Contents - Stop Organ Trafficking Now
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Contents - Stop Organ Trafficking Now
Contents Page Preface 1 Hemodialysis 3 Hemodialysis Data in KSA 6 Map of Dialysis Centers in KSA 46 47 Peritoneal Dialysis Peritoneal Dialysis Data in KSA 48 Renal Replacement Therapy 54 Prevalence and Incidence of Dialysis Patients 55 Deceased Heart Beating Donor and Organ Donation 56 Deceased Donor Epidemiology 2011 59 Deceased Donor Epidemiology 1986-2011 64 Hospitals Sharing in Organ Donation Program 70 Organ Transplantation 76 Kidney Transplantation 78 Map of Renal Transplant Centers in KSA 82 Liver Transplantation 83 Heart Transplantation 88 Lung Transplantation 90 Bone Transplantation 92 Corneal Transplantation 93 Deceased Organ Transplantation 96 97 Appendices 1 - Responsibilities of SCOT 98 2 - General Regulations for Organ Transplantation in the KSA 99 3 - Memorandum by the Minister of Health on Deceased Organ Donation 103 4 - Official Statement of the National Committee for the Diagnosis of Death by Neurological Criteria and Ventilator System 104 5 - Purport of the Senior Ulama Commission 105 6- Resolutions of the Council of Islamic Jurisprudence on Resuscitation Apparatus 106 0 RENAL REPLACEMENT THERAPY ORGAN DONATION AND TRANSPLANTATION IN THE KINGDOM OF SAUDI ARABIA Preface The annual report 2012 highlights the present status of renal replacement therapy in the Kingdom of Saudi Arabia. The report is classified into dialysis- hemo and peritoneal-, organ donation and organ transplantation sections. All necessary steps have been undertaken by the Medical Department at the Saudi Center for Organ Transplantation (SCOT), to ensure accuracy. SCOT is the central body coordinating renal replacement therapy throughout the Kingdom. The data are provided in table and graphic forms and each section has a brief introduction highlighting the salient aspects of the data contained in the relevant section. 1 Kingdom of Saudi Arabia according 13 Emirates Surface Area: 2.25 Million Square Kilometers Total Population: 28.4 Million 2 Hemodialysis 2012 3 Dialysis: Introduction From a solitary center in 1971, rapid expansion has occurred in dialysis facilities in the Kingdom of Saudi Arabia. There are presently 182 dialysis centers having 4992 machines catering to 12844 patients. The ministry of health offers a large percentage of these facilities with contributions made by the Non-MOH government sectors as well as the private sector. Among patients on dialysis, males (55%) slightly out number females (45%). The maximum number of patients is in the socially highly productive age-group of 26 to 55 years. About 6.8% of the dialysis patients are older than 75 years and only 1.8% is less than 15 years. Hepatitis B seems to be in good control (4.0%) while hepatitis C continues to be a problem (19% positive) among dialysis patients, but there is a significant decrease in prevalence from 69% in 1996 to 19% in 2012. Of the 12844 patients on dialysis, about 24% are in the active waiting list for transplantation with another 20% being evaluated for inclusion in the waiting list. It is worthwhile to mention that 31% of the dialysis patients are hypertensive, 14% are diabetic in addition to 30% suffer of both diabetes and hypertension. The proportion of hemodialysis patients treated by Erythropoietin is 83%, and it ranges between 12% and 100% according to center and health sector. Patients with Hematocrit less than 30% represent 23.4% of the hemodialysis patients while those with albumin less than 30g/dl constitute only 16.6%. Patients also differ greatly with respect to the type of vascular access used; with 69% of them use AVF, 15% on Jugular Cath., 6% V. Graft and 10% others types of vascular access . 4 Active patients with serum phosphorus greater than 1.9 mmol/L (6 mg/dl) represent 25.3% of the hemodialysis patients, whereas, patients with serum calcium less than 2.1 mmol/L (8.4mg/dl) are 24.6%. Vitamin D is used only by 15.3% of patients as injection while 79.1% of them take it orally. Of the total 5612 diabetic HD patients, 47.6% (2672 patients) are receiving insulin, 17.3% (970 patients) receiving oral hypoglycemic agents, and 25.3% (1418 patients) receiving diet only. On the other hand, patients diagnosed of having hyperglycemia before or after dialysis were 2617 (46.6%) and 525 (9.4%) respectively. Out of the total number of the 182 dialysis centers, 67.6% of which gets support from social workers while 73.1% from dietitian’s services. There has been a constant increase in the number of patients on dialysis over the years and at the present rate it is expected that the number will exceed 15,000 patients by the end of year 2015. 5 Hemodialysis Centers in Saudi Arabia Riyadh Region MOH Hospitals Hospital Name King Saud Medical Complex Yamama Hospital King Saud Chest Hospital Prince Salman Hospital. Al Iman General Hospital Children's Hospital (RMC) Prince Salman Kidney Center King Khalid Hospital, Kharj Afif General Hospital Wadi Dawasser General Hospital King Khalid Hospital, Majma'ah Dawadmi General Hospital Al Qawaeyah General Hospital Al Aflaj General Hospital Al Sulayel General Hospital Hotat Bani Tamim General Hospital Hotat Sudair General Hospital Shagrah General Hospital Al Zulfi General Hospital Huraimala General Hospital Ruwaidah General Hospital Tumair General Hospital Al Muzahmiyah General Hospital Sajir General Hospital * Thadiq General Hospital Nafee General Hospital Artawiyah General Hospital Al Ghat General Hospital King Fahad Medical City Prince Salman Bin Mohammed Dilem Total Consultant Nephrologists Nephrology Specialists GP's Nurses 0 0 1 0 1 2 3 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 16 16 1 0 3 1 4 8 2 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 7 1 47 28 2 2 3 2 0 12 3 0 2 1 2 3 1 2 1 1 2 2 1 1 1 2 2 1 1 2 1 4 0 85 186 22 14 18 14 7 68 28 8 13 13 12 4 9 4 6 7 7 9 4 2 5 4 2 3 4 5 5 30 5 518 6 No. of Outlet Connections 73 13 16 17 24 9 96 28 10 20 10 20 8 18 14 14 6 12 17 10 8 4 10 8 7 13 8 6 12 14 525 Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 149 23 24 29 26 9 163 58 19 32 20 25 9 27 12 16 13 18 16 9 8 4 10 7 7 9 17 6 18 7 790 305 64 31 81 49 14 350 115 40 65 33 48 17 43 11 17 7 28 27 13 16 3 16 12 7 10 10 8 0 18 1458 390 39 0 0 0 0 0 1 0 1 1 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 0 527 Data on Hemodialysis Patients in Saudi Arabia Riyadh Region Hospital Name King Saud Medical Complex Yamama Hospital King Saud Chest Hospital Prince Salman Hospital Al Iman General Hospital Children’s Hospital (RMC) Prince Salman Kidney Center King Khalid Hospital, Kharj Afif General Hospital Wadi Dawasser General Hospital King Khalid Hospital, Majma’ah Dawadmi General Hospital Al Qawaeyeh General Hospital Al Aflaj General Hospital Al Sulayel General Hospital Hotat Bani Tamim General Hospital Hotat Sudair General Hospital Shagrah General Hospital Al Zulfi General Hospital Huraimala General Hospital Ruwaidah General Hospital Tumair General Hospital Al Muzahmiyah General Hospital Sajir General Hospital * Thadiq General Hospital Nafee General Hospital Artawiyah General Hospital Al Ghat General Hospital King Fahad Medical City Prince Salman Bin Mohammed Dilem Total NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 151 0 27 0 7 6 0 15 1 1 0 1 0 1 1 1 0 1 1 2 0 1 2 1 1 0 0 4 0 2 20 12 5 9 20 2 108 110 10 16 3 6 4 3 2 7 1 7 5 2 7 1 4 3 0 3 1 2 0 5 11 3 0 3 0 0 26 6 2 2 22 1 0 0 0 0 0 0 0 0 0 0 2 1 0 0 2 1 0 0 11 12 8 26 2 0 55 56 7 7 11 5 1 10 2 4 1 2 7 2 4 0 0 2 0 0 2 0 0 5 15 0 0 0 0 13 43 0 0 2 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 12 6 0 0 5 0 2 0 10 2 1 12 2 8 1 1 0 2 1 2 0 0 5 3 0 3 2 0 0 2 120 13 10 1 5 0 72 5 0 0 4 0 2 0 0 3 0 1 0 0 0 0 3 0 0 4 2 0 0 3 70 15 8 39 20 9 84 32 10 24 10 24 6 13 5 5 2 19 13 7 5 0 2 7 5 2 6 0 0 7 50 28 7 25 15 0 54 42 17 41 11 21 7 18 5 6 5 6 6 6 10 2 8 5 2 4 2 3 0 5 14 1 1 10 8 0 18 17 9 8 4 0 5 4 3 2 1 1 3 0 1 2 0 2 0 3 2 0 0 2 227 378 82 242 76 82 248 449 411 121 7 Hemodialysis Centers in Saudi Arabia Makkah / Jeddah /Taif Region Hospital Name King Fahd Hospital, Jeddah King A Aziz Hospital & Oncology Center, Jeddah Al Noor Specialist Hospital, Makkah King Abdul Aziz Hospital, Makkah King Faisal Hospital, Makkah Basharahil Hospital, Makkah King Abdul Aziz Specialist Hospital, Taif Rabiq General Hospital Al Qunfudah General Hospital Turabah General Hospital Al Khurmah General Hospital Adhum General Hospital Raniah General Hospital Messan General Hospital * Al Laith General Hospital Total Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 4 8 12 101 71 76 669 1050 2 2 4 17 17 36 45 4 4 0 1 1 8 4 2 0 9 5 2 0 99 45 18 2 72 30 23 3 94 77 17 3 450 160 48 13 50 12 0 0 4 8 0 86 79 80 479 25 0 0 0 0 0 0 0 2 0 2 0 0 0 0 0 1 0 6 1 1 0 1 1 1 6 32 3 2 5 4 3 7 9 32 18 9 12 10 6 11 12 62 23 13 13 10 6 15 30 124 33 24 16 23 8 21 0 0 0 0 0 0 0 0 18 35 43 430 402 537 2143 1141 8 Data on Hemodialysis Patients in Saudi Arabia Makkah / Jeddah / Taif Region Hospital Name King Fahd Hospital, Jeddah King A.Aziz Hospital and Oncology Center, Jeddah Al Noor Specialist Hospital, Makkah King Abdul Aziz Hospital, Makkah King Faisal Hospital, Makkah Basharahil Hospital, Makkah King Abdul Aziz Specialist Hospital, Taif Rabiq General Hospital Al Qunfudah General Hospital Turabah General Hospital Al Khurmah General Hospital Adhum General Hospital Raniah General Hospital Messan General Hospital * Al Laith General Hospital Total NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 97 72 19 196 7 22 0 247 288 79 0 12 0 17 0 0 4 16 8 3 20 54 26 242 6 18 18 219 64 41 9 28 5 52 0 6 32 28 73 21 3 11 11 10 0 0 12 1 0 0 1 1 15 2 10 3 10 5 3 1 66 182 19 92 7 21 51 76 80 55 3 4 1 0 0 1 0 0 8 34 9 6 5 11 0 8 0 2 0 0 0 4 0 0 5 37 4 4 5 4 4 3 1 2 0 0 0 0 0 3 5 6 6 0 1 0 0 2 0 7 0 2 0 5 0 0 13 41 16 10 8 6 1 17 7 32 12 12 1 9 5 1 5 21 1 4 1 2 2 1 215 450 75 678 26 89 136 711 607 240 9 Hemodialysis Centers in Saudi Arabia Madina Region Hospital Name King Fahad Hospital, Madina Yanbu General Hospital Prince A.M.H.Al Ulla Bader General Hospital Khaiber General Hospital Al Mahd General Hospital Al Hanakiyah General Hospital Al Eass General Hospital Total 76 28 8 20 13 18 30 7 Total No. of HD Machines 136 24 18 15 13 18 23 9 Total HD Pts. 2012 493 60 31 21 18 30 38 21 No. of Follow up Tx. Pts 2012 130 0 0 0 0 0 0 0 200 256 712 130 Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections 4 0 0 0 0 0 0 1 5 3 1 1 1 1 1 1 6 1 0 0 0 0 1 0 110 21 10 4 6 6 9 4 5 14 8 170 Data on Hemodialysis Patients in Saudi Arabia Madina Region Hospital Name NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 King Fahd Hospital, Madina Yanbu General Hospital Prince A.M.H.Al Ulla Bader General Hospital Khaiber General Hospital Al Mahd General Hospital Al Hanakiyah General Hospital Al Eass General Hospital 75 7 0 0 0 0 2 1 138 3 11 2 6 8 9 9 14 1 1 1 0 4 5 0 95 7 5 2 1 3 1 0 17 0 0 0 0 0 1 1 10 7 3 0 0 5 3 1 70 8 2 1 0 1 0 4 100 20 7 5 4 16 7 14 135 18 15 3 12 10 19 2 46 1 12 1 0 1 4 0 Total 85 186 26 114 19 29 86 173 214 65 10 Hemodialysis Centers in Saudi Arabia Tabuk Region Hospital Name Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 1 0 0 0 0 0 0 2 0 2 1 0 1 0 7 2 0 1 2 0 2 24 8 7 7 8 6 3 22 21 16 14 13 13 12 45 21 16 14 7 13 6 110 32 15 12 23 35 13 128 0 5 5 0 0 1 1 6 14 63 111 122 240 139 King Khalid Hospital Tabuk Dhuba General Hospital Haql General Hospital Al Wajeh General Hospital Tayema General Hospital Hawraa Amloj General Hospital Al Bada General Hospital Total Data on Hemodialysis Patients in Saudi Arabia Tabuk Region Hospital Name King Khalid Hospital Tabuk Dhuba General Hospital Haql General Hospital Al Wajeh General Hospital Tayema General Hospital Hawraa Amloj General Hospital Al Bada General Hospital Total NonSaudi Pts New Pts. 2012 HBsAg+ve HCV+ve Pts Pts 17 3 0 1 0 43 4 4 1 4 10 1 0 1 0 1 5 0 22 Hypertensive Pts Both HD Pts. Died 2012 40 10 4 3 12 45 4 4 7 10 12 2 1 1 1 3 16 5 1 0 1 9 0 0 22 43 94 75 18 Pts < 15 Yrs Pts > 75 yrs 38 4 3 3 1 0 0 0 0 0 10 0 1 2 2 Diabetic Pts 25 6 7 1 0 0 2 1 7 4 2 2 0 65 14 53 1 11 Hemodialysis Centers in Saudi Arabia Eastern / Al Hasa / Hafar Al Batin Region Hospital Name Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 6 3 2 0 2 0 0 0 8 4 2 3 0 0 1 1 12 9 2 5 3 1 1 2 243 90 36 31 25 8 8 8 72 71 14 42 36 8 4 16 121 80 40 45 23 9 6 23 398 288 93 116 49 15 12 25 61 111 45 39 10 0 0 0 13 19 35 449 263 347 996 266 Dammam Medical Complex King Fahad Hospital, Hofuf Qatif Central Hospital King Khalid Hospital, Hafr Al Batin Al Jubail General Hospital Abgaig General Hospital Al Gaissoma General Hospital Al Niyeriah General Hospital Total Data on Hemodialysis Patients in Saudi Arabia Eastern / Al Hasa / Hafar Al Batin Region Hospital Name Dammam Medical Complex King Fahad Hospital, Hofuf Qatif Central Hospital King Khalid Hospital, Hafr Al Batin Al Jubail General Hospital Abgaig General Hospital Al Gaissoma General Hospital Al Niyeriah General Hospital Total NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs 60 14 2 70 107 14 11 6 0 61 40 14 1 4 4 9 26 0 Diabetic Pts 5 53 2 6 37 2 8 0 11 6 1 0 1 19 3 0 2 5 0 0 0 4 2 2 2 0 0 0 0 90 