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In
order to satisfy the needs of ESRD patients in the Kingdom,
the number of kidney transplants needed is estimated at 30 per
million population per year, i.e., approximately 300 a year.
At present, only about 150 renal transplants are being
performed each year. About
80 of these are with kidneys from cadaveric donors and the
remaining, using kidneys from live-related donors.
The number of live-related donors is limited and cannot
obviously cover the need.
In addition, not all willing live-related donors are
found fit to donate their kidneys.
In
the Kingdom of Saudi Arabia, transplantation using
living-unrelated donors is
completely prohibited.
This is based on Islamic and ethical considerations.
The international trend in this regard is also similar.
Thus,
the only potential source that can meet the demands of the
patients with ESRD in the Kingdom is cadaveric donors.
Moreover, there is an increasing demand for
transplantation of other organs, such as liver, heart,
pancreas and cornea. Obviously,
these can come only from cadaveric donors.
In this respect, it should be pointed out that the
estimated number of potential cadaveric donors in the
intensive care units (ICU) in the Kingdom is about 2000 each
year and one can expect that at least half of them should be
suitable for organ donation.
Based on the current estimates, about 150-200
donors per year would almost completely satisfy the need of
kidneys required for transplantation in the Kingdom and will
provide a potential source for other organs as well.
2.2 THE CONCEPT OF BRAIN DEATH
The concept of death based on viability of the brain,
termed brain death, is now a recognised entity
in medicine. The
diagnosis is made by clinical examination and objective
investigations. The
diagnosis of brain death can be made in every hospital with a
well-functioning ICU and must be done as a part of the I
general management of any patient fulfilling the criteria of
brain-death, irrespective of the issue of organ donation.
The question nowadays is not whether the diagnosis of
brain-death is accepted, but is regarding further management
of the brain-dead patients, i.e., whether to continue to
sustain them on life supporting equipments or not.
2.2.1 Who is responsible for the
diagnosis of brain death?
It
is mandatory that a neurologist, a neuro-surgeon, an
internist, an ICU physician, an anesthesiologist, a
pediatrician or a consultant physician with experience in
evaluation of brain-dead patients performs the examinations.
Neither a nephrologist nor a transplant surgeon should
be involved in the establishment of diagnosis of brain death.
2.2.2 Who is responsible for the care of patients with
brain
death?
The
following professionals are responsible for the care of the
brain-dead patient: an ICU physician, an anesthesiologist, an
internist, a neurosurgeon or a neurophysician in cooperation
with-a nephrologist.
2.3 CADAVERIC DONORS
Cadaveric donors are in great demand since they can
donate kidneys as well as other organs.
However, only those who have been diagnosed properly
without any doubt of brain death should be considered.
It must be emphasized here that waiting does not
clarify the situation. Patients
with brain damage are either dead or alive
and, there is no compromised condition in between.
Nevertheless, there can be a great deal of
misdiagnosis,.- if all the requirements of a well designed
brain-death protocol like that of the National Kidney
Foundation (NKF) are not entirely fulfilled. There should be no uncertainty while establishing the
diagnosis. None
of the required tests should be missed.
For example, apnea test is mandatory.
Always keep in mind that in order to have a successful
cadaveric organ transplantation program, a clear
diagnosis, far from any doubt is most
essential when dealing with brain-dead patients.
2.4 THE POTENTIAL CADAVERIC DONOR
2.4.1 Initial recognition of a potential donor
A potential cadaveric donor is usually a patient in coma,
due to any of the following conditions and requiring
ventilatory support:
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