Transplantation Society Regional Perspectives
Status of Liver Transplantation in the Arab World Hatem Khalaf,1,17 Ibrahim Marwan,2 Mohammed Al-Sebayel,3 Mahmoud El-Meteini,4 Adel Hosny,5 Mohamed Abdel-Wahab,6 Khaled Amer,7 Mohamed El-Shobari,6 Refaat Kamel,4 Mohammed Al-Qahtani,8 Iftikhar Khan,8 Abdulla Bashir,9 Saeb Hammoudi,9 Sameer Smadi,10 Mohamad Khalife,11 Walid Faraj,11 Kamel Bentabak,12 Tahar Khalfallah,13 Assad Hassoun,14 Asem Bukrah,15 and Ibrahim Mustafa16 Keywords: Arab, Egypt, Saudi Arabia, Doha Donation Accord, Deceased donation, Living donation. (Transplantation 2014;97: 722Y724)
he liver transplantation experience of 11 countries in the League of Arab States is presented in this Regional Perspective and provided in an ongoing series of such perspectives through the auspices of The Transplantation Society (1Y3). The history and current experience of 27 liver transplant centers throughout these 11 countries is a seminal recording of both deceased (DDLT) and living donor (LDLT) liver transplantation in the Arab World. The data of this report were assembled by responses to an email questionnaire from 26 of the 27 centers with information regarding the date of the first liver transplant (LT), the total number of LT (including DDLT and LDLT), and the most common indication for LT in those centers.
T
The authors declare no fundng or conflicts of interest. 1 Hamad Medical Corporation, Doha, Qatar. 2 National Liver Institute, Minoufiya University, Minoufiya, Egypt. 3 King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 4 Ain Shams University, Cairo, Egypt. 5 Cairo University, Cairo, Egypt. 6 Mansoura University, Mansoura, Egypt. 7 International Medical Center (IMC), Cairo, Egypt. 8 King Fahad Specialist Hospital, Dammam, Saudi Arabia. 9 Jordan Hospital, Amman, Jordan. 10 King Hussein Medical Center, Amman, Jordan. 11 American University of Beirut, Beirut, Lebanon. 12 Centre Pierre et Marie Curie, University of Algiers, Algiers, Algeria. 13 Mongi Slim University Hospital, Tunis, Tunisia. 14 Zheen International Hospital, Erbil, Iraq. 15 National Organ Transplant Program, Tripoli Central Hospital, Tripoli, Libya. 16 Theodor Bilharz Research Institute, Cairo, Egypt. 17 Address Correspondence to: Hatem Khalaf, M.Sc., Ph.D., F.E.B.S., Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. E-mail: [email protected] H.K. initiated the research and wrote the article. All other authors participated in data analysis and performance of the research. From the Pan Arab Liver Transplantation Society (PALTS). Received 27 December 2013. Accepted 8 January 2014. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0041-1337/14/9707-722 DOI: 10.1097/TP.0000000000000062
722
www.transplantjournal.com
The Arab World is composed of 22 countries in the League of Arab States founded in 1945. It has a combined population of approximately 350 million people and is united by Arabic language, culture, Islamic religion, and geographic contiguity. Additionally, certain Arab countries share a high prevalence of viral hepatitis with an increasing need for LT in those countries (4, 5). The first DDLT in the Arab World was performed in 1990 at Riyadh Military Hospital in Saudi Arabia (6). The first LDLTwas performed in 1991 at the National Liver Institute in Egypt (7). Between 1990 and August 2013, 3,804 liver transplants (3,052 [80%] LDLT and 752 [20%] DDLT) were performed at the 27 in 11 Arab countries (Table 1). The largest percentage of liver transplantation has been performed by 13 transplant centers in Egypt (56%) followed by four transplant centers in Saudi Arabia (35%) and two transplant centers in Jordan (5%). In the remaining eight Arab countries, liver transplant activity has been limited to one program in each country. The most common indication for LT in this series was end-stage liver cirrhosis caused by hepatitis C virus or hepatitis B virus, with or without hepatocellular carcinoma. More than 70% of the LDLT in this series were performed by the transplant centers in Egypt (Table 2) with five living donor deaths reported (0.2% rate of mortality) (8Y12). Egypt has the highest prevalence of hepatitis C virus (HCV) worldwide, estimated to be 15% and 26% of the population (13). More than 90% of the DDLT in this series were performed in Saudi Arabia; four liver transplant centers in Saudi Arabia have collectively performed 1,338 LT (52% DDLT and 48% LDLT), including 13 split LT procedures. There were no reported living donor deaths in Saudi Arabia (14, 15). A small number of transplants have been performed in Algeria, Tunisia, and Lebanon (16, 17). The initial transplant programs in Libya, Kuwait, and United Arab Emirates performed a few liver transplants, but they were subsequently suspended because of logistical and technical reasons. A program for LDLT has recently been developed in Iraq with a potential of performing 15 LDLT per year; also, a DDLT program has begun in Qatar with four transplants performed to date (18). Missing in this report are the current annual data of patient and allograft survival. The progress of liver transplantation Transplantation
& Volume 97, Number 7, April 15, 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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* 2014 Lippincott Williams & Wilkins
TABLE 1. Liver transplant activity in the Arab world until August 2013 arranged according to date of the first liver transplant Country
First LT
LDLT
DDLT
Total
%
Saudi Egypt Tunisia Lebanon Algeria Jordan Libya UAE Kuwait Iraq Qatar Total
1990 1991 