STEP I
DONOR DETECTION:
Identification and recognition of a potential organ donor is initially done in Intensive Care Unit by ICU consultant, treating doctor, Neuro-physician, Neurosurgeon or Anaesthesiologist, (rarely done in Emergency Room or Surgical and Medical Units).

STEP II
NOTIFICATION:
Once a doctor detect, suspect and identify a potential brain death case he should immediately notify SCOT. Notification could be done by direct telephone call at 01 445 1100 ( Toll Free 800 124 5500 ) or by fax at 01 445 3934 through nurse or regional coordinators, SCOT nursing coordinator usually call the ICU’s daily.
SCOT nurses call the 116 ICU daily enquiring about potential brain death, a good professional relation must be developed between coordinator and medical staff in different ICU in the Kingdom.
 

SCOT will follow-up the case from the moment the medical coordinator is notified about a potential donor.

 

Once the case is notified by ICU, full medical data is taken by SCOT nursing coordinators such as personal data, cause of brain death, history and etc. Data is subjected to medical and administrative discussion in a meeting on a daily basis. Organ viability or fitness for donation is being evaluated. SCOT is also responsible to take the address and contact numbers of the family of the potential donor. Then the case is to be followed-up by medical and nursing coordinators to monitor any abnormality in values; e.g. electrolyte imbalances and which must be corrected. Further investigation is requested and carried out such as serology and cultures. Proper and good donor maintenance is required during the period.

STEP III
DOCUMENTATION:
It is to be carried out by two physicians trained in diagnosis of brain death cases. Steps of diagnosis should be followed according to the rules and regulation issued by the Ministry of Health and brain death committee in SCOT. (See chapter of Protocol of Brain Death Diagnosis).

STEP IV
FAMILY APPROACH-1:
ICU physician or treating doctor should inform the family about the patient's condition, the message should be clear to them that their patient sustains irreversible brain damage explaining that following full investigations and medical check-up the patient is now brain death. No hope must be given that the patient could be treated elsewhere, no weak or misleading word should be used; e.g. (seriously ill).
Treating physician should not get himself involved in getting consent. Physician who documents the case should (never) be involved in getting consent or any communication with the family.

No hope should be given that there is any chance of treating the patients elsewhere.

STEP V:
SCOT coordinators make sure that documentation paper is forwarded to SCOT via fax. All necessary documents of donor are attached to donor file, fully checked and reviewed by the medical coordinator and being discussed in daily meeting.

STEP VI:
FAMILY APPROACH-2:
(This is a role of Administrative Coordinator) Once a file of potential brain death is checked by SCOT medical coordinator and found that he is fit for organ donation, the address or contact numbers of the late patient's family is handed over to administrative coordinator to approach the family. The administrative coordinator starts his communication with the family of brain death patient, regional administrative coordinator or a hospital coordinator arrange for a meeting with the family on a fixed time to meet, then select the best place (not in ICU) to talk and discuss the concept of organ donation. Administrative coordinator should be aware of social, medical background of the case.

CONSENT: Only written consent is accepted from the next of kin with two witnesses. If the potential donor is an expatriate the family is contacted by telephone after some period of receiving the news of death of their relative. If the family agreed for organ donation they can sign the consent and sent it back by fax or they can give authorization to a relative who is living in the Kingdom of Saudi Arabia to sign the consent on their behalf. This is strictly followed by SCOT coordinators. Consent is not accepted verbally.

STEP VII:
ORGAN DISTRIBUTION AND RETRIEVAL:
Once the consent is obtained, file of the donor is re-evaluated by the medical and nurse coordinator, organs are offered and full information is given to the transplant centers. It is evaluated by them and gives their acceptance or rejection of the offer. Sometimes, transplant centers are requesting for some investigations and updates.

Kidneys are distributed according to affiliated transplant center and zonal distributions. 12 kidney transplant centers share the distribution.

Liver is distributed by rotation to two centers according to the rules and regulations set by SCOT and the Liver transplant committee. An urgent request from transplant centers is considered.

Heart goes to the transplant center which send the urgent waiting list or by rotation to two centers. If no recipient for whole heart, it is retrieve to be source for valves.

Lung is offered to the transplant center if there is available recipient. Combined heart and lung transplantation occasionally takes place.

Pancreas is transplanted alone or combined with kidney or used as source of pancreatic islet cell.

Cornea usually harvested by one centre.
Once all the organs are accepted, a fixed time is agreed upon by transplant centers, a medical air evacuation is notified, the team fly to donor hospital (if outside Riyadh).

Occasionally liver team performs the retrieval of liver and kidney. If no liver is to be retrieved, renal team goes for kidney retrieval.
Once organs are retrieved, these are handed over to specific transplant centers.

STEP VIII:
SCOT medical staff nurses and coordinators, follows the process of transplant, recipient's information are taken from transplant coordinators of transplant centers and encoded in SCOT computer system.

STEP IX:
SCOT administrative coordinators follow up the process of the dead body by sending the mortal remains to its native country (this applicable if the donor is expatriate), and all necessary administrative paper works for funeral and social support for the donor family.

 

Ministry of Health  (MOH) will bear the cost of sending the body of the deceased donor to his homeland accompanied by one chaperone.