Improving organ donation in central Saudi Arabia

Organ transplantation is successful. The main challenge in the Kingdom of Saudi Arabia [KSA] and elsewhere continues to be organ shortage. This shortage was not resolved by utilization of living donors. Previous studies indicate that there is underreporting of brain death cases, lack of completion of documentation process, poor medical care in some instances and finally high refusal rate for consent. In order to put this problem in perspective and find a solution, we initiated a collaborative project between 4 hospitals in Riyadh, KSA and The Saudi Center for Organ Transplantation. The initial result of this project is presented in this article. A donor team was formed to deal and facilitate the logistical aspect of donation in the 3 main Ministry of Health hospitals in Riyadh. Data with regard to the number of donors reported, documentation and success rate were recorded over 3-months [October 2003 to December 2003] and compared with the preceding 9 months. During the period from January 2003 to September 2003, the total number of case reported to the Saudi Center for Organ Transplantation in Riyadh region, was 94. Only 53% were fully documented. Families were approached in 45 of these 50 cases in terms of donation and consent was obtained in 15. However, the number harvested was only 10 [11% yield from total number reported]. During the period from October 2003 until the end of December 2003, the total number of cases reported from 3 hospitals was 19. Seventeen [90%] of them were documented. The families were approached in 16 cases and consent was obtained in 6. All 6 [32%] donors were harvested. The above result clearly indicates that a donor team supporting the intensive care unit [ICU] can improve the donation. It is expected that application of a similar project to more ICUs in KSA will have a substantial positive impact on the rate of organ donation

efficiency in the utilization of potential donors for organ transplantation in Riyadh, Saudi Arabia

Organ transplantation programs have been successful in the Kingdom of Saudi Arabia. This success is limited by organ shortage. The aim of this study is to find out the percentage of actual donors out of all potential donors in intensive care units [ICU], and to look at problems related to the donation process, particularly from the logistical point of view. The study was conducted prospectively for a one year period, June 2001 through to May 2002, in 4 main Riyadh hospitals. Mortality data was collected by a medical professional in each ICU and analyzed on a weekly basis. Final analysis was made at the end of the year. Five hundred and forty-two deaths occurred in these ICUs. Fifty-four% occurred in one hospital. The number of brain death cases in all hospitals was 114 cases. Thirty-eight cases were reported to the Saudi Center for Organ Transplantation [33%]. Documentation was completed in only 23 cases [60%]. In these, there was a significant delay in documentation [second test was carried out in 6-12 hours in 4 cases only]. We have found that the reporting of brain death cases was low [33%]. Dealing with the reported cases is inefficient since only 4 cases were able to become the actual donor out of 38 cases. We found also that there is a gross difference in the number of brain death cases among different hospitals. To improve the efficiency of ICUs in dealing with brain death cases [reporting, documentation, maintenance and consent] will require solving several problems at the medical, administrative, and religious and mass media levels

High bile duct injury following laparoscopic cholecystectomy

Laparoscopic cholecystectomy is now widely applied in hospitals throughout the Kingdom of Saudi Arabia [KSA]. Iatrogenic bile duct injury occurs rarely. It is a serious complication with long term consequences on patients. This paper describes our experience in dealing with this complication and the eventual outcome of the patients. Between July 1993 and December 1999, 17 patients with high bile duct injury were referred to the Hepatobiliary Unit of King Khalid University Hospital and King Fahad National Guard Hospital, Riyadh, KSA. Their charts were reviewed retrospectively. Once a patient was referred, a clinical evaluation with particular attention to the presence of sepsis was made. The anatomy of biliary duct was then delineated. Corrective surgery was attempted through hepaticojejunostomy. Follow up was at least 3 years in all cases. There were 15 females and 2 males with an average age of 37 years. Eleven patients presented with bile duct injury and 6 had a stricture following an attempted repair. Five patients had Bismuth type E2 injury and the rest were higher [E3, E4, E5]. Re-stricture occurred in 7 patients, 3 of them had concomitant arterial injury. All responded to radiological manipulati High bile duct injury following laparoscopic cholecystectomy is a devastating complication, with a high rate of recurrence after repair. Care of such patient should be carried out in a specialized unit with a strict follow up to try to avoid end stage liver failure requiring liver transplantation

Rectal carcinoma in Riyadh Central Hospital

Patients with rectal carcinoma were studied retrospectively in Riyadh Central Hospital, Riyadh, Saudi Arabia over a 4 year period [1985-1988]. There were 53 patients, 34% of whom were below the age of 40. Diagnosis was made after an average of 6.9 months following the first symptoms. This late presentation also reflects the fact that only 58% presented with potentially curable disease. Colostomy was not accepted by 13% of this group, thus losing the chance of possible cure. The diagnostic yield and cure rate should rise if awareness of the disease among medical practitioners and the general population is aroused in our region. Stoma associations can offer health education in this field and are indispensible to the total care of patients with rectal carcinoma

Penetrating abdominal injury: toward more conservative management

Over a period of five years, 139 patients were admitted to general surgical wards at the Riyadh Central Hospital because of penetrating wounds to the abdomen. Of these, 56% of the patients sustained stab wounds and the remaining 44% were victims of gunshot or compressed air gun injuries. All patients were admitted initially for clinical evaluation and observation with the aid of a few diagnostic laboratory and radiology tests. Exploratory laparotomy was performed in 82% of the patients. The rate of negative findings at laparotomy was unacceptably high at 25%. Mortality and morbidity occurred only in the patients who underwent laparotomy. Of analysis of the data support adoption of a more conservative approach in the treatment of such patients, provided they are evaluated carefully and observed by experienced staff

Colorectal carcinoma: review of 110 cases

Over the 4-year period [1045 to 1408H], 110 cases of colorectal carcinoma were treated at Riyadh Central Hospital. The charts were reviewed with particular reference to the epidemiological characteristics. There were 59 [54%] Saudi patients with an average age of 51 years. Thirty-one percent of the patients were under 40. The male to female ratio was 2:1. The disease was found to involve the left side of the colon in 60% of the patients, while the right colons was involved in 35%. A curative resection was attempted in 38 [35%] patients. Mortality in the 77 patients who underwent surgery was 9%. It appears that colorectal carcinoma in the Saudi population affects a younger age group than that observed in the West, with a good percentage [35%] of right-sided colonic cancer. Because the familial non-polyposis from colonic cancer in this group of patients, we recommend that surveillance be directed to the respective families so that asymptomatic patients can be identified in an early stage of the disease