospital - Jeddah**

4 King Abdul Aziz Specialist Hospital- Taif

5 King Faisal Hospital Makkah

6 King Fahad Hospital- Jeddah

7 Al Khurma Hospital

8 Al Noor Specialist Hospital

9 Al Qunfudah General Hospital*

10 King Abdul Aziz Hospital- Makkah

11 Messan General Hospital 12 Rabiq General Hospital

13 Raniah General Hospital

14 Turabah General Hospital

15 Prince Abdul Majid Dialysis Center*

*Diaverum

**Davita

Govt. Non-MOH Hemodialysis Centers in Makkah/Jeddah/Taif Region

N Hospital

1 Al Hada Armed Forces Hospital- Taif

2 King Abdul Aziz University Hospital- Jeddah

3 King Abdulaziz Medical City- Jeddah (KFNGH)

4 King Fahad Armed Forces Hospital- Jeddah

5 King Faisal Specialist Hospital- Jeddah

6 King Abdullah Hemodialysis Project-Jeddah*

*National Guard

7

ANNUAL REPORT 2014


Western Region

Private Hemodialysis Centers in Makkah/Jeddah/Taif Region

N Hospital

1 Abdulakrim Bakr Medical Center, Jeddah

2 Al Bir Clinic 1 Charity D.C, (Al Kandara) Jeddah

3 Al Faisal Polyclinic- Jeddah

4 Al Mustagbal Hospital- Jeddah

5 Al Takaful Al- Khairy K.D.C Makkah

6 Asia Dialysis Center - Makkah

7 Charity Community Dialysis Center- Makkah

8 Dr. Abdurahman Baksh Hospital- Jeddah

9 Dr. Erfan and Bagedo- Jeddah

10 Dr. Suleiman Al Fakeeh Hospital- Jeddah

11 New Jeddah Clinic Hospital

12 Prince Mansour Charity Dialysis Center- Jeddah

13 Taibah Dialysis Center- Makkah

14 Al Bir Charity Dialysis Center (2)Jeddah

15 Bugshan General Hospital - Jeddah

16 International Renal Care Center- Jeddah

17 Saudi German Hospital- Jeddah

10 Basharahil Hospital- Makkah

MOH Hemodialysis Centers in Madina Region

N Hospital

1 Al Eass General Hospital

2 Al Mhad General Hospital

3 Badr General Hospital

4 King Fahad Hospital- Madina

5 Prince Abdul Mohsin Hospital. A1 Ulla

6 Al Hanakiya General Hospital

7 Khaiber General Hospital

8 Yanbu General Hospital

Govt. Non-MOH Hemodialysis Centers in Madina Region

N Hospital

1 Royal Commission Medical Center- Yanbu

8

ANNUAL REPORT 2014


Western Region

Private Hemodialysis Centers in Madina Region

N Hospital

1 Madina National Hospital

2 Saudi German Hospital- Madina

9

ANNUAL REPORT 2014


Eastern Region

MOH Hemodialysis Centers in Eastern Region

N Hospital

1 Al Jubail General Hospital

2 Dammam Medical Complex

3 King Fahad Specialist Hospital- Dammam

4 Abgaig General Hospital

5 Al Gaissoma General Hospital

6 Al Nairiyiah General Hospital

7 King Fahad Hospital- Hofuf

8 King Khalid General Hospital- Hafar al Baten*

9 Qateef Central Hospital

*Diaverum

Govt. Non-MOH Hemodialysis Centers in Eastern Region

N Hospital

1 Royal Commission Hospital- Jubail (Ex. Al Fanater)

2 Dahran Health Center (ARAMCO)

3 King Abdul Aziz Medical City, Ahsa (NG)

4 King Fahad Military Medical Complex- Dhahran

5 King Fahad University Hospital- Al Khobar

6 King Khalid Medical City- Hafar Al Batin

7 Al Khafji Joint Operation Hospital

Private Hemodialysis Centers in Eastern Region

N Hospital

1 Al Mouwasat Hospital- Dammam

2 Al Moosa General Hospital, Ahsa

3 Saad Specialist Hospital- Al Khobar

4 Al Ahsa Hospital

5 Al Mana Hospital- Dammam

6 Al Mouwasat Hospital- Qateef

10

ANNUAL REPORT 2014


Northern Region

MOH Hemodialysis Centers in Al Jouf Region

N Hospital

1 Domat Al Jundal General Hospital 2 Prince A.R Sudeiry Hospital- Skaka 3 Tabarjal General Hospital

MOH Hemodialysis Centers in Hail Region

N Hospital

1 Al Shammali General Hospital 2 Al Sulaymi General Hospital 3 Hail General Hospital 4 King Khalid Hospital- Hail 5 Baqaa General Hospital 6 Samira General Hospital

MOH Hemodialysis Centers in Northern Borders Region

N Hospital

1 Al Owaigila General Hospital

2 Ar-ar Central Hospital

3 Al Qurrayat General Hospital

4 Rafah General Hospital

5 Turaif General Hospital

MOH Hemodialysis Centers in Tabuk Region

N Hospital

1 Al Hawraa Hospital Amloj

2 King Khalid Hospital- Tabuk

3 Al Bada General Hospital

4 Al Wajeh General Hospital

5 Dhuba General Hospital

6 Haql General Hospital

7 Tayma General Hospital

Govt. Non-MOH Hemodialysis Centers in Tabuk Region

N Hospital

1 King Salman Military Hospital Tabuk

11

ANNUAL REPORT 2014


Southern

MOH Hemodialysis Centers in Al Baha Region

N Hospital

1 Gilwah General Hospital

2 King Fahad Hospital- Al Baha

3 Al Mandag General Hospital

4 Al Mikhwah General Hospital

5 Beljurasy General Hospital

6 Gilwah General Hospital

Private Hemodialysis Centers in Al Baha Region

N Hospital

1 Ghodran Hospital- Beljurashi

MOH Hemodialysis Centers in Assir Region.

N Hospital

1 Al Majardah General Hospital

2 Assir Kidney Center

3 Balasmar General Hospital

4 Mohayel General Hospital

5 Sabt Al Alayah General Hospital

6 Ahad Rufaidah General Hospital

7 Al Nammas General Hospital

8 Dharan Al Janoub Hospital

9 K.A.A.Daughter's Charity Center for Renal Diseases

10 Rijal Almaa General Hospital

11 Sarat Obaidah General Hospital

12 Tathleeth General Hospital

13 Besha General Hospital (Psych. H)*

14 Khamis Mushayt General Hospital*

*Diaverum

12

ANNUAL REPORT 2014


Southern

Govt. Non-MOH Hemodialysis Centers in Assir Region

N Hospital

1 KFMH- Khamis Mushayt

Private Hemodialysis Centers in Assir Region

N Hospital

1 Saudi German Hospital- Abha

2 Abha Private Hospital

MOH Hemodialysis Centers in Gizan Region

N Hospital

1 King Fahad Central Hospital- Gizan

2 Sabia General Hospital

3 Fursan General Hospital

4 Samtha General Hospital

MOH Hemodialysis Centers in Najran Region

N Hospital

1 Habona General Hospital

2 King Khalid Hospital - Najran

3 Sharurah General Hospital

13

ANNUAL REPORT 2014


Outsourcing Hemodialysis Centers

MOH Diaverum

Central Region

Riyadh

Prince Mohammad Bin Abdulaziz Hospital Hospital-Riyadh

Qassim

King Saud Hospital Unaiza

Western Region

Makka/Jeddah/Taif

Al Qunfudah General Hospital Prince Abdul Majid Dialysis Center

Eastern Region

King Khalid General Hospital- Hafar al Baten

Southern Region

Assir

Besha General Hospital (Psych. H)

Khamis Mushayt General Hospital

MOH Davita

Central Region

Qassim

Buraida Central Hospital

Western Region

Makka/Jeddah/Taif

King Abdul Aziz Hospital - Jeddah

Govt. Non-MOH Diaverum (Prince Naif Dialysis Center)

Central Region

Riyadh

Security Forces Hospital - Riyadh

14

ANNUAL REPORT 2014

Table 1: Total No. of Hemodialysis Centers in MOH* According to Region

Region No. of

Hospitals

Consultant

Nephrologists

Nephrology

Specialists GP's Nurses

No. of Outlet

Connections

Total No. of

HD

Machines

Total HD

Pts. 2014

No. of Follow

up Tx. Pts

2014

Riyadh 29 17 39 90 516 511 804 1474 471

Makkah/Jeddah 13 15 33 35 363 378 449 1593 362

Madina 8 6 9 10 170 206 285 758 137

Tabuk 7 1 6 14 71 143 178 260 155

Eastern 8 19 19 30 469 229 283 1066 332

Qassim 10 5 7 15 106 133 202 406 35

Al Baha 5 1 3 8 53 78 135 231 0

Al Jouf 3 0 6 8 55 63 108 202 0

Northern Borders 5 2 4 10 70 147 154 191 42

Hail 6 1 3 13 45 100 149 294 43

Jizan 4 2 7 8 124 124 177 659 96

Najran 3 2 3 4 46 79 98 185 0

Assir 12 0 13 11 161 227 319 795 53

Total 113 71 152 256 2249 2418 3341 8114 1726

*MOH Excluding Outsourcing Dialysis Program (Diaverum and Davita)

15

ANNUAL REPORT 2014

Table 1.1: Total No. of Hemodialysis Centers in MOH* According to Region

Region Non-

Saudi Pts

New Pts.

in 2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs Pts > 75 yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts.

Died 2014

Riyadh 106 240 61 254 40 117 221 394 556 145

Makkah/Jeddah 196 346 63 437 19 60 192 546 263 221

Madina 95 195 21 113 18 35 82 166 225 79

Tabuk 26 69 13 51 6 29 35 88 86 25

Eastern 92 251 23 127 16 65 143 281 444 115

Qassim 25 73 16 51 2 35 35 182 147 38

Al Baha 7 40 7 47 0 18 32 91 53 18

Al Jouf 8 50 0 23 6 19 66 43 55 22

Northern Borders 4 26 8 21 8 9 39 40 107 29

Hail 10 102 4 46 4 36 69 60 75 43

Jizan 117 130 49 146 8 29 60 279 65 99

Najran 32 56 9 18 8 6 45 52 33 16

Assir 30 158 26 122 1 103 79 204 229 65

Total 748 1736 300 1456 136 561 1098 2426 2338 915

*MOH Excluding Outsourcing Dialysis Program (Diaverum and Davita)

16

ANNUAL REPORT 2014

Table 2: Total No. of Hemodialysis Centers in MOH* DAVITA Outsourcing Dialysis Program According to Region

Region No. of

Hospitals

Consultant

Nephrologists

Nephrology


No. of Outlet

Connections

Total No. of

HD

Machines

Total HD

Pts. 2014

No. of Follow

up Tx. Pts

2014

Riyadh 0 0 0 0 0 0 0 0 0

Makkah/Jeddah/Taif 1 2 4 5 18 17 29 48 0

Eastern 0 0 0 0 0 0 0 0 0

Qassim 1 1 10 0 31 48 53 96 0

Assir 0 0 0 0 0 0 0 0 0

Total 2 3 14 5 49 65 82 144 0

Table 2.1: Total Data on Hemodialysis Patients in MOH* DAVITA Outsourcing Dialysis Program According to Region

Hospital Name

Non-

Saudi

Pts

New Pts. in

2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs

Pts >

75 yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts.

Died 2014

Riyadh 0 0 0 0 0 0 0 0 0 0

Makkah/Jeddah/Taif 0 6 0 13 0 0 11 17 8 6

Eastern 0 0 0 0 0 0 0 0 0 0

Qassim 0 96 2 9 2 5 4 31 41 2

Assir 0 0 0 0 0 0 0 0 0 0

Total 0 102 2 22 2 5 15 48 49 8

*MOH Outsourcing Dialysis Program Davita

17

ANNUAL REPORT 2014

Table 3: Total No. of Hemodialysis Centers in MOH* DIAVERUM Outsourcing Dialysis Program According to Region

Region No. of

Hospitals

Consultant

Nephrologists

Nephrology


No. of Outlet

Connections

Total No. of

HD

Machines

Total HD

Pts. 2014

No. of Follow

up Tx. Pts

2014

Riyadh 1 2 1 4 36 29 47 180 39


Eastern 1 0 2 5 33 46 65 140 45

Qassim 1 0 1 0 19 20 32 151 1

Assir 2 2 1 2 34 68 89 247 0

Total 7 8 14 47 182 301 366 1068 85

Table 3.1: Total Data on Hemodialysis Patients in MOH DIAVERUM* Outsourcing Dialysis Program According to Region

Hospital Name

Non-

Saudi

Pts

New Pts. in

2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs

Pts >

75 yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts.

Died 2014

Riyadh 27 17 3 20 2 10 23 23 35 2


Eastern 2 37 5 13 2 6 70 24 46 37

Qassim 1 12 4 12 2 10 50 48 19 18

Assir 4 27 3 22 2 18 14 46 76 14

Total 39 325 32 150 9 86 235 267 215 98

* MOH Outsourcing Dialysis Program Diaverum

18

ANNUAL REPORT 2014

Table 4: Total of Hemodialysis Centers in GOVT. NON-MOH** All Sectors According to Region

Region No. of

Hospitals

Consultant

Nephrologists

Nephrology


No. of Outlet

Connections

Total No. of

HD

Machines

Total HD

Pts. 2014

No. of Follow

up Tx. Pts

2014

Riyadh* 7 31 21 18 406 398 475 1137 3272


Madina 1 1 1 0 17 24 24 61 13

Tabuk 1 3 1 0 68 38 55 210 183

Eastern 7 15 10 4 124 115 156 309 259

Assir 1 7 2 9 110 74 99 282 1853

Total 23 76 59 35 969 986 1194 2816 5995

Table 4.1: Total Data on Hemodialysis Patients in GOVT. NON-MOH** All Sectors According to Region

Hospital Name Non-

Saudi Pts

New Pts.

in 2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs

Pts >

75 yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts.

Died 2014

Riyadh* 29 375 43 133 15 143 160 243 358 73


Madina 5 17 3 7 0 5 0 35 23 8

Tabuk 1 64 5 17 8 18 0 27 183 49

Eastern 17 65 7 17 0 41 8 78 154 44

Assir 1 137 8 19 6 32 36 88 102 32

Total 102 978 92 250 51 312 314 641 1064 277

**Gov’t Non-MOH including Outsourcing Dialysis Program Diaverum Riyadh (Prince Naif Dialysis Center in Security forces Hospital) & King

Abdullah Hemodialysis Project)

19

ANNUAL REPORT 2014

Table 5: Total of Hemodialysis Centers in Private Sector According to Region

Region No. of

Hospitals

Consultant

Nephrologists

Nephrology


No. of Outlet

Connections

Total No. of

HD

Machines

Total HD

Pts. 2014

No. of Follow

up Tx. Pts

2014

Riyadh 14 10 16 11 131 192 206 607 33


Madina 2 2 1 1 6 13 14 30 0

Eastern 6 9 6 3 101 131 179 330 25

Al Baha 1 0 1 0 3 8 4 6 4

Assir 2 1 2 0 4 10 9 10 1

Total 42 42 51 30 424 658 749 2224 140

Table 5.1: Total Data on Hemodialysis Patients in Private Sector According to Region

Hospital Name Non-

Saudi Pts

New Pts.

in 2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs

Pts >

75 yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts.

Died 2014

Riyadh 364 164 12 77 6 46 72 203 193 48


Madina 4 6 0 2 0 2 16 6 8 3

Eastern 33 145 3 33 0 65 7 60 241 52

Al Baha 2 2 0 6 0 1 1 1 3 0

Assir 4 5 0 2 0 0 0 4 4 0

Total 1377 546 67 342 19 153 236 658 834 235

20

ANNUAL REPORT 2014

Table 6: Total of Hemodialysis Centers in All Sectors According to Region

Region No. of

Hospitals

Consultant

Nephrologists

Nephrology


No. of Outlet

Connections

Total No. of

HD

Machines

Total HD

Pts. 2014

No. of Follow

up Tx. Pts

2014

Riyadh 51 60 77 123 1089 1130 1532 3398 3815

Makkah/Jeddah 39 60 95 95 864 1174 1333 4049 854

Madina 11 9 11 11 193 243 323 849 150

Tabuk 8 4 7 14 139 181 233 470 338

Eastern 22 43 37 42 727 521 683 1845 661

Qassim 12 6 18 15 156 201 287 653 36

Al Baha 6 1 4 8 56 86 139 237 4

Al Jouf 3 0 6 8 55 63 108 202 0

Northern Borders 5 2 4 10 70 147 154 191 42

Hail 6 1 3 13 45 100 149 294 43

Jizan 4 2 7 8 124 124 177 659 96

Najran 3 2 3 4 46 79 98 185 0

Assir 17 10 18 22 309 379 516 1334 1907

Total 187 200 290 373 3873 4428 5732 14366 7946

21

ANNUAL REPORT 2014

Table 6.1: Total Data on Hemodialysis Patients in All Sectors According to Region

Hospital Name Non-

Saudi Pts

New Pts.

in 2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs

Pts >

75 yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts.

