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Organ Donation: Relieving Pain, Reviving Hope

A report by Saudi Press Agency as part of FANA's economic affairs

RIYADH, Feb 12 (KUNA) -- Najlaa Al-Sudairi, a consultant in international media relations, never thought that she would one day embark on two different journeys: donate an organ to one of her closest relatives, or she would have to wait for a donor to save her beloved daughter.
These two experiences turned her life upside down.
More than two decades ago, Najlaa, who was leading a normal life like any other girl, found herself compelled to make a life-saving decision at a young age. She decided to donate her kidney to her sister, Seetah, who was suffering from kidney failure. Despite her fear of hospitals and doctors, and her limited understanding of organ transplantation, Seetah's struggle with dialysis and the hardships she endured day after day made Najlaa opt for the only choice that would put an end to her sister's tragedy: donate a kidney.
"When I underwent examinations at the hospital, all my previous fears vanished completely, and I began to live with hope, envisioning my sister Seetah leading a normal life. And that is exactly what happened," Najlaa said.
"The operation was successful, thank God, and I felt an indescribable sense of fulfillment for relieving my sister's suffering. Witnessing her full recovery filled me with immeasurable joy," she added.
After all these long years, fate decided last year that Najlaa would have to go through another bitter experience: having to wait for a donor to save her daughter Sultanah, whose liver functions had failed. Sultanah's condition was critical, and her health deteriorated significantly.
While desperately searching for a donor to save her daughter's life, Najlaa endured unimaginable agony and pain every time she helplessly looked at her beloved daughter. However, the Most Merciful granted Sultanah, who could die any time, a brand new life.
In another case, Abdullah Al-Tamimi, a liver cirrhosis patient, he described his experience as "life after death." Suffering from organ failure, he was frequenting hospitals, clinging to life. As his condition worsened, a liver transplant became necessary to save him.
"I am a man who is satisfied with Allah's fate and decree, and my concern was not so much for myself but for my family, who needed me. I constantly prayed to Allah to take care of them after I go," Abdullah said, recalling the bleak times.
"After going through utter darkness, a glimmer of light shone upon my life and the lives of my family. Allah blessed me with recovery after I received the liver of a brain-dead patient through the Saudi Center for Organ Transplantation," he said with visible relief.
The Saudi Center for Organ Transplantation (SCOT), a Beacon of Hope for Patients in Need of Organ Transplant.
The history of organ transplantation in Saudi Arabia dates back to 1979, when the first kidney transplant was performed at Prince Sultan Military Medical City. It is, however, the establishment of the National Kidney Center, through an initiative by King Salman bin Abdulaziz Al-Saud when he was governor of the Riyadh Region, that marks the actual beginning of the organ donation and transplantation program in the Kingdom.
A Royal Decree was issued establishing the National Kidney Center. Another decree changed its name to SCOT.
SCOT regulates the practice of organ donation and transplantation in the Kingdom. It sets policies and procedures for donation, standards and conditions for licensing transplant operations, monitors and evaluates facilities, registers and follows up on cases of patients with organ failure before and after transplantation, is informed about cases of brain death, and supervises waiting lists and determines the priority of those who are eligible.
Over the past 40 years, organ donation and transplantation has grown significantly throughout the Kingdom, with transplant centers spread across the country and performing various types of organ transplants, such as kidney, heart, liver, lung, pancreas, intestine, and tissues such as bones and corneas.
The Kingdom ranks second globally in organ donation among living people, according to the Global Observatory on Donation and Transplantation statistics for 2022.
The center launched the Athar electronic platform to digitize donation procedures and the organ supply chain, employ Artificial Intelligence (AI) to match tissues between donor and potential recipient, get easy access to therapeutic procedures, and equal opportunities in obtaining services, and calculate performance indicators on the donation and organ transplantation journey.
The platform also enables electronic connectivity and integration with health information systems, and follows up on the status of donation from the time a case is reported until the completion of the donation procedures, in a digital form, providing a value-added service to donors. The first phase of the platform was launched on January 7, 2024.