252 24 133 9 12 Hypertensive Pts Both HD Pts. 2012 158 82 25 146 134 66 35 38 4 55 57 4 21 3 2 2 3 12 3 4 1 17 4 4 8 6 6 4 14 4 0 0 1 56 135 355 380 103 Hemodialysis Centers in Saudi Arabia Qassim Region Hospital Name Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 5 1 1 0 0 0 0 0 0 0 0 5 2 1 0 2 0 0 0 0 0 0 4 5 0 1 2 2 1 1 1 1 1 38 30 21 11 18 10 4 6 4 3 3 27 20 20 17 25 13 7 9 10 10 9 43 37 33 21 40 21 10 11 20 9 7 160 107 62 32 67 40 11 10 10 9 8 35 4 1 0 0 0 0 0 0 0 0 7 10 19 148 167 252 516 40 King Fahad Specialist Hospital, Buraidah Buraidah Central Hospital King Saud Hospital, Unaiza Al Bukariyah General Hospital Al Rass General Hospital Al Midnab General Hospital Ayun Al Juwah General Hospital Dhariyah General Hospital Riyadh Al Khabra General Hospital Qiba General Hospital Oklat Al Sugour General Hospital Total Data on Hemodialysis Patients in Saudi Arabia Qassim Region Hospital Name King Fahad Specialist Hospital, Buraidah Buraidah Central Hospital King Saud Hospital, Unaiza Al Bukariyah General Hospital Al Rass General Hospital Al Midnab General Hospital Ayun Al Juwah General Hospital Dhariyah General Hospital Riyadh Al Khabra General Hospital Qiba General Hospital Oklat Al Sugour General Hospital Total NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs 11 7 5 0 0 0 0 0 0 0 0 39 27 15 9 7 2 4 2 1 2 3 6 2 2 2 3 2 1 1 1 1 0 17 12 15 3 8 8 3 3 1 2 0 1 0 1 0 1 1 0 0 0 0 0 8 11 3 4 7 1 0 4 2 1 1 Diabetic Pts 29 7 4 0 16 1 0 1 1 1 1 23 111 21 72 4 42 61 13 Hypertensive Pts Both HD Pts. Died 2012 67 45 12 14 12 18 4 5 3 3 5 51 43 16 11 24 17 4 1 5 2 1 23 17 15 1 7 5 1 1 3 1 1 188 175 75 Hemodialysis Centers in Saudi Arabia Al-Baha Region Hospital Name King Fahd Hospital, Al Baha Beljurashi General Hospital Al Mikhwah General Hospital Gilwah General Hospital Al Mandag General Hospital Total Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 0 1 0 0 0 1 1 1 1 1 2 2 1 1 2 20 16 11 8 5 17 24 20 18 10 55 41 23 18 10 68 54 48 22 13 0 0 0 0 0 1 5 8 60 89 147 205 0 Data on Hemodialysis Patients in Saudi Arabia Al- Baha Region Hospital Name NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 King Fahad Hospital, Al Baha Beljurashi General Hospital Al Mikhwah General Hospital Gilwah General Hospital Al Mandag General Hospital 3 1 0 1 0 17 6 4 5 2 2 2 2 1 0 25 9 12 6 1 1 1 0 0 0 6 3 3 3 6 5 3 2 1 1 17 28 20 10 1 27 19 5 4 9 4 4 4 2 1 Total 5 34 7 53 2 21 12 76 64 15 14 Hemodialysis Centers in Saudi Arabia Al-Jouf Region Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 Prince A.R.Sudeiry Hospital, Sakaka 0 4 3 37 32 67 110 0 Tabarjal General Hospital 0 1 1 8 16 18 23 0 Domat Al Jundal Hospital 0 1 3 9 23 24 37 0 0 6 7 54 71 109 170 0 Hospital Name Total Data on Hemodialysis Patients in Saudi Arabia Al-Jouf Region HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 0 13 2 11 57 35 18 10 11 1 4 1 0 6 2 3 5 1 8 0 3 0 11 3 5 10 5 7 42 1 20 3 22 66 42 31 20 NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts Prince A.R.Sudeiry Hospital, Sakaka 6 23 Tabarjal General Hospital 0 Domat Al Jundal Hospital Hospital Name Total 15 Hemodialysis Centers in Saudi Arabia Northern Borders / Qurrayat Region Hospital Name Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 0 2 0 0 0 2 0 0 0 0 2 2 3 1 2 16 20 12 11 3 32 53 41 16 10 42 40 36 22 10 48 63 42 26 5 9 42 0 1 0 2 2 10 62 152 150 184 52 Al Qurrayat General Hospital Ar Ar Central Hospital Rafha General Hospital Turaif General Hospital Al Owaigila General Hospital Total Data on Hemodialysis Patients in Saudi Arabia Northern Borders / Qurrayat Region Hospital Name Al Qurrayat General Hospital Ar Ar Central Hospital Rafha General Hospital Turaif General Hospital Al Owaigila General Hospital Total Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 1 4 8 4 14 6 0 0 4 0 0 0 4 2 2 3 20 11 3 12 2 57 10 10 15 8 1 0 1 0 1 0 3 2 0 8 28 1 13 42 24 93 30 NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts < 15 Yrs Pts 3 18 3 23 0 0 0 0 11 5 0 4 1 0 1 3 35 16 Hemodialysis Centers in Saudi Arabia Hail Region Hospital Name Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 King Khalid Hospital, Hail Hail General Hospital Baqaa General Hospital Al Sulaymi General Hospital Al Shammali General Hospital Samira General Hospital 1 0 0 0 0 0 3 0 0 0 0 0 4 2 2 1 1 1 25 4 5 2 5 3 60 10 12 4 6 8 88 9 16 4 9 7 186 12 26 8 18 13 38 0 2 0 0 0 Total 1 3 11 44 100 133 263 40 Data on Hemodialysis Patients in Saudi Arabia Hail Region Hospital Name NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs King Khalid Hospital, Hail Hail General Hospital Baqaa General Hospital Al Sulaymi General Hospital Al Shammali General Hospital Samira General Hospital 8 1 0 0 0 0 76 4 13 2 4 5 3 0 0 0 1 0 37 3 1 1 2 2 4 0 0 1 0 0 20 0 3 0 3 6 Diabetic Pts 67 0 3 0 1 0 Total 9 104 4 46 5 32 71 17 Hypertensive Pts Both HD Pts. Died 2012 38 2 7 5 5 3 29 5 16 3 9 9 38 1 2 0 6 3 60 71 50 Hemodialysis Centers in Saudi Arabia Gizan Region Hospital Name Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 1 0 1 0 3 2 3 0 4 1 0 0 65 22 35 3 70 25 26 3 99 56 38 4 290 140 202 3 96 0 0 0 2 8 5 125 124 197 635 96 King Fahad Central Hospital, Jizan Samtah General Hospital Sabiah General Hospital Fursan General Hospital Total Data on Hemodialysis Patients in Saudi Arabia Gizan Region Hospital Name NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 King Fahad Central Hospital, Jizan Samtah General Hospital Sabiah General Hospital Fursan General Hospital 39 76 22 63 6 10 12 133 23 53 20 31 0 24 34 1 13 15 0 62 29 0 1 2 0 13 9 1 9 27 1 30 63 1 15 26 1 21 29 1 Total 90 135 50 154 9 33 49 227 65 104 18 Hemodialysis Centers in Saudi Arabia Najran Region Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 Prince Sultan Center for Kidney Diseases, Najaran 1 2 1 33 30 68 106 0 Sharurah General Hospital 0 1 2 9 28 23 33 0 Habona General Hospital 0 0 2 4 10 9 10 0 1 3 5 46 68 100 149 0 Hospital Name Total Data on Hemodialysis Patients in Saudi Arabia Najran Region NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Prince Sultan Center for Kidney Diseases, Najaran 27 23 5 18 0 8 Sharurah General Hospital 2 6 4 5 1 Habona General Hospital 0 3 0 0 29 32 9 23 Hospital Name Total 19 Hypertensive Pts Both HD Pts. Died 2012 16 34 29 13 4 5 6 9 4 0 2 0 1 6 1 1 14 21 41 44 18 Diabetic Pts Hemodialysis Centers in Saudi Arabia Assir / Bisha Region Hospital Name Assir Kidney Center K.A.A.Daughters' Charity Center Khamis Mushayt General Hospital Mohayel General Hospital Sarat Obaidah General Hospital Al Majarah General Hospital Al Nammas General Hospital Tathleeth General Hospital Dharan Al Janoub Hospital Balasmar General Hospital Besha General hospital, (Psych.Hospital) Rijal Almaa General Hospital Sabt Al Alayah General Hospital Ahad Rufaida General Hospital Total Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 0 1 0 0 0 0 0 0 0 0 2 2 1 1 1 1 2 1 1 1 5 2 0 1 0 1 0 0 0 1 49 48 15 19 5 8 7 6 5 2 29 38 16 35 20 11 15 16 14 11 45 48 26 55 22 22 15 17 14 10 208 153 56 113 19 58 30 20 36 29 45 0 0 1 0 0 0 0 4 0 1 1 2 22 52 40 95 0 0 0 0 0 0 1 2 1 1 5 7 8 10 14 8 12 12 10 18 30 28 0 0 0 2 15 16 206 289 348 893 50 20 Data on Hemodialysis Patients in Saudi Arabia Assir / Bisha Region HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both 9 0 1 11 0 3 0 0 0 0 28 28 7 49 4 8 2 11 6 4 1 0 0 0 0 0 0 0 0 0 7 5 0 1 4 15 4 3 3 3 10 10 0 20 0 1 2 0 5 0 47 57 32 58 7 20 11 6 12 19 25 35 19 18 10 10 14 14 14 10 HD Pts. Died 2012 7 14 8 24 2 8 6 2 1 3 6 2 14 0 7 4 36 46 12 0 0 0 3 12 1 1 0 0 2 4 14 0 0 0 3 5 0 9 1 0 8 8 18 1 14 6 2 5 1 32 149 27 181 1 60 62 339 236 95 NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts Assir Kidney Center K.A.A.Daughters' Charity Center Khamis Mushayt General Hospital Mohayel General Hospital Sarat Obaidah General Hospital Al Majardah General Hospital Al Nammas General Hospital Tathleeth General Hospital Dharan Al Janoub Hospital Balasmar General Hospital Besha General Hospital, (Psych.Hospital) Rijal Almaa General Hospital Sabt Al Alayah General Hospital Ahad Rufaida General Hospital 9 15 2 1 0 1 0 0 3 1 31 13 11 15 4 24 10 5 8 6 0 Total Hospital Name 21 GOVT. NON-MOH Hospitals Hospital Name King Faisal Specialist Hospital, Riyadh King Abdulaziz Medical City, Riyadh (KFNGH) Armed Forces Hospital, Riyadh King Khalid University Hospital, Riyadh Security Forces Hospital, Riyadh Khamis Mushyat .Military Hospital North West Armed Forces Hospital, Tabuk Al Hada Military Hospital, Taif King Fahad Military Complex, Dhahran King Fahad Armed Forces Hospital, Jeddah King Fahad University Hospital, Al Khobar King Abdulaziz Medical City, Jeddah (KKNGH) King Faisal Specialist Hospital, Jeddah King Abdul Aziz University Hospital, Jeddah King Khalid Medical City, Hafr Al Batin Royal Com. Hospital Jubail (Ex. Al Fanater) Dhahran Health Center (ARAMCO) * Royal Commission Medical Center, Yanbu King Abdul Aziz Medical City, Ahsa (NG) Al Kharj Military Industrial Corp. Hospital Al Khafji Joint Operation Hospital King Fahad Specialist Hospital - Dammam Total Hemodialysis Centers in Saudi Arabia Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 7 4 0 40 65 76 112 No. of Follow up Tx. Pts 2012 1534 6 4 5 95 40 56 251 650 6 8 5 7 3 4 3 4 4 6 8 8 14 4 4 4 8 2 3 0 0 1 0 0 0 4 2 91 46 21 72 50 40 28 44 24 79 14 12 44 38 44 18 35 12 101 34 35 60 49 51 31 48 18 285 66 57 189 194 147 48 170 64 750 122 8 468 210 13 0 208 1 3 3 0 26 18 26 108 114 2 3 0 1 4 1 2 0 1 4 4 4 0 1 0 1 0 2 0 1 0 0 3 1 0 0 3 0 0 0 34 15 11 16 24 15 20 6 5 10 21 15 7 16 11 24 12 10 10 8 38 18 11 16 22 16 27 12 7 7 127 53 6 55 19 63 72 31 10 16 57 0 0 4 181 1 0 0 4 0 78 82 22 733 553 759 2143 4325 22 GOVT. NON-MOH Hospitals Hospital Name King Faisal Specialist Hospital, Riyadh King Abdulaziz Medical City, Riyadh (KFNGH) Armed Forces Hospital, Riyadh King Khalid University Hospital, Riyadh Security Forces Hospital, Riyadh Khamis Mushayt .Military Hospital North West Armed Forces Hospital, Tabuk Al Hada Military Hospital, Taif King Fahad Military Complex , Dhahran King Fahad Armed Forces Hospital, Jeddah King Fahad University Hospital, Al Khobar King Abdulaziz Medical City, Jeddah (KKNGH) King Faisal Specialist Hospital, Jeddah King Abdul Aziz University Hospital, Jeddah King Khalid Medical City, Hafr Al Batin Royal Com. Hospital Jubail (Ex. Al Fanater) Dhahran Health Center (ARAMCO) * Royal Commission Medical Center, Yanbu King Abdul Aziz Medical City, Ahsa (NG) Al Kharj Military Industrial Corp. Hospital, Riyadh Al Khafji Joint Operation Hospital King Fahad Specialist Hospital - Dammam Total Data on Hemodialysis Patients in Saudi Arabia NonSaudi Pts 1 New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 18 2 35 6 6 6 36 60 9 2 70 7 44 6 32 90 80 90 36 2 7 2 0 0 0 0 0 10 88 5 10 43 133 46 11 25 6 15 4 3 7 5 6 6 15 0 27 13 16 22 15 9 2 27 9 6 1 0 6 7 6 0 0 0 31 6 5 25 25 23 4 0 7 1 29 18 61 40 30 14 53 5 59 23 11 84 30 40 32 61 13 107 14 9 52 76 37 8 46 25 35 5 5 24 63 27 6 10 28 0 17 2 13 0 10 0 2 50 19 24 85 0 4 3 20 6 8 12 6 21 12 0 1 12 6 20 15 15 8 0 3 3 3 0 2 18 5 22 20 0 1 0 2 0 0 6 1 6 0 0 0 0 0 0 0 6 3 3 10 0 2 0 11 11 1 6 4 31 10 3 24 6 9 30 4 4 4 4 12 2 4 0 5 0 5 10 16 1 2 0 2 4 12 0 1 0 1 0 1 2 0 1 4 3 5 4 7 3 4 82 656 76 256 54 229 412 570 685 318 23 Private Sector Hospitals Hospital Name Riyadh Care Hospital * Dr.A. Al Mishari Hospital, Riyadh Al Hammadi Hospital, Riyadh Al Khawalid Kidney Center, Riyadh Dar Al Shifa Hospital, Riyadh Saudi German Hospital ,Riyadh * Saudi German, Hospital Jeddah Dr.Suleiman Fakeeh Hospital, Jeddah Dr. Erfan & Bagedo, Jeddah Al Mustagbal H Hospital, Jeddah New Jeddah Clinic Hospital Al Mana Hospital, Dammam Al Takaful Al Khairy K.D.C. Makkah Charity Community Dialysis C. Makkah Asia Kidney Center, Makkah Al Moosa General Hospital, Ahsa Saad Specialist Hospital, Al Khober Sultan B.A Humanitarian City, Riyadh * Specialized Medical Center Hospital, Riyadh Al Ahsa Hospital Arab Medical Dar Dialysis Center, Riyadh Dr. A. Rahman Baksh, Jeddah Bugshan Hospital, Jeddah Total Hemodialysis Centers in Saudi Arabia Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 1 1 2 1 0 0 1 1 5 0 1 3 0 0 1 1 2 0 0 1 0 2 1 1 1 2 3 2 1 1 2 1 1 1 1 0 2 0 0 0 0 0 0 0 0 4 0 2 0 1 3 0 0 0 25 8 3 5 3 7 11 16 18 4 6 33 10 10 10 16 20 9 17 9 13 19 5 9 10 18 17 5 10 25 25 27 31 16 20 20 39 10 9 15 3 13 10 23 19 5 12 39 25 31 37 25 29 13 71 21 41 42 9 33 53 74 86 25 19 100 96 95 86 46 45 6 2 15 8 0 0 0 30 30 0 6 4 15 0 0 15 0 2 0 1 1 1 7 10 11 55 0 1 0 0 10 14 18 34 0 1 1 1 17 37 39 151 0 2 1 26 0 0 23 1 0 15 10 3 261 12 5 374 16 6 447 30 14 1232 6 1 134 24 Private Sector Hospitals (...contd.) Hospital Name Al Mouwasat Hospital, Dammam * Saudi German Hospital, Abha Saudi German Hospital, Madina Madina National Hospital. Al Mouwasat Hospital Al Qateef Ghodran Hospital, Beljurashi Al Faisal Polyclinic, Jeddah Dr. Suleiman Al Habeeb Medical Center, Riyadh Prin. Mansour Charity Dialysis Cent. Jeddah Taiba Dialysis Center, Makkah Al Bir Charity Dialysis Center (2) Jeddah Abdulkarim Bakr Medical Center, Jeddah Al Bir Clinic 1 Charity D.C , (AlKandara) , Jeddah Dr. Ali Lahibi Dialysis Center, Jeddah * International Renal Care Center, Jeddah Demas Dialysis Center, Riyadh