Died 2014

Riyadh 526 796 119 484 63 316 476 863 1142 268

Makkah/Jeddah 1220 1128 158 812 55 214 531 1243 939 457

Madina 104 218 24 122 18 42 98 207 256 90

Tabuk 27 133 18 68 14 47 35 115 269 74

Eastern 144 498 38 190 18 177 228 443 885 248

Qassim 26 181 22 72 6 50 89 261 207 58

Al Baha 9 42 7 53 0 19 33 92 56 18

Al Jouf 8 50 0 23 6 19 66 43 55 22

Northern Borders 4 26 8 21 8 9 39 40 107 29

Hail 10 102 4 46 4 36 69 60 75 43

Jizan 117 130 49 146 8 29 60 279 65 99

Najran 32 56 9 18 8 6 45 52 33 16

Assir 39 327 37 165 9 153 129 342 411 111

Total 2266 3687 493 2220 217 1117 1898 4040 4500 1533

22

ANNUAL REPORT 2014

Table 7: Total of Hemodialysis Centers in MOH* All Sector According to Global Region

Region No. of

Hospitals

Consultant

Nephrologists

Nephrology


No. of Outlet

Connections

Total No. of

HD

Machines

Total HD

Pts. 2014

No. of Follow

up Tx. Pts

2014

Central 42 25 58 109 708 741 1138 2307 546

Western 24 27 55 86 611 739 896 2749 499

Eastern 9 19 21 35 502 275 348 1206 377

Northern 21 4 19 45 241 453 589 947 240

Southern 26 7 27 33 418 576 818 2117 149

Total 122 82 180 308 2480 2784 3789 9326 1811

Table 7.1: Total Data on Hemodialysis Patients in MOH* All Sector According to Global Region

Hospital Name Non-

Saudi Pts

New Pts.

in 2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs

Pts >

75 yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts. Died

2014

Central 159 438 86 346 48 177 333 678 798 205

Western 296 779 101 646 38 137 363 855 535 333

Eastern 94 288 28 140 18 71 213 305 490 152

Northern 48 247 25 141 24 93 209 231 323 119

Southern 190 411 94 355 19 174 230 672 456 212

Total 787 2163 334 1628 147 652 1348 2741 2602 1021

* Including Diaverum and Davita Outsourcing dialysis Unit

23

ANNUAL REPORT 2014

Table 8: Total of Hemodialysis Centers in GOVT. NON-MOH** All Sector According to Global Region

Region No. of

Hospitals

Consultant

Nephrologists

Nephrology


No. of Outlet

Connections

Total No. of

HD

Machines

Total HD

Pts. 2014

No. of Follow

up Tx. Pts 2014

Central 7 31 21 18 406 398 475 1137 3272

Western 7 20 25 4 261 361 409 878 428

Eastern 7 15 10 4 124 115 156 309 259

Northern 1 3 1 0 68 38 55 210 183

Southern 1 7 2 9 110 74 99 282 1853

Total 23 76 59 35 969 986 1194 2816 5995

Table 8.1: Total Data on Hemodialysis Patients in GOVT. NON-MOH** All Sector According to Global Region

Hospital Name Non-

Saudi Pts

New Pts.

in 2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs

Pts >

75 yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts.

Died 2014

Central 29 375 43 133 15 143 160 243 358 73

Western 54 337 29 64 22 78 110 205 267 79

Eastern 17 65 7 17 0 41 8 78 154 44

Northern 1 64 5 17 8 18 0 27 183 49

Southern 1 137 8 19 6 32 36 88 102 32

Total 102 978 92 250 51 312 314 641 1064 277

**Gov’t Non-MOH including Outsourcing Dialysis Program Diaverum Riyadh (Prince Naif Dialysis Center in Security forces Hospital) & King

Abdullah Hemodialysis Project)

24

ANNUAL REPORT 2014

Table 9: Total of Hemodialysis Centers in Private Sector According to Global Region

Region No. of

Hospitals

Consultant

Nephrologists

Nephrology


No. of Outlet

Connections

Total No. of

HD

Machines

Total HD

Pts. 2014

No. of Follow

up Tx. Pts

2014

Central 14 10 16 11 131 192 206 607 33

Western 19 22 26 16 185 317 351 1271 77

Eastern 6 9 6 3 101 131 179 330 25

Northern 0 0 0 0 0 0 0 0 0

Southern 3 1 3 0 7 18 13 16 5

Total 42 42 51 30 424 658 749 2224 140

Table 9.1: Total Data on Hemodialysis Patients in Private Sector According to Global Region

Hospital Name Non-

Saudi Pts

New Pts.

in 2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs

Pts >

75 yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts.

Died 2014

Central 364 164 12 77 6 46 72 203 193 48

Western 974 230 52 224 13 41 156 390 393 135

Eastern 33 145 3 33 0 65 7 60 241 52

Northern 0 0 0 0 0 0 0 0 0 0

Southern 6 7 0 8 0 1 1 5 7 0

Total 1377 546 67 342 19 153 236 658 834 235

25

ANNUAL REPORT 2014

Table 10: Total of Hemodialysis Centers in All Sectors According to Global Region

Region No. of

Hospitals

Consultant

Nephrologists

Nephrology


No. of Outlet

Connections

Total No. of

HD

Machines

Total HD

Pts. 2014

No. of Follow

up Tx. Pts

2014

Central 63 66 95 138 1245 1331 1819 4051 3851

Western 50 69 106 106 1057 1417 1656 4898 1004

Eastern 22 43 37 42 727 521 683 1845 661

Northern 22 7 20 45 309 491 644 1157 423

Southern 30 15 32 42 535 668 930 2415 2007

Total 187 200 290 373 3873 4428 5732 14366 7946

Table 10.1: Total Data on Hemodialysis Patients in All Sectors According to Global Region

Hospital Name Non-

Saudi Pts

New Pts.

in 2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs

Pts >

75 yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts. Died

2014

Central 552 977 141 556 69 366 565 1124 1349 326

Western 1324 1346 182 934 73 256 629 1450 1195 547

Eastern 144 498 38 190 18 177 228 443 885 248

Northern 49 311 30 158 32 111 209 258 506 168

Southern 197 555 102 382 25 207 267 765 565 244

Total 2266 3687 493 2220 217 1117 1898 4040 4500 1533

26

ANNUAL REPORT 2014

Table 11: Total of Hemodialysis Centers in Saudi Arabia According to Sector

Hospital Sector No. of

Hospitals

Consultant

Nephrologists

Nephrology


No. of Outlet

Connections

Total No. of HD

Machines

Total HD

Pts. 2014

No. of Follow up

Tx. Pts 2014

Ministry of Health Hospitals 113 71 152 256 2249 2418 3341 8114 1726

MOH: Diaverum 7 8 14 47 182 301 366 1068 85

MOH: Davita 2 3 14 5 49 65 82 144 0

GOVT. Non-MOH Hospitals 20 69 56 23 768 630 828 2271 5987

Gov’t. Non-MOH: King

Abdullah HD Project 2 5 1 8 146 301 301 348 8

Gov’t. Non-MOH: Diaverum 1 2 2 4 55 55 65 197 0

Private Sector Hospitals 42 42 51 30 424 658 749 2224 140

Total 187 200 290 373 3873 4428 5732 14366 7946

Table 11.1: Total Data on Hemodialysis Patients in Saudi Arabia According to Sector

Hospital Name Non-Saudi

Pts

New Pts.

in 2014

HBsAg+ve

Pts

HCV+ve

Pts

Pts < 15

Yrs

Pts > 75

yrs

Diabetic

Pts

Hypertensive

Pts Both

HD Pts. Died

2014

Ministry of Health Hospitals 748 1736 300 1456 136 561 1098 2426 2338 915

MOH: Diaverum 39 325 32 150 9 86 235 267 215 98

MOH: Davita 0 102 2 22 2 5 15 48 49 8

GOVT. Non-MOH Hospitals 98 624 73 217 48 260 220 532 980 262

Gov’t. Non-MOH: King Abdullah

HD Project 0 314 7 12 3 28 1 44 84 1

Gov’t. Non-MOH: Diaverum 4 40 12 21 0 24 93 65 0 14

Private Sector Hospitals 1377 546 67 342 19 153 236 658 834 235

Total 2266 3687 493 2220 217 1117 1898 4040 4500 1533

27

ANNUAL REPORT 2014

Dialysis Centers in Saudi Arabia 1971-2014

New Hemodialysis Patients in Saudi Arabia 1995-2014

1 2 6

22

37

51

63

76

91

94

97

10

3

10

3

10

6

11

0 1

24

12

4

13

0

13

6

14

4

14

7

14

9 16

0 17

1

17

3

17

5

17

6

17

7

18

2

18

2

18

4

18

7

0

20

40

60

80

100

120

140

160

180

200

19

71

19

74

19

76

19

84

19

86

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

2084

1733 1918

2042

1718

1958 2080

2389

2847 2944

2643 2846

3089 3187

3281

3687

0

500

1000

1500

2000

2500

3000

3500

4000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

28

ANNUAL REPORT 2014

Dialysis Population Net Annual Increase 1993-2014

93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

No. of Pts. 3357 3666 3737 4189 4665 5010 5706 6694 7004 7391 7020 7214 7837 8761 9419 10203 10928 11437 12116 12844 13160 14366

0

2000

4000

6000

8000

10000

12000

14000

16000

29

ANNUAL REPORT 2014

Hemodialysis Centers Affiliation 2014

Hemodialysis Machines 2014

Hemodialysis Patients Nationality 2014

MOH 122 (65%)

Diaverum: 7 Davita: 2

Govt't Non- MOH 23 (13%)

King Abdullah Dialysis Project: 2

Diaverum: 1

Private 42 (22%)

MOH

Gov't. Non-MOH

Private

Total: 187

MOH 3789 (66%)

Gov't Non-MOH 1194 (21%)

Private 749 (13%)

MOH

Gov't. Non-MOH

Private

Total: 5732

Saudi 12100 (84%)

Non-Saudi 2266 (16%)

Saudi

Non-Saudi

Total: 14366

30

ANNUAL REPORT 2014

Sex Distribution amongst HD Patients 2014

Age Distribution amongst HD Patients 2014; Age Group by Year

Hemodialysis Patients; Age above 75 years & below 15 years 2014

Male 8198 (57%)

Female 6168 (57%)

Male

Female

Total: 14366

30 187

915

3289 3220 3400

2208

1117

0

500

1000

1500

2000

2500

3000

3500

4000

< 10 10 - 15 16-25 26-45 46-55 56-65 66-75 >75

Total 14366

15-75 years 13032 (91%)

Above 75 years 1117 (8%)

Below 75 years 217 (1%)

15-75 years

Above 75 years

Below 15 years

Total: 14366

31

ANNUAL REPORT 2014

Blood Groups amongst HD Patients 2014

Types of Vascular Accesses of HD Patients 2014

HD Patients Treated with Erythropoietin by Health Sector2014

A 3906 (27%)

B 2396 (17%)

AB 648 (4%)

O 7416 (52%)

A

B

AB

O

Total: 14366

AVF 9609 (67%)

Jugular Cath 2783 (19%)

Others 1129 (8%)

Vascular Graft 845 (6%)

AVF

Jugular Cath.

Others

Vascular Graft

MOH Govt. Non-MOH Private Sector

Total HD Pts.: 14366 9326 2816 222400%

Treated by EPO-r: 12269 8300 2056 1913

Percentage: 85.4% 89% 73% 86%

0100020003000400050006000700080009000

10000

32

ANNUAL REPORT 2014

HD Patients HBsAg Screen Status 2014

HD Patients HCV Antibody Status 2014

HCV Positive HD Patients Region Wise 2014

Negative 13873 (97%)

Positive 493 (3%)

HBsAg Negative

HBsAg Positive

Negative 12146 (85%)

Positive 2220 (15%)

HCV Antibody Negative

HCV Antibody Positive

Central Western Eastern Southern Northern

HCV+ve: 2220 556 934 190 382 158

T Pts. On HD: 14366 4051 4898 1845 2415 1157

25% 42%

9% 17% 7%

0

1000

2000

3000

4000

5000

6000

*% from HD Pts.

33

ANNUAL REPORT 2014

Cause of Renal Failure No. %

Diabetic Nephropathy 5991 41.7%

Hypertensive Nephropathy 5100 35.5%

Unknown Etiology 1016 7%

Primary Glomerular Disease 689 5%

Obstructive Uropathy 320 2%

Hereditary Renal Disease 279 2%

Congenital Malformation 215 1.5%

Vasculitis 183 1.3%

Primary Tubulo-Interstitial Disease 161 1%

Pregnancy Related 110 1%

Others 302 2%

Total 14366 100%

Causes of End-Stage Renal Disease in HD Patients 2014

Prevalence of Diabetes Mellitus & HTN in Dialysis Pts. 2014

Waiting List for Renal Transplantation among Dialysis Pts. 2014

DM & HTN 4500 (31%)

HTN Only 4040 (28%)

Non-DM & HTN 3928 (28%)

DM Only 1898 (13%)

Total: 14366

On Active Waiting List, 2873 (20%)

On Waiting List for Work-up, 2873 (20%)

34

ANNUAL REPORT 2014

MOH

Hospitals Military

Hospitals National

Guard Security Forces

University Hospitals

King Faisal Specialist Hospitals

Private Sector

Other Hospitals

HD Centers: 187

122 7 6 1 3 2 42 4

HD Patients: 14366

9326 1184 798 197 202 281 2224 154

Machines: 5732

3789 395 431 65 104 126 749 73

Outlets: 4428

2784 303 378 55 114 71 658 65

Pts/Outlets: 3.2

3.3 3.9 2.1 3.6 1.8 3.9 3.4 2.4

Number of HD Pts., Centers & Machines in MOH & Non-MOH Hospitals 2014

HD Pts. & Machines in MOH Hospitals according to Region 2014

HD Pts. & Machines in MOH Hospital according to Region 2014

Western Central Southern Eastern Northern

Patients: 9326 2749 2307 2117 1206 947

Outlets: 2784 739 741 576 275 453

Machines: 3789 896 1138 818 348 589

Pts./Outlets: 3.3 3.7 3.1 3.6 4.4 2

0

500

1000

1500

2000

2500

3000

PrivateSector

MilitaryHospital

NationalGuard

KFSHospitals

UniversityHospitals

SecurityForces

OtherHospitals

Patients: 5040 2224 1184 798 281 202 197 154

Outlets: 1644 658 303 378 71 114 55 65

Machines: 1943 749 395 431 126 104 65 73

Pts./Outlets: 3.1 3.4 3.9 2.1 4 1.8 3 2.4

0

500

1000

1500

2000

2500

35

ANNUAL REPORT 2014

Peritoneal dialysis

In 2014, a total of 35 active peritoneal dialysis centers were recorded from MOH & Gov’t. Non-

MOH. Among these PD centers, 20 centers belong to MOH while 15 to Gov’t Non-MOH sector. With

a total of 1,416 patients, 70% of them were on Automated/Continuous Cyclic Peritoneal Dialysis

or (CCPD/APD) machines, 27% were on Continuous Ambulating Peritoneal Dialysis (CAPD) and

3% were on Intermittent Peritoneal Dialysis (IPD).

By the end of 2014, a total of 1,416 patients on peritoneal dialysis were recorded by SCOT, of

these 490 were new patients. Age Distribution of patients with ESRD showed that 90% were

adults while only 10% were children.

Hepatitis B and C infection has shown that 2.4% of the ESRD patients are found to be HBsAg

positive and 3.5% were HCV antibody positive.