Regarding the sequence of case follow-up at SCOT, clinical organ transplantation coordinator Dr. Khaled Al-Ruqi said that it starts with the reception of a report from a hospital that has a potential brain death case. Once the report is received, the follow-up process commences with the involvement of attending and monitoring doctors who oversee the diagnosis of brain death and ensure its accuracy. 

In Saudi Arabia, diagnosing brain death is a meticulous process.
According to SCOT, Brain Death Diagnosis by Neurological Criteria National Committee Chairman and head of Neurology Division at Security Forces Hospital Dr. Faisal Al-Suwaidan, who explained that it is not sufficient to prove only brain stem death, as is done in some countries.
Instead, a complete brain death must be established with 100 percent accuracy to avoid any errors or shortcomings in the diagnosis. This is achieved by following the Saudi protocol for diagnosing brain death, which is renowned for its stringent guidelines.
The protocol is regularly updated with the latest scientific data on diagnostic tools, ensuring that confirmation and certainty can be obtained within the necessary time frames.
In addition, advanced tests are utilized to demonstrate the cessation of blood circulation to the brain and the absence of electrical activity in brain cells. The tests conducted in the Kingdom hospitals are compulsory and not optional, unlike in some countries. This highlights the unwavering commitment of officials and doctors to ensuring that there are no errors in the diagnosis of brain death.
Once the diagnosis of brain death is confirmed, arrangements are made for the family to meet with the medical team at the hospital. The dialogue with the family is attended by intensive care doctors who are fully prepared to address any concerns or questions.
SCOT ensures the safety of organs throughout the entire process, from case follow-up to obtaining approval from the family for donation. Additionally, it prioritizes the safety of the organ recipients after transplantation. This is crucial because the ultimate goal of transplantation is to enhance the quality of life for patients with organ failure.
SCOT Organs Procurement Manager Ahmad Jaafari said that one of SCOT's key responsibilities is to conduct laboratory tests and examinations on potential organ donors. This ensures that the organs are safe and functioning properly. Once this is established, SCOT selects the most suitable patient or beneficiary who is in urgent need of transplant.
The center is responsible for coordinating with the hospitals where the donor is located, and ensuring the arrangement of operating rooms upon the arrival of medical teams.
Should the case be outside Riyadh, coordination is made with the Saudi Medical Appointments and Referrals Centre (SMARC) at the Ministry of Health to secure aircraft equipped to transport medical teams to the city where the donor is located or to one of the Gulf countries.
In terms of the time elapsed between organ removal and transplantation, the process happens "exceptionally quickly," according to Jaafari.
Following the removal, organs are meticulously preserved and transferred with great care. They are then transplanted as swiftly as possible, he said, emphasizing the critical role of time in organ viability post removal.
For example, in the case of heart transplantation, from the moment of removal to the actual transplant surgery, the process is completed within four hours. The lung transplantation process takes six hours, the liver requires 12 hours, and for both kidneys, the time frame ranges from 24 to 48 hours.
The center collaborates with organ removal teams to ensure the timely delivery of organs to transplantation centers, typically within a period of 4-6 hours.
There is an agreement between the center and the Gulf countries regarding the reception of organ donation notifications. Subsequently, direct coordination takes place with transplantation centers to gather data from surgeons, coordinators, and nursing staff participating in the surgery.
Additionally, coordination with medical evacuation, passports and customs, and airport security is conducted to facilitate the transportation process. All these procedures are completed in less than 12 hours, considering the critical role of time in these cases.
Concerning organ donation from a living person to one facing organ failure, Dr. Sultan Al-Dalbahi, a kidney diseases and transplantation consultant, and the head of the Executive Committee for Organ Transplantation at the General Directorate for Health Services in the Ministry of Defense, asserted that the organ donation process is safe.