Kingdom Hospital National Hospital, Riyadh Total Consultant Nephrologists 2 1 1 1 1 0 1 Hemodialysis Centers in Saudi Arabia No. Of Nephrology Total No. Of GP's Nurses Outlet Specialists HD Machines Connections 1 0 13 12 25 1 0 2 5 5 1 0 3 5 6 1 0 3 6 9 1 0 12 18 19 1 0 3 8 4 1 2 10 15 15 Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 53 8 18 16 46 5 76 5 0 5 0 1 2 0 3 0 2 4 4 3 12 5 2 2 0 18 26 21 157 0 1 1 1 1 1 2 0 1 0 8 10 17 30 26 21 34 26 23 98 70 80 0 0 0 0 1 1 8 16 21 58 0 1 2 1 0 0 2 2 1 1 1 2 0 0 0 0 26 15 9 3 3 21 28 25 3 2 27 28 25 4 3 93 65 32 8 10 0 4 0 3 0 45 44 23 428 645 745 2137 159 25 rivate Sector Hospitals Data on Hemodialysis Patients in Saudi Arabia 13 6 13 20 1 8 15 14 53 13 6 70 HD Pts. Died 2012 28 0 1 3 1 1 5 6 7 3 5 20 45 29 16 20 23 10 11 0 40 10 4 12 0 10 7 29 22 6 9 14 8 0 2 7 13 15 27 4 0 6 0 6 27 3 42 1 3 6 65 37 11 0 0 8 0 1 0 3 0 3 0 11 6 7 6 7 0 50 223 11 77 175 410 439 154 Non-Saudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs 14 13 34 42 8 24 10 19 24 22 7 21 22 10 10 4 4 6 17 29 14 12 11 28 4 0 0 9 0 0 0 8 0 3 0 1 7 4 3 8 0 8 6 4 18 3 2 5 0 0 1 0 0 0 0 0 2 0 0 0 2 0 0 1 0 2 5 5 4 0 2 10 95 5 7 34 0 1 4 94 82 1 5 1 9 19 11 1 1 8 9 0 1 0 27 33 6 2 1 4 0 1 0 0 0 3 14 8 1 28 29 0 0 1 2 11 0 2 Arab Medical Dar Dialysis Center, Riyadh 146 38 0 Dr. A. Rahman Baksh, Jeddah Bugshan Hospital, Jeddah 23 10 17 4 725 312 Hospital Name Riyadh Care Hospital * Dr.A. Al Mishari Hospital, Riyadh Al Hammadi Hospital, Riyadh Al Khawalid Kidney Center, Riyadh Dar Al Shifa Hospital, Riyadh Saudi German Hospital ,Riyadh * Saudi German Hospital, Jeddah Dr. Suleiman Fakeeh Hospital, Jeddah Dr. Erfan & Bagedo, Jeddah Al Mustagbal H Hospital, Jeddah New Jeddah Clinic Hospital Al Mana Hospital, Dammam Al Takaful Charity Socical K.D.C. Makkah Charity Community Dialysis C. Makkah Asia Kidney Center, Makkah Al Moosa General Hospital, Ahsa Saad Specialist Hospital ,Al Khobar Sultan B.A Humanitarian City, Riyadh * Specialized Medical Center Hospital, Riyadh Al Ahsa Hospital Sub-Total 26 Hypertensive Diabetic Pts Pts 27 31 1 12 0 28 3 17 0 7 10 11 20 10 20 27 0 27 0 10 2 4 2 12 Both Private Sector Hospitals (… contd.) Data on Hemodialysis Patients in Saudi Arabia Hospital Name NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 Sub-Total 725 312 50 223 11 77 175 410 439 154 Al Mouwasat Hospital, Dammam * Saudi German Hospital, Abha Saudi German Hospital, Madina Madina National Hospital Al Mouwasat Hospital Al Qateef Ghodran Hospital, Beljurashi Al Faisal Polyclinic, Jeddah Dr. Sulaiman Al Habeeb Medical Center, Riyadh Prince. Mansour Charity Dialysis Center, Jeddah Taiba Dialysis Center- Makkah Al Bir Charity Dialysis Center (2) Jeddah Abdulkarim Bakr Medical Center, Jeddah Dr. Ali Lahibi Dialysis Center, Jeddah * Riyadh or jeddah Al Bir Clinic 1 Charity D.C , (AlKandara) , Jeddah International Renal Care Center, Jeddah Demas Dialysis Center, Riyadh Kingdom Hospital National Hospital, Riyadh 7 4 1 1 0 0 74 7 4 6 1 15 0 17 0 0 0 0 0 0 0 2 2 1 0 8 0 12 0 0 0 0 0 0 0 7 0 3 2 13 0 0 2 0 6 12 3 0 5 8 4 2 4 15 0 36 28 3 10 0 27 5 31 0 0 3 0 3 0 6 2 9 0 2 0 1 0 3 4 1 147 33 0 16 1 4 21 7 22 15 93 68 64 25 11 21 4 8 0 20 18 8 2 0 0 0 2 6 2 6 9 43 25 23 30 14 37 11 6 15 7 43 3 10 1 12 10 28 38 12 58 5 0 15 0 0 7 14 11 7 13 30 4 6 30 11 2 6 4 1 0 0 7 4 1 0 0 0 0 1 6 0 1 0 0 13 0 1 13 3 1 1 33 5 5 3 6 0 7 0 1304 558 70 349 16 134 272 640 745 246 Total 27 Total No. of Hemodialysis Centers in MOH According to Region No. of Hospitals Consultant Nephrologists Nephrology Specialists GP's Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 Riyadh 30 16 47 85 518 525 790 1458 527 Makkah/Jeddah 15 18 35 43 430 402 537 2143 1141 Madina 8 5 14 8 170 200 256 712 130 Tabuk 7 1 6 14 63 111 122 240 139 Eastern 8 13 19 35 449 263 347 996 266 Qassim 11 7 10 19 148 167 252 516 40 Al Baha 5 1 5 8 60 89 147 205 0 Al Jouf 3 0 6 7 54 71 109 170 0 Northern Borders 5 2 2 10 62 152 150 184 52 Hail 6 1 3 11 44 100 133 263 40 Jizan 4 2 8 5 125 124 197 635 96 Najran 3 1 3 5 46 68 100 149 0 Assir 14 2 15 16 206 289 348 893 50 119 69 173 266 2375 2561 3488 8564 2481 Region Total 28 Total Data on Hemodialysis Patients in MOH According to Region NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 Riyadh 227 378 82 242 76 82 248 449 411 121 Makkah/Jeddah 215 450 75 678 26 89 136 711 607 240 Madina 85 186 26 114 19 29 86 173 214 65 Tabuk 22 65 14 53 1 22 43 94 75 18 Eastern 90 252 24 133 9 56 135 355 380 103 Qassim 23 111 21 72 4 42 61 188 175 75 Al Baha 5 34 7 53 2 21 12 76 64 15 Al Jouf 7 42 1 20 3 22 66 42 31 20 Northern Borders 3 35 8 28 1 13 42 24 93 30 Hail 9 104 4 46 5 32 71 60 71 50 Jizan 90 135 50 154 9 33 49 227 65 104 Najran 29 32 9 23 1 14 21 41 44 18 Assir 32 149 27 181 1 60 62 339 236 95 837 1973 348 1797 157 515 1032 2779 2466 954 Hospital Name Total 29 Region Total of Hemodialysis Centers in GOVT. NON-MOH Sector According to Region Total No. of No. of Consultant Nephrology No. of Outlet GP's Nurses HD Hospitals Nephrologists Specialists Connections Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 Riyadh 6 32 32 8 299 220 314 802 3214 Makkah/Jeddah 6 17 24 4 174 157 197 668 408 Tabuk 1 3 4 0 50 38 49 194 230 Eastern 8 19 8 9 138 94 139 290 190 Assir 1 7 14 1 72 44 60 189 468 22 78 82 22 733 553 759 2143 4510 Total Total Data on Hemodialysis Patients in GOVT. NON-MOH Sector According to Region NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Riyadh 16 195 31 140 19 85 Makkah/Jeddah 48 207 25 60 21 Tabuk 0 133 5 15 Eastern 18 78 8 Assir 0 43 82 656 Hospital Name Total Hypertensive Pts Both HD Pts. Died 2012 154 225 281 92 62 120 157 169 74 7 25 40 30 76 63 19 1 32 37 74 107 65 7 22 6 25 61 84 52 24 76 256 54 229 412 570 685 318 30 Diabetic Pts Region No. of Hospitals Total of Hemodialysis Centers in Private Sector According to Region Total No. of Consultant Nephrology No. of Outlet GP's Nurses HD Nephrologists Specialists Connections Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 Riyadh 14 12 12 8 129 194 214 584 33 Makkah/Jeddah 17 20 23 13 184 322 352 1182 96 Madina 2 2 2 0 6 11 15 34 5 Eastern 6 10 5 2 104 105 155 324 23 Al Baha 1 0 1 0 3 8 4 5 2 Assir 1 1 1 0 2 5 5 8 0 41 45 44 23 428 645 745 2137 159 Total Total Data on Hemodialysis Patients in Private Sector According to Region NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Riyadh 359 195 17 90 5 30 Makkah/Jeddah 903 279 51 231 10 Madina 2 7 0 1 Eastern 36 73 2 Al Baha 0 0 Assir 4 1304 Hospital Name Total Hypertensive Pts Both HD Pts. Died 2012 84 222 186 71 41 142 351 338 138 0 5 18 6 10 3 25 1 58 28 57 203 34 0 0 0 0 0 0 5 0 4 0 2 0 0 0 4 3 0 558 70 349 16 134 272 640 745 246 31 Diabetic Pts Total of Hemodialysis Centers in All Sectors According to Region Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 101 946 939 1318 2844 3774 81 60 773 857 1070 3930 1644 8 17 8 191 235 287 809 136 8 4 10 14 113 149 171 434 369 Eastern 22 42 32 46 691 462 641 1610 479 Qassim 11 7 10 19 148 167 252 516 40 Al Baha 6 1 6 8 63 97 151 210 2 Al Jouf 3 0 6 7 54 71 109 170 0 Northern Borders 5 2 2 10 62 152 150 184 52 Hail 6 1 3 11 44 100 133 263 40 Jizan 4 2 8 5 125 124 197 635 96 Najran 3 1 3 5 46 68 100 149 0 16 10 30 17 280 338 413 1090 518 182 192 299 311 3536 3759 4992 12844 7150 No. of Hospitals Consultant Nephrologists Nephrology Specialists GP's Riyadh 50 60 91 Makkah/Jeddah 37 54 Madina 11 Tabuk Region Assir Total 32 Riyadh Makkah/Jeddah Madina Tabuk Eastern Qassim Al Baha Al Jouf Northern Borders Hail Jizan Najran Assir NonSaudi Pts 602 1163 90 22 144 23 5 7 3 9 90 29 36 Total 2223 Hospital Name Total Data on Hemodialysis Patients in All Sectors According to Region New Hypertensive HBsAg+ve HCV+ve Pts < Pts > Diabetic Pts. in Pts Pts Pts 15 Yrs 75 yrs Pts 2012 768 130 472 100 197 486 896 914 149 963 57 189 387 1188 215 28 121 19 37 115 210 198 19 68 8 47 83 124 403 34 177 11 146 200 486 111 21 72 4 42 61 188 34 7 53 2 21 12 76 42 1 20 3 22 66 42 35 8 28 1 13 42 24 104 4 46 5 32 71 60 135 50 154 9 33 49 227 32 9 23 1 14 21 41 196 34 205 7 85 123 427 3187 494 2402 227 33 878 1716 3989 Both HD Pts. Died 2012 878 1105 233 151 690 175 69 31 93 71 65 44 291 284 448 72 81 202 75 15 20 30 50 104 18 119 3896 1518 Region Central Total of Hemodialysis Centers in MOH Sector According to Global Region No. of Total No. Total No. of Consultant Nephrology GP's Nurses Outlet of HD HD Pts. Hospitals Nephrologists Specialists Connections Machines 2012 41 23 57 104 666 692 1042 1974 No. of Follow up Tx. Pts 2012 567 Western 23 23 49 51 600 602 793 2855 1271 Eastern 8 13 19 35 449 263 347 996 266 Northern 21 4 17 42 223 434 514 857 231 Southern 26 6 31 34 437 570 792 1882 146 119 69 173 266 2375 2561 3488 8564 2481 Total Hospital Name Total Data on Hemodialysis Patients in MOH Sector According to Global Region New NonHypertensive HBsAg+ve HCV+ve Pts < Pts > Diabetic Saudi Pts. in Pts Pts Pts 15 Yrs 75 yrs Pts 2012 Pts Both HD Pts. Died 2012 Central 250 489 103 314 80 124 309 637 586 196 Western 300 636 101 792 45 118 222 884 821 305 Eastern 90 252 24 133 9 56 135 355 380 103 Northern 41 246 27 147 10 89 222 220 270 118 Southern 156 350 93 411 13 128 144 683 409 232 837 1973 348 1797 157 515 1032 2779 2466 954 Total 34 Region Central Total of Hemodialysis Centers in GOVT. NON-MOH Sector According to Global Region Total No. of Total No. Consultant Nephrology No. of HD Pts. GP's Nurses Outlet of HD Hospitals Nephrologists Specialists 2012 Connections Machines 6 32 32 8 299 220 314 802 No. of Follow up Tx. Pts 2012 3064 Western 6 17 24 4 174 157 197 668 393 Eastern 8 19 8 9 138 94 139 290 190 Northern 1 3 4 0 50 38 49 194 210 Southern 1 7 14 1 72 44 60 189 468 22 78 82 22 733 553 759 2143 4325 Total Total Data on Hemodialysis Patients in GOVT. NON-MOH Sector According to Global Region NonNew Hypertensive HBsAg+ve HCV+ve Pts < Pts > Both Diabetic Hospital Name Saudi Pts. in Pts Pts Pts 15 Yrs 75 yrs Pts Pts 2012 HD Pts. Died 2012 Central 16 195 31 140 19 85 154 225 281 92 Western 48 207 25 60 21 62 120 157 169 74 Eastern 18 78 8 19 1 32 37 74 107 65 Northern 0 133 5 15 7 25 40 30 76 63 Southern 0 43 7 22 6 25 61 84 52 24 82 656 76 256 54 229 412 570 685 318 Total 35 Region Central Total of Hemodialysis Centers in Private Sector According to Global Region No. of Total No. Total Consultant Nephrology No. of GP's Nurses Outlet of HD HD Pts. Hospitals Nephrologists Specialists Connections Machines 2012 14 12 12 8 129 194 214 584 No. of Follow up Tx. Pts 2012 33 Western 19 22 25 13 190 333 367 1216 101 Eastern 6 10 5 2 104 105 155 324 23 Northern 0 0 0 0 0 0 0 0 0 Southern 2 1 2 0 5 13 9 13 2 41 45 44 23 428 645 745 2137 159 Total Hospital Name Total Data on Hemodialysis Patients in Private Sector According to Global Region New NonHypertensive HBsAg+ve HCV+ve Pts < Pts > Both Diabetic Pts. in Saudi Pts Pts Pts 15 Yrs 75 yrs Pts 2012 Pts HD Pts. Died 2012 Central 359 195 17 90 5 30 84 222 186 71 Western 905 286 51 232 10 46 160 357 348 141 Eastern 36 73 2 25 1 58 28 57 203 34 Northern 0 0 0 0 0 0 0 0 0 0 Southern 4 4 0 2 0 0 0 4 8 0 1304 558 70 349 16 134 272 640 745 246 Total 36 Region No. of Hospitals Total of Hemodialysis Centers in All Sectors According to Global Region Total No. of Consultant Nephrology No. of Outlet GP's Nurses HD Nephrologists Specialists Connections Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 Central 61 67 101 120 1094 1106 1570 3360 3814 Western 48 62 98 68 964 1092 1357 4739 1780 Eastern 22 42 32 46 691 462 641 1610 479 Northern 22 7 21 42 273 472 563 1051 461 Southern 29 14 47 35 514 627 861 2084 616 182 192 299 311 3536 3759 4992 12844 7150 Total Total Data on Hemodialysis Patients in All Sectors According to Global Region NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Central 625 879 151 544 104 239 Western 1253 1129 177 1084 76 Eastern 144 403 34 177 Northern 41 379 32 Southern 160 397 2223 3187 Hospital Name Total Hypertensive Pts Both HD Pts. Died 2012 547 1084 1053 359 226 502 1398 1338 520 11 146 200 486 690 202 162 17 114 262 250 346 181 100 435 19 153 205 771 469 256 494 2402 227 878 1716 3989 3896 1518 37 Diabetic Pts Total of Hemodialysis Centers in Saudi Arabia According to Sector Hospital Sector Ministry of Health Hospitals GOVT. Non-MOH Hospitals Private Sector Hospitals Total Nurses No. of Outlet Connections Total No. of HD Machines Total HD Pts. 2012 No. of Follow up Tx. Pts 2012 266 2375 2561 3488 8564 2481 82 22 733 553 759 2143 4510 45 44 23 428 645 745 2137 159 192 299 311 3536 3759 4992 12844 7150 No. of Hospitals Consultant Nephrologists Nephrology Specialists GP's 119 69 173 22 78 41 182 Total Data on Hemodialysis Patients in Saudi Arabia According to Sector Hospital Name NonSaudi Pts New Pts. in 2012 HBsAg+ve Pts HCV+ve Pts Pts < 15 Yrs Pts > 75 yrs Diabetic Pts Hypertensive Pts Both HD Pts. Died 2012 Ministry of Health Hospitals 837 1973 348 1797 157 515 1032 2779 2466 954 GOVT. Non-MOH Hospitals 82 656 76 256 54 229 412 570 685 318 1304 558 70 349 16 134 272 640 745 246 2223 3187 494 2402 227 878 1716 3989 3896 1518 Private Sector Hospitals Total 38 Dialysis Centers 1971 - 2012 171 173 175 176 177 182 182 160 124 124 103 103 106 110 94 97 