36

ANNUAL REPORT 2014

Table 12: MOH Hospitals; Peritoneal Dialysis in the Kingdom of Saudi Arabia 2014

Hospital Name

Total

No. of

Pts

New Pts

2014

Type of Peritoneal Dialysis Pediatrics Adults HBsAg+ve HCV+ve

No. of

Non-

Saudi Pts

No. of

Deaths

2041 CAPD IPD CCPD/APD

King Saud Medical City 148 39 65 0 83 0 148 3 5 4 15

Children Hospital (KSMC) 10 3 0 0 10 10 0 0 0 4 0

King Salman Kidney Center, Riyadh 12 0 7 0 5 0 12 1 1 0 0

King Fahad Medical City, Riyadh 23 0 0 14 9 0 23 1 0 0 3

King Fahad Specialist Hospital, Buraidah 63 28 3 32 28 3 60 3 1 1 2

King Fahad Specialist Hospital, Dammam 29 10 0 0 29 9 20 0 1 0 4

King Fahd Hospital, Jeddah 37 12 1 0 36 3 34 1 1 0 6

King Abdul Aziz Hospital, Jeddah 26 10 18 0 8 0 26 0 1 0 2

Al Noor Specialist Hospital, Makkah 14 4 2 0 12 1 13 0 1 0 4

King Fahd Hospital, Madina 20 1 2 0 18 0 20 0 1 4 2

Dammam Medical Complex 33 18 0 0 33 0 33 1 0 0 3

King Fahd Hospital, Hofuf 36 10 0 0 36 0 36 1 5 1 1

Qateef Central Hospital 14 7 1 0 13 0 14 0 1 0 1

King Abdulaziz Specialist Hospital, Taif 27 7 1 0 26 0 27 0 2 0 2

King Khalid Hospital, Hail 15 8 0 0 15 0 15 0 3 2 0

Maternity and Children Hospital, Madina 21 9 7 0 14 21 0 1 0 3 0

K.AA. Daughters Charity Center for Renal

Diseases 40 20 13 0 27 6 34 3 2 3 6

King Fahad Hospital, Gizan 21 14 2 0 19 4 17 1 0 0 5

King Fahad Hospital, Al Baha 11 11 9 0 2 0 11 1 0 0 4

King Khaled Hospital, Najran 3 3 3 0 0 0 3 0 0 0 0

Total: 20 603 214 134 46 423 57 546 17 25 22 60

37

ANNUAL REPORT 2014

Table 12.1 GOVT. NON- MOH Hospitals; Peritoneal Dialysis in the Kingdom of Saudi Arabia 2014

Hospital Name

Total

No. of

Pts

New Pts

2014


No. of

Non-

Saudi Pts

No. of

Deaths


King Faisal Specialist Hospital, Riyadh 77 34 17 0 60 32 45 1 3 3 0

King Abdulaziz Medical City, Riyadh (KFNGH) 55 4 13 0 42 20 35 0 0 1 1

Prince Sultan Military Medical City, Riyadh 55 21 18 0 37 0 55 0 5 1 6

King Khalid University Hospital, Riyadh 61 12 15 0 46 0 61 0 1 6 3

Security Forces Hospital, Riyadh 106 28 45 0 61 0 106 4 1 2 10

Khamis Mushyat Military Hospital 88 40 78 0 10 5 83 4 4 0 8

King Salman Military Hospital, Tabuk 22 7 2 0 20 6 16 0 1 0 2

Al Hada Military Hospital, Taif 59 27 7 0 52 6 53 2 2 0 6

King Fahd Armed Forces Hospital, Jeddah 44 12 24 0 20 0 44 1 1 0 2

King Fahd University Hospital, Al Khobar 141 66 8 0 133 0 141 3 3 12 11

King Faisal Specialist Hospital, Jeddah 23 6 10 0 13 0 23 0 1 0 2

King Abdulaziz University Hospital, Jeddah 28 8 5 0 23 10 18 0 0 11 1

Dhahran Medical Center (ARAMCO) * 24 5 1 0 23 6 18 0 0 0 5

King Abulaziz Med. City and National Guard,

Al Hassa 8 2 1 0 7 2 6 1 1 0 2

King Abdulaziz Medical City, Jeddah (KFNGH) 22 4 4 0 18 2 20 1 1 0 3

Total: 15 813 276 248 0 565 89 724 17 24 36 62

38

ANNUAL REPORT 2014

Table 13: All Sector; Total Peritoneal Dialysis in the Kingdom of Saudi Arabia According to Sector- 2014

Hospital Name No. of

Hospitals

Total

No. of

Pts

New Pts

2014


No. of

Non-

Saudi Pts

No. of

Deaths


MOH Hospitals 20 603 214 134 46 423 57 546 17 25 22 60

GOVT. NON-MOH Hospitals 15 813 276 248 0 565 89 724 17 24 36 62

Total : 35 35 1416 490 382 46 988 146 1270 34 49 58 122

39

ANNUAL REPORT 2014

Total Active PD in KSA 1995-2014

PD Pts.; Treatment Modality 2014

PD Pts. Adults and Pediatrics 2014

132 133 196 196

302 335 379

442 506

595 645

772 861

965

1112 1196

1240 1327

1402 1416

0

200

400

600

800

1000

1200

1400

1600

APD/CCPD 988 (70%)

CAPD 382 (27%)

IPD 46 (3%)

Total: 1416

Pediatric 146 (10%)

Adult 1270 (90%)

Total: 1416

40

ANNUAL REPORT 2014

PD Pts. HBsAg Status 2014

PD Pts. HCV Antibody Status 2014

PD Distribution Region Wise 2014

Negative 34 (2%)

Positive 1382 (98%)

Total: 1416

Negative 1367 (97%)

Positive 49 (3%)

Total: 1416

Central: 610 Western: 321 Eastern: 285 Southern: 163 Northern: 37

MOH: 20 256 145 112 75 15

Govt. Non-MOH: 15 354 176 173 88 22

0

50

100

150

200

250

300

350

400

41

ANNUAL REPORT 2014

Renal Replacement Therapy 2014

Dialysis Population: Current & Projected 1995-2020;

Average Net Annual Increase: 594 Pts.

Average Percentage of Annual Increase: 7.7%

HD 14366 (61%)

Renal Tx. Followed Up 7946 (33%)

PD 1416 (6%)

Total: 23,728 (791 pmp)

3869 4322

4861 5206

6008

7029 7383

7833 7526

7809

8492

9533

10280

11168

12040 12633

13356

14171 14562 14790

15979

17168

18951

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2016 2018 2020

42

ANNUAL REPORT 2014

Dialysis Centers in KSA 2014

@Dialysis Centers

#More than one (1) Dialysis Center

Renal Replacement Therapy in KSA 1995-2014

33

60

37

13

40

46

43

96

43

82

40

43

48

65

56

56

63

78

69

02

81

82

90

02

96

00

10

01

0

80

73

80

98

74

08

71

50

72

69

79

46

37

37

41

89

46

65

50

10

57

06

66

94

70

04

73

91

70

20

72

14

78

37

85

00

94

50

10

50

0

10

92

8

11

43

7

12

11

6

12

84

4

13

16

0

14

36

6

132 133

196 196

302 335

379 442 506

595

645 780

861 1010

1112 1196 1240 1327 1402

1416

0

5000

10000

15000

20000

25000

Post Renal Tx. HD PD

43

Region Population 2014 Dialysis Pts. 2014 Prevalence (pmp) Northern 1,741,586 1,194 686 Southern 4,709,220 2,578 547 Western 9,910,724 5,219 527 Central 9,758,662 4,661 478 Eastern 4,650,183 2,130 458

Total 30,770,375 15,782 513 Table14: Prevalence of Dialysis Pts. According to Region 2014

Region Population 2014 New Dialysis Pts. 2014 Incidence (pmp) Northern 1,741,586 326 187 Western 9,910,724 1,446 146 Southern 4,709,220 643 137 Eastern 4,650,183 616 132 Central 9,758,662 1146 117 Total 30,770,375 4,177 136

Table 15: Incidence of Dialysis Pts. According to Region 2014

ANNUAL REPORT 2014

44

ANNUAL REPORT 2014

Preface

The annual report 2014 of Saudi Center for

Organ Transplantation (SCOT) is based

largely on data in 2014 and cumulate data

since the start of organ donation and

transplantation program in the Kingdom of

Saudi Arabia.

The data collected from SCOT records and

follow up the reports from respective

transplant programs in the Kingdom.

The medical department at SCOT conducted

the required analysis, collated the statistics,

created figures and tables, drafted the text

and designed the documents. The data

provided in the tables and figures and each

chapter has a brief introduction highlighting

the salient aspects of data contained in

relevant sections.

Overview and highlights

It contains chapters on Deceased Donors

after Brain Death and Organ Donation

which highlights the current activities of

deceased organ donation program as well

as hospital sharing in all regions of the

Kingdom and another chapter on

transplantation activities which include

kidneys, liver, heart, pancreas, lung, corneal

transplantation as well as bone donation.

Each section of organ transplantation

activities includes data on deceased and

living transplantation in currently active

transplant centers. Also new this year is

when possible, similar data and formats are

used for each section of organ activities;

however, this is not always possible

because some data are not pertinent to all

organs.

Additionally, separate indices of tables and

figures presented were included this year

for easy access of our data and glossary of

abbreviation has been added.

The data of this annual report will also be

available on our website: www.scot.gov.sa

http://www.scot.gov.sa/

45

Deceased Donors after Brain Death & Organ Donation

The Kingdom of Saudi Arabia has an active deceased donation and transplantation

program under the supervision of the Saudi Center for Organ Transplantation (SCOT)

Clear policies have been laid down to facilitate diagnosis of Death by Brain Function

Criteria and the management of potential deceased donors

Religious scholars approved the concept of Death by Brain Function Criteria and Organ Donation

The critical pathway of deceased organ donation was

applied in all donors reported to Saudi Center for

Organ Transplantation (SCOT) with 570 possible, 350

potential, 279 eligible, 110 consent and 101 actual

DBD donors. Averages of 19 pmp for possible DBD

donors were reported in 2014 and 21 pmp (mean

donors) in the last 5 years.

In 2014, Characteristics of possible DBD donors

shows that majority were in age group between 21-

50 compared to the age group 11-40 over the years.

Males constitute 70% of the donors with male to

female ratio of 3:1 compared to 4:1 over the years.

Non-Traumatic cause due to CVA represents majority

of causes of death among possible DBD donors

followed by the traumatic cause due to MVA in

contrary to data over the years; where traumatic is

the major cause of death.

Potential DBD donors were fully documented

according to the Saudi National Protocol with 279

eligible DBD donors approached for organ donation;

of which, 110 (39%) were consented and 101 (92%)

were recovered.

Evaluation and management of all possible DBD

donors were continuously followed by SCOT

according to the Directory of Regulation of Organ

Donation and Transplantation in the Kingdom of

Saudi Arabia with the different ICU’s until recovery of

organs for the purpose of transplantation or

cardiopulmonary arrest.

Transportation during the process of organ recovery

were effectively used in majority of actual DBD

donors which includes air and land transport.

It is worth mentioning that there was an increase in

the consent rate per organ from DBD donors where in

100% of consents were obtained for kidneys and

liver, 97% for heart, 60% for corneas and 28% for

bones compared to the previous year.

Of the 570 possible deceased cases in the year 2014, 110 of them gave consent for organ

donation. Retrieval was carried out in 92% of the consented cases

ANNUAL REPORT 2014

46

ANNUAL REPORT 2014

Figure I.1: The Critical Pathway of Deceased Organ Donation

Transplant International©2011 European Society for Organ Transplantation 24 (2011) 373–378

47

The Critical Pathways of Deceased Organ

Donation

In 2014, the total possible DBD donors were 570,

350potential, 279 eligible, 110 consents and 101

actual donors (see figure I.2). Since 1986, the possible

DBD donors reached 10591, 6447 potential, 5454

eligible, 1817 consents and 1635 actual cases (see

figure I.3).

Figure I.2: Critical pathway of deceased organ donation in 2014

Figure I.3: Critical pathway of deceased organ donation 1986-

2014

Region Wise

In 2014, the highest numbers of possible DBD donors

were from Riyadh region resulting in 124 potential,

107 eligible, 47 consents and 45 actual DBD donors

while the Southern region was the lowest this year

with 25 possible, 2 potential and eligible DBD donors

with no consent acquired (see table I.1).

Region Possible Potential Eligible Consented Actual

Riyadh 163 124 107 47 45

Western 132 63 42 11 9

Qassim

and Hail 79 46 35 7 7

Eastern 77 41 34 13 11

Northern 25 10 2 1 1

Southern 25 2 2 0 0

Outside

Kingdom 69 64 57 31 28

Total 570 350 279 110 101

Table I.1: Critical pathway of deceased organ donation, region

wise in 2014

Possible DBD Donors

In 2014, there were 570 possible donors and since

1986, there were a total of 10591 possible donors

reported to SCOT. Over the years, there was an

increase in the number of possible DBD donors with

the peak in 2012 with 710 DBD donors and it was

same in the last 2 years (see figure I.4).

Figure I.4: Annual trend of possible DBD donors over the years

1986-2014

Possible DBD donor characteristics

In 2014, analysis of the age distribution of the

possible DBD donors shows that the majority were

mainly in the age group between 21-50 yrs.

composing 63%of the cases, with the highest number

in age group between 21-30 yrs., having 23% of the

possible DBD donors (see figure I.5). Since 1986, the

majority of possible DBD donors were mainly from

age group between 11-40 years composing 62% of

the cases (see figure I.6).

Analysis of the gender among possible DBD donors

shows that males represent 77% of the donors while

females constitute the remaining 23% with a male to

female ratio of 3:1. Since 1986, the males represent

80% of the possible DBD donors and females

represent 20% with a male to female ratio of 4:1 (See

figures I.7 & I.8).

Nationality distribution among possible DBD donors

shows that Saudis were 260 (46%) and non-Saudis

representing 310 (54%) of the donors. Since 1986,

Saudis represent 54% of the possible DBD donors and

non-Saudis 46% (see figures I.9 and I.10).

570

350

279

110 101

Possible Potential Eligible Consented

forDonation

Actual

10591

6447 5454

1817 1635

Possible Potential Eligible Consentedfor

Donation

Actual

7

24

13

6

14

8

14

6

15

4

18

7

21

0

34

8

36

7

37

4

35

5

38

5

42

7

36

4

34

8

33

7

36

0

37

2

41

0 5

26

47

4

53

3

50

3 6

15

71

0

63

1

57

0

57

0

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

ANNUAL REPORT 2014

48

ANNUAL REPORT 2014

Analysis of the causes of death among possible DBD

donors in 2014, shows that traumatic causes were

43% and non-traumatic causes were 57%. Majority of

the traumatic causes were from Motor Vehicle

Accident (MVA) 83% while non-traumatic causes

were mainly due to Cerebro-Vascular Accident (CVA)

65% (See table I.2).

Over the years, there was no significant change in the

trend of causes of death among possible DBD donors.

Since 1986, traumatic causes were 57% and non-

traumatic causes were 40% and the remaining 3%

were categorized as others. Majority of the traumatic

causes were from Motor Vehicle Accident (MVA) 82%

while non-traumatic causes were mainly due to

Cerebro-Vascular Accident (CVA) 66% (see table I.3).

Figure I.5: age distribution of possible DBD donors 2014

Figure I.6: age distribution of possible DBD donors 1986-2014

Figure I.7: Sex distribution in possible DBD donors 2014

Figure I.8: Sex distribution in possible DBD donors1986-2014

Figure I.9: Nationality distribution in possible DBD donors 2014

32

76

132

114 114

65

25 12

0 - 10 11 - 20 21 - 30 31 - 40 41 - 50 51 - 60 61 - 70 < 70

1253

1845

2675

2081

1394

825

336 182

0-10 11-20 21-30 31-40 41-50 51-60 61-70 >70

438 77%

132 23%

Male

Female

8430 80%

2161 20%

Male

Female

310 54%

260 46%

non-Saudi

Saudi

49

Figure I.10: Nationality distribution in possible DBD donors

1986-2014

Cause of Death N %

Traumatic 245 43%

Motor Vehicle Accident (MVA)

204

Fall From Height (FFH) 31

Direct Head Trauma (DHT) 10

Non-Traumatic 325 57%

Cerebro-Vascular Accident (CVA)

210

Anoxia 101

CNS tumor 14

Total 570 100%

Table I.2: Cause of death among possible DBD donors in 2014

Cause of Death N %

Traumatic 6055 57%

Motor Vehicle Accident (MVA)

4950

Fall from height (FFH)

669

Direct head trauma (DHT)

326

Gunshot 110

Non-traumatic 4190 40%

Cerebro-Vascular Accident (CVA)

2780

Anoxia 986

CNS tumor 424

Others 346 3%

Total 10951 100%

Table I.3: Cause of death among possible DBD donors in 1986-

2014

Potential DBD donors

In 2014, there were 350 potential DBD donors and

since 1986, a total of 6447 potential DBD donors were

reported to SCOT. Over the years, there was an

increase in the number of potential DBD donors with

the peak in 2011 (see figure I.9).

The 350 potential DBD donors were fully documented

according to the Saudi National Protocol for Diagnosis

of Death by Brain Function Criteria (see figure I.10 &

I.11 cumulative).

Figure I.9: Annual trend of potential DBD donors 1986-2014

Figure I.10: Documented and non-documented possible DBD

donors 2014

Figure I.11: Documented and non-documented possible DBD

donors 1986-2014

Eligible DBD Donors

In 2014, there were 279 eligible DBD donors

approached for organ donation. Since 1986, a total of

5454 eligible DBD donors were approached for organ

donation by SCOT. Over the years, there an increase

in the number of approached eligible DBD donors

with the peak in 2011 (see figure I.12). Approached

and Not approach families of DBD donors for organ

donation were also documented in 2014 and

cumulatively from 1986. (see figure I.13 & I.14)

5747 54%

4844 46%

Saudi

non-Saudi

6 21

96

93

99

81

10

5 13

9

24

7

25

9

25

6

25

1

19

7

21

1

19

8

21

8

20

8

21

9 2

61

24

5

35

8

28

8

35

9

30

0

36

9

38

5

32

4

30

4 3

50

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

350 61%

220 39%

Documented

Not Documented

6447 61%

4144 39%

Documented

Not Documented

ANNUAL REPORT 2014

50

ANNUAL REPORT 2014

Figure I.12: Annual trend of approached eligible DBD donors

1986-2014

Figure I.13: approached and not-approached eligible DBD

donors 2014

Figure I.14: approached and not-approached eligible DBD

donors 1986-2014

Of the 279 approached eligible DBD donors, 110

(39%) were consented for organ and tissue donation

and the remaining 169 (61%) donors, the family

refused organ donation (see figure I.15 & 1.16

cumulative) and the trend of consented eligible DBD

donors including consent from outside the Kingdom

of Saudi Arabia in 1986-2014 is shown in (figure I.17).

Figure I.15: Consented and non-consented approached eligible

DBD donors 2014

Figure 1.16: Consented and non-consented approached eligible

DBD donors 1986-2014

Figure I.17: Annual trend of consented eligible DBD donors

1986-2014

Actual DBD Donors

Of the 110 consented eligible DBD donors; 101 (92%)

were recovered (actual DBD donor) and 9 (8%) were

not recovered (figure I.19). Since 1986, a total of 1635

consented eligible DBD donors were recovered and

182 were not recovered (figure I.20). The annual

trend of actual DBD donors is shown in (figure I.18).