"Donors typically resume normal life within two weeks to a month post donation, enjoying a similar quality of life as non-donors. Adhering to the surgeon's instructions during healing is crucial, as is maintaining an ideal weight and lifestyle. Donors usually return to regular life and work activities within one month to 45 days after transplantation," Dr. Al-Dalbahi said.
He also emphasized that the Kingdom regulations prohibit a single donor from donating more than one organ. This safeguard is crucial for the donor's well-being and health, as well as the quality of the transplanted organ post-procedure, he said. 
According to a statement issued by the General Secretariat of the Council of Senior Scholars, organ donation is a kind act that Sharia has endorsed as a great reward since it helps save lives, one of the major purposes of Islam.
The idea of organ donation is elaborated in the Quranic verse which says: "And that whoever saved one [life] should be regarded as though he had saved all mankind." Another verse says: "And do good; indeed, Allah loves the doers of good." The command to do good in this verse includes all types of benevolence, the greatest of which is preserving someone's life, alleviating their pain or curing their illness.
Following the Islamic law, according to the statement of the general secretariat, is sufficient to achieve all the good and everything that is in the best interest of individuals and groups, as it calls for cooperation and compassion, and encourages organ donation, as a form of solidarity between members of the society.
This is mentioned in the Prophet's Hadith: "The believers in mutual kindness, compassion and sympathy are just like one body. When one of the limbs suffers, the whole body responds to it with wakefulness and fever." Advisor to the Royal Court and member of the Council of Senior Scholars Sheikh Dr. Abdullah Al-Mutlaq, said: "Organ donation is a significant and vital matter related to reviving souls and making people happy. These operations occur in all societies, and their success has become obvious. Many families have benefited from them, and they are God's blessings on nowadays people, who have witnessed the words of God Almighty." According to Al-Mutlaq, organ donation is implemented in one of the following ways.
Donation by living people of an organ whose removal would not affect the donor, according to studies from the World Health Organization.
Donation from a brain-dead person who has left a will in which he donates his organs after passing away, which can be considered an everlasting charity.
As Al-Mutlaq said, a person who donates his organs and helps maybe 10 people could not be compared to one who did not donate and whose organs decayed after burial without benefiting a fellow human being.
"I spoke with one of the prominent sheikhs and he told me that he has an implanted cornea and that he thanks God for restoring his sight to see and read again, whereas before he was deprived of such a blessing," he said.
The third option is for the guardians of the brain-dead patient to decide to donate. Upon this decision, both the deceased and his or her guardian are rewarded for doing everlasting charity.
The Saudi leadership gave the highest support to SCOT when both Custodian of the Two Holy Mosques King Salman bin Abdulaziz Al-Saud, and Crown Prince and Prime Minister Mohammad bin Salman bin Abdulaziz, registered, in May 2021, in the organ donation program.
This gesture is another proof of the great care that patients with terminal organ failure receive from the Custodian of the Two Holy Mosques and the Crown Prince, who encourage all citizens and residents to register in the program, citing its great importance in giving hope to patients whose lives depend on donated organs.
According to SCOT, this initiative increased the number of people registered in the program from 50,000 to more than 500,000 donors by the end of 2023.
Najlaa Al-Sudairi said: "I lived the experience of donating. The practice of giving, contentment, and solidarity that our Islamic religion calls for, and receiving a reward from Allah the Almighty is truly a wonderful feeling. Especially when the donation is for someone close to you and whose life you care about." She recalls her experience more than two decades after her child received an organ for transplantation. She said she is indescribably happy to see her daughter experiencing a normal life after God has blessed her with recovery following the organ donation from a brain-dead person. She vowed to continue urging people everywhere to take the initiative to register in the organ donation program.
Sheikh Al-Mutlaq said: "I am among those who hastened to support those who call on people to donate, whether from a living donor or from the dead. I have registered myself as a post-death organ donor. Upon calling on people to fulfill this matter, we were among the first to donate and take pride in it." Organ transplantation is the only solution for patients with terminal organ failure. It means saving lives, just as God tells people. (end) bs