97 91 94 130 136 144 147 149 76 63 51 37 22 6 1 2012 2010 201 2009 2008 2007 2006 2005 2004 2003 2002 200 99 2000 98 96 95 93 92 91 90 89 88 86 84 76 74 197 New Hemodialysis Patients 1995 - 2012 2847 3089 2944 3187 2846 2643 2389 2084 1918 1733 2042 1958 2080 1718 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Dialysis Population Net Annual Increase 1993 - 2012 13,000 12,000 11,000 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2011 2012 No. of Pts 3357 3666 3737 4189 4665 5010 5706 6694 7004 7391 7020 7214 7837 8761 9419 10203 10928 11437 12116 12116 12844 * Average Percentage of Annual Increase 7.3% 39 Hemodialysis Centers - 2012 Gov. Non-MOH 22 (12%) Private 41 (23%) MOH 119 (65%) Total - 182 Hemodialysis Machines - 2012 Govt. Non-MOH 759 (15%) MOH 3488 (70%) Private 745 (15%) Total - 4992 Hemodialysis Patients Nationality- 2012 Non-Saudi 2223 (17%) Saudi 10621 (83%) Total - 12844 40 Hemodialysis Patients Sex Distribution - 2012 Female 5739 (45%) Male 7105 (55%) Total - 12844 Hemodialysis Patients Age Distribution - 2012 3039 3027 2983 Total - 12844 1930 878 760 35 < 10 192 10 - 15 16-25 26-45 46-55 56-65 66-75 >75 Age-group in year Hemodialysis Patients Above 75 years and Below 15 years of Age - 2012 Above 75 years 878 (6.8%) 15 -75 years 11739 (91.4%) Below 15 years 227 (1.8%) Total - 12844 41 Hemodialysis Patients Blood Groups - 2012 A 3572 (28%) B 2254 (18%) AB 667 (5%) O 6351 (49%) Total - 12844 Type of Vascular Access of HD Patients Year 2012 Graft 733 (6%) AVF Jugular Cath. 8932 (69%) 1925 (15%) Others 1254 (10%) Total - 12844 HD Patients Treated by Erythropoietin According to Health Sector - 2012 12844 = Total HD Patients 10661= Treated by EPO-r Percentage= 83% MOH 8564 7002 81.8 Non-MOH 2143 1822 85.0 42 Private Sector 2137 1837 86.0 Hemodialysis Patients HBsAg Status - 2012 Positive 494 (4%) Negative 12350 (96%) Total - 12844 Hemodialysis Patients HCV Antibodies Status -2012 Negative 10442 (81%) Positive 2402 (19%) Total - 12844 HCV Positive HD Patients According to Region - 2012 * % from HD Pts 23% 16%* 21% 11% HCV +ve = 2402 Total Pts on HD=12844 Riyadh/ Qassim 544 3360 Jeddah/ Medina 1084 4739 43 Eastern Region 177 1610 Southern Region 435 2084 15% Northern Region 162 1051 Causes of End-Stage Renal Disease in Hemodialysis Patients - 2012 Cause of Renal Failure Diabetic Nephropathy Hypertensive Nephropathy Unknown Etiology Primary Glomerular Disease Obstructive Uropathy Hereditary Renal Disease Congenital Malformation Primary Tubulo-Interstitial Disease Vasculitis Pregnancy Related Others Total No. 4968 4549 1109 656 346 257 243 192 156 89 279 12844 % 38.7 35.4 8.6 5.1 2.7 2.0 1.9 1.5 1.2 0.7 2.2 100 Prevalence of Diabetes Mellitus and Hypertension in Dialysis Patients - 2012 DM & HTN 3896 (30%) DM only 1716 (14%) HTN only 3989 (31%) None DM or HTN 3243 (25%) Total - 12844 Waiting List for Renal Transplantation among Dialysis Patients -2012 Waiting List for Work-up 2569 (20%) Active Waiting List 3049 (24%) Total: 12884 44 Number of HD Patients, Centers & Machines in MOH and Non-MOH Hospitals -2012 MOH Hospitals Military Hospitals National Guard Security Forces University Hospitals K. F. S. Hospitals Private Sector Other Hospitals HD Centers – 182 119 9 3 1 3 2 41 4 HD Patients – 12844 8564 1080 431 57 183 239 2137 153 Machines – 4992 2488 370 109 35 70 114 745 61 Outlets – 3759 2561 285 70 12 41 86 645 59 3.3 3.8 6.2 4.8 4.5 2.8 3.3 2.6 Pts/Outlets – 3.4 Hemodialysis Patients and Machines in MOH Hospitals According to Region - 2012 Patients= 8564 Outlets= 2561 Machines= 3488 Pts/Outlets= 3.3 Central 1974 692 1042 2.9 Northern 857 434 514 2.0 Southern 1882 570 792 3.3 Eastern 996 263 347 3.8 Western 2855 602 793 4.7 Hemodialysis Patients and Machines in Non-MOH Hospitals -2012 Patients 4280 Outlets 1198 Machines 1504 Pts/Outlets 3.6 Military Hospitals 1080 285 370 3.8 National Guard 431 70 109 6.2 Security Forces 57 12 35 4.8 45 University Hospitals 183 41 70 4.5 KFS Hospitals 239 86 114 2.8 Private Sector 2137 645 745 3.3 Other Hospitals 153 59 61 2.6 Dialysis Centers in the Kingdom of Saudi Arabia - 2012 @ Turaif Qurayyat @ @Tabargel @ Arar @ Sakakah Dawmat Jandal @ @ Haql @ Rafha # Tabuk @Dhuba @ Taima @Hafar Batin @ Hayil Jubail@ Qatif@ @Dammam Dhahran# # Khobar Bukayriyah@ # Buraydah Unayzah @ @ Zilfi @ Hafouf @ Rass Umwlajj @ @Majmah @Rumah # Madinah Yanbu @ @ Badr Shuhada Shaqra@ # Riyadh @ Prince A Muhesin @Dawadmi @ Kharj @ Afif @ Quwayiyah Rabigh @ @ Hawtah @ Aflaj #Jeddah # Makkah # Taif Sulayyil@ @ Wadi Dawasir # Bishah Baha@ @Baljurashi Makhwah @ @ Tathlith Qunfudah@ Majardah @ @Namass Mohayil @ @ Balasmar # Khamis Mushayt Wajh @ Khayber @ U Abha # @ Sarat Abidah @Dhahran Janoub Samta @ Sabya @ Jizan @ @ Najran 46 @ Dialysis Center # More than one Dialysis Center @ Sharourah Peritoneal Dialysis 2012 47 Peritoneal Dialysis The total number of patients treated by peritoneal dialysis had slightly increased from 1240 patients in 2011 to 1327 in the year 2012 in 32 hospitals. Among these hospitals 15 are from MOH hospitals, 16 under governmental NON-MOH hospitals, and one from private sector hospitals. At the same time, 479 new patients have been registered this year on peritoneal dialysis while the total death among P.D patients was registered to be 9% (120 patients) this year. There are 27% (359 patients) P.D patients being treated with continuous ambulant peritoneal dialysis (CAPD), 70% (927 patients) with automated/continuous cyclic peritoneal dialysis (APD/CCPD), and 3% (41 patients) are treated with intermittent peritoneal dialysis (IPD). The adult P.D patient accounts 87% of the total while children represent 13%. It is recognized that 3% of the patients on P.D are HBs Ag+ve. As for HCV, it is found that 4% are HCV antibodies positive. More efforts are needed to popularize the use of this modality of treatment in all the regions of the Kingdom. 48 MOH Hospitals Peritoneal Dialysis in the Kingdom of Saudi Arabia 2012 Type of Peritoneal Dialysis Total No. of Pts New Pts 2012 Adults HBsAg+ve HCV+ve CCPD/APD Pediatri cs No. of NonSaudi Pts No. of Deaths 2012 CAPD IPD King Saud Medical Complex 161 73 70 0 91 0 161 5 12 7 25 Children Hospital (KSMC) 10 3 0 0 10 10 0 0 0 4 0 Prince Salman Kidney Center, Riyadh 14 9 9 0 5 0 14 1 1 0 0 King Fahad Medical City, Riyadh 55 25 0 9 46 33 22 1 1 2 5 King Fahad Specialist Hospital, Buraidah 63 28 3 32 28 3 60 3 1 1 2 King Fahd Hospital, Jeddah 45 20 5 0 40 1 44 4 4 7 6 King Abdul Aziz Hospital & Oncology Center, Jeddah 20 6 0 0 20 0 20 1 0 0 1 Al Noor Specialist Hospital, Makkah 24 6 3 0 21 5 19 0 3 4 3 King Fahd Hospital, Madina 20 1 2 0 18 0 20 0 1 4 2 Dammam Medical Complex 28 17 0 0 28 1 27 1 0 0 3 King Fahd Hospital, Hofuf 33 12 0 0 33 0 33 2 2 1 2 Qateef Central Hospital 37 5 2 0 35 19 18 0 3 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 12 3 1 0 11 12 0 1 0 3 1 564 223 96 41 427 84 480 19 33 35 53 Hospital Name Total: 15 49 GOVT. NON- MOH Hospitals Peritoneal Dialysis in the Kingdom of Saudi Arabia 2012 Pediatrics Adults HBsAg+ve HCV+ve No. of Non-Saudi Pts No. of Deaths 2012 48 21 47 1 2 2 0 0 39 19 40 0 2 1 3 30 0 30 0 60 4 3 2 8 16 18 0 46 0 64 0 2 2 0 106 28 45 0 61 0 106 4 1 2 10 Khamis Mushyat Military Hospital 72 29 62 0 10 8 64 6 4 0 12 North West Armed Forces Hospital, Tabuk 27 15 2 0 25 8 19 0 1 0 4 Al Hada Military Hospital, Taif 59 27 7 0 52 6 53 2 2 0 6 Armed Forces Hospital, Jeddah 44 12 24 0 20 0 44 1 1 0 2 King Fahd University Hospital, Al Khobar 75 20 15 0 60 0 75 1 2 0 10 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) * 20 8 0 0 20 2 18 0 0 0 2 6 3 0 0 6 2 4 0 0 0 0 22 4 4 0 18 2 20 1 1 0 3 King Fahad Specialist Hospital, Dammam 29 10 0 0 29 9 20 0 1 0 4 Total: 16 762 255 262 0 500 87 675 20 23 20 67 Total No. of Pts New Pts 2012 CAPD IPD CCPD/APD King Faisal Specialist Hospital, Riyadh 68 25 20 0 King Abdulaziz Medical City, Riyadh (KFNGH) 59 17 20 Armed Forces Hospital, Riyadh 60 27 King Khalid University Hospital, Riyadh 64 Security Forces Hospital, Riyadh Hospital Name King Abulaziz Med. City and National Guard, Al Hassa King Abdulaziz Medical City, Jeddah (KKNGH) Type of Peritoneal Dialysis 50 Private Sector Hospitals Total Peritoneal Dialysis in the Kingdom of Saudi Arabia According to Sector - 2012 No. of Hospitals Total No. of Pts New Pts 2011 Al-Hammadi Hospital - Riyadh 1 1 Total: 1 1 1 Hospital Name All Sector: HBsAg+ve HCV+ve No. of NonSaudi Pts No. of Deaths 2011 IPD CCPD/APD 1 1 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 Total Peritoneal Dialysis in the Kingdom of Saudi Arabia According to Sector- 2012 Total No. of Pts New Pts 2012 MOH Hospitals 15 564 GOVT. NON-MOH Hospitals 16 Private Sector Hospitals Total : 32 Adults CAPD No. of Hospitals Hospital Name Pediatrics Type of Peritoneal Dialysis Pediatrics Adults HBsAg+ve HCV+ve No. of NonSaudi Pts No. of Deaths 2012 Type of Peritoneal Dialysis CAPD IPD CCPD/APD 223 96 41 427 84 480 19 33 35 53 762 255 262 0 500 87 675 20 23 20 67 1 1 1 1 0 0 1 0 0 0 0 0 32 1327 479 359 41 927 172 1155 39 56 55 120 51 Total Active PD in the Kingdom of Saudi Arabia 1995 - 2012 1327 1196 1240 1112 965 861 772 595 302 335 442 Peritoneal Dialysis Patients Treatment Modality - 2012 APD/CCPD 927 (70%) IPD 41 (3%) CAPD 359 (27%) Total - 13270 Peritoneal Dialysis Patients Adults and Children - 2012 Children 172 (13%) Adults 1155 (87%) Total - 1327 52 2011 2012 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 196 196 1997 1996 1995 132 133 379 645 506 Peritoneal Dialysis Patients HBsAg Status - 2012 Positive 39 (3%) Negative 1288 (97%) Total - 1327 Peritoneal Dialysis Patients HCV Antibodies Status - 2012 Positive 56 (4%) Negative 1271 (96%) Total - 1327 Peritoneal Dialysis Distribution according to Region - 2012 Total - 1327 MOH= 564 Non-MOH= 762 Private= 1 Central Region=661 303 357 1 Western Region=324 148 176 0 Eastern Region= 228 98 130 0 53 Southern Region= 72 0 72 0 Northern Region= 42 15 27 0 Renal Replacement Therapy - 2012 PD 1327(6%) Renal Tx. Followed Up 7150 (34%) HD 12844 (60%) Total = 21,321 (751 PMP) Renal Replacement Therapy in K.S.A 1010 Post Renal Transplant HD PD 1196 1240 1327 1112 861 780 645 442 506 379 196 7391 7214 6694 2012 2011 9600 10010 8182 9002 8073 8098 7408 7150 2010 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 6902 5656 6378 4396 4382 4043 4865 3360 3713 4046 2009 5706 2008 5010 2007 4665 2006 4189 7020 7004 2005 132 3737 10928 11437 12116 12844 7837 302 196 9450 8500 335 133 10500 595 Dialysis Population: Current and Projected 1995 - 2020 18000 18218 16000 16456 15281 14000 14171 12000 12040 12633 13356 11168 10000 10280 9533 8000 7833 7526 7809 7029 7383 6000 8482 6008 4000 3869 4322 4861 5206 2000 0 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2015 2019 2020 Average Net Annual Increase = 606 Patients Average Percentage of Annual Increase = 8% 54 Prevalence of Dialysis Patients According to Region -2012 Population (2011) Dialysis Patients (2012) Prevalence (PMP) Western 9,108,436 5,063 556 Southern 4,373,549 2,156 493 Northern 2,239,669 1,093 488 Central 8,364,471 4,021 481 Eastern 4,290,230 1,838 428 Total 28,376,355 14,171 499 Region Incidence of Dialysis Patients According to Region-2012 Population (2011) New Dialysis Patients (2012) Incidence (PMP) Northern 2,239,669 402 179 Central 8,364,471 1,131 135 Western 9,108,436 1,229 135 Eastern 4,290,230 478 111 Southern 4,373,549 426 97 28,376,355 3,666 129 Region Total 55 Deceased Heart Beating Donor and Organ Donation 2012 56 _________________________________________________________ Deceased Heart Beating Donor and Organ Donation ______________________________________________________________________________ The Kingdom of Saudi Arabia has an active deceased transplant program under the supervision of the Saudi Center for Organ Transplantation. 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. At the end of the year 2012, a total of 9451 possible deceased cases have been reported to SCOT and of which, 631 were reported during the year 2012 from 94 intensive care units (ICUs) around the Kingdom. An Average of 598 cases per year was reported in the last 5 years. Male to Female ratio was 4 to 1 respectively. Ages below 40 years formulated 59% of the donors. Head Injuries constituted 47% of the causes of death, while non-traumatic causes were reported in 53% of the cases, resulting mostly from cerebro-vascular accidents (66%) and brain anoxia (25%). Road Traffic Accidents constituted 39% of the circumstance that lead to death. Of the direct causes of death, intra-cerebral hemorrhage was found in 72%. Of the 631 possible deceased cases in the year 2012, 324 (51%) were medically documented. And of these cases, the family had been approached in 271 and 93 of them gave consent for organ donation (i.e. 34% of the approached families), while family refusal constituted 66%. Retrieval was carried out in 89% of the consented cases. Medical causes such as cardiac arrest / multi-system failure and family refusal, are generally the reasons for failure to retrieve organs. Management of all possible cases was followed up by the SCOT with the different ICU’s in the kingdom. This usually ends up when death is declared following irreversible cardio-pulmonary arrest. It was noticed that 99% of the total consents included kidneys as donated organs; liver was donated in 99% and heart in 83% of the successful cases. Total cornea was the least, with only 30%. 