3 2

1

87

84

88

74 89

13

3

23

5

23

1

23

0

23

8

18

6

19

4

16

7 19

5

17

7

16

7

21

4

20

3

28

9

23

5

28

2

23

3

29

7

30

9

27

1

24

3 2

79

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

279 80%

71 20%

Approached

not Approached

5454 85%

993 15%

Approached

not Approached

169 61%

110 39%

Family Refusal

Consented

3637 67%

1817 33%

Family Refusal

Consented

0 1

0

31

23

42

34

43

52

88

80

54

54

50

43

33

41

31

46

46

51

91

66

10

0

73

10

1

81

73

6

5 7

9

6 10

7

3 1

5

10

13

17

20

19

18

9 14

12

20

12

31

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

Consent Inside Kingdom

Consent Outside Kingdom

51

Figure 1.18: Annual trend of actual DBD donor 1986-2014

Figure I.19: Recovered and non-recovered consented eligible

DBD donor 2014

Figure I.20: Recovered and non-recovered consented eligible

DBD donor 1986-2014

Utilized DBD donor

From the 101 actual DBD donors; 88 were utilized in

the Kingdom, 5 were utilized by Transplant Center

from Outside the Kingdom (cases from GCC countries)

and the remaining 4 were not utilized. (Details of the

not utilized actual DBD donors are listed in table I.4).

Reason N %

Unfit 2 50%

Peritonitis 1

Determined unsuitable donor 1

Donor sudden cardiac arrest 1 25%

Technical 1 25%

Administrative issue 1

Total 4 100%

Table I.4: Reasons of not utilized actual DBD donors 2014

Organ specific utilization of actual DBD donor is as

follows: Kidneys in 67 donors, liver in 69, heart in 31,

pancreas in 2 and lung in 10 donors.

Logistics

Transportation was effectively used over the years

during the process of organ recovery for the purpose

of organ transplantation. In 2014, transportation

were used in 76 (69%) of the actual DBD donor;

wherein air transport was used in 39 (39%) of the

actual DBD donor and ambulance in 37 (37%) and the

remaining 35%, no transportation was used (mainly,

the donor is in transplant center) 25 (25%) (see

figure I.21)

Figure I.21: Transportation used during organ recovery 2014

0 10

31 23

40 32 34

51

82 71

48 55 54

47

33

54

38 39

54 62

102

80

105

68

98

73 83

67

101

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

101 92%

9 8%

Recovered

Not Recovered

1635 90%

182 10%

Recovered

Not Recovered

39 38%

37 37%

25 25%

Medevac Ambulance No Transportation used

ANNUAL REPORT 2014

52

ANNUAL REPORT 2014

Hospital Sharing in Organ Donation Program

The total number of hospitals who reported possible

deceased donor (DD) cases during the year 2014 was

103 hospitals. These were divided into either large

(>20 ICU beds), Medium (10-20 ICU beds) or small

(<10 ICU beds). The top 3 hospital with the outmost

consented cases are acknowledged below with their

corresponding ICU beds.

Large hospitals (38) reported 230 cases (40.3% of the

total), of which 134 (58%) were fully documented

and 34 consents were obtained for organ donation

(32.69% of total consents).

In this group, 16 consents were obtained from King

Saud Medical Complex, Riyadh (KSMC). KSMC is also

considered to be the largest source of consented cases

in the kingdom for the last nine years. King Abdul-

Aziz Medical City (National Guard Hospital), Riyadh

came next with 9 consents followed by King Fahd

Hospital, Jeddah, Ar-Ar Central Hospital, Obeid

Specialized Hospital Hofuf, King Saud Hospital,

Unaiza, Maternity and Children Hospital Jeddah, Al

Hayat Hospital Riyadh, Dr. Ahmed Abanamy Hospital

and Riyadh Care Hospital having 1 consented case

each.

Medium sized hospitals, with 10-20 ICU beds,

contributed with 37.5% (214 cases) of the total

number of reported cases and 35 consents (32% of

total consents) were obtained for organ donation.

The most active hospitals in this group were Al Iman

Hospital-Riyadh with 10 consents, National Hospital-

Riyadh, Al Noor Specialist Hospital-Makkah and King

Faisal Hospital-Makkah having 4 consents, then

followed by King Fahd Specialist Hospital-Qassim and

Buraida Central Hospital also with both having 3

consents each. Dammam Medical Complex had 2

consented cases. Lastly, Prince Salman Hospital-

Riyadh, King Fahd Hospital-Hofuf, King Abdulaziz

specialist Hospital-Taif, Dr. Sulaiman Habib Hospital-

Riyadh and Saudi German Hospital-Riyadh each are

having 1 consented case for organ donation.

Small sized hospitals, with less than 10 ICU beds,

shared 57 possible deceased cases (10% of the total

Possible DD) and 10 consents (9%) were obtained

from them.

Among this group, Al Mowasat Hospital-Dammam

was the most active with a total of 4 cases consented

for organ donation followed by Maternity and

Children Hospital-Dammam having 2 consented cases

then followed by Jubail General Hospital, Dr. Sulaiman

Habib Hospital (Takasusi)-Riyadh, Al Jazeera

Hospital-Riyadh and King Abdul-Aziz Medical City

(National Guard Hospital) Al Hassa with 1 consented

case each.

Activities of the organ sharing program between the

Kingdom and GCC countries showed that 31

consented cases were obtained under this program;

distributed between Kuwait Hospitals (24 cases),

Qatar Hospitals (2 cases), Bahrain Hospitals (4) and

UAE Hospitals (1).

53

In 2014, there were 103 ICUs reporting possible DBD donors to the organ donation program in the Kingdom of Saudi

Arabia. Over the years, there was an increase in the number of ICUs contributing to this program see figure I.22.

Figure I.22: Annual trend of ICUs contributing in deceased donation program

Distribution of consents by region shows that 54 (49%) consents were obtained from the Central region (34 from

MOH hospitals, 9 from Govt. Non-MOH hospitals and 11 from private hospitals). The Eastern region came next with

13 (12%) consents; followed by the Western region with 11 (10%) consents then Northern region with 1 (1%)

consented cases (see table 1.5)

Region Possible

DD Consent for Organ

Donation Actual DD

Central (Riyadh, Kharj, Qassim and Hail)

242 54 52

Western (Jeddah, Makkah, Madinah & Taif)

132 11 9

Eastern (Dammam, Hofuf, Al Khobar, Dhahran, Khafji, Qateef, Jubail & Hafar Al Baten)

77 13 11

Southern (Assir, Al Baha, Gizan & Najran)

25 0 0

Northern (Tabuk, Al Jouf, Northern Borders)

25 1 1

Outside KSA (Kuwait, Qatar & Bahrain)

69 31 28

TOTAL 570 110 101

Table I.5: distribution of possible, consented and actual deceased donors according to region

The total number of 102 hospitals had reported 570 possible deceased donors (DD) during

the year 2014 with 110 consents obtained for organ donation & 101 donors utilized for

transplantation purposes

1 8

30

36

33

36

33

42

58

62

58

59

68

70

73

61

65

68

73

75

83

83

83

85

97

95

94

92

10

3

198

6

198

7

198

8

198

9

199

0

199

1

199

2

199

3

199

4

199

5

199

6

199

7

199

8

199

9

200

0

200

1

200

2

200

3

200

4

200

5

200

6

200

7

200

8

200

9

201

0

201

1

201

2

201

3

201

4

ANNUAL REPORT 2014

ANNUAL REPORT 2014

54

Donation after Brain Death (DBD) Donor

Possible, Potential, Eligible, Consented and Actual from Different Hospitals in Saudi Arabia 2014

Table I.6: Hospitals with ICU's Having More than 20 Beds

No. Hospital Name Possible

DD Potential

DD Eligible

DD Consented

DD Actual

DD

1 King Saud Medical City (KSMC)-Riyadh 48 38 31 16 14

2 King Abdul-Aziz Medical City & National Guard Hospital (KAMC & NGH)-Riyadh

33 25 24 9 9

3 King Fahd Hospital-Jeddah 13 5 4 1 1

4 King Abdul-Aziz University Hospital (KAUH)-Jeddah

6 4 4 0 0

5 Ar Ar Central Hospital 6 5 2 1 1

6 King Saud Hospital (KSH)-Unaiza 6 2 2 1 1

7 Dr. Sulaiman Habib Hospital Ar Rayan-Riyadh 3 1 1 0 0

8 King Faisal Specialis Hospital and Research Center (KFSH&RC)-Jeddah

1 0 0 0 0

9 Obeid Specialized Hospital-Riyadh 1 0 0 0 0

10 King Fahad Hospital (KFH)-Madinah 18 7 6 0 0

11 King Khalid Hospital (KKH)-Hail 22 5 1 0 0

12 Prince Sultan Military Medical City (PSMMC)-Riyadh

4 4 3 0 0

13 King Abdullah Medical City-Makkah 5 4 1 0 0

14 King Fahad Armed Forces Hospital (KFAFH)-Jeddah

4 2 1 0 0

15 Al Hada Military Hospital-Taif 3 1 1 0 0

16 King Fahad Medical City (KFMC)-Riyadh 3 1 1 0 0

17 Maternity and Children Hospital (MCH)-Jeddah 3 2 2 1 1

18 Assir Central Hospital 6 1 1 0 0

19 Dr. Abdulrahman Al Mishari Hospital-Riyadh 2 2 1 0 0

55

20 Obeid Specialized Hospital-Hofuf 4 2 2 1 1

21 King Abdul-Aziz Medical City & National Guard Hospital (KAMC & NGH)- Jeddah

1 0 0 0 0

22 Maternity and Children Hospital (MCH)-Madinah

3 1 1 0 0

23 Al Hayat Hospital-Riyadh 2 2 1 1 1

24 Riyadh Care Hospital-Riyadh 3 3 3 1 1

25 Al Mana Hospital-Al Khobar 2 2 2 1 0

26 Maternity and Children Hospital (MCH)-Makkah 1 1 0 0 0

27 Security Forces Hospital-Riyadh 2 2 2 0 0

28 King Khalid University Hospital (KKUH)-Riyadh 3 2 2 0 0

29 Prince Salman Miltary Hospital-Tabuk 3 0 0 0 0

30 Dr. Ahmed Abanamy Hospital-Riyadh 4 4 3 1 1

31 Hotat Bani Tamim Hospital-Riyadh 1 0 0 0 0

32 Al Hera General Hosptial-Makkah 3 2 2 0 0

33 Hail General Hospital 1 0 0 0 0

34 Prince Abdulrahman Sudeiry Hospital (PASH)-Al Jouf

5 3 0 0 0

35 Al Qurayyat General Hospital 1 0 0 0 0

36 King Fahad Military Hospital (KFMH)-Khamis Mushayt

2 0 0 0 0

37 Health Oasis Hospital-Riyadh 1 0 0 0 0

38 Prince Abdulaziz Bin Musaad Hospital-Ar Ar 1 1 0 0 0

TOTAL 230

(40.3%)*

134

104

34 (31%) **

31

(*) Percentage from total possible donors, (**) Percentage from total consented donors.

ANNUAL REPORT 2014

ANNUAL REPORT 2014

56

Table 1.7: Hospitals with ICU’s Having 10 to 20 Beds


DD Potential

DD Eligible

DD Consented

DD Actual

DD

1 Prince Salman Hospital-Riyadh 8 6 6 1 1

2 King Khalid Hospital-Al Kharj 3 1 1 0 0

3 King Fahad Specialist Hospital (KFSH)-Qassim 11 8 5 3 3

4 Al Rass General Hospital 18 15 14 0 0

5 Al Iman Hospital-Riyadh 17 15 14 10 10

6 Al Mana Hospital-Dammam 2 2 0 0 0

7 National Hospital-Riyadh 7 5 5 4 4

8 Al Noor Specialist Hospital-Makkah 23 15 7 4 4

9 King Fahad Hospital (KFH)-Hofuf 5 4 3 1 1

10 King fahad university Hospital (KFUH)-Al Khobar

10 1 1 0 0

11 Buraida Central Hospital 18 15 12 3 3

12 Dammam Medical Complex 17 10 8 2 2

13 King AbdulAziz Hospital (KAH)-Jeddah 6 3 2 0 0

14 King Fahad Hospital(KFH)-Al Baha 11 0 0 0 0

15 King Khalid Hospital (KKH)-Tabuk 5 1 0 0 0

16 King Abdul Aziz Specialist Hospital (KASH)-Taif 14 5 2 1 1

17 King Fahad Hospital (KFH)-Makkah 12 9 8 4 2

18 Dr. Sulaiman Habib Hospital-Qassim 1 0 0 0 0

19 Abu Arish General Hospital 4 1 1 0 0

20 Wadi Dawasir Military Hospital-Riyadh 2 2 2 0 0

21 Dr. Sulaiman Habib Hospital Olaya-Riyadh 1 1 1 1 1

57

(*) Percentage from total possible donors, (**) Percentage from total consented donors

22 Security Forces Hospital-Dammam 1 1 1 0 0

23 Saudi German Hospital-Riyadh 3 3 1 1 1

24 Ohud General Hospital-Madinah 1 0 0 0 0

25 King Fahad Military Medical City (KFMMC)-Dhahran

3 2 1 0 0

26 Al Mana Hospital-Al Hassa 1 0 0 0 0

27 Imam Abdulrahman National Guard Hospital-Dammam

2 2 2 0 0

28 Imam Abdulrahman Al Faisal Hospital-Riyadh 1 1 1 0 0

29 Turaef General Hospital 5 1 0 0 0

30 PASH-Al Jouf (Prince Metab Bin Abdulaziz) 2 0 0 0 0

TOTAL 214

(37.5%)*

129

98

35 (32%)

33

ANNUAL REPORT 2014

ANNUAL REPORT 2014

58

Table 1.8: Hospitals with ICU’s Having Less than 10 Beds

(*) Percentage from total possible donor (**) Percentage from total consented donors.


DD Potential

DD Eligible

DD Consented

Actual DD

1 Jubail General Hospital 6 4 4 1 1

2 Al Mowasat Hospital-Dammam 9 5 5 4 3

3 Al Thager Hospital-Jeddah 2 0 0 0 0

4 Qateef Central Hospital 6 0 0 0 0

5 King Faisal Hospital (KFH)-Taif 5 0 0 0 0

6 Kingdom Hospital-Riyadh 2 1 0 0 0

7 Khamis Mushayt General Hospital 1 0 0 0 0

8 Dr. Sulaiman Habib Hospital Takasusi-Riyadh 3 2 2 1 1

9 Maternity and Children Hospital (MCH)-Buraida

2 1 1 0 0

10 Al Jeddaani Hospital-Jeddah 2 1 1 0 0

11 Al Yamama Hospital-Riyadh 3 1 1 0 0

12 Maternity and Children Hospital MCH-Dammam

3 2 2 2 2

13 Dallah Hospital-Riyadh 2 1 0 0 0

14 Yanboo Royal Medical Center 1 0 0 0 0

15 Hafar Al Batin Central Hospital 1 0 0 0 0

16 King Fahad Hospital (KFH)-Tabuk 1 0 0 0 0

17 Rafha General Hospital 1 0 0 0 0

18 Sharourah General Hospital 1 0 0 0 0

19 Al Jazeera Hospital-Riyadh 1 1 1 1 1

20 Al Yousif Hospital-AL Khobar 1 0 0 0 0

21 King Abdul-Aziz Medical City & National Guard Hospital (KAMC & NGH)-AL Hassa

4 4 3 1 1

TOTAL 57

(10%) 23 20

10 (9%)

9

59

Table 1.9: Hospitals outside the Kingdom of Saudi Arabia

No Hospital Name Possible DD Potential DD Eligible DD Consented

DD Actual DD

1 Kuwait Hospitals 55 53 47 24 22

2 Qatar Hospitals 2 2 2 2 2

3 Bahrain Hospitals 6 5 5 4 4

4 UAE Hospitals 5 4 3 1 0

5 Oman Hospital 1 0 0 0 0

TOTAL 69 64 57 31 28

Table 1.10 Total Number of DBD Donor for All Hospitals

Hospital Name Possible DD Potential

DD Eligible

DD Consented

DD Actual

DD

Greater than 20 ICU Beds 230 134 104 34 31

10 - 20 ICU Beds 214 129 98 35 33

Less than 10 ICU Beds 57 23 20 10 9

Outside KSA 69 64 57 31 28

TOTAL 570 350 279 110 101

ANNUAL REPORT 2014

ANNUAL REPORT 2014

60

Organ Transplantation

Organ transplantation is the best existing method for

the treatment of end-stage organ failure and due to

the increasing demand for viable organs in the

Kingdom of Saudi Arabia; the deceased organ

donation program was initiated. Later on, the

mentioned program was boosted with the inception

of the National Kidney Foundation (NKF) in 1984 and

further during 1993, the organization was upgraded

and renamed to the presently known institution, the

Saudi Center for Organ Transplantation (SCOT).

In 1979, the 1st kidney transplantation was

performed in the kingdom from living donor in Prince

Sultan Military Medical City (formerly known as

RKH), and later in 1986 the 1st deceased kidney

transplantation was performed by the same

transplant center. By 2014, a total of 627 kidneys

were transplanted wherein, 496 kidneys were

transplanted from living donors and 131 kidneys

came from deceased organ donor. Since the start of

the program, a total of 6316 from living and 2694

from deceased kidneys were transplanted.

