Cadaveric renal transplantation in the Kingdom of Saudi Arabia

Because of the large families we have and the The development of renal transplantation in Saudi importance of supporting kinship that Islam directs Arabia there have been many willing donors. However, it is of interest that the majority of donations come from Background siblings or offspring and relatively small numbers of The first renal transplant operation to be carried out donors are parental, unlike the case in the West [1]. in the Kingdom took place in March 1979—a daughter Nevertheless, it was clear from very early on that to father donation. It was clear even then that endlive donation was not sufficient by any stretch of the stage renal failure (ESRF) was quite common in the imagination, as indeed, is the case universally. country. Reports since then estimated it to be over 100 per million per year and in the south, where malaria An Intermezzo—out of Country transplantation and schistosomiasis are prevalent, the incidence is even We were determined (and still are) not to allow comhigher. The Kingdom of Saudi Arabia is a vast country mercial transplantation for the well debated ethical with an area of 2.5 million sq. km and a population reasons and knowing that it will kill off our live related of 17 million according to the 1992 census. It contains programmes and impede the cadaveric programme. the two most sacred Mosques for Moslems all over As a result, many of our patients had to go abroad the world, in Mecca and Medina which every able for transplantation and we received patients from Moslem is obligated to visit at least once in his/her many countries but the majority were from USA and lifetime. India. Transplantation in USA proved costly (an average 200 000 dollars for each transplantation) and Facilities transplantation in India had its own ethical and medical problems [2,3]. Initially, only live related transplantation was underThe answer to these problems was, of course, to taken in Riyadh Armed Forces Hospital (RAFH). establish a local cadaveric programme. Concomittant with this, Saudi doctors were undertaking training in renal (and indeed organ) transplantation Approval of religious authorities in USA, Canada, UK and Germany and eventually came to run their own renal transplant programmes in The Saudi Arabians are deeply religious people; virtuvarious hospitals in the Kingdom. Currently, there are ally in every action they take, they are guided by the 11 such centres in all the five regions of the Kingdom teaching and guidance of Islam. It was therefore neces(north, south, west, east and central ). All are run by sary before starting a transplantation programme to local teams. In addition, there are three liver transplant seek the opinion and approval of our religion through centres, two heart transplant centres and eight cornea discussions with religious leaders. transplant centres. A series of meetings took place regarding live related organ donations, cadaveric organ donations, brain death and cessation of therapy in brain death patients Life donor transplantation all from the Islamic view point. All these concepts As mentioned above, all early transplants were from were found permissible from Islamic point of view live related transplantation. (The only two exceptions under strict adherance to proper and accurate diagnosis being spousal donations and donations from breast and application of the highest standard of medical milk kinships—as outlined and governed by Islamic practice and ethics. Commercial transplantation was, ruling in this connection.) however, found unpermissible.