57 More energetic measures are still required to increase the number of reports of possible deceased cases as well as obtaining cases. Only this will help bridging the gap between supply and demand for organs given that more than 3000 patients are in the active waiting list for organ transplantation. 58 Cause of Death by Brain Function Criteria in the Possible Deceased Cases Year 2012 Cases Reported - 631 Non-Traumatic 332 (52.6%) Traumatic 298 (47.2%) - CVA 220 (66.3%) - RTA 249 (83.6%) - FFH 33 (11.1%) - DHT 14 (4.7%) - Gunshot 2 (0.6%) - Anoxia 84 (25.3%) - CNS Tumor 28 (8.4%) Others 1 (0.2%) Possible Deceased Cases Nationality and Sex Year 2012 Cases Reported - 631 Non Saudi 329 (52%) Female 126 (20%) Male 505 (80%) Saudi 302 (48%) Death by Brain Function Criteria Age Distribution of Possible Deceased Cases 2012 111 (17.6%) 141 (22.3%) Total - 631 119 (18.9%) 98 (15.5%) 82 (13.0%) 20 (3.2%) 0-10 11-20 21-30 31-40 41-50 59 51-60 33 (5.2%) 27 (4.3%) 61-70 >70 Deceased Heart Beating Circumstances and Mechanisms Year 2012 BD Mechanisms BD Circumstances Case Reported - 631 455 (72 1%) ICH 103 (16 3%) Cardiovascular 65 (10 3%) Others 2 (0 3%) Seizure 249 (39.5% Motor Vehicle Accident 1 (0 15%) Drowning 1 (0 15%) Electrical 382 (60.5% Non-Motor Vehicle Accident 1 (0 15%) Drug Intoxication 1 (0 15%) Stab Wound 1 (0 15%) Asphyxia 1 (0 15%) Gunshot Wound Possible Cases: Documented / Not Documented 2012 Documentation Completed 324 (51%) Documentation not Completed 307 (49%) Total - 631 60 Potential Deceased Cases: Families Approached / Not Approached 2012 Families Approached 271 (84%) Families Not Approached 53 (16%) Total - 324 Reasons of Failure to Approach Families 2012 Sudden Cardiac Arrest after Documentation 47 (89%) Unfit 6 (11%) Total - 53 Families Approached Possible Deceased Cases Consented / Not Consented for Donation 2012 Consent Not Obtained 178 (66%) Consent Obtained 93 (34%) Total - 271 61 Consent Eligible Deceased Cases: Harvested / Not Harvested 2012 Harvested 83 (89%) Not Harvested 10 (11%) Total - 93 Reasons of Not Harvesting Organs 2012 Sudden Cardiac Arrest 4 (40%) Unfit 6 (60%) Total - 10 62 Deceased Heart Beating Cases Possible, Eligible, Consented and Actual Year 2012 631 324 271 93 (*34 %) Possible Potential Eligible Consented for Donation 83 Actual *Percentage of Families Approached Use of Medevac in Harvesting of Organs 2012 Air Medevac 19 (23%) Patient in Tx Center 34 (41%) Ambulance 29 (35%) Total - 82 Death by Brain Function Criteria Possible, Potential, Eligible, Consented and Actual Region Wise Year 2012 Possible Potential Eligible Central Region 282 178 151 55 Western 139 34 24 2 2 Eastern 85 41 33 12 10 Northern 22 12 9 2 1 Southern 44 10 8 2 1 Outside KSA 59 49 46 20 19 Total 631 324 271 93 83 63 Consented Harvested 50 Annual Trend of Number of ICUs Contributing in Deceased Donation Program 1986 - 2012 Current total number of active ICUs in Saudi Arabia - 116 97 95 94 83 83 83 85 58 62 58 59 30 68 61 65 73 75 42 8 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 1 36 33 36 33 73 68 70 Trend of Possible Deceased Donor Reported over the Years 1986-2012 710 Cases Reported - 9451 615 533 526 474 427 374 355 385 348 367 136 148 146 154 410 364 348 360 372 337 210 24 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 7 187 **631 503 *Average cases reported in the lasts 5 years: 598/year **Incidence of Possible DD: 23 PMP Cause of Death by Brain Function Criteria in the Possible Deceased Cases (1986 – 2012) Total Case Reported - 9451 Non-Traumatic 3542 (37%) Traumatic 5563 (59%) - CVA 2370 (67%) - Anoxia 776 (22%) - CNS Tumor 396 (11%) - RTA 4539 (82%) - FFH 615 (11%) - DHT 299 (5%) - Gunshot 110 (2%) Others 346 (4%) 64 Possible Deceased Donors Age Distribution (1986 – 2012) 2406 (25%) Total Cases Reported - 9451 1837 (19%) 1701 (18%) 1205 (13%) 1180 (13%) 693 (7%) 279 (3%) 0-10 11-20 21-30 31-40 41-50 51-60 150 (2%) 61-70 >70 Possible Deceased Cases Nationality and Sex 1986 - 2012 Saudi 5216 (55%) Female 1888 (20%) Non - Saudi 4235 (45%) Male 7563 (80%) Trend of Potential Deceased Cases over the Years 1986 - 2012 369 359 358 Total - 5793 385 324 288 247 261 259 256 251 197 211 218 198 208 300 245 219 139 96 93 99 21 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 6 105 81 65 Trend of Eligible Deceased Cases after Documentation 1986 - 2012 Total - 4932 289 235 231 230 238 235 214 195 186 194 167 177 297 282 309 271 233 203 167 133 89 87 84 88 74 21 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 3 Correlation Between Possible and Potentially Deceased Cases 1986 - 2012 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Possible - 9451 615 187 210 348 367 374 355 385 427 364 348 337 360 372 410 526 474 533 503 615 710 631 Potential - 5793 86-91 92 396 105 139 247 259 256 251 197 211 198 218 208 219 261 245 358 288 359 300 369 385 324 Potential / Possible - 61% 64 56 66 71 71 68 71 51 49 54 63 62 61 40 60 68 61 67 63 60 54 51 Possible Deceased Cases Trend of Consented for Donation 1986 - 2012 Consent Obtained - 1630 18 14 20 19 17 12 20 1986 0 1987 10 31 1988 23 1989 42 1990 34 1991 43 1992 52 1993 88 1994 80 1995 54 1996 54 1997 50 1998 43 1999 33 2000 41 2001 31 2002 46 2003 46 2004 51 2005 91 2006 66 2007 100 2008 73 2009 101 2010 81 2011 73 2012 6 10 9 7 13 15 3 10 Cases from Organ Sharing Program (Spain, Kuwait, Qatar and Bahrain) 66 Deceased Cases Correlation Between Eligible and Consented for Donation 1986- 2012 8691 92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 F. Approach - 4932 357 89 133 235 231 230 238 186 194 167 203 289 235 282 233 297 Consented - 1630 140 43 52 88 80 54 60 60 50 36 56 41 46 59 68 111 85 118 82 115 93 93 Percentage - 33% 39 48 39 37 35 23 25 32 26 22 195 29 177 23 167 28 214 28 34 38 36 42 35 39 309 30 271 34 Deceased Cases Trend of Actual Deceased Donor 1986 - 2012 Harvested- 1630 105 102 82 98 62 51 40 31 83 80 71 48 55 54 54 68 73 54 47 32 34 33 38 39 23 10 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 0 Failure to Retrieve Organs 1986-2012 Possible Deceased Donors - 9451 Unknown Address 148 (2%) Consented 1630 (17%) Medical Causes 4230 (54%) Others 195 (3%) Family Refusal 3248 (41%) 67 Medical Causes of Failure to Retrieve Deceased Organs 1986 - 2012 2837 (65%) Total - 4326 1060 (25%) 340 (8%) Cardiac Arrest Multisystem Failure Unfit Organs 89 (2%) Systemic Infection *The multi-system failure was due in 50% of the cases to the delay in confirming the diagnosis of brain death (persistence of electrical activity in the electroencephalogram) Trend of Contribution of Family Refusal Towards Failure to Retrieve Organs 1986 - 2012 86-91 92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Fail to Ret. - 7729 475 144 158 260 285 320 295 235 377 328 292 296 314 313 342 415 389 415 421 500 617 538 F. Refusal - 3258 217 48 82 148 151 182 178 126 144 131 123 133 113 146 131 175 140 163 151 182 216 178 Ratio - 42% 46 33 52 57 53 57 60 39 38 40 42 45 36 47 38 42 36 39 36 36 35 33 Consent Obtained in Potential Deceased Heart Beating Cases with Approachable Families 1986- 2012 No Consent 3302 (67%) Consent Obtained 1630 (33%) Total - 4932 68 Deceased Heart Beating Cases Possible, Eligible, Consented and Actual 1986 - 2012 9451 4932 1630 (*33%) Possible Eligible 1467 Consented for Donation Actual *Percentage of Consent for Donation Comparison on Possible, Potential, Eligible, Consented and Actual Cases (2003-2007) Vs. (2008-2012) 2008 – 2012 Cases 28% Percentage on Conversion of the Critical Pathways of Organ Donation e od Possible Cases Potential Eligible Consented Actual 2003 - 2007 2 42 64% 8 % 33% 9 % 2008 - 20 2 2992 58% 80% 36% 85% Deceased Organ Transplantation in KSA (2003 – 2007) Vs. (2008 – 2012) 673 2003-2007 2008-2012 527 271 175 175 94 42 Kidney Liver Whole Heart 125 132 110 Heart for Valves Corneas 69 14 Lungs 69 7 8 Pancreas Hospital Sharing in Organ Donation Program The total number of hospitals who reported possible deceased donor (DD) cases during the year 2012 was 94 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 (17) reported 146 cases (23% of the total), of which 85 (58%) were fully documented and 24 consents were obtained for organ donation (26% of total consents). In this group, 17 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 seven years. King Abdulaziz Medical City (National Guard Hospital), Riyadh came next with 6 consents followed by Prince Sultan Military Medical City, Riyadh with one consent. Medium sized hospitals, with 10-20 ICU beds, contributed with 42% (266 cases) of the total number of reported cases. However, only 22 consents (24% of total consents) were obtained for organ donation. The most active hospitals in this group were Prince Salman Hospital, Riyadh with 6 consents followed by King Khalid Hospital, Al Kharj with 3 consents. King Fahd Specialist Hospital, Qassim, Dammam Medical Complex and King Fahd Hospital, Hofuf obtained 2 consents each. And lastly; Al Noor Specialist Hospital, Makkah, King Khalid Hospital, Tabuk, King Fahd Hospital, Al Baha, Dr. Ahmed Abanamy Hospital, Riyadh, Dr. Sulaiman Al Habib Hospital (Al Rayan), Riyadh, Al Manae General Hospital, Al Khobar and Dr. Sulaiman Habib Hospital (Olaya), Riyadh; each obtained 1 consent. Small sized hospitals, with less than 10 ICU beds, shared 160 possible deceased cases (25% of the total Possible DD) and 27 consents were obtained from them i.e. (29% of total consent). Among this group, National Hospital, Riyadh was the most active with a total of 5 cases consented for organ donation followed by 3 consents obtained from Kingdom Hospital, Riyadh. 70 Moreover, Al Iman General Hospital, Riyadh, Al Rass General Hospital, Al Qassim, Al Mowasat Hospital, Riyadh, each contributed with 2 consents. And finally, one consent was obtained from each of the following hospitals: Al Qateef Central Hospital, Buraida Central Hospital, Al Qassim, Al Jubail General Hospital, King Khalid General Hospital, Hafar Al Baten, Ar-Ar Central Hospital, Al Mana General Hospital, Dammam, King Saud Hospital, Unaiza, Abu Arish Hospital, Saad Specialist Hospital, Al Khobar, Obeid Specialized Hospital, Riyadh, King Faisal Specialist Hospital and Research Center, Jeddah, Obeid Specialized Hospital, Hofuf, King and Khalid Military Hospital, Hafar Al Baten. Activities of the organ sharing program between the Kingdom and GCC countries showed that 20 consented cases were obtained under this program; distributed between Kuwait Hospitals (19 cases) and Qatar Hospitals (one case). The following table shows the distribution of possible, consented and actual deceased donors according to region: Central (Riyadh, Kharj, Qassim and Hail) Western (Jeddah, Makkah Madinah & Taif) Eastern (Dammam, Hofuf, Al Khobar, Dhahran, Khafji, Qateef, Jubail & Hafar Al Baten) Southern (Assir, Al Baha, Gizan & Najran) Northern (Tabuk, Al Jouf, Northern Borders) Outside KSA (Kuwait, Qatar & Bahrain) 282 139 Consent for Organ Donation 55 2 85 12 10 44 2 1 22 2 1 59 20 19 Total 631 93 83 Possible DD Region Actual DD 50 2 Distribution of consents by region shows that 55 (59%) consents were obtained from the Central region (34 from MOH hospitals, 7 from Govt. Non-MOH hospitals and 14 from private hospitals). The Eastern region came next with 12 (13%) consents; followed by the Western, Southern, and Northern region with 2 (2%) consents for each. 71 Deceased Heart Beating Donor (DD) Possible, Potential, Eligible, Consented and Actual from Different Hospitals in Saudi Arabia 2012 Table (1): Hospitals with ICU's Having More than 20 Beds Possible DD Potential DD Eligible DD Consented Actual DD 1 King Saud Medical Complex (*) 55 41 37 17 15 2 King Abdulaziz Medical City & NGH-Riyadh 26 21 19 6 5 3 King Fahd Hospital- Madinah 15 4 2 0 0 4 King Fahd Hospital-Jeddah (*) 10 1 1 0 0 5 Armed Forces Hospital-Riyadh (RKH) 6 King Khalid University Hospital-Riyadh 9 7 5 3 5 3 1 0 1 0 7 King Faisal Specialist Hospital-Riyadh 4 2 2 0 0 8 Security Forces Hospital - Riyadh 3 3 3 0 0 9 King Abdullah Medical City – Makkah 10 King Fahad Armed Forces Hospital - Jeddah 11 North West Armed Forces Hospital-Tabuk 3 3 3 2 1 0 2 1 0 0 0 0 0 0 0 12 King Abdulaziz University Hospital - Jeddah 13 Maternity and Children Hospital - Jeddah 3 1 0 1 0 1 0 0 0 0 14 Maternity and Children Hospital Madina 1 1 1 0 0 15 Dallah Hospital – Riyadh 1 0 0 0 0 16 Dr. Sulaiman Fakeeh Hospital – Jeddah 17 Ohud General Hospital – Madinah 1 1 0 0 0 0 0 0 0 0 146 (23.1%)* 85 77 24 (26)** 21 No. Hospital Name Total (*) Percentage from total possible cases, (**) Percentage from total consented cases. 