The liver transplantation program in the Kingdom

was started in 1990 and by the end of 2014, a total of

198 liver transplantations were performed, this

includes 128 livers from living and 70 livers came

from deceased donation. Since the liver

transplantation program was initiated, there had

been a total of 738 living and 790 deceased livers

transplanted in the kingdom.

In 1986, 1st heart transplantation was performed in

Prince Sultan Military Hospital-Riyadh (formerly

known as Riyadh Military Hospital) which marked the

start of the heart transplantation program in the

Kingdom. By 2014, 31 hearts had been transplanted.

Up to present, a total of 280 hearts were transplanted

in addition, 19 hearts were also procured as sources

of valves. In total, 602 hearts were recovered as

sources of valves since 1993.

The 1st Lung transplantation in the Kingdom was

performed in 1991 at King Fahd Hospital-Jeddah. In

2014, 19 lungs were recovered and transplanted from

deceased donors. Up to date 144 lungs were

transplanted to 88 recipients, which either received

single or double lung transplantation.

Pancreas transplantation was done in the kingdom in

2009 in Al Shaty Teaching Hospital in Jeddah. In 2014,

2 pancreases were transplanted inside the kingdom.

In total, 27 pancreases were transplanted since the

program was started.

Tissue Donation, which includes corneas, bones and

other musculoskeletal connective tissues were

started in the kingdom in 1983 and 2009 respectively.

In 2014, 13 corneas were recovered by KKESH, while

126 bones and 58 musculoskeletal were procured by

KFSH & Research Center-Riyadh. Since the start of

each respective program, a total of 690 corneas were

recovered inside the kingdom, while 225 bones and

96 musculoskeletal connective tissues were

recovered by respective center.

The organ sharing program between the GCC

countries and the Kingdom of Saudi Arabia was 1st

implemented in 1996. In 2014, there were a total of

44 organs and tissues recovered and transplanted

inside the kingdom. Since the cooperation was

initiated, there had been a total of 63 kidneys, 120

livers, 15 whole hearts, 22 lungs, 1 pancreas, 54

hearts as source of valves and 4 corneas shared to the

Kingdom in addition to 1 kidney shared by SCOT to

United Arab Emirates (U.A.E.).

In 2014, a total of 627 kidneys, 198 livers, 19 lungs, 31 hearts and 2 pancreases were

transplanted in addition to 126 bones, 58 musculoskeletal connective tissues and 11

corneas were recovered.

61

Kidney Transplantation

In the year 2014, 645 kidneys had been transplanted inside the kingdom of Saudi Arabia with 514 kidneys

transplanted from living and 131 were transplanted from deceased donors. (Details of the living and deceased kidney

transplantation are shown in Table II.1.1)

It is worth mentioning that a total of 9028 kidneys were transplanted inside the kingdom from 1990-2014; of these

transplantation activities, 6054 (67%) were from living related, 2694 (30%) were from deceased donors and 280

(3%) from living unrelated kidney donor. Illustration of the cumulative living and deceased kidney transplantation is

shown in (figure II.1.1)

1. DECEASED KIDNEY DONATION 2014

110 deceased donors were consented for the purpose

of organ donation and 100% of them were also

consented for kidney donation; of which 67 donors

were utilized for kidney by transplant centers inside

the Kingdom, 24 donors were utilized by kidney

transplant centers outside the kingdom (cases from

GCC countries), 17 donors were not recovered and

the remaining 2 donors, kidneys were discarded

(recovered but not transplanted). (The details of

utilized kidney donor characteristics are listed in table

II.1.2) and the details of the deceased kidney donation

are listed in (Tables II.1.3 & II.1.4 cumulative)

Characteristic N %

Age

0-10 4 6%

11-20 2 3%

21-30 11 16%

31-40 23 35%

41-50 16 23%

51-60 9 14%

61-70 2 3%

Blood Group

A 21 30%

B 16 25%

AB 4 6%

O 26 39%

Gender

Male 58 87%

Female 9 13%

Donor Type

SCD 47 70%

ECD 20 30%

Cause of Death

Anoxia 12 17%

CVA 24 36%

Head trauma 30 45%

CNS tumor 1 1%

Circumstance of Death

MVA 17 25%

Non-MVA 50 75%

Table II.1.2: Deceased kidney donor characteristics

Characteristics of utilized deceased kidney donors 2014

Kidney Donor Risk Index (KDRI)

KDRI for locally recovered deceased kidneys was

ranging between 0.73 and 2.25 with mean KDRI of

1.25; of which 22% of the cases has the KDRI <1, 54%

are between 1-1.5 and 24% had KDRI of 1.5 above.

2. DECEASED KIDNEY TRANSPLANTATION

2014

220 deceased kidneys were consented for the

purpose of kidney transplantation; with 131 kidneys

transplanted inside the kingdom (6 kidneys were

transplanted as en-bloc to 3 recipients), 46 were

transplanted by transplant centers outside the

kingdom and 8 kidneys were discarded. The total

deceased kidney transplantation this year were

performed in 9 out of the 10 currently active kidney

transplant centers all over the Kingdom (see table

II.1.5). Illustration of the cumulative deceased kidney

transplantation is shown in (figureII.1.2).

N Transplant Center Transplanted

1 King Fahd Specialist Hospital-Dammam 37

2 King Faisal Specialist Hospital & Research Center-Riyadh

29

3 King Faisal Specialist Hospital & Research Center-Jeddah

22

4 Prince Sultan Military Medical City-Riyadh

21

5 King Abdul-Aziz Medical City & National Guard-Riyadh

17

6 Al Hada Military Hospital-Taif 2

7 King Fahd Hospital-Jeddah 1

8 King Faisal Military Hospital-Khamis Mushayt

1

9 King Salman Military Hospital-Tabuk 1

10 King Fahd Armed Forces Hospital-Jeddah

0

Total 131*

Table II.1.5: Deceased kidney transplantation

Performance of deceased kidney transplantation in currently active

national kidney transplant centers in 2014 *6 kidneys transplanted as en-bloc to 3 recipients

Non-recovered deceased kidneys

220 deceased kidneys were consented for kidney

donation; out of which, 35 (16%) were not recovered

(see table II.1.6). The major causes of non-recovered

kidneys are shown in (table II.1.7).

ANNUAL REPORT 2014

ANNUAL REPORT 2014

62

Reasons of Non Recovery N %

Sudden cardiac arrest 18 51%

Infection 6 17%

Peritonitis 2

Fungal 2

TB 2

No available suitable recipient 4 11%

Hepatitis B+ & C+ 4

Diseased Kidney 4 11%

CKD 2

ESRD 2

Technical 2 6%


Congenital Anomalies 1 3%

No left kidney found 1

Total 35 100%

Table II.1.6: Reasons of non-recovered deceased kidneys

Reasons of non-recovery of kidneys among eligible donors consented

for kidney donation in 2014 Discarded deceased kidneys

220 deceased kidneys were consented for kidney

donation; of which 8 (4%) kidneys were discarded

(see table II.1.8). Causes of discarded deceased kidneys

from 1986-2014 are listed in (table II.1.9).

Reason of Discard N %

Glumerulosclerosis 3 38%

Tuberculosis 2 25%

Pyelonephritis 1 12%

Black discoloration 1 12%

Traumatic kidney injury 1 12%

Total 8 100%

Table II.1.8: Reasons of discarded deceased kidneys

Discarded kidneys among actual deceased kidney donors 2014

Cold ischemia time (CIT)

The CIT for locally transplanted deceased kidneys

were ranging from 2 to 31 hrs. 30 minutes with mean

CIT of 12 hrs. In 52 % of cases, the deceased kidney

transplantation was practiced with CIT < 12 hrs, 41%

of which ranged from >12-24 hrs, while 7% ranged

from >24-36 hrs.

SCD & ECD kidney transplantation

131 total deceased kidneys were transplanted; with

93 (71%) kidneys were transplanted from standard

criteria donors (SCD) and the remaining 38 (29%)

kidneys transplanted from expanded criteria donors

(ECD). The criteria for ECD kidneys transplanted are

listed in (table II.1.11).

Characteristics Utilized Kidneys

Age ≥ 60 years 5

Age 50-59 years and having 2 of the following:

21

CVA

Hypertension

SCr. ≥ 133 µmol/L (1.5 mg/dl)

CVA, Hypertension and SCr. result doubled during admission and before retrieval

12

Total 38

Table II.1.11: Transplanted deceased ECD kidneys

Transplanted deceased ECD kidneys in 2014

Adult and pediatric deceased kidney

transplantation

131 deceased kidneys were transplanted inside the

kingdom, with 108 (82%) kidneys transplanted to

adults and 23 (18%) kidneys were transplanted to

pediatric recipient (see table II.1.10).

N Transplant Center Adult Pediatric Total

1 King Fahd Specialist Hospital-Dammam

29* 8 37


22 7 29

3 King Faisal Specialist Hospital & Research Center-Jeddah

21 1 22


18 3 21

5 King Abdul-Aziz Medical City & National Guard-Riyadh

14 3 17

6 Al Hada Military Hospital-Taif 2 0 2

7 King Fahd Hospital-Jeddah 0 1 1


1 0 1

9 King Salman Military Hospital-Tabuk

1 0 1


0 0 0

Total 108 23 131*

Table II.1.10: Adult and pediatric deceased kidney

transplantation

Deceased donor–recipient matching

Matching sex was done in 46% of cases and matching

blood group for kidney transplantation between

deceased donors and recipients were done in 92% of

the cases. Age distribution between deceased kidney

donor and recipient is shown in (table II.1.12)

Donor Age

(yrs.)

Recipient Age (yrs.) Recipient/

Kidneys <5 5-15 16-29

30-50

51-65 >65

<5 3/5* 1 4/6

5-15 3 1 4

16-29 5 5 11 21

30-50 8 22 35 10 4 79

51-65 7 11/12* 2 20/21

>65 0

Total 19/21 27 55 21/22 6 128/131

Table II.1.12: Age distribution between deceased kidney donor

and recipients 2014

*enbloc deceased kidney transplantation were performed to 2

pediatric and 1 adult recipient by KFSH-Dammam

63

3. LIVING KIDNEY TRANSPLANTATION 2014

A total of 514 living kidney transplants had been

performed; with 466 (91%) kidney transplantation

from living related donors and 48 (9%) kidney

transplantation from living unrelated donor. The total

living kidney transplantation this year was performed

in 10 currently active kidney transplant centers (see

table II.1.13). Illustration of the cumulative living

kidney transplantation is shown in (figure II.1.3).

N Hospital Name Living

Related Living

Unrelated Total


142 5 147

2 King Faisal Specialist Hospital-Jeddah

89 22 111


84 3 87


64 8 72

5

King Abdul-Aziz Medical City & National Guard-Riyadh

32 2 34

6 King Fahd Hospital-Jeddah

13 5 18

7 Al Hada Military Hospital-Taif

13 2 15


12 0 12


11 0 11

10 Prince Salman Military Hospital-Tabuk

5 0 5

11 Saad Specialist Hospital-Al Khobar

1 1 2

Total 466 48 514

Table II.1.13: Living kidney transplantation 2014

Performance of living kidney transplantation in currently active

national kidney transplant centers in 2014

Transplant center Living

Deceased Total LR LUR

King Faisal Specialist Hospital & Research Center-Riyadh

142 5 29 176

King Faisal Specialist Hospital-Jeddah

89 22 22 133

King Fahd Specialist Hospital-Dammam

84 3 37 124

Prince Sultan Military Medical City-Riyadh

64 8 21 93

King Abdul-Aziz Medical City & National Guard-Riyadh

32 2 17 51

King Fahd Hospital-Jeddah

13 5 1 19

Al Hada Military Hospital-Taif

13 2 2 17

King Fahd Armed Forces Hospital-Jeddah

12 0 0 12

King Faisal Military Hospital-Khamis Mushayt

11 0 1 12

Prince Salman Military Hospital-Tabuk

5 0 1 6

Saad Specialist Hospital-Al Khobar

1 1 0 2

Total

466 48 131 645

Table II.1.1: Living and deceased kidney transplantation

Transplant centers performing living and deceased kidney

transplantation in 2014

Kidneys from deceased donors N %

Transplanted in KSA 131 59%

Transplanted by other transplant centers in GCC countries

46 21%

Not recovered kidneys 35 16%

Discarded kidneys 8 4%

Total 220 100%

II.1.3: Deceased kidney donation 2014

Kidneys from deceased donors N %

Transplanted in KSA 2694 94%

Discarded 163 6%

Total 2857 100%

II.1.4: Deceased kidney donation 1986-2014

Non-recovered kidneys N %


Medical reason 15 43%

Technical 2 6%

Total 35 100%

Table II.1.7: Major Causes of non-recovered deceased kidneys

2014

The causes of non-recovered deceased kidneys among eligible donors

consented for kidney donation in 2014

ANNUAL REPORT 2014

ANNUAL REPORT 2014

64

Figure II.1.3: Cumulative living kidney transplantation

Details of living kidney transplantation in the Kingdom of Saudi

Arabia during 1979-2014;

Total living kidney transplantation: 6316

Cause N %

Congenital & vascular anomalies 34 21%

CKD 24 15%

Traumatic renal injury 22 13%

Necrosis 18 11%


Malignancy & neoplastic kidney 10 6%

Technical 9 6%

Vascular thromobosis 9 6%

TB 7 4%

Sepsis 5 3%

Sent abroad 3 2%

Fibrosis/sclerosis 3 2%

Glumerulosclerosis 3 2%

Multiple renal stones 1 0.5%

Pyelonephritis 1 0.5%

Black discoloration 1 0.5%

Total 163 100%

Table II.1.9: Causes of discarded deceased kidneys

Discarded kidneys among actual deceased donors during 1986-2014

Figure II.1.2. : Cumulative deceased kidney transplantation

Details of the deceased kidney transplantation in the Kingdom of

Saudi Arabia 1984-2014;

Total deceased kidney transplantation: 2694

Figure II.1.1: Cumulative living and deceased kidney transplantation

Details of living and deceased kidney transplantation in the Kingdom of Saudi Arabia during 1979-2014;

Total kidneys transplantation: 9010

11

1

4

21

2

0

36

3

6

30

4

9

63

7

7

77

6

3

64

1

28

1

45

1

22

1

36

1

47

1

74

1

60

1

88

1

95

2

28

2

51

2

28

2

08

2

21

2

20

26

0

22

8 27

2

34

9

43

1

50

6

46

2 5

14

0

100

200

300

400

500

600

19

79

19

81

19

83

19

85

19

87

19

89

19

91

19

93

19

95

19

97

19

99

20

01

20

03

20

05

20

07

20

09

20

11

20

13

2 4

28

59

57

74

62

65

95

15

4

13

1

83

88

84

76

59

89

57

71

88

95

15

1

12

2

16

6

11

1

15

6

12

2

11

8

96

13

1

0

20

40

60

80

100

120

140

160

180

19

84

19

85

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

11

1

4

21

2

0

36

3

6

30

4

9

63

7

7

77

6

3

64

12

8

14

5

12

2

13

6

14

7

17

4

16

0

18

8

19

5

22

8

25

1

22

8

20

8

22

1

22

0

26

0

22

8

25

2

31

3 38

5

43

2

40

6

46

6 20

3

6

46

7

4

56

4

8

2

4 0

2

8 5

9

57

7

4

62

6

5 95

1

54

1

31

8

3 88

8

4 76

5

9 8

9 57

7

1

88

9

5

15

1 12

2

16

6 11

1

15

6

12

2

11

8

96

1

31

0

100

200

300

400

500

600

700

19

79

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

Total Deceased: 2694

Total Living Unrelated: 280

Total Living Related: 6054

65

Liver Transplantation

In the year 2014, 198 livers had been transplanted inside the kingdom of Saudi Arabia; with 128 livers transplanted

from living and 70 transplanted from deceased donor. Details of the living and deceased liver transplantation 2014 are

shown in (table II.2.1).

It is worth mentioning that a total of 1596 livers were transplanted inside the kingdom from 1979 to 2014; of these

transplant activities, 790 (49%) were transplanted from deceased donors, 738 (46%) were from living related

donors and 68 (4%) were from living unrelated donor. Illustration of cumulative living and deceased liver

transplantation is shown in (figure II.2.1).

1. DECEASED LIVER DONATION 2014


of organ donation. 110 (100%) were consented for

liver donation in 2014 (see table II.2.2); out of which,

69 donors were utilized, 35 donors were not

recovered and the remaining 6 donors, livers were

discarded (recovered but not transplanted). The

details of utilized liver donor characteristics are listed

in (table II.2.3). Details of the cumulative deceased

liver donation are listed in (table II.2.4).

Characteristic N %

Age

0-10 2 3%

11-20 3 4%

21-30 13 19%

31-40 23 33%

41-50 13 19%

51-60 14 20%

61-70 1 1%

Blood Group

A 19 35%

B 24 27%

AB 2 3%

O 24 35%

Gender

Male 58 84%

Female 11 16%

Cause of Death

Anoxia 12 17%

CVA 29 42%

Head trauma 27 39%

CNS tumor 1 1%


MVA 15 22%

Non-MVA 54 78%

Table II.2.3: Deceased liver donor characteristics

Characteristics of utilized deceased liver donors in 2014

1. DECEASED LIVER TRANSPLANTATION 2014

110 deceased livers that were consented for liver

donation, there were 70 livers transplanted inside the

kingdom with 35 not recovered and 6 discarded. The

deceased liver transplantations this year were

performed in 3 currently active liver transplant

centers in the kingdom (See table II.2.5).

