Monday 20th September 2021

General procedures that must be followed by all hospitals and transplant centers:

Reporting of all possible brain death cases.
All hospitals are responsible for establishing internal committees, which will be fully responsible for handling cases with brain death and organ transplantation.

 

1.1 Role of intensive care and emergency units:

Identification of potential brain dead patients and early notification of suspected cases to the Saudi Center for Organ Transplantation (SCOT) must be regarded as one of the main responsibilities of the intensive care units. Also, regular communication between the coordinator at the hospital and coordination office at the SCOT is part of their daily routine and is important for subsequent evaluation of their performance.

It is incumbent on the director of the donor hospital to ensure that proper supervision of the management and follow-up of the cases of the donors and implementation of this order are undertaken.

Staff in the emergency room (ER) should be educated about the concepts of brain death and organ donation program. When a potential donor is brought to the ER, attempts to resuscitate must be made without losing hope, and there should be coordination with the ICU for further care.

Staff in the intensive care units in the hospitals should show interest in the training courses organized by the SCOT on a regular basis. The courses are meant to train the staff on concepts of diagnosis of brain death, care of the deceased as well as procedures for organ donation.

 

1.2 Coordinators in donor hospitals: all hospitals shall form internal committees consisted of medical and administrative coordinators who would be responsible for handling all cases of brain death and organ donation as follows:

1.2.1 Notification and follow-up: coordinators in hospitals should report suspected brain death cases to the SCOT continue to send information on a regular basis and all necessary samples to the laboratory. They should also coordinate with regional coordination offices (RCO) and the SCOT in order to follow all the special procedures related to brain death and contacting the family members regarding donation.

1.2.2 Approaching family of the deceased and convince them to consent for donation in coordination with the SCOT and the RCO; special training is necessary to accomplish this mission.

 

See appendix 6: organ transplant centers, and appendix 7: hospitals distribution to transplant centers.

 

1.3 The role of RCO in organ donation:

1.3.1 Goal: Organ promotion through intensive care units and emergency departments in the various regions of the Kingdom.
1.3.2 The affiliation of the RCOs and their mechanism of action:
– The RCOs belong fully to the SCOT in all administrative, financial, and organizational aspects.
– The SCOT specifies the locations of RCOs and their affiliated donor hospitals.

 

1.3.3 The missions:

1.3.3.1 Communication with intensive care units in hospitals regarding organ donors through daily communication and regular visits to overcome the difficulties encountered in the program.
1.3.3.2 Early identification of cases of brain death and follow-up of the diagnostic procedures and medical care.
1.3.3.3 Interview with the family of deceased donor for organ donation and end the administrative procedures after the removal of organs.
1.3.3.4 Assistance in raising awareness of those working in the medical field as well as the general public about the importance of organ donation and spreading knowledge through seminars, lectures and workshops in hospitals in coordination with the SCOT.
1.3.3.5 To report periodically on the activities of the office to the SCOT.

 

1.3.4 Requirements for the establishment and operation of the RCOs:
1.3.4.1 Customize a convenient place for the Coordinating office (at the donor hospital or a separate building).
1.3.4.2 Provision of office equipment and means of communication (Direct dial phone – Fax – Internet) and a computer with a printer and accessories.
1.3.4.3 Providing a portable electroencephalogram (EEG) machine.
1.3.4.4 Staff in coordinating offices: They should at least consist of the following personnel:
1.3.4.4.1 Doctor trained to deal with cases of brain death and care of the donor.
1.3.4.4.2 Administrative coordinator trained to deal with organ donation and procedures.
1.3.4.4.3 Nurse or technician trained to perform EEG and draw blood samples and support medical and administrative staff.
1.3.4.4.4 Secretary fluent in Arabic, English and can operate a computer and its applications.
1.3.4.4.5 Suitable means of transportation for the medical and adminis-trative teams other tasks related to the RCO.

 

1.3.5 Role of medical coordination in the RCO:
1.3.5.1 Ensure that the intensive care units in hospitals identify cases of brain death through routine visits to those units.

1.3.5.2 When a suspected case of brain death is identified in any donor hospital in his district, he will be responsible for:
1.3.5.2.1 Reporting to the SCOT the status of the cases and coordination with medical and administrative coordinator at the respective hospital.
1.3.5.2.2 Coordination with the ICU doctor in charge to follow the national protocol diagnosing death using neurological criteria within the earliest possible time and to overcome the difficulties that can be encountered.
1.3.5.2.3 Coordination with the ICU doctor in charge of the case to maintain the organ donor and overcome the difficulties and other relevant requirements.
1.3.5.2.4 Coordination with the treating physician in the hospital inform and explain to the relatives the status of the deceased.
1.3.5.2.5 Coordination with the SCOT and the donor hospital once the approval for organ donation is obtained in order to determine the place and time of the harvesting procedure and provide assistance with special technical materials needed to preserve and transport the retrieved organs.
1.3.5.2.6 Coordination with the SCOT and donor hospitals in his area to organize training workshops to disseminate awareness among medical workers and the public about the importance of organ donation and transplantation.
1.3.5.2.7 Submission of periodic reports (at least every 3 months) to the SCOT, including the statistics and obstacles and proposed solutions to improve performance and results.

 

1.3.6 Role of administrative coordinator in regional coordination:

The administrative coordinator must have obtained at least a high school certificate and be familiar with the legal and medical aspects of the meaning of death and the importance of organ donation and transplantation. He should have the ability to communicate with the family of the deceased and to establish new relationships with different operators and relevant departments in hospitals, administrative and governmental bodies in his area.

1.3.6.1 Work along with the medical coordinator in overcoming any obstacles that may hinder the diagnosis of death due to administrative aspects.

1.3.6.2 Careful interview with the family of the deceased to introduce the idea of organ donation for their approval on it, and to ensure continuity of communication with them even after organ donation.

1.3.6.3 Overcome the administrative difficulties that might hinder organ donation procedures before, during and after the removal of organs in coordination with the SCOT (such as a death certificate, operating rooms, and delivery of the corpse to his family, etc.).

1.3.6.4 Inform the SCOT about the personnel involved in the success of the case and their roles in it, and follow-up with material and moral incentives for them.

1.3.6.5 Work along with members of the RCO in spreading awareness about the importance of organ donation through seminars and training courses.

1.3.6.6 Continuity of communication and support for families after completion of organ donation

1.3.6.7 Work together with the medical coordinator for the submission of the periodic repots to the SCOT about the activities of the RCO and collaboration with SCOT research activities.