72 No. Table (2): Hospitals with ICU’s Having 10 and 20 Beds Possible Potential Eligible Hospital Name Consented DD DD DD Actual DD 1 2 Prince Salman Hospital – Riyadh King Khalid Hospital-Hail 30 23 17 6 14 2 6 0 5 0 3 4 5 Mena Hospital – Makkah King Fahd Specialist Hospital- Al Qassim (*) Al Noor Specialist Hospital-Makkah (*) 21 19 19 5 10 7 4 7 5 0 2 1 0 2 1 6 7 Dammam Medical Complex (*) King Khalid Hospital-Al-Kharj 17 13 6 9 4 8 2 3 2 3 8 King Fahd Hospital- Hofuf 13 6 6 2 2 9 King Fahd Hospital-Gizan (*) 13 0 0 0 0 10 King Khalid Hospital-Tabuk (*) 11 Assir Central Hospital – Abha (*) 12 12 8 1 6 0 1 0 1 0 12 King Abdulaziz Specialist Hospital-Taif 12 0 0 0 0 13 King Abdulaziz Hospital – Makkah 8 0 0 0 0 14 King Fahd University Hospital- Al Khobar 15 King Fahd Hospital-Al-Baha 7 6 0 4 0 4 0 1 0 1 16 King A/Aziz Hospital & Oncology Center-Jeddah 17 Dr. Ahmed Abanami Hospital – Riyadh 5 4 1 4 0 4 0 1 0 1 18 Dr. Sulaiman Al Habib Hospital – Khurais 4 1 1 1 1 19 King Abdulaziz Medical City & NGH – Jeddah 4 1 1 0 0 20 Al Hada Military Hospital-Taif 21 Al Mousa Gen. Hospital – Al Hassa 4 3 1 2 0 2 0 0 0 0 22 King Faisal Military Hospital-Khamis Mushyat 23 King Fahd Medical City – Riyadh 3 3 1 0 1 0 0 0 0 0 2 2 1 1 1 1 1 1 1 266 (42.2%)* 2 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 97 75 0 1 1 0 0 0 0 0 0 22 (24%)** 24 25 26 27 28 29 30 31 32 King Khalid Hospital – Najran Al Mana General Hospital – Al Khobar Dr. Sulaiman Al Habib Hospital – Olaya King Fahd Military Medical Complex - Dhahran Dr. Sulaiman Al Habib Hospital – Qassim ARAMCO – Dharhan Saudi German Hospital – Riyadh King Khalid Hospital – Majmaah King Abdulaziz Medical City- Al Hassa Total (*) Percentage from total possible cases, (**) Percentage from total consented cases. 73 20 No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Table (3): Hospitals with ICU’s Having Less than 10 Beds Possible Potential Eligible Hospital Name Consented DD DD DD Al-Iman General Hospital – Riyadh 13 11 8 2 Al Rass General Hospital – Al Qassim 13 9 7 2 Al Qateef Central Hospital 13 4 3 1 Buraida Central Hospital – Al Qassim 10 9 7 1 National Hospital-Riyadh 8 8 8 5 Kingdom Hospital – Riyadh 7 6 5 3 Al Jubail General Hospital 6 6 4 1 Al Thager Hospital-Jeddah 6 1 0 0 King Khalid General Hospital-Hafar Al-Baten 5 4 4 1 Ar-Ar Central Hospital 5 4 3 1 Al Mana General Hospital-Dammam 5 4 2 1 King Saud Hospital-Unaiza 5 3 3 1 King Faisal Hospital- Makkah 5 3 2 0 Abu Arish Hospital 5 1 1 1 Dawadmi General Hospital 5 1 0 0 KFH – Taif 5 0 0 0 Najd Consulting Hospital – Riyadh 4 3 3 2 Rabiq Hospital Makkah 4 1 1 0 Al Hera General Hospital – Makkah 3 3 2 0 Saad Specialist Hospital- Al Khobar 3 2 2 1 Obeid Specialized Hospital-Riyadh 3 2 2 1 Al Mana Hospital – Al Hassa 3 1 0 0 Shagra General Hospital – Riyadh 2 0 0 0 Al Qunfudah Hospital 2 0 0 0 Madneb General Hospital – Al Qassim 2 0 0 0 Wadi Dawasir General Hospital 2 0 0 0 King Faisal Specialist Hospital – Jeddah 1 1 1 1 Obeid Specialized Hospital – Hofuf 1 1 1 1 King Khalid Military Hospital – Hafar Al Batin 1 1 1 1 Al Azhar Hospital – Riyadh 1 1 1 0 Najran General Hospital 1 1 1 0 Al Imam Abdulrahman Bin Faisal H.- Dammam 1 1 1 0 Sub – Total: 150 92 73 27 (*) Percentage from total possible cases (**) Percentage from total consented cases. 74 Actual DD 2 2 0 1 5 3 1 0 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 1 0 0 0 23 Continuation Table (3): Hospitals with ICU’s Having Less than 10 Beds Possible Potential Eligible Actual No. Hospital Name Consented DD DD DD DD 33 Afif General Hopsital - Riyadh 1 1 0 0 0 34 Al Gedaani Hospital – Jeddah 1 0 0 0 0 35 King Fahad Hospital – Tabuk 1 0 0 0 0 36 Rafha General Hospital – Tabuk 1 0 0 0 0 37 Maternity and Children Hospital – Qassim 1 0 0 0 0 38 Ghassan Pharaon Hospital- Khamis Mushayat 1 0 0 0 0 39 Abqaiq General Hospital 1 0 0 0 0 40 King Saud Hospital – Jeddah 1 0 0 0 0 41 Beljaraisy General Hospital 1 0 0 0 0 42 Maternity and Children Hospital - Dammam 1 0 0 0 0 160 27 Grand Total: 93 73 23 (25.4%)* (29%) ** (*) Percentage from total possible cases (**) Percentage from total consented cases. Table (4): Hospitals outside the Kingdom of Saudi Arabia No. Hospital Name Possible DD Potential DD Eligible DD 1 Kuwait Hospitals 55 46 43 19 18 2 Bahrain Hospitals 2 2 2 0 0 3 Qatar Hospitals 2 1 1 1 1 59 49 46 20 19 Total Consented Actual DD Table (5): Total Number of Brain Death Cases for All Hospitals Hospital Name Possible DD Potential DD Eligible DD Consented Actual DD Greater than 20 ICU Beds 146 85 77 24 21 10 - 20 ICU Beds 266 97 75 22 20 Less than 10 ICU Beds Outside KSA 160 59 93 49 73 46 27 20 23 19 631 324 271 93 83 Total 75 Organ Transplantation 2012 76 Organ Transplantation By the end of year 2012, a total of 5356 living donor and 2467 deceased donor renal transplantation have been performed inside the Kingdom of Saudi Arabia. It is worth mentioning that the deceased organ transplantation program in the Kingdom received a big boost with the inception of the National Kidney Foundation in 1984 and further in 1993 when this organization was upgraded and renamed as Saudi Center for Organ Transplantation (SCOT). A total of 622 kidneys have been transplanted during year 2012, of which 504 were from living donors and 118 from deceased donors. Among the 118 deceased kidneys, 13 were used for pediatric recipients and 7 were given for urgent condition recipients. Liver transplantation program in the Kingdom was started in the year 1990. Up to end of 2012, a total of 1240 liver transplants have been performed. This includes 569 liver transplants from living donors including pediatric recipients performed at the Prince Sultan Military Medical City (formerly Riyadh Military Hospital) and adult recipients performed in King Faisal Specialist Hospital-Riyadh, King Abdulaziz Medical City and National Guard Hospital-Riyadh, and King Fahd Specialist Hospital-Dammam. In the year 2012, there were 96 liver transplants from living and 50 from deceased donors. Between 1986 and 2012, there were 228 whole hearts and 564 hearts as sources for valves have been transplanted. Although more than 24,000 corneal transplants have been performed in the Kingdom from 1983 to 2012, the number of locally harvested corneas is dismally low (663 corneas). Lung transplantation activity (started in 1990), has a total of 94 lungs transplanted to 61 recipients as single or bilateral. A total of 19 pancreases were transplanted since 1990. Bone transplantation started in the year 2009. This year 17 bones were harvested and 8 musculoskeletal tissue retrieved. 77 As for organ sharing program with Kuwait, Spain, Qatar, Kingdom of Bahrain, SCOT benefited from 53 kidneys, 94 livers, 8 whole hearts, 47 heart for valves, and 13 lungs since the program took place with these countries. Kidney Transplantation – 2012 In this year, 622 kidneys have been transplanted inside the Kingdom of Saudi Arabia. A total of 504 kidney transplants were done from living donors and 118 from deceased donors. The following table shows the performance of the national transplant centers during 2012. Deceased and Living Kidney Transplantation in Saudi Arabia -2012 Living Donors No. Hospital Name Related Unrelated 1 2 3 4 5 6 7 8 9 10 11 King Faisal Specialist Hospital & Research Center, Riyadh King Fahd Specialist Hospital, Dammam Prince Sultan Military Medical City, Riyadh King Faisal Specialist Hospital & Research Center, Jeddah King Abdulaziz Medical City and National Guard, Riyadh King Fahd Hospital, Jeddah King Faisal Military Hospital, Khamis Mushayt King Fahd Armed Forces Hospital, Jeddah Al-Hada Military Hospital, Taif Prince Salman Military Hospital, Tabuk Saad Specialist Hospital, Al Khobar * Deceased Donors Total 141 3 26 170 78 51 3 20 28 20 109 91 54 24 13 91 30 1 17 48 22 18 3 43 27 2 4 33 15 6 6 1 0 1 0 1 0 5 2 0 15 12 8 2 73 118 622 TOTAL: 431 * Private sector hospitals performing living kidney transplantation Performance of Deceased Kidney Transplantation in 2012 Number of Number of Number of Harvested Kidneys Transplanted Kidneys Transplanted Patients 128 118 117 1 kidney transplanted as enbloc by KFSH-Jeddah 78 · 10 kidneys were harvested but not transplanted for the following reasons: o 3 kidneys due to vascular atheroma o 1 kidney due to multi cyst o 1 kidney due to solid organ injury o 2 kidney due to biopsy report o 1 kidney due to technical reason o 2 kidneys due to congenital abnormality · Cold Ischemic Time (CIT) for locally harvested deceased kidneys was ranging between 1 to 36 hours. Mean CIT was 11.38 hours, 65% of them (77 kidneys) were from ≤ 12 hours, 30% (35 kidneys) were from between 13-24 hours and only 5% (6 kidneys) were from between 25-36 hours. · In 95% of cases, the deceased kidney transplantation was practiced with CIT ≤ 24 hours. · On the other hand, matching sex (male to male or female to female) kidney transplantation from deceased donors was done in 58% of the cases. · Age distribution of recipients and donors of the deceased kidneys are indicated in the following table. Age Distribution for Recipients and Donors of the Deceased Kidneys Recipient Age (Years) <5 5-15 16-29 30-49 50-59 ≥ 60 TOTAL Donor Age (Years) <5 1 1 - 5-15 - 16-29 5 7 12 2 30-49 2 5 20 29 7 5 50-59 3 8 4 1 ≥ 60 - < 65 1 2 2 2 0 26 68 16 5 TOTAL 2 11 32 49 13 10 117 There are 21 expanded criteria donors (ECD) in the year 2012. This is based on the following criteria: Donor Characteristic: · Age ≥ 60 years - 6 kidneys · Age 50 – 59 years / CVA / HTN and/or S.Cr ≥ 133 µmol/L (1.5 mg/dl) - 8 kidneys · CVA / HTN / S.Cr doubled at harvesting - 7 kidneys According to the data of renal failure patients in the kingdom of Saudi Arabia, 197 patients underwent living renal transplant operations outside the kingdom during the year 2012. 79 1979 11 1980 14 1981 21 1982 20 1983 36 1984 36 2 1985 30 4 1986 49 0 1987 63 28 77 59 1988 77 57 1989 1990 63 74 1991 64 62 65 128 1992 95 145 1993 154 122 1994 131 136 1995 83 147 1996 88 174 1997 84 160 1998 76 188 1999 59 195 2000 89 228 2001 57 251 2002 71 228 2003 88 208 2004 95 221 2005 151 220 2006 122 260 2007 166 228 2008 111 252 2009 313 2010 385 2011 430 2012 156 59 57 2 4 Total deceased : 2467 Total Living Unrelated: 175 Total Living Related: 5181 Before 118 Before 122 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 11 14 21 20 36 36 30 49 63 77 77 63 64 128 145 122 136 147 174 160 188 195 228 251 228 208 221 220 260 228 272 349 Total living kidney transplantation: 5356 74 95 83 88 84 62 65 59 NKF 80 431 Living Kidney Transplantation 1979-2012 504 NKF SCOT Total Deceased Kidney Transplantation 1984-2012 Total deceased kidney transplantation: 2467 154 151 166 76 89 88 156 131 122 111 20 SCOT 122 118 71 95 57 28 0 Living and Deceased Kidney Transplantation 1997-2012 36 46 73 Kidneys from Deceased Donors 1986-2012 Retrieved but not Used 139 (5%) Transplanted 2467 (95%) Total: 2606 Reasons for Not Using Retrieved Deceased Donor Kidneys Total : 139 3 Sent Abroad 4 Sepsis 5 Tuberculosis 8 Vascular Thrombosis 9 Technical 10 Malignancy & Neoplastic Kidney 13 No Suitable Recipient Chronic Kidney Disease 18 Necrotic 18 Traumatic Renal Injury 18 33 Congenital & Vascular Abnormalities Kidney Transplantation Inside and Outside the Kingdom (1997-2012) From Living Related From Deceased Outside the Kingdom (URL) 723 700 647 646 597 503 436 441 382 349 327 241 228 174 88 160 163 84 251 228 188 183 195 76 59 208 221 57 7 88 95 228 220 5 89 272 260 66 22 235 233 56 197 157 22 8 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 81 Kidney Transplantation Centers in the Kingdom of Saudi Arabia * Tabuk - KAAMHT * Dammam - KFSH Dhahran - KFMMCD Madinah * * Riyadh * - RAFH - KFHM Private transplant centers performing living transplant. Saad Specialist Hospital Dr. Suleiman Fakeeh Hospital - Jeddah New National Jeddah Hospital Government Centers currently INACTIVE KFH – Madinah KFMH - Dhahran * * Jeddah * * - KFHJ * - KAAHJ *Taif - AHMHT - KFSH - KAMC & NG - KFMHJ - KFSHJ - KAMC & NG * Khamis Mushayt - KMMH 82 Liver Transplant - 2012 The number of possible deceased cases consented for liver donation this year was 92. Harvesting was taken place in 59 cases, however only 50 livers were transplanted; 25 at King Faisal Specialist Hospital and Research Center, Riyadh (2 cases transplanted as split liver), 16 at King Abdulaziz Medical City and National Guard Hospital, Riyadh and 9 at King Fahd Specialist Hospital, Dammam. Livers were not harvested in 44 cases due to the following reasons: 1. Consented not harvested in 24 cases due to: · Elevated liver enzymes (6 cases) · Hemodynamic instability of the donor (6 cases) · No suitable recipient (1 case) · Sudden cardiac arrest (4 cases) · Technical problem to include medevac, weather condition and more time needed before harvesting (3 cases) · 2. 