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Kidney Transplantation
Criteria for cadaveric kidney transplantation

Patients are included in the local and national waiting lists for kidney transplantation provided the following criteria are met with:

  1. Patients should have end-stage renal disease (ESRD).

  2. The patients should not have any other organ disease of significance (e.g., active tuberculosis, active peptic ulcer, malignancy or active acute or chronic infection).

  3. The result of all investigations done on this patient must be within normal limits. (See appendix 10 for the non-diabetic ESRD patients and appendix 11 for diabetic patients).

  4. The patient must be between 3 and 60 years old and body weight should be more than 10 kg, if a child. In case of diabetic patients, they will be evaluated on individual basis.

  5. The patient must be psychologically stable and compliant to therapy.

  6. The patient must be HIV negative.

  7. The patient must be hepatitis B negative. If he/she is hepatitis B positive, liver biopsy must be normal.
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  1. Patients, who are positive for anti-glomerular basement membrane anti-bodies, anti-DNA antibodies or antineutrophil cytoplasmic autoantibodies must turn negative before they are put on the waiting list.

  2. Under special circumstances concerning hepatitis serology, the following is to be noted:

  • HBs Ag positive patients and hepatitis B immune patients can be transplanted with kidneys from HBs Ag positive cadaveric donors.

  • Hepatitis C positive carriers can be transplanted with hepatitis C positive cadaveric kidneys.
Criteria for living related donation

  1. The donor should be blood related up to the 2nd degree of must be the wet mother or her children, or spouse. This must be confirmed by official specialized institutions.

  2. The act of donation must be without any pressure and the donor must be fully convinced.

  3. The donor should be completely healthy both physically and psychologically (see requested investigations for living related donor in appendix 12)

  4. Patient's age must be not less than 18 years and not more than 60 years.

  5. The donor's blood group should be compatible with that of the recipient.

  6. The cross-match should be negative.

  7. The donor must be HB's Ag negative.
Contra-indications for kidney transplantation
  1. Patients have incurable malignant disease.

  2. Patients with primary oxalosis (except if the patients will undergo a combined kidney and liver transplant).

  3. Patients with positive HIV.

  4. Patients addicted to narcotics and other similar drugs.

  5. Non-compliant patients.

  6. Patients with organic diseases like:

  • Liver Cirrhosis.

  • Periportal fibrosis with advanced esophageal varices

  • End-stage heart failure, Class IV not responding to treatment.

  • End-stage respiratory failure which restricts the patient's daily activities.

  • Progressive cerebral disease (of any etiology).

  • Irreversible collagen vascular disease.

  • Chronic active hepatitis.
Priority criteria for kidney transplantation

The Saudi Center for Organ Transplantation has laid down priority criteria for kidney transplantation as follows:

  • First: If the patient has life threatening vascular access problems, he has absolute priority for transplantation wherever he is, and as soon as a suitable kidney is available on the condition that the decision is taken by the kidney transplant center to which the patients is attached after officially informing the Saudi Center for Organ Transplantation.

  • Second: For patients who do not have vascular access problem, the priority level is based on the points given as follows:

  PRIORITY CRITERIA PRIORITY SCORE
1 Cytotoxic antibodies 1 for each 10% more than 50%
2 age: 3 to 5 yrs
age: 6 to 10 yrs
age: 11 to 45 yrs		 3
2
1
3 Period on dialysis 0.1 per each month on dialysis
4 Previous failed LRD Tx. 2
5 HLA match 1 per each antigen match
6 Identical blood group 3
7 Identical age-group 2


Distribution of kidneys

The harvested kidneys will be distributed as follows: *

  1. The first kidney will be transplanted to a suitable patient in the national waiting list of the Saudi Center for Organ Transplantation according to priority. Patient should be brought to the transplant center that has performed the harvesting, except for patients attached to another organ transplant center. In such cases, the kidney will be sent to that center for transplantation. The second kidney will be transplanted to one patient from the local waiting list according to priority that is put by Saudi Center for Organ Transplantation. If possible and according to priority levels, the kidney in the organ transplant center should be transplanted to one of the patients from the hospital that reported brain death.

  2. Kidney should be transplanted to Saudi patients whenever a suitable patient is available. If there is no suitable Saudi patients any where in the Kingdom, and after obtaining consent from the Saudi Center for Organ Transplantation, kidney may be transplanted to a non-Saudi patient with priority for residents followed by visitors.

  3. Kidney could be exchanged with other countries according to agreement established between the Saudi Center for Organ Transplantation and similar institutions in these countries.

* A suitable patient is one who fulfills medical fitness and priority criteria.