It is worth mentioning that out of the 69 recovered

deceased livers, 1 was split and transplanted to 2

recipients by King Faisal Specialist Hospital & Research

Center-Riyadh.

N Hospital Name Deceased

Donors


27

2 King Abdul-Aziz Medical City and National Guard-Riyadh

27

3 King Fahd Specialist Hospital-Dammam 16

Total 70

Table II.2.5: Deceased liver transplantation 2014

Performance of deceased liver transplantation in currently active

national liver transplant centers in 2014

Non-recovered deceased livers

110 deceased livers were consented for liver

donation; out of which, 35 (32%) were not recovered


deceased livers are mainly due to donor sudden

cardiac arrest, determined unsuitable liver donor and

hemodynamic instability. Major causes of non-

recovered deceased livers in 2014 are listed in (see

table II.2.7). Illustration of the cumulative major cause

non-recovered deceased liver transplantation from

1994 is shown in (table II.2.8).


Sudden cardiac arrest 9 25%

Determined unsuitable liver donor 7 20%

High liver enzymes 6

Low donor weight 1

Hemodynamic instability 7 20%

Biopsy findings 4 11%


No HCV+ compatible recipient

2

Infection 2 6%

Technical 2 6%

No medevac available 1


Diseased Liver 1 3%

Cirrhosis 1

Macroscopic findings 1 3%

Fatty 1

Total 35 100%

Table II.2.6: Reasons of non-recovered deceased livers

Reasons of non-recovery of livers among eligible donors consented

for liver donation in 2014

ANNUAL REPORT 2014

ANNUAL REPORT 2014

66

Discarded deceased livers

110 deceased livers were consented for liver

donation; out of which, 6 (5%) were discarded (see

table II.2.9). Causes of discarded deceased livers from

1994-2014 are listed in (table II.2.9).


Hepatocyte necrosis & steatosis 4 66%

High liver enzymes & biopsy report

1 17%

Infection (TB) 1 17%

Total 6 100%

Table II.2.9: Reasons of discarded deceased livers

Discarded livers among actual deceased liver donors in 2014

Adult and Pediatric deceased liver

transplantation

A total of 70 deceased livers were transplanted inside

the Kingdom with 61 (87%) livers transplanted to

adult recipients and 9 (13%) livers transplanted to

pediatric recipient (see table II.2.11).

N Liver Transplant Center Adult Pediatric T


23 4 27


23 4 27


15 1 16

Total 61 9 70

Table II.2.11: Adult and pediatric deceased liver transplantation

Pediatric and adult deceased liver transplanted in currently active


Cold ischemia time (CIT)

CIT for locally transplanted deceased livers was

ranging from 1hr. 7 minutes to 13 hrs. 33 mins., with

mean CIT at 6 hrs. 46 mins. In 34 (49%), the deceased

livers were practiced with CIT ≤ 6 hrs., 35 (50%) at

≥6-12 hrs. and the remaining 1 (1%) was done with

>12 hrs.

Deceased donor-recipient matching

Matching sex was done in 53% of the cases and

matching blood group for liver transplantation

between deceased donors and recipients was done in

89% of the cases. Age distribution between deceased

kidney donor and recipient is shown in (table II.2.12).

Donor Age (yrs.)

Recipient Age (yrs.)

Total <5

5-15

16-29

30-50

51-65

>65

<5 2* 2

5-15 2 2

16-29 1 3 1 7 12

30-50 1 6 11 20 1 39

51-65 1 5 8 1 15

>65 0

Total 2 2 10 19 35 2 70

Table II.2.12: Age distribution between deceased liver donor

and recipients 2014; *performed as split liver transplantation

1. LIVING LIVER TRANSPLANTATION 2014

A total of 128 living liver transplants were performed;

124 (97%) were from living related donors and 4

(3%) livers were from living unrelated liver donor.

The total living liver transplantations this year were

performed in 4 currently active national liver

transplant centers (see table II.2.13).

N Hospital Name Living

Related Living

Unrelated Total


93 2 95


14 0 14


13 0 13


4 2 6

Total 124 4 128

Table II.2.13: living liver transplantation

Performance of living liver transplantation in currently active


Transplant center Living

Deceased Total LR LUR

King Faisal Specialist Hospital Riyadh

93 2 27 122

King Fahd Specialist Hospital Dammam

13 0 16 29

King Abdulaziz Medical City Riyadh

14 0 27 41

Prince Sultan Military Medical City Riyadh

4 2 0 6

Total 124 4 70 198

Table II.2.1: living and deceased liver transplantation

Transplant centers performing living and deceased liver

transplantation in 2014

Livers from deceased donors N %

Transplanted 70 63%

Not recovered 35 32%

Discarded 6 5%

Total 110 100%

Table II.2.2: Deceased liver donation 2014

Livers from deceased donors N %

Transplanted 790 54%


Discarded 207 14%

Total 1452 100%

Table II.2.4: Livers from deceased donors 1994-2014

Not recovered deceased livers N %

Medical reason 24

Donor sudden cardiac arrest 9

Technical 2

Total 35 100%

Table II.2.7: Major causes of non-recovered deceased livers

Major causes of non-recovered deceased livers among eligible donors

consented for liver donation in 2014

67

Cause N %

Fatty Changes 90 43%

Granulomatous Changes/Fibrosis/Atherosclerosis

40 19%

Ischemia/Long CIT 21 10%

Macro/Microstasis, Steatosis 20 10%

Sepsis 11 5%

Hepatitis (B,C) Changes 6 3%

Neoplastic 6 3%

Cardiac Arrest (Donor/Recipient) 5 2%

Infectious Disease (TB, Bilharziasis, Others) 5 2%

Congenital/Vascular Abnormalities 1 .4%

Necrosis 1 .4%

Traumatic Liver Injury 1 .4%

Total 207 100%

Table II.2.10: Causes of discarded deceased livers 1994-2014

Discarded livers among actual deceased donors consented for liver

donation during 1994-2014

Not recovered deceased livers N %

Medical reason 354

Donor sudden cardiac arrest 94

Technical 7

Total 455 100%

Table II.2.8: Major causes of non-recovered deceased livers

Major causes of non-recovered deceased livers among eligible donors

consented for liver donation 1994-2014

Figure II.2.1: Cumulative living and deceased liver transplantation in KSA

Details if the living and deceased liver transplantation in the Kingdom of Saudi Arabia 1994-2014;

Total deceased and living liver transplantation 1990-2014: 1596

1 2 2 44 45

28 26 20 18 10 19 10 15 29 28

49 54 59 51 62 49 50 49

70 1 7 16

11 19 19

41 32

37 39 38 58 26 72

92 106

124

14

43 4

3

4

0

50

100

150

200

250

19

90

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

Total Deceased: 790

Total Living Related: 738

Total Living Unrelated: 68

ANNUAL REPORT 2014

ANNUAL REPORT 2014

68

Heart Transplantation

In the year 2014, 31 whole hearts had been transplanted and 19 hearts were recovered as source of valves inside the

kingdom of Saudi Arabia. It is worth mentioning that a total of 280 hearts had been transplanted from 1986-2014 in

addition, 602 hearts were recovered as sources of valves since 1993. Illustration of the cumulative deceased heart

transplantation and recovered hearts as source of valves in Saudi Arabia is shown in (figure II.3.1).

1. DECEASED HEART DONATION 2014


of organ donation with 107 (97%) were consented

for heart donation (see table II.3.1); of which, 31

donors were recovered, 19 were recovered hearts as

source of valves and 57 donors were not recovered.

The details of the utilized deceased heart donor

characteristics are listed in (table II.3.1.2). Illustration

of the cumulative deceased heart donation from 1986

is shown in (table II.3.3).

Characteristic N %

Age

11-20 1 3%

21-30 9 29%

31-40 15 48%

41-50 5 16%

51-60 1 3%

Blood Group

A 8 26%

B 8 26%

AB

O 15 48%

Gender

Male 30 97%

Female 1 3%

Cause of Death

Anoxia 5 16%

CVA 4 13%

Head trauma 22 71%


MVA 14 45%

Non-MVA 17 55%

Table II.3.2: Deceased heart donor characteristics

Characteristics of utilized deceased heart donors in 2014

2. DECEASED HEART TRANSPLANTATION

2014

107 (97%) deceased hearts were consented for the

purpose of heart donation; with 31 (29%) hearts

transplanted by two heart transplant centers inside

the kingdom (see table II.3.4). In addition, 19 Heart for

valves were also recovered (see table II.3.5).

Transplant Center Transplanted Deceased

Hearts


26

Prince Sultan Cardiac Center-Riyadh

5

Total 31

Table II.3.4: Deceased hearts transplantation

Performance of deceased heart transplantation in currently active

national heart transplant centers in 2014

Non-recovered hearts

107 deceased hearts were consented for heart

donation; out of which 57 (53%) were not recovered


deceased hearts are mainly due to determined

unsuitable heart donor, no available suitable recipient

and diseased heart.


Determined unsuitable heart donor 16 28%

Old age 11

High dose inotropic agents 2

History of post cardiac arrest

2

Multi-organ failure 1


No ABO identical recipient 6

Donor-recipient mismatch

o Weight disproportion

4

No HCV+ compatible recipient

3

Diseased Heart 11 19%

Low ejection fraction during echocardiography

8

History of post CABG 2

Severed hypertrophy 1

Hemodynamic instability 6 10.5%

Technical 6 10.5%

Cardiac catheterization cannot be performed

5

Recipient unavailable 1


Infection 2 4%

Fungal 1

Peritonitis/puruluent discharge

1

Total 57 100%

Table II.3.6: reasons of non-recovered deceased hearts

Reasons of non-recovered deceased hearts among eligible donors

consented for heart donation in 2014

Adult and pediatric heart transplantation

31 hearts were transplanted inside the kingdom with

27 (87%) hearts utilized for adult recipients and 4

(13%) hearts for pediatric recipients (see table II.3.7).

N Liver Transplant Center Adult Pediatric T


22 4 26

2 Prince Sultan Cardiac Center-Riyadh

5 0 5

Total 27 4 31

Table II.3.7: Adult and pediatric deceased heart transplantation

Adult and pediatric deceased heart transplantation in currently

active national heart transplant centers in 2014

69



matching blood group for heart transplantation




Donor Age (yrs.)

Recipient Age (yrs.) Total

<5 5-15

16-29

30-50

51-65

>65

16-29 4 4 2 10

30-50 1 6 9 4 20

51-65 1 1

Total 1 10 13 7 31

Table II.3.8: Age distribution between deceased heart donor and

recipients 2014

Aortic valve

Pulmonary

valve Total

Used 5 13 18

To be used 0 0 0

Discarded 14 6 20

Total 19 19 38

Table II.3.5: Heart for valve recovery and utilization

Recovered heart as source of valves from eligible deceased hearts in

2014

Hearts from deceased donors N %

Consented 107 97%

Transplanted 31

Recovered as source of valves 19

Not recovered 57

Discarded 0

Not consented 3 3%

Total 110 100%

Table II.3.1: Deceased heart donation 2014

Hearts from deceased donors N %

Consented 1391 86%

transplanted 280

Recovered as source of valves 602

Not recovered 509

Discarded 0

Not consented 219 14%

Total 1610 100%

Table II.3.3: Deceased heart donation 1986-2014

Figure II.3.1: Cumulative deceased heart transplantation and recovered hearts as source of valves in Saudi Arabia 1986-2014

1 1 3

8 9

5 6

12 12

7 5 5 4

6 3 3 2

5 4

8

13 12

19

15

19 19 22 21

31

9

36 39

26 23

33 35

19

27

17

22

32

38

52

31 29 29

20 23 24

19 19

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

Total Whole Heart: 280 Total Hearts as Source of Valves: 602

ANNUAL REPORT 2014

ANNUAL REPORT 2014

70

Lung Transplantation

In the year 2014, 19 lungs have been transplanted from deceased donation inside the kingdom of Saudi Arabia. It is

worth mentioning that a total of 144 lungs have been transplanted from 1991-2014. Illustration of the cumulative

deceased lung transplantation is shown in (figure II.4.1).

1. DECEASED LUNG DONATION 2014

110 deceased donors were consented for deceased

organ donation. 103 (94%) were consented for lung

donation (see table II.4.1); of which, 10 donors were

utilized for lung transplantation, 92 donors were not

recovered and the remaining 1 donor, the lungs were

discarded (recovered but not transplanted). The

details of the utilized lung donor characteristics are

listed in table II.4.2.

Characteristic N %

Age

21-30 1 10%

31-40 3 30%

41-50 2 20%

51-60 4 40%

Blood Group

A 4 40%

B 2 20%

AB

O 4 40%

Gender

Male 8 80%

Female 2 20%

Cause of Death

Anoxia 3 30%

CVA 5 50%

Head trauma 2 20%


MVA 1 10%

Non-MVA 9 90%

Table II.4.2: Deceased Lung Donor Characteristics

Characteristics utilized deceased lung donors

2. DECEASED LUNG TRANSPLANTATION

2014

206 deceased lungs that were consented for lung

donation; there were 10 lungs transplanted inside the

Kingdom wherein, 18 lungs were transplanted as

double lungs to 9 recipients and a single lung

transplanted to 1 recipient, 184 lungs were not

recovered and 3 were discarded. The deceased lung

transplantations this year was performed by King

Faisal Specialist Hospital & Research Center, Riyadh

the currently active lung transplant center in the

Kingdom (see table II.4.3).

Lung Transplant Center Deceased

Lung Transplanted

Lung Transplants


19 10

Table II.4.3: Deceased Lung Transplantation

Performance of deceased lung transplantation in currently active

national lung transplant center in the year 2014

Non-recovered deceased lungs

206 deceased lungs were consented for lung

transplantation; out of which 184 (89%) were not

recovered (see table II.4.5). The major causes of non-

recovered deceased lungs is shown in (figure II.4.6)


Poor lung function 24 26%

Low PO2 during challenge test 21

Blood clots seen during bronchoscopy

1

Poor ABG result 1

Poor bronchoscopy result 1

No available suitable lung recipient 22 24%

Deceased Organ 10 11%

Abnormal cxr 2

Atelectasis 2

Lung infiltration 4

Pleural effusion 2

Technical 10 11%

Challenge test cannot be performed

1

Needed more time for evaluation

3

No blood sample available for cross-match

2

Recipient not fit for transplantation

2

Recipient unavailable 1

No surgeon 1

Hemodynamic Instability 7 8%

Infection 6 7%

Lung consolidation 5

HCV+ 1

Traumatic Lung Injury 5 5%

Lung contusion 3

Lung hemorrhage 1

Traumatic lung injury 1

Determined unsuitable lung donor 4 4%

Old age 2

Long stay in ICU 1

History of prolonged cardiac arrest

1


Others 1 1%

History of severe smoking 1

Total 92 100%

Table II.4.5: Reasons of non-recovered deceased lungs

Reasons of non-recovered of lungs among eligible donors consented

for lung donation in 2014

Discarded Lungs

206 deceased lungs were consented for lung

donation; out of which, 3 (1%) were discarded (see

table II.4.7).

71

Reason of discard N %

High ventilator settings with bilateral lung contusions

2 67%

Recipient for single lung transplantation

1 33%

Total 3 100%

Table II.4.7: Reasons of discarded deceased lungs

Discarded lungs among actual deceased lung donors in 2014

Adult and pediatric lung transplantation

19 deceased lungs were transplanted inside the

kingdom and all were transplanted to 10 (100%)

adult recipients (see table II.4.8).

Lung Transplant Center Adult Pediatric

Single Double Single Double


1 9

Table II.4.8: Adult and Pediatric Lung Transplantation

Adult and pediatric deceased lung transplanted in currently active

national lung transplant center in 2014



matching blood group for lung transplantation




Donor

Age (yrs.)

Recipient Age (yrs.) Total

<5 5-15

16-29

30-50

51-65

>65

16-29 1 1

30-50 2 2 1 5

51-65 1 2 1 4

Total 4 4 2 10

Table II.4.9: Age distribution between deceased lung donor and

recipients 2014

Transplant Center Period No of

Transplant Operation

King Faisal Specialist Hospital & RC-Riyadh

1996-2014 72

King Faisal Specialist Hospital & RC-Jeddah

2001-2011 12

King Fahd Hospital-Jeddah 1991-1994 4

Total 88

Table II.4.4: deceased lung Transplantation Activity 1991-2014

Total lungs transplanted: 144

Total transplant recipient: 88

Lungs from deceased donors N %

Transplanted 10 10%


Discarded 1 1%

Total 103 100%

Table II.4.1: Lungs from deceased donation 2014

Not recovered N %


Technical 10 11%

Donor sudden cardiac arrest 3 3

Total 92 100%

Table II.4.6: Major causes of non-recovered lungs 2014

The reasons of non-recovery of lungs among eligible donors

consented for liver donation 2014

Figure II.4.1: Cumulative deceased lung transplantation 1991-2014

4 4 4

1

5 6

3

1

4

19 19 24

31

19

1

5

25

125Total Lungs Transplanted: 144

ANNUAL REPORT 2014

ANNUAL REPORT 2014

72

Pancreas Transplantation

In the year 2014, 2 pancreases had been transplanted inside the kingdom of Saudi Arabia with a total of 27

pancreases were transplanted inside the kingdom from 1990-2014. It is worth mentioning that the first pancreas

transplantation in the Kingdom was performed in 1990 then followed by kidney-pancreas transplantation in 1991.