3. Unfit due to infection (4 cases) Liver was rejected during harvesting in 9 cases due to: · Fatty liver (5 cases) · Liver fibrosis (2 cases) · Liver necrosis (2 cases) Liver was rejected by transplant centers after harvesting in 11 cases due to: · Elevated liver enzymes (1 case) · Fatty liver (2 cases) · Liver fibrosis (4 cases) · Neoplasm (2 case) · Sepsis (1 case) · Steatosis (1 case) 83 Living Liver Transplantation - 2012 96 cases of living liver transplantation were done during this year, 10 at Prince Sultan Military Medical City-Riyadh, 76 at King Faisal Specialist Hospital-Riyadh, 9 at King Abdulaziz Medical City - National Guard Hospital-Riyadh and 1 at King Fahd Specialist Hospital - Dammam. Details of this were shown in the tables below: Riyadh Military Hospital Case No. Age of Recipient 1 9 months 2 Reason for Liver Failure Relation Age of Donor End stage liver disease Unrelated 26 years old 2 years old NSCH Unrelated 34 years old 3 2 years old Biliary Atresia Aunt 26 years old 4 3 years old PEIC Unrelated 32 years old 5 1 year old End stage liver disease Mother 26 years old 6 1 year old Biliary Atresia Father 29 years old 7 1 year old PFIC type II Father 41 years old 8 1 year old Criggler Najjar Syndrome Aunt 37 years old 9 8 years old End stage liver disease Mother 35 years old 10 1 year old Criggler Najjar Syndrome Uncle 30 years old King Abdulaziz Medical City and National Guard Hospital - Riyadh Case No. Relation Age of Donor Sister 38 years old Son 29 years old Wilson’s Disease Father 32 years old 35 years old Wilson’s Disease Sister 29 years old 5 8 months Biliary atresia Mother 27 years old 6 4 years old Crigler Najjar Syndrome Brother 19 years old 7 8 9 58 years old 3 years old 16 months HCV Alagille Syndrome PFIC Son Mother Brother 25 years old 33 years old 30 years old Age of Recipient Reason for Liver Failure 1 43 years old HBV 2 60 years old HCV+HCC 3 11 years old 4 84 King Faisal Specialist Hospital - Riyadh Case No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 Age of Recipient 55 years old 64 years old 11 months 56 years old 48 years old 1.4 years old 67 years old 21 years old 4 years old 56 years old 1.9 years old 47 years old 57 years old 63 years old 2 years old 1.8 years old 62 years old 4 years old 0.8 months 1.2 years old 17 years old 46 years old 27 years old 53 years old 52 years old 2 years old 71 years old 67 years old 15 years old 58 years old 63 years old 1.9 years old 57 years old 59 years old 64 years old 0.4 months 2 years old 41 years old 0.4 months 52 years old 3 years old 34 years old 50 years old 68 years old Reason for Liver Failure HCV HCV, HCC Hyperoxaluria Type 1 HBV Cryptogenic ESLD, HCC Hepatoblastoma HCV, PVT, s/p Splenectomy, HCC AIH, DM Histiocytosis X, Diabetes Insipidus Cryptogenic ESLD, Sheehan’s Syndrome PFIC 2 HCV Cryptogenic, sec syphilis, TB, DM` Bilharzial Cirrhosis/PVT Biliary Atresia Citrullinemia HCV, HBV, HCC PFIC I or II Biliary Atresia + Choledocal Cyst Biliary Atresia + Esophageal Cyst PFIC III HCV+HBV+HCC (full left lobe) AIH (left lobe) AIH (hematochromotosis) HBV+HCC Neonatal jaundice/PSC/sc. Cholangitis HBV NASH HCV/SLE HCV HCV+HCC+PVT PFIC Cryptogenic Cirrhosis Secondary Biliary Cirrhosis/PBC/Bilioenteric Anastomosis HCV PFIC II Biliary atresia (ABO incompatible) HBV+HDV+PVT PFIC II HCV+HCC PFIC II Cryptogenic HBV Cryptogenic 85 Relation Daughter Son Mother Daughter Son Uncle Son Cousin Mother Daughter Auntie Son Son Son Cousin Auntie Son Mother Uncle Father Mother Cousin Brother Daughter Daughter Uncle Daughter Niece Cousin Son Nephew Mother Son Son Daughter Mother Mother Son Uncle Son Uncle Cousin Cousin Daughter Age of Donor 34 years old 35 years old 31 years old 21 years old 26 years old 24 years old 24 years old 30 years old 37 years old 31 years old 18 years old 25 years old 18 years old 63 years old 23 years old 19 years old 30 years old 35 years old 21 years old 30 years old 41 years old 31 years old 20 years old 25 years old 23 years old 20 years old 30 years old 41 years old 21 years old 21 years old 24 years old 25 years old 22 years old 31 years old 30 years old 20 years old 35 years old 19 years old 27 years old 22 years old 33 years old 21 years old 31 years old 21 years old 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 .10 months 61 years old 10 years old 2 years old 59 years old 57 years old 1.8 years old 6 years old 55 years old 0.1 months 67 years old 1.3 years old 0.9 years old 62 years old 48 years old 10 months 1.1 years old 0.4 years old 69 years old 0.7 years old 0.8 years old 47 years old 65 years old 0.7 months 5 years old 0.7 years old 3 years old 1.4 years old 1.11 years old 49 years old 61 years old 57 years old ESLD secondary to cholodochial cyst NASH+HCC PFIC II Biliary Atresia HCV+HCC HCV PFIC (type III?) vs. Atresia Choledocal Cyst(Type 4) Cryptogenic/NASH PFIC HBV+HCC (full left graft) PFIC II PFIC II HCV (left graft) HCV Biliary atresia (ABO incompatible) Biliary atresia Biliary atresia Cryptogenic+HCC PFIC II PFIC I vs. II HCV HCV+HCC PFIC vs. Neonatal PSC vs Autoimmune Biliary hypoplasia (Allagile?) (ABO incompatible) Bile acid synthesis disorder? Chonic rejection (Retransplant) (ABO incompatible) Biliary Atresia Cholochal cyst IV Cryptogenic HCV+HCC+Chronic renal Failure Cryptogenic +HCC Mother Unrelated Cousin Brother Daughter Son Father Mother Son Mother Nephew Father Mother Son Son Relative Mother Mother Son Father Mother Brother Son Father Mother Mother Mother Sister Mother Son Son Son 27 years old 27 years old 26 years old 21 years old 30 years old 28 years old 30 years old 37 years old 32 years old 38 years old 33 years old 31 years old 39 years old 30 years old 23 years old 22 years old 36 years old 30 years old 13 years old 30 years old 21 years old 23 years old 25 years old 28 years old 41 years old 31 years old 31 years old 18 years old 21 years old 29 years old 35 years old 26 years old King Fahad Specialist Hospital - Dammam Case No. 1 Age of Recipient 7 years old Reason for Liver Failure Glycogen Storage Disease Relation Mother 86 Age of Donor 24 years old Living and Deceased Liver Transplantation 1990 - 2012 Total Living Related: 508 Total Living Unrelated: 61 Total Deceased: 671 43 37 4 92 14 72 58 26 39 38 1996 2011 2012 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1 1997 2 1995 1992 32 62 49 50 49 54 59 51 7 16 11 19 19 29 28 28 26 20 18 10 19 10 15 1994 2 44 45 1993 1 1990 41 Causes of Unused Harvested Livers 1994-2012 87 (44%) 1) Fatty changes 2) Granulomatous changes/Fibrosis/Atherosclerosis 3) Ischemic/long CIT 4) Macro/Microstasis Steatosis 5) Sepsis 6) Hepatitis (B C) changes 7) Cardiac Arrest – Donor/Recipient 8) Neoplastic 9) Infectious Disease (TB bilharziasis others) 10) Congenital/Vascular Abnormalities 40 (20.2%) 21 20 (10.6%) (10.1%) 11 (5.6%) 1 2 3 4 6 5 4 3 1 (2.0%) (2.5%) (3.0%) (1.5%) (0.5%) 5 6 7 8 9 Total - 198 Livers from Deceased Donors 1994-2012 Cardiac Arrest Harvested but not Used 198 (15.7%) before Retrieval 81 (6.4%) Not Harvested due to Medical Reasons 310 (24.6%) Transplanted 671 (53.1%) Technical Reasons 3 (0.2%) Total: 1263 87 10 Heart Transplantation - 2012 A total of seventy four (74) consented cases were obtained for heart donation in the year 2012 (79.6% of the total consented cases). Twenty two (22) whole hearts were harvested and transplanted. Nineteen (19) whole hearts at King Faisal Specialist Hospital, Riyadh and three (3) at Prince Sultan Military Medical City, Riyadh, in addition to twenty four (24) hearts harvested to be used as a source for valves; all were given to King Faisal Specialist Hospital, Riyadh. Twenty Eight (28) hearts were consented for donation but not harvested for the following reasons: · Unfit donor due to medical reasons (sepsis, donor history, medical condition) (4) cases. · Technical reasons (transportation and logistics) (1) case. · No recipients (4) cases. · Not offered (limited time) (12) cases. · Bad echo result, Low Ejection Fraction (3) cases. · Positive culture results (blood, sputum, etc) (1) case. · Further diagnostic test unavailability (cardiac catheterization) (1) case. · Sudden cardiac arrest (2) cases. Donor Heart Valve Procurement and Utilization in the Year 2012 Aortic Valve Pulmonary Valve Collected 24 24 Used 5 19 Still to be used 0 0 Discarded 19 5 88 Heart Transplantation 1986-2012 52 Whole Heart: 228 Heart for Valves: 564 39 38 36 35 33 32 31 29 29 27 26 23 23 2224 20 19 19 22 19 19 17 15 12 8 9 13 12 9 5 6 8 7 3 5 5 6 4 5 3 3 1 4 2 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 1 12 Hearts from Deceased Donors 1986-2012 Transplanted Whole Hearts 228 (16%) Not Consented for Heart Retrieval 204 (14%) Not Harvested Hearts after obtaining Consent 427 (30%) Hearts as Source of Valves 564(40%) Total = 1423 89 Lung Transplantation – 2012 There were a total of seventy one (71) consents obtained for lung donation for the year 2012 (76%) of the total consented cases for organ donation. Of which, twelve (12) cases were harvested and transplanted by King Faisal Specialist Hospital and Research Center, Riyadh. It is worth mentioning that for the first time; single lung donor was transplanted for two recipients in two (2) cases and ten (10) were utilized as double lung transplantation. Harvested Donor 12 Transplanted per lung / recipient year 2012 Transplanted Organ Transplant Recipient / Operations Single Lung Double Lung 4 20 14 Among the seventy one (71) consents obtained for lung donation, 59 of which were not harvested due to the following reasons: 1. Young and old age (6 cases) 2. Arrested before harvesting (4 cases) 3. Technical reasons (4 cases) · No medevac · Recipient refuse to be transplanted · Recipient unavailable · No surgeon 4. Medical reasons or unfit (12 cases) · Hepatitis C positive (1 case) · Lung infiltration (3 cases) · Atelectasis (1) · Hemorrhage seen during bronchoscopy (1 case) · Asthma (1 case) · Long stay in ICU with MRSA positive (1 case) · Pus seen during bronchoscopy (2 cases) · Severe pulmunary hypertension (1 case) · Neurocysticercosis (1 case) 5. Low PO2 after challenge test (18 cases) 6. Low PO2 after challenge test with pus and/or pneumonia during bronchoscopy (5 cases) 7. No suitable recipient (8 cases) 8. Not offered, donor unstable (1 case) 9. Unable to do challenge test, donor unstable (1 case) 90 Lung Transplantation in Kingdom of Saudi Arabia Hospital Name No. of Transplant Operation King Fahd Hospital, Jeddah 4 (1991-1994) King Faisal Specialist Hospital, Riyadh 45 (Since 1996) King Faisal Specialist Hospital, Jeddah 12 (Since 2001) Total lungs transplanted - 94 Total lungs transplant patient – 61 Lung Transplantation 1991-2012 2005 2004 2003 2001-2002 1996 1991-1994 4 1 2012 3 1 2011 6 2009 5 4 2008 4 2006 4 19 2010 24 19 Total Lungs Transplanted: 94 Lung Donation in Deceased Cases year 2012 Not Consented Retrieved Cases for Lung Retrieval 22 (24%) 12 (13%) Arrested before Retrieval 4 (4%) Not Retrieved Not Retrieved Cases due to Medical Reasons 51 (55%) for Technical Reasons 4 (4%) Total = 93 91 Bone Transplantation - 2012 Bone donation program from deceased donors started in the kingdom in the year 2009 at King Faisal Specialist Hospital and Research Center – Riyadh. At present, bone harvesting goes along with multi-organ retrieval team from actual deceased donor from central region. In the year 2012, six (6) consented and harvested cases (6.5%) for bone donation were acquired from 93 consented cases. Out of which, 17 types of bones were retrieved and 8 musculoskeletal tissues. The table and graph below illustrates the total number and type of bone harvested during the year 2009 – 2012. Bone Type Femur Tibia and Fibula Pelvic Humerus Radius and Ulna Total: Number of Retrieved Bones 38 34 4 2 2 80 Bone Harvesting Activity in Saudi Arabia 2009-2012 29 21 17 13 2009 2010 2011 Total Bones Harvested: 80 92 2012 Cornea Transplantation – 2012 Corneal donation program (as a tissue) is currently harvested along with multi - organ retrieval from actual deceased heart beating organ donors. In the year 2012, consent for corneal donation was obtained in 30 eligible deceased organ donors (32 %) of total consented cases. (8) Cases were harvested while the remaining (22) were not harvested for the following reasons: · Eye trauma / bad cornea (3) cases. · Hepatitis B core antibody positive (4) cases · Positive results on cultures (6) cases. · Not offered (6) cases · No available Hepatitis B core result or culture report (3) cases. The King Khalid Eye Specialist Hospital – Riyadh, being the most active corneal transplant in the kingdom have a 444 patients from their waiting list. The hospital also harvested 16 corneas from the kingdom’s organ donation program, out of which 5 were already transplanted. In addition, 1209 corneas were also transplanted through corneas imported from outside KSA. The institution also distributed 675 to other corneal transplant center. The Eye Hospital – Jeddah records 107 waiting lists for the year 2012. They have a total of 65 numbers of transplanted foreign corneas. King Abdulaziz University Hospital – Riyadh on the other hand, listed 45 patients for corneal transplant. They have a total of 74 corneal transplants for the year 2012. 