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- Technical
facilities required
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The
hospital in which a kidney transplant center will be
established must have the following departments:
Cardiology, Gastroenterology (with endoscopy), Chest
(with endoscopy), Radiology, Hematology, Pathology
laboratory, Biochemistry laboratory, Nephrology with
hemodialysis unit (preferably containing portable
dialysis machines), and ICU.
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At
least two operating rooms must be available.
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There
should be at least two rooms for management of
post-transplant patients.
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- Supporting
Services
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Laboratory:
All routine investigations necessary for the
patients either before or after the transplantation
must be available. Facilities to do tissue typing,
cytotoxic antibodies and blood levels of drugs
including cyclosporine or similar drugs should be
available.
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Radiology:
Conventional X-ray, ultrasound, radioisotope
scanning and computerized axial tomography must be
available in the hospital.
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Drugs
The following drugs must be permanently available in
the center:
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Immunosuppressive
drugs: Cyclosporine, Azathioprine, Prednisolone and
Other similar drugs.
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Drugs
for treating rejection episodes such as
methylprednisolone, anti-lymphocyte or anti-thymocyte
globulin and monoclonal antibodies (OKT3).
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Solution
for perfusing the organs such as Eurocollins
solution or Wisconsin University solution.
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Drugs
for treating bacterial, viral, fungal or parasitic
infections.
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Procedures
to be followed by kidney transplant centers to fulfill their
responsibilities towards dialysis units and ICUs attached to
them (according to regional distribution)
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Every
renal transplant center renders the necessary technical
assistance to all dialysis units attached to it.
This includes the following.
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It
constitutes a referral center for difficult cases,
surgical or non-surgical, concerning renal
transplantation.
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It
performs tissue typing on all ESRD patients fit for
transplantation.
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It
decides the fitness of patients for transplantation
and sends their names and results of investigations
to the Saudi Center for Organ Transplantation in the
special forms assigned for this.
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Every
renal transplant center organizes training programs for
ICU personnel responsible for the diagnosis and management
of brain death so as to enable them to identify
brain-death cases and report them early to the Saudi
Center for Organ Transplantation. This is done so that the
Saudi Center for Organ Transplantation can participate in
the documentation and management of brain-death cases in
accordance with the procedures laid down by its
Brain-Death Committee.
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Each
renal transplant center receives and follows-up all
information about all brain death cases in the ICUs
attached to it through Saudi Center for Organ
Transplantation. The initial reporting should always to be
to Saudi Center for Organ Transplantation following which
coordination between Saudi Center for Organ
Transplantation, the organ transplant center and the
reporting ICU proceeds till organ retrieval.
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Every
renal transplant center should participate in increasing
the awareness about brain death and organ transplantation
amongst all nationals and expatriates resident in the
region attached to it by conducting regular meetings.
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Criteria for
continuity of kidney transplant centers
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Application
of the criteria relevant for the establishment of new
transplant centers, as mentioned previously.
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The
number of renal transplants performed in the center should
be not less than 12 per year.
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The
center must contribute in the training activities to the
staff and help in the management of brain-dead cases in
the ICUs attached to it in collaboration with the Saudi
Center for Organ Transplantation and must deliver to it
reports about these activities.
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The
transplant center should satisfy its entire obligations
towards the nationals and expatriates by conducting
meetings concerning all aspects of organ transplantation
and brain death and must submit regular reports about
these activities to the Saudi Center for Organ
Transplantation.
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A
detailed scientific annual report about the results of
transplantation performed in each center must be forwarded
to the Saudi Center for Organ Transplantation. It should
include the following points:
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- The
condition of the transplanted patients.
- The
state of transplanted kidney.
- Rate
of complications.
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The
kidney transplant committee attached to the Saudi Center
for Organ Transplantation will evaluate all the
transplantation centers every two years. A permanent
smaller committee will be established from the main
committee, which has the right to visit any kidney
transplant center, at any time and whenever it is judged
necessary to examine the pace of work in the respective
center.
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The
Kidney Transplant Committee should meet annually to review
all the reports from different transplant centers in the
Kingdom including mortality rate, incidence of organ
rejection, complications of transplantation as well as the
reports submitted by the permanent smaller committee. If
it appears that one of these centers is not applying these
regulations and/or the success rate of transplant
surgeries performed is not satisfactory, the permanent
committee shall visit the center in order to explore the
reasons and handicaps preventing this center from carrying
out its functions properly. The center will be given three
to improve its performance following which the kidney
transplant committee will re-evaluate this center with the
right to submit the proposal of closure of this center to
the licensing authority in the Ministry of Health, if no
improvement occurs. The majority of 2/3rd take the
decision of the committee with a least 70% of its members
present.
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These
criteria apply to all kidney transplant centers currently
existing in the Kingdom as well as to the centers, which
will be opened in future.
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