Another combined operation was also done in 1992 at Al Shati Hospital in collaboration with King Abdul-Aziz

Hospital-Jeddah. Illustration of the cumulative deceased pancreas transplantation is shown in (figure II.5.1).

1. DECEASED PANCREAS DONATION 2014


of organ donation and 84 (76%) were consented for

pancreas donation for KSA; out of which, 2 donors

were utilized for pancreas transplantation, 81 donors

were not recovered and the remaining 1 donor, the

pancreas was discarded (recovered not transplanted)

(see table II.5.1). The details of utilized pancreas

donor characteristics are listed in (table II.5.2)

Characteristic N %

Age

0-10 1 50%

11-20 1 50%

Blood Group

A

B 1 50%

AB

O 1 50%

Sex

Male 2 100%

Female

Cause of Death

Head trauma 2 100%


MVA 2 100%

Table II.5.2: Deceased pancreas donor characteristics

Characteristics of utilized deceased pancreas donors in 2014

2. DECEASED PANCREAS TRANSPLANTATION

2014

84 deceased pancreases were consented for pancreas

donation; with 2 pancreases transplanted inside the

Kingdom as Pancreas Transplant Alone (PTA), and 1

pancreas discarded. The 2 pancreas were

transplanted in 1 out of the 2 currently active

pancreas transplant centers in the Kingdom (see table

II.5.3).

N Hospital Name Transplanted

Deceased Pancreases


2

Table II.5.3: deceased pancreas transplantation

Performance of deceased pancreas transplantation in currently

active national pancreas transplant center in 2014

Non-recovered deceased pancreas

84 deceased pancreases were consented for pancreas

donation; out of which 81 were not recovered (see

table II.5.4). The major causes of non-recovered

deceased pancreas are shown in (table II.5.5).


Determined unsuitable pancreas donor

56 69%

High pancreas enzyme 18

Old age 16

DM 13

Long stay in ICU 8

Young age 1



Technical 5 6%

Macroscopic findings 5 6%


Traumatic organ injury 1 1%

Total 81 100%

Table II.5.4: Reasons for non-recovered deceased pancreases

Reasons of non-recovered deceased pancreas among eligible donors

consented for pancreas donation but not recovered in 2014

Discarded deceased pancreas

84 pancreases were consented for pancreas donation;

of which, 1 (50%) was discarded (see table II.5.6).


Fatty pancreas 1 100

Table II.5.6: Reason of discarded pancreas

Discarded pancreas among actual deceased donors consented for

pancreas donation in 2014

Adult and pediatric pancreas transplantation

2 pancreases were transplanted inside the kingdom

both to adult recipients as PTA (see table II.5.7).

N Pancreas Transplant

Center Adult Pediatric T


2 0 2

Table II.5.7: adult and pediatric deceased pancreas

transplantation

Adult and pediatric deceased pancreas transplantation in currently

active pancreas transplant center in 2014

73

Pancreas from deceased donors N %

Transplanted 2 2.4%

Not recovered 81 96.4%

Discarded 1 1.2%

Total 84 100%

Table II.5.1: Pancreas from deceased donors 2014

Not recovered N %


Technical 5 6

Donor sudden cardiac arrest 1 1

Total 81 100%

Table II.5.5: Major causes of non-recovered deceased pancreas

2014

The reasons of non-recovery of pancreas among eligible donors

consented for pancreas donation in 2014

Figure II.5.1: Cumulative deceased pancreas transplantation

Details of the deceased pancreas transplantation in the Kingdom of Saudi Arabia 1990-2014; total deceased kidney transplantation: 27

1

2

1

2 2 2

1 1

4

2

1

6

2

0

1

2

3

4

5

6

7

1990 1991 1992 2004 2005 2006 2007 2008 2009 2010 2011 2013 2014

Total Pancreas: 27

ANNUAL REPORT 2014

ANNUAL REPORT 2014

74

Corneal Recovery

Corneal tissue donation program and transplantation was established in the kingdom since 1983. Corneas were

recovered along with multi-organ retrieval from actual DBD donors. In the year 2014, 13 corneas were recovered

inside the Kingdom of Saudi Arabia, A total sum of 692 corneas had been recovered inside the kingdom from 1983-

2014. Illustration of cumulative corneal recovery is shown in figure II.6.1. It is worth mentioning that King Khalid Eye

Specialist Hospital-Riyadh, being the most active corneal transplant center having 566 patients in their waiting list

and performing 879 corneal transplantation which were harvested abroad and transplanted, in addition to 701

corneas sent to other eye care facilities.

1. DECEASED CORNEAL DONATION 2014


of organ donation and 44 (40%) of them were

consented for corneal donation; 7 donors were

recovered and 37 were not recovered. The details of

the recovered corneal donor characteristics are listed

in (table II.6.1).

Characteristic N %

Age

21-30 1 17%

41-50 5 83%

Blood Group

A 1 17%

B 3 50%

AB

O 2 33%

Gender

Male 5 83%

Female 1 17%

Cause of Death

CVA 4 67%

Head trauma 2 33%


MVA 1 17%

Non-MVA 5 83%

Table II.6.1: Deceased Cornea Donor Characteristics

Characteristics of utilized deceased donors from whom corneas were

recovered and transplanted

2. DECEASED CORNEAL RECOVERY 2014

88 deceased corneas were consented for the purpose

of corneal recovery; with 13 corneas recovered and

75 were not recovered. Deceased corneal recovery

was performed by 2 currently active corneal

transplant centers (see table II.6.2).

N Cornea Transplant Center Recovered

Corneas

1 King Khalid Eye Specialist Hospital-Riyadh

11

2 King Abdul-Aziz Specialist Hospital-Taif 2

Total 13

Table II.6.2: Deceased corneal recovery

Performance of deceased corneal recovery in currently active

national corneal transplant center in 2014

Non-recovered deceased corneas

88 deceased corneas were consented for corneal

donation and of which, 75 were not recovered (see

table II.6.3).


Technical 32 43%

Infection 30 40%


Determined unsuitable cornea donor 5 7%


Total 75 100%

Table II.6.3: Reasons for non recovered deceased corneas

Reasons of non-recovered deceased corneas among eligible donors

consented for corneal in 2014

Discarded corneas

88 deceased corneas were consented for corneal

donation; out of which 2 (2%) were discarded (see

table II.6.4).


No syphilis screen 2 100

Table II.6.4: Reason of discarded deceased corneas

Discarded corneas among actual deceased donors in 2014

Figure II.6.1: cumulative corneal recovery

Details of the deceased corneal recovery and transplantation in the Kingdom of Saudi Arabia 1983-2014

3150

350 355 380

693 840 843

731 642 741 800 931

1133 946 941

1167 1344

1005

1578 1366

945

1577

1209 962 879

9 14 13 23 62 36 49 48 53 34 26 38 16 21 19 31 44 17 32 23 24 15 16 16 13

Total Corneas Recovered Locally: 692 Total Corneas Recovered Abroad: 25508

75

Bone Banking

Bone donation program from deceased donors was started in the Kingdom by King Faisal Specialist Hospital &

Research Center in 2009. Up to date, bone recovery goes along with multi organ recovery from actual DBD donors

from central region. In the year 2014, 126 bones and 58 musculoskeletal tissues were recovered inside the Kingdom

of Saudi Arabia. It is worth mentioning that 226 bones had been recovered in addition to 90 musculoskeletal

connective tissues were recovered for the purpose of bone allograft. Illustration of the cumulative recovered

deceased bones and musculoskeletal tissues is shown in (figure II.7.1).

DECEASED BONE DONATION 2014

110 deceased donors were consented for tissue

donation, of which 31 (28%) were consented for bone

and musculoskeletal tissue donation wherein, 23

(74%) donors were recovered and the remaining 8

(26%) were not recovered. The details of the utilized

deceased bone and musculoskeletal tissue donor

characteristics are listed in table II.7.1.

Characteristic N %

Age

21-30 2 9%

31-40 6 26%

41-50 9 39%

51-60 5 22%

61-70 1 4%

Blood Group

A 6 26%

B 6 26%

AB 1 4%

O 10 5%

Gender

Male 21 91%

Female 2 9%

Cause of Death

Anoxia 2 9%

CVA 14 61%

Head trauma 7 30%


MVA 14 45%

Non-MVA 17 55%

Table II.7.1: Deceased bone and musculoskeletal connective

tissue donor characteristics

Characteristics of utilized deceased donors from whom bones and

musculoskeletal connective tissues were recovered and recovered

Of the 31 the bone tissue donors, 126 bones and 58

musculoskeletal tissues were recovered, a total of 38

femurs, 37 tibias, 37 fibulas and 14 pelvises including

58 musculoskeletal connective tissues (see II.7.2).

Bone Bank Femur Tibia Fibula Pelvis MST


38 37 37 14 58

Table II.7.2: Deceased bone and MSCT recovery

Performance of deceased bone and MST recovery in currently active

national bone bank in 2014

Non-recovered bones

31 deceased donors were consented for bone

donation and of which, 7 (6%) were not recovered

see (table II.7.3).


Donor outside Riyadh 5 71%

Donor poor general condition 1 14%

Administrative issue 1 14%

Total 7 100%

Table II.7.3: Reasons of non-recovered bones

Reasons of non-recovery of bones among eligible deceased donors

consented for bone donation in 2014

Figure II.7.1: cumulative recovered deceased bones and musculoskeletal tissues 2009-2014

13

29 21 17 20

126

3 4 8 17

58

2009 2010 2011 2012 2013 2014

Total Bones Recovered: 226

Total Musculoskeletal Connective Tissue Recovered: 90

ANNUAL REPORT 2014

ANNUAL REPORT 2014

76

Organ Sharing between the Kingdom of Saudi Arabia and GCC Countries 2014

In 2014, 45 organs and tissues were recovered from DBD donors in GCC countries and shared to the Kingdom. Of the

shared organs; 8 kidneys, 21 livers, 5 whole hearts, 4 lungs and 7 hearts as source of valves were recovered. Over the

years, there was continuous successful cooperation in organ sharing program between the GCC countries and it is

worth mentioning that this year, 45 organs and tissues were shared from Kuwait, Qatar and Bahrain which marked

the peak of organ sharing since 1996. In addition to this year’s organ sharing program, 1 kidney was shared to U.A.E.

by the Kingdom (see table II.8.1).

Year Recovered/Transplanted Organs Total

Recovered/Tx. Organs Kidney Liver Heart HFV Lung

1996-2000 6/6 19/14 4 /4 11 2/2 42/37

2001 13/12 3/3 - 1 - 17/16

2002 2/2 2/2 - 2 - 6

2004 6/6 6/5 1 /1 4 - 17/16

2005 7/7 13/10 1 /1 12 4/2 37/32

2006 6/3 12/8 - 7 - 25/18

2007 2/2 14/13 1 /1 2 - 19/18

2008 6/5 12/11 - - - 18/16

2009 2/2 5/5 - 1 - 8/8

2010 2/2 11/10 - - - 13/12

2011 4/3 5/3 1/1 - - 10/7

2012 6/3 13/10 - 7 10/10 36/30

2013 2/2 5/6** 2/2

4/4 13/14

2014 8/8 21/20 5/5 7/7 4/4 45/44

Total 72/63 141/120 15/15 54 24/22 306/274

Table II.8.1: Recovery and transplantation activities from organ sharing program between the kingdom and other countries* 1996-2014,

*Kuwait, Qatar, Bahrain and Spain, **Tx. as split liver transplantation

Year Country Transplanted Organs

Total Organs Kidney Liver Heart HFV Lung

1996-2002 Kuwait 3 19 4 14 2 42

2000-2001 Spain 17 - - - - 17

2004-2009

Kuwait 10 39 2 18 2

108 Qatar 15 12 1 8 -

Bahrain - 1 - - -

2010

Kuwait - 5 - - -

12 Qatar 2 4 - - -

Bahrain - 1 - - -

2011 Kuwait 1 2 1 - -

7 Qatar 2 1 - - -

2012 Kuwait 1 9 - 7 10

30 Qatar 2 1 - - -

2013 Kuwait 2 6 1 - 2

14 Qatar - - 1 - 2

2014

Kuwait 1 16 5 4 4

44 Qatar 4 1 - - -

Bahrain 3 3 - 3 -

Total 63 120 15 54 22 274

Table II.8.2: Transplant activities from organ sharing program between the kingdom and other countries 1996-2014

77

Figure II.8.1: Cost of organ and tissue utilized inside and outside the Kingdom in 2014 (Million SR)

The figure shows cost of transplantation for different organs (kidney, liver heart, etc.) and the amount of savings when comparing inside

and outside the Kingdom in organ transplantation

Figure II.8.2: comparison of estimated total cost of organs and tissues transplanted inside and outside the Kingdom in 2014

Estimated savings: 259.578 Million SR

Figure II.8.3: Total number of deceased organs and tissues utilized 1986-2013

Figure II.8.4: Total deceased organs and tissues transplanted in KSA 1986-2014

Total Organs (kidney, liver, heart, pancreas, lung): 3926

Total Tissues (corneas, heart for valves, bones, musculoskeletal tissues): 1609

Kidney LiverWholeHeart

Lungs PancreasHeart for

ValvesCornea Bones

No. of Organs 131 70 31 19 2 19 11 126

Cost Inside KSA 6.5 24.5 15.5 9.5 1.2 5.7 0.44 2.52

Cost Outside KSA 65.5 140 62 38 2.4 9.5 0.132 7.56

65514000

325092000

0 100000000 200000000 300000000 400000000

Total cost inside KSA

Total cost outside KSA

2694

790

280 27 144

602 690

225 90 0

500

1000

1500

2000

2500

3000

Kidney Liver WholeHeart

Pancreas Lung HFV Cornea Bones MSCT

29

62

65

85

70

74

11

1 21

1

18

3

11

7

11

9

11

0

10

1

72

11

3

71

92

12

8

13

9

21

8

18

9

24

6

18

5

25

6

21

0

21

4

20

3

25

3

9

14

13

32

98

75

75

71

86

69

45

65

33

43

51

69

96

49

61

65

76

63

65

72

21

4

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

ANNUAL REPORT 2014

ANNUAL REPORT 2014

78

Appendix I

Responsibilities of the Saudi Center for Organ

Transplantation (SCOT) 1. Setting up a national registry for end-stage organ failure patients, organ transplant recipients and organ donors

with their follow-up and outcome, and setting up the necessary procedures. 2. Receiving and following-up of brain death cases in intensive care units, coordinating the removal of organs after

getting the necessary approvals and distributing the organs to the organ transplant centers in the various health institutions in the Kingdom.

3. Coordinating with the concerned authorities to send medical teams to the various areas in the Kingdom and

abroad, to remove the organs from the person mentioned in paragraph 2 of this clause and transplant it to a patient.

4. Cooperating and coordinating with the health authorities in the field of organ transplantation, both inside the

Kingdom and abroad. 5. Preparing and updating the necessary procedures for organ transplantation from living donors in accordance

with Sharia law restrictions. 6. Preparing and updating the policies and procedures (measures, descriptions, conditions and restrictions) related

to organ transplantation in the Kingdom. 7. Monitoring and following-up on the application of organ transplantation programs, carrying out regular

appraisals of the establishments and following-up with the specialized bodies. 8. Preparing administrative and financial roles for the personnel of the center, the researchers and those

collaborating with it. 9. Holding symposia and conferences and educational and training programs, in the field of organ failure, organ

donation and transplantation, on regional and international levels and holding orientation programs. 10. Offering awareness and educational health programs, in the field of organ failure

and organ donation and transplantation in the community. 11. Publishing a scientific journal specializing in organ transplantation on the subjects of organ failure, organ

donation and transplantation. 12. Taking part in scientific research related to organ transplantation and organ failure, in the Kingdom and abroad. 13. Cooperating with charities to support organ failure patients.

79

Appendix II

Regulations for Organ Transplantation

in the Kingdom of Saudi Arabia

Regulations are essential to the process of organ donation and transplantation and therefore, the Higher National

Committee for the Development of Organ Donation and Transplantation in the Kingdom of Saudi Arabia (KSA), which

was formed according to the Ministerial resolution 14853/84 dated 30/2/1431, reviewed the regulations and passed

them as follows:

Item 1: The following terms are defined as follows:

Council: The Council for the Health Services

Center: The Saudi Center for Organ Transplantation (SCOT)

Directory: The Directory for Organ Donation and Transplantation in the KSA.

Item 2: Only authorized specialized physicians can perform organ transplantation from the living or deceased

human donors to a human recipient with intention for cure and rescue according to the

regulations included in this document.

Item 3: Any rightful person can donate or place a directive for donation of one of his body organs to rescue

or treat a patient with end-stage organ failure. A statement should be signed by the donor as a will

for donation. Nevertheless, only those who attain 18 years of age can donate to their relatives.

Item 4: Fully known medical investigations as advised by the specialist in the field should be performed

before approving the organ donation from living donors. Full discussion of the risks and possible

outcomes should be conducted with the donor before donation.

Item 5: Donors have the right to withdraw their consent for donation any time before the operation

without penalties. No donor can claim his organ after transplantation is completed.

Item 6: It is prohibited for living donors to donate vital organs, donation of which could result in the death

of the donor or complete disabling of vital functions.

Item 7: Organ donation can be from the persons only after full documentation of death by a committee of

specialized physicians and in the absence of

a directive by the donor objecting to donation during his life.

