A high-volume heart transplantation center in an Islamic country

Abstract

Cardiac transplants are performed sporadically or not at all in the majority of predominantly Muslim countries in the Middle East. We examined our experience in 76 patients who underwent heart transplantation between January 2005 and May 2010 in our center in Saudi Arabia. Excluded were 50 transplants performed between 1989 and 2004, due to incomplete data. Primary outcomes were complications, 30-day and late mortality rates, and 1-year survival. The heart transplant activity between 2005 and 2010 (15.0 per year) was 4.5-fold higher than that between 1989 and 2004 (3.3 per year). There were 61 (80%) men and 15 (20%) women, with a mean age of 35 years (range, 13-57 years). The mean waiting list time was 64 days (range, 1-262 days), and hospital stay was 30 days (range, 12-166 days). Major complications were infection (10), low-grade rejection (9), reoperation for hemorrhage (8), and sternal dehiscence (2). The 30-day mortality was 7.8% (6/76). Actuarial survival was 87.4% at 1 year and 81.5% at 3 years. A hospital in a Muslim country can increase cardiac transplant activity with excellent 30-day mortality and early survival comparable to that in worldwide counterparts.

Heart Transplantation in the Middle East Gulf Region

“…7 By the end of 2016, a total of 339 have been performed inside the kingdom, the majority (250 heart transplants) at KFSH with more than 95% of the recipients being Saudi citizens. [6][7][8][9][10] Most heart donors have been non-Saudi expatriates with only 1% to 6% coming from Saudi nationals. 10,11 The mean recipient age was 33 ± 13 years, thus significantly younger compared with that in the International Society For Heart and Lung Transplantation (ISHLT) registry (55 years).…”

“…[6][7][8][9][10] Most heart donors have been non-Saudi expatriates with only 1% to 6% coming from Saudi nationals. 10,11 The mean recipient age was 33 ± 13 years, thus significantly younger compared with that in the International Society For Heart and Lung Transplantation (ISHLT) registry (55 years). 11,12 Five-year survival for transplanted patients was 78%, in line with outcomes in the ISHLT registry.…”

Brain-Dead Patients are not Cadavers: The Need to Revise the Definition of Death in Muslim Communities

“…Potential donors were transferred from surrounding affiliated hospitals and distant cities to the designated organ procurement units at transplant centers who specialized in preserving transplantable organs in potential brain-dead donors before surgical procurement (Najafizadeh et al 2012). The above strategies would increase the yield of transplantable organs (e.g., hearts) in Muslim communities (Canver et al 2011; Kazemeyni et al 2009; Mandegar et al 2009; Najafizadeh et al 2012). The availability of heart-beating donors would also increase so that “[a] hospital in a Muslim country can increase cardiac transplant activity….comparable to that in worldwide counterparts” (Canver et al 2011).…”

“…The above strategies would increase the yield of transplantable organs (e.g., hearts) in Muslim communities (Canver et al 2011; Kazemeyni et al 2009; Mandegar et al 2009; Najafizadeh et al 2012). The availability of heart-beating donors would also increase so that “[a] hospital in a Muslim country can increase cardiac transplant activity….comparable to that in worldwide counterparts” (Canver et al 2011). Utilitarian reasoning would be invoked to facilitate end-of-life organ procurement because “…it is a pity to waste such candidate cadavers without trying to save the life of many others who need their organs” (Albar 2012).…”

“…Both the heart and the brain are capable of recovering respective functions in non-heart-beating donors (Joffe et al 2011; Marquis 2010). Therefore, in both heart-beating (Canver et al 2011) and non-heart-beating (Faraj et al 2010) donors, organs are likely to be surgically procured from patients who do not fulfill the Islamic definition of death approved in 1986. For the same reasons, Western scholars have criticized the noncompliance of organ donation from heart-beating (Nair-Collins 2010) and non-heart-beating (Harrington 2009) donors with the stipulated accepted medical standard of determining death in the UDDA.…”