307.5: Deceased organ allocation and procurement of high risk organs in KSA (2013-2018).

Background: The organ donation is a need due to the huge gap between supply and demand. Proper identification and management of organs and determining prior conditions and/or pathology before and during organ allocation will help better assessment and judgment of the organs, thus improving the allocation process, organ acceptance and utilization by transplant centers. Objective: To evaluate the role of detection and allocation of high risk organs to improve the donation and utilization program in general. Methods: This retrospective study over a 6-year period from 2013-2018 of all consented brain death cases. Analysis of annual reports and collected SCOT data and also our dynamic cases study. Results: Over the 6-year period (2013-2018), a total of 3616 possible deceased donors were reported to SCOT. 2169 (60%) has been converted to potential donors. 1800 (83%) become eligible donors after family approached, 557 (31%) had been consented for organ donation and 539 (96.8%) consented donors were recovered. A total of 1,675 (70.6%) solid organs and 697 (29.4%) tissues were recovered. Organs recovered were, 787 transplanted kidneys, 56 kidneys (6.6%) were discarded mainly due to CKD and vascular diseases. 460 livers were recovered, wherein, 396 (86%) transplanted, 64 (14%) were discarded, 260 lungs were transplanted, with non-recovered lungs of 49%. 288 hearts were recovered of which, 113 (39%) transplanted and 175 recovered as source of heart for valves, and 53 pancreases were transplanted over the past 6 years. Deceased organ distribution and allocation is based on recipient priority criteria and zonal distribution system, following the Guidelines in the Directory of Regulations of Organ Transplantation. High-risk or marginal organs, such as 128 (18%) kidneys from extended criteria donors with the median age of 46 years and died due to CVA (63%) over the last 6 years, to prevent the delay of acceptance of these marginalized kidneys and improve its utilization, these kidneys were allocated to 5 transplant centers, 3 in central region, 1 in eastern and 1 in western which used to accept and transplant a marginal kidneys. Conclusions: Improving the deceased allocation and procurement of high risk organ requires a multifactorial approach which involves the cooperation between the doctors and surgeon in managing the high risk deceased donors. Improving the sharing of information on HLA cross-matching of the donors to all transplant centers. Giving recognition to these transplant centers and encouraging the ICU staff regarding the best practice of donor management and maintenance. Predicting organ pathology by providing medical imagery, such as ultrasounds, CT scans, bronchoscopy and heart echocardiograms prior organ allocation thus, improving organ allocation. Reconditioning and maintaining the marginal donors and organs and drafting a new regulation leads to more successful transplantation and less discarded organs. References: 1. SCOT Annual Report 2013-2018 2. Stewart D. Transplantation. 2017;101:575-587 3. Matas AJ. Sometimes zero is the correct answer. Am J Transplant. 2011;11:411. 4. Schold JD, American Transplant Congress Abstracts. 2009 Abstracts 272.