3150 Corneal Transplantation 1983-2012 1577 945 1209 1578 1366 1344 1005 1167 941 1133 946 931 800 741 642 731 840 843 16 24 15 32 23 17 44 31 21 19 38 93 16 26 53 34 48 49 62 36 355 380 23 13 14 9 350 693 Harvested Abroad: 23667 Harvested Locally: 663 Harvesting/Transplantation Activities from Organ Sharing Program between the Kingdom and other Countries* (1996-2012) Harvested/Transplanted Organs Year Total Harvested/ Transplanted Organs Kidneys Liver Whole Heart Heart for Valves Lungs 1996-2000 6/6 19/14 4/4 11/11 1/1 41/36 2001 13/12 3/3 - 1/1 - 17/16 2002 2/2 2/2 - 2/2 - 6/6 2004 6/6 6/5 1/1 4/4 - 17/16 2005 7/7 13/10 1/1 12/12 4/2 37/32 2006 6/3 12/8 - 7/7 - 25/18 2007 2/2 14/13 1/1 2/2 - 19/18 2008 6/5 12/11 - - - 18/16 2009 2/2 5/5 - 1/1 - 8/8 2010 2/2 10/10 - - - 12/12 2011 4/3 5/3 1/1 - - 10/7 2012 6/3 13/10 - 7/7 10/10 36/30 Total 62/53 114/94 8/8 47/47 15/13 246/215 *Kuwait, Qatar, Bahrain and Spain Organ Sharing Program between the Kingdom and other Countries (1996-2012) Year Country Deceased Shared Organs 1996-1999 Kuwait 31 2000 Spain 5 2001 Spain / Kuwait 16 2002 Kuwait 6 2004 Kuwait / Qatar 16 2005 Kuwait / Qatar 32 2006 Kuwait / Qatar 18 2007 Kuwait / Qatar / Bahrain 18 2008 Kuwait / Qatar 16 2009 Kuwait / Qatar 8 2010 Kuwait / Qatar / Bahrain 12 2011 Kuwait / Qatar 7 2012 Kuwait / Qatar Total 30 215 94 Cost of Organ and Tissue Transplantation Inside and Outside the Kingdom for year 2012 (Million SR) Bone is not added Total Organs/Tissues: 271 Kidney Liver Whole Heart Lungs Heart for Valves Cornea No. of Organs 118 50 22 24 24 16 17 Cost Inside KSA 5.9 17.5 11 12 7.2 0.064 0.34 Cost Outside KSA 59 100 44 48 12 0.192 1.02 Bones The figure shows cost of transplant for different organs (Kidney, Liver, Heart, etc ) and the amount of saving when comparing inside and outside organ transplantation Comparison of Estimated Total Cost of Organs and Tissues Transplanted Inside and Outside the Kingdom for Year 2012 (Million SR) Total Cost Inside KSA 54.004 264.212 Total Cost Outside KSA Estimated Total Saving – 210.208 Million SR 95 Deceased Organ Donation Program Total Number of Deceased Organs Transplanted 1986-2012 2467 671 663 564 228 Kidneys Liver Whole Heart 94 19 Lungs Pancreas 80 Corneas Heart for Valves Bones Total Deceased Organs and Tissues Transplanted in KSA (1986 – 2012) 59 57 210 214 2011 2012 61 49 256 2010 246 185 2009 2008 2007 189 69 139 2005 2006 218 51 128 92 2003 2004 43 65 2001 113 33 45 101 72 2000 1999 96 71 110 1998 SCOT 2002 71 86 119 1997 69 75 117 1996 1995 65 96 98 75 183 32 211 1994 13 111 74 1992 1993 9 14 85 70 65 1991 62 1989 1987 1988 0 29 1986 1990 NKF 73 Tissues (Corneas, Heart for Valves, Bones): 1308 Organs (Kidneys, Liver, Whole Heart, Pancreas, Lungs): 3470 Appendices 97 Appendix I Responsibilities of the Saudi Center for Organ Transplantation (SCOT) Co-ordination of medical care facilities offered to patients with end-stage organ failure by various health agencies in the Kingdom and supervising organ transplant programs as well as follow-up of the application of the procedures related to them. Co-ordination and follow-up of all brain-death cases from different hospitals in the Kingdom as well as harvesting and distribution of organs. Taking care of public health education through mass media and other similar means. Preparing training programs and convening scientific meetings for all personnel in the field of organ transplantation. Publication of scientific bulletins as well as exchange of information with international centers in the field of organ transplantation. Conducting studies and research on the diseases that lead to end-stage organ failure to enable the authorities to provide better health care to these patients. Laying down criteria concerning establishment of organ transplant centers as well as continued evaluation of these centers. 98 Appendix II General Regulations for Organ Transplantation in the Kingdom of Saudi Arabia Based on the letter of the Head of the Council of Ministers No. 7/1561/M dated 19/05/1404 H addressed to the Minister of Health, it was approved to establish the National Kidney Foundation under the supervision of a Committee chaired by the Minister of Health with membership of representatives from the Presidency of the National Guard, Ministries of Defense and Aviation, Higher Education and Health as well as King Faisal Specialist Hospital and Research Center. The committee was entrusted with the responsibility of determining the objectives and activities of the National Kidney Foundation and to assume the responsibilities and duties necessary for its initiation and functioning. Several scientific committees have been established in accordance with the decision of the Deputy Minister for Executive Affairs, Ministry of Health to carry out these responsibilities. These Committees include Brain-Death Committee, Kidney Transplant Committee, Hemodialysis Committee, Peritoneal Dialysis Committee and Computer Committee. With the increase of activities of the center and the need to co-ordinate care of other endstage organ diseases (heart, lung, pancreas, liver and cornea), the Council of Ministers Resolution No. 80 dated 20/06/1413 H was issued to rename National Kidney Foundation as Saudi Center for Organ Transplantation. Based on that resolution, many new committees were established each including official representatives from the above mentioned institutions. These committees were Cardiac Transplant Committee, Liver Transplant Committee, Lung Transplant Committee and Cornea Transplant Committee. After convening intensive meetings, these committees have laid down the regulations that follow. The Saudi Center for Organ Transplantation is the sole authority responsible for cocoordinating and supervising all aspects related to organ transplantation and brain-death in the Kingdom. The general regulations which all hospitals and organ transplant centers should follow have been put forward. They are: All potential brain-death cases should be reported directly to the Saudi Center for Organ Transplantation. 99 Each hospital in the Kingdom should establish local committees which are responsible for matters pertaining to brain-death cases and organ transplantation in the respective hospital as follows: Brain-death committee: This committee should comprise of an internist, an administrative director or equivalent, and a brain-death co-ordinator. This committee is responsible for follow-up of all matters related to brain-death cases and their reporting. The committee also submits proposals for developing the brain-death program in its region to the Saudi Center for Organ Transplantation. The responsibilities of the braindeath co-ordinator are to report brain-death cases to the Saudi Center for Organ Transplantation and to update follow-up information about these cases continuously. He should arrange for sending all necessary blood samples to the laboratory to ensure the fitness of brain-death organs and act as the liason between the Saudi Center for Organ Transplantation and the organ transplant center to which his hospital is attached. Convincing committee: This committee is formulated by the Hospital Director, its responsibilities being to approach the family and relatives of the brain-death case for the purpose of obtaining their consent for organ donation. Documentation of brain-death is done in accordance with the steps laid down in the Brain-death Documentation Form, and according to special procedures that have been laid down by the Brain-Death Committee in the Saudi Center for Organ Transplantation. If the brain-dead patient is a female, it should be ensured that she is not pregnant and if so, organ donation is not considered at all except when there is fetal death. Also, no member of the medical team involved in the transplantation of organs should participate in the diagnosis of brain-death. Consent for organ donation should be obtained from the heritors of brain-death case whether they are inside or outside the Kingdom and in accordance with the special consent form, except if the deceased has expressed his desire to donate organs, when alive in this will that has been attested by the tribunal. If the brain-death case is unidentified the consent of the official specialized organization should be obtained before harvesting is performed. 100 The hospitals should co-ordinate with the Saudi Center for Organ Transplantation before performing any organ harvesting to enable beneficial distribution of the organs in accordance with the regulations in this booklet. Organ harvesting should be performed in the same hospital where brain-death is diagnosed and no case could be transferred to another hospital except when there is an absolute necessity. The hospital in which brain-death was diagnosed is responsible for issuing the death certificate. When brain-death is confirmed and consent is obtained from the family for organ donation, distribution and transplantation of the organs should be carried out as laid down in the regulations concerning each organ. Before performing living related transplantation the following conditions should be fulfilled. Blood relationship till the second degree should exist or the donor should be wet mother or her children, or spouse (except for transplantation of bone marrow). These relationships should be attested by official specialized organizations. Donor should be in good health and it should be ensured that organ donation will not be harmful to the donor or recipient. Transplantation of single organs on which life of the donor is dependent is prohibited. Organ donation should be accepted by the donor without any social or financial pressure. Organ donation should be on written consent and signed by the donor who has the right to change his mind at any time before surgery. Relevant medical examination should be performed as laid down in these regulations. The donor should be informed about all possible and probable hazards resulting from organ removal and this should be documented in his medical file. An organ transplant co-ordinator should be assigned in each organ transplant center entrusted with the following responsibilities. Acts as liaison between the Saudi Center for Organ Transplantation and the organ transplant center. 101 Reporting the names of all patients fit for transplantation to the Saudi Center for Organ Transplantation in order to include them in the national waiting list as well as preparation of a local waiting list for each organ transplant center, according to priority regulations for each organ. Co-ordination with the Saudi Center for Organ Transplantation when there is a braindeath case in any of the hospitals affiliated to his center and extending assistance as needed. Informing the Saudi Center for Organ Transplantation when a suitable patient fit for transplantation is not available in the local waiting list. In every hospital, other than the organ transplant center an organ transplant coordinator should be assigned to send the update all information related to patients with end-stage organ failure (kidney, heart, liver lung etc.) who are fit for transplantation in accordance with special forms issued for this purpose. A second person should be appointed to continue duties when he is absent. Each hospital and organ transplant center should send a list of the names of end-stage organ failure patients to the Saudi Center for Organ Transplantation which is turn establishes national and local waiting lists for each organ transplant in accordance with priority regulations. This waiting list is sent back to organ transplant centers to act accordingly. Each transplant center should provide reports and statistics of organ transplant recipients, both from living related and cadaveric donors, every three months to the Saudi Center for Organ Transplantation in accordance with the special forms of transplant follow-up. All kidney transplant centers have to carry out their responsibilities towards the patients in the areas which are under their sin accordance with the established regulations. Evaluation of organ transplant centers is done every two years by specialized scientific committees in each respective filed and in accordance with the criteria laid down by the Saudi Center for Organ Transplantation. 102 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 103 OFFICIAL STATEMENT OF THE NATIONAL COMMITTEE FOR THE DIAGNOSIS OF DEATH BY NEUROLOGICAL CRITERIA AND VENTILATOR SYSTEM. STATEMENT 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. The National Committee For The Diagnosis Of Death By Neurological Criteria Dr. Mohammad Zuheir Alkawi Dr. Abdullah Turki Chairman, Senior Consultant Neurologist King Faisal Specialist Hospital & Research Center, Riyadh Consultant Pediatric Intensivist, Director, Pediatric Critical Care Unit King Faisal Specialist Hospital & Research Center, Riyadh Dr. Mohammed Al-Bar Dr. Mohammad Ibrahim Almajeed Consultant, Islamic Medicine King Abdul Aziz University - Jeddah Consultant Anesthesiologist, King Khalid University Hospital – Riyadh Dr. Nabil Biary Dr. Awad Addasi Consultant, Neurologist Riyadh Military Hospital Consultant Intensivist, Riyadh Military Hospital This statement is approved by the Saudi Society of Critical Care (SCCS): Dr. Yasser Mandourah Dr. Amin M. Yousef Consultant Intensivist, Head, Saudi Society of Critical Care Head, Intensive Care Unit Riyadh Military Hospital Consultant Intensivist, Deputy Head, Saudi Society of Critical Care Head, Intensive Care Unit King Saud Medical Complex , Riyadh 104 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. 105 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. 106
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