Item 8: Organ donations, as in item 7, can be performed if brain stem death is documented by the available

means of technology.

Item 9: Commercial transplantation is prohibited in any manner.

Item 10: Transplantation is performed only in centers authorized by the Ministry of Health in the GCC

Countries.

Item 11: Penalties will be levied in case of any violation of the above regulations according to system of the

medical practice, after intensive investigation by the SCOT and the concerned authorities.

ANNUAL REPORT 2014

ANNUAL REPORT 2014

80

Appendix III

Memorandum by the Minister of Health on

Deceased Organ Donation

Ref: 328025/11

Date: 17/12/1432H

13/11/2011G

Important Memo

His Excellency the Director of the National Guard Health Affairs

His Excellency the Executive Administrator of the General Organization

King Faisal Specialist Hospital and Research Center

Deputy Minister of Higher Education

His Excellency Deputy Minister for Executive Affairs

His Excellency Director General of Medical Services of the Armed Forces

Director General of Security Forces Hospital Program

Due to the importance of supporting the national program for organ donation and transplantation and the large

increase in the number of patients on waiting lists for transplantation and the resulting health and social burden on

the patients and financial burden on different health sectors , I appeal to the staff in all hospitals and especially those

in the intensive care units, emergency departments, neurology and neurosurgical departments, and all relevant

departments to cooperate with the Saudi Center for Organ Transplantation of the administration of each hospital

to fulfill the following:

1. Early Notification of cases of brain death to Saudi Center for Organ Transplantation and considering that as

the core tasks of intensive care physicians and other relevant departments.

2. Support for organ donation in the hospital and put the appropriate plan with the Saudi Center for Organ

Transplantation for optimizing cases of organ donation after death and overcome the obstacles faced by.

3. Facilitate continuous communication of medical and administrator coordinators inside the hospitals with

intensive care units and emergency departments and relevant departments with respect to the organ

donation and transplantation program.

DR. ABDULLAH BIN ABDELAZIZ AL RABEEAH

Minister of Health

Chairman of the Health Services Council

81

Appendix IV

Official Statement of the National Committee for the

Diagnosis of Death by Neurological Criteria and

Ventilator System

The members of National Committee for diagnosis of death by Neurological Criteria held a meeting in Saudi Center

for Organ Transplantation (SCOT) on Sunday 31/01/2010 (23/11/1431H) to discuss what has been published

recently in the media about the reluctance of some medical doctors on the “fatwa” on removing the ventilator

machine from brain dead case where some consider it as killing a person.

Accordingly the following steps were done by the committee:

Review of these articles and international global scientific publications emerging on the subject.

Review of the medical ethics of diagnosis of death by neurological criteria.

Review the legal opinion “Fatwa” issued within the Kingdom of Saudi Arabia (Senior Ulama Commission) or

abroad, especially the resolution of the Council of Islamic Jurisprudence on Resuscitation Apparatus.

Hence, we have decided unanimously the following:

1. The diagnosis of death by the time was, and continues to be a medical decision made by the experienced

professionals.

2. The concept of brain death based on evidence has not undergone any recent disputing developments both in

the definition or diagnosis using the Saudi protocol. Moreover, the protocol used within the Kingdom of

Saudi Arabia is one of the most demanding protocols in the world.

3. According to the diagnosis of brain death by neurological criteria using the strict scientific protocol, the

deceased person reaches the point of no return and no chance that he will regain his life.

4. It is permissible to remove the respirator from the persons diagnosed dead by the neurological criteria

according to the scientific protocol applied in all the health institutions in the Kingdom and supervised by

the committees of ethics and medical expertise.

This statement is approved by the Saudi Society of Critical Care (SCCS):

Dr. Yasser Mandourah

Consultant Intensivist, Head, Saudi Society of Critical Care

Head, Intensive Care Unit Riyadh Military Hospital

Dr. Amin M. Yousef

Consultant Intensivist, Deputy Head, Saudi Society of Critical Care

Head, Intensive Care Unit King Saud Medical Complex , Riyadh

The National Committee For The Diagnosis Of Death By Neurological Criteria

Dr. Mohammad Zuheir Alkawi

Chairman, Senior Consultant Neurologist

King Faisal Specialist Hospital & Research Center, Riyadh

Dr. Abdullah Turki

Consultant Pediatric Intensivist, Director, Pediatric Critical Care Unit

King Faisal Specialist Hospital & Research Center, Riyadh

Dr. Mohammed Al-Bar

Consultant, Islamic Medicine King Abdul Aziz University - Jeddah

Dr. Mohammad Ibrahim Almajeed

Consultant Anesthesiologist, King Khalid University Hospital – Riyadh

Dr. Nabil Biary

Consultant, Neurologist Riyadh Military Hospital

Dr. Awad Addasi

Consultant Intensivist, Riyadh Military Hospital

ANNUAL REPORT 2014

ANNUAL REPORT 2014

82

Appendix V

Purport of the Senior Ulama Commission

Decision No. 99 Dated 06-11-1402 H

The board unanimously resolved the permissibility to remove an organ, or a part thereof from a Moslem or Thimmi

living person and graft it onto him, should the need arise, should there be no risk in the removal and should the

transplantation seem likely successful.

The board also resolved, by majority the following:

The permissibility to remove an organ or part thereof from a dead person for the benefit of a Moslem,

should the need arise, should the removal cause no harm and should the transplantation seem likely

successful.

The permissibility for the living person to donate one of his organs or part thereof for the benefit of a

Moslem in need thereof.

Senior Ulama Commission.

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Appendix VI

Resolution of the Council of Islamic Jurisprudence

on Resuscitation Apparatus

Decision No. (5) D 3/07/86

The council of Islamic Jurisprudence in its third meeting held in Amman, capital of Jordan from 8 to 13 Safar 1407 H

corresponding to 11 to 16 October 1986 and after discussing all relevant aspects of resuscitation apparatus and after

hearing the detailed explanation from specialist doctors, decide the following:

A person is pronounced legally dead and consequently, all dispositions of the Islamic law in case of death apply if one

of the two following conditions has been established:

There is total cessation of cardiac and respiratory functions, and doctors have ruled that such cessation is

irreversible.

There is total cessation of all cerebral functions and experienced specialized doctors have ruled that such cessation is

irreversible and that brain has started to undergo autolysis.

In this case, it is permissible to take the person off resuscitation apparatus, even if the function of some organs e.g.,

heart are still artificially maintained.

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Glossary: Brain Death Irreversible cessation of cerebral and brain stem; characterized by the absence of electrical activity in the brain, blood flow to the brain, and brain function as determined by clinical assessment of responses. A brain dead person is dead, although his or her cardiopulmonary functioning may be artificially maintained for some time. Critical Pathway of Deceased Organ Donation Provides a systematic approach to the organ donation process, considering both donations 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. Donor Someone from whom at least one organ or tissue is recovered for the purpose of transplantation. A deceased donor is a patient who has been declared brain death or cardiac death criteria. Deceased Donor or DD An individual from whom at least one solid organ is recovered or the purpose of transplantation after suffering brain death or cardiac death. Living Donor Is one who donates an organ or segment of an organ for the intent of transplantation. Possible Deceased Organ Donor A patient with a devastating brain injury or lesion or a patient with a circulatory failure and apparently medically suitable for organ donation

Potential DBD donor A person whose clinical condition is suspected to fulfill brain death criteria. Eligible DBD donor A medically suitable person who has been declared dead based on neurologic criteria as stipulated by the law of the relevant jurisdiction. Actual DBD donor

A Consented eligible donor: a. In whom an operative incision was

made with the intent of organ recovery for the purpose of transplantation.

b. From whom at least one organ was recovered for the purpose of transplantation.

Utilized DBD donor An actual donor from whom at least one organ was transplanted. Organ Donation: is the donation of biological tissue or an organ of the human body to a recipient in need of transplantation. Living Organ Donation Organ donation from living donor to living recipient Deceased Organ Donation Organ donation from deceased donor who is pronounced brain dead or circulatory death who is apparently medically suitable for organ donation Organ Recovery / Procurement The obtaining of organs for transplantation, which included methods of obtaining through programs, systems or organization. It includes also the transporting of donor organs, after surgical removal to the hospital for processing and transplant. Organ Failure Is altered organ function in an acutely ill patient requiring medical intervention to achieve homeostasis. Organ Transplant An operation moving an organ from one organism (donor) to another one (recipient) Allograft An organ or tissue that is transplanted from one person to another of the same species: i.e. human-to-human. Biopsy A tissue sample from the body, removed and examined under a microscope to diagnose fro disease, determine organ rejection, or assess donated organ or tissues. Chronic Developing slowly and lasting for a long time, possible the rest of person’s life. e.g. chronic kidney disease

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Split Liver Transplantation The division of a donor liver into parts in order to transplant the tissue into a child or small recipient En bloc Kidney Transplantation the transplant of both kidneys into a single receiver and using the donor aorta and vena cava for vascular anastomosis. Cold Ischemia Time or CIT or in surgery The time between the chilling of a tissue, organ, or body part after its blood supply has been reduced or cut off and the time it is warmed by having its blood supply restored. This can occur while the organ is still in the body or after it is removed from the body if the organ is to be used for transplantation.

Kidney Donor Risk Index or KDRI Is an estimate of the relative risk of post-transplant kidney graft failure (in an average, adult recipient) from a particular deceased donor compared to the median (50th percentile) donor. Expanded-criteria donors or ECD Refer to older kidney donors (≥60 yr) or donors who are aged 50 to 59 yr and have two of the following three features: Hypertension, terminal serum creatinine >1.5 mg/dl, or death from cerebrovascular accident.

Standard Criteria Donor or SCD Is a donor who is under 50 years of age and suffered brain death from any number of causes. This would include donors under the age of 50 who suffer from traumatic injuries or other medical problems such as a stroke.

Abbreviations:

SCOT: Saudi Center for Organ Transplantation

NFK: National Kidney Foundation

DBD: Donation After Brain Death

DD: Deceased Donor

PMP: Per Million Population

CVA: Cerebrovascular accident

MVA: Motor Vehicle Accident

ICU: Intensive Care Unit

FFH: Fall from Height

DHT: Direct Head Trauma

CNS: Central Nervous System

GCC: Gulf Cooperation Council

MOH: Ministry of Health

Gov’t: Government

HFV: Heart for Valves

HCV: hepatits C Virus

TB: Tuberculosis

LR: Living Related

LUR: Living Unrelated

MSCT: Musculoskeletal Connective Tissue

SCD: Standard Criteria Donor

ECD: Expanded-criteria donors

KDRI: Kidney Donor Risk Index

CIT: Cold Ischemia Time

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Index:

Tables:

I. Deceased Donors after Brain Death & Organ Donation I.1: Critical pathway of deceased organ donation, region wise in 2014 I.2: Cause of death among possible DBD donors in 2014 I.3: Cause of death among possible DBD donors in 1986-2014 I.4: Reasons of not utilized actual DBD donors 2014 I.5: distribution of possible, consented and actual deceased donors according to region I.6: Hospitals with ICU's Having More than 20 Beds I.7: Hospitals with ICU’s Having 10 to 20 Beds 1.8: Hospitals with ICU’s Having Less than 10 Beds I.9: Hospitals outside the Kingdom of Saudi Arabia I.10 Total Number of Brain Death

II. Organ Transplantation II.1: Kidney Transplantation II.1.1: Living and deceased kidney transplantation II.1.2: Deceased kidney donor characteristics II.1.3: Deceased kidney donation 2014 II.1.4: Deceased kidney donation 1986-2014 II.1.5: Deceased kidney transplantation II.1.6: Reasons of non-recovered deceased kidneys II.1.7: Major Causes of non-recovered deceased kidneys 2014 II.1.8: Reasons of discarded deceased kidneys 2014 II.1.9: Causes of discarded deceased kidneys 1986-2014 II.1.10: Adult and pediatric deceased kidney transplantation II.1.11: Transplanted deceased ECD kidneys II.1.12: Age distribution between deceased kidney donor and recipients 2014 II.1.13: Living kidney transplantation 2014

II.2: Liver Transplantation II.2.1: living and deceased liver transplantation II.2.2: Deceased liver donation 2014 II.2.3: Deceased liver donor characteristics II.2.4: Livers from deceased donors 1994-2014 II.2.5: Deceased liver transplantation 2014 II.2.6: Reasons of non-recovered deceased livers II.2.7: Major causes of non-recovered deceased livers (2014) II.2.8: Major causes of non-recovered deceased livers (1994-2014) II.2.9: Reasons of discarded deceased livers 2014 II.2.10: Causes of discarded deceased livers 1994-2014

II.2.11: Adult and pediatric deceased liver transplantation II.2.12: Age distribution between deceased liver donor and recipients 2014 II.2.13: living liver transplantation

II.3: Heart Transplantation II.3.1: Deceased heart donation 2014 II.3.2: Deceased heart donor characteristics II.3.3: Deceased heart donation 1986-2014 II.3.4: Deceased hearts transplantation II.3.5: Heart for valve recovery and utilization II.3.6: reasons of non-recovered deceased hearts II.3.7: Adult and pediatric deceased heart transplantation II.3.8: Age distribution between deceased heart donor and recipients 2014

II.4: Lung Transplantation II.4.1: Lungs from deceased donation 2014 II.4.2: Deceased Lung Donor Characteristics II.4.3: Deceased Lung Transplantation 2014 II.4.4: deceased lung Transplantation Activity 1991-2014 II.4.5: Reasons of non-recovered deceased lungs II.4.6: Major causes of non-recovered lungs 2014 II.4.7: Reasons of discarded deceased lungs II.4.8: Adult and Pediatric Lung Transplantation II.4.9: Age distribution between deceased lung donor and recipients 2014

II.5: Pancreas Transplantation II.5.1: Pancreas from deceased donors 2014 II.5.2: Deceased pancreas donor characteristics II.5.3: deceased pancreas transplantation II.5.4: Reasons for non-recovered deceased pancreases II.5.5: Major causes of non-recovered deceased pancreas II.5.6: Reason of discarded pancreas II.5.7: adult and pediatric deceased pancreas transplantation

II.6: Corneal Transplantation II.6.1: Deceased Cornea Donor Characteristics II.6.2: Deceased corneal recovery II.6.3: Reasons for non-recovered deceased corneas Table II.6.4: Reason of discarded deceased corneas

II.7: Bone Transplantation II.7.1: Deceased bone and musculoskeletal connective tissue donor characteristics II.7.2: Deceased bone and MSCT recovery II.7.3: Reasons of non-recovered bones

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II.8: Organ Sharing between the Kingdom of Saudi Arabia and GCC Countries 2014 II.8.1: Recovery and transplantation activities from organ sharing program between the kingdom and other countries* 1996-2014, *Kuwait, Qatar, Bahrain and Spain II.8.2: Transplant activities from organ sharing program between the kingdom and other countries 1996-2014

Figures:

I. Deceased Donors after Brain Death & Organ Donation I.1: Critical Pathway of Organ Donation I.2: Critical pathway of deceased organ donation in 2014 I.3: Critical pathway of deceased organ donation 1986-2014 I.4: Annual trend of possible DBD donors over the years 1986-2014 I.5: age distribution of possible DBD donors 2014 I.6: age distribution of possible DBD donors 1986-2014 I.7: Sex distribution in possible DBD donors 2014 I.8: Sex distribution in possible DBD donors 1986-2014 I.9: Annual trend of potential DBD donors 1986-2014 I.10: Documented and non-documented possible DBD donors 2014 I.11: Documented and non-documented possible DBD donors 1986-2014 I.12: Annual trend of approached eligible DBD donors 1986-2014 I.13: approached and not-approached eligible DBD donors 2014 I.14: approached and not-approached eligible DBD donors 1986-2014 I.15: Consented and non-consented approached eligible DBD donors 2014 1.16: Consented and non-consented approached eligible DBD donors 1986-2014 I.17: Annual trend of consented eligible DBD donors 1986-2014 1.18: Annual trend of actual DBD donor 1986-2014 I.19: Recovered and non-recovered consented eligible DBD donor 2014 I.20: Recovered and non-recovered consented eligible DBD donor 1986-2014 I.21: Transportation used during organ recovery 2014 I.22: Annual trend of ICUs contributing in deceased donation program

II. Organ Transplantation

II.1: Kidney Transplantation II.1.1: Cumulative living and deceased kidney II.1.2: Cumulative deceased kidney transplantation II.1.3: cumulative living kidney transplantation

II.2: Liver Transplantation II.2.1: Cumulative living and deceased liver transplantation in KSA

II.3: Heart Transplantation II.3.1: Cumulative deceased heart transplantation and recovered hearts as source of valves in Saudi Arabia 1986-2014

II.4: Lung Transplantation II.4.1: Cumulative deceased lung transplantation 1991-2014

II.5: Pancreas Transplantation II.5.1: Cumulative deceased pancreas transplantation II.6: Corneal Transplantation II.6.1: cumulative corneal recovery

II.7: Bone Transplantation II.7.1: cumulative recovered deceased bones and

II.8: Organ Sharing between the Kingdom of Saudi Arabia and GCC Countries 2014 II.8.1: Cost of organ and tissue utilized inside and outside the Kingdom in 2014 (Million SR) II.8.2: comparison of estimated total cost of organs and tissues transplanted inside and outside the Kingdom in 2014 II.8.3: Total number of deceased organs and tissues utilized 1986-2013 II.8.4: Total deceased organs and tissues transplanted in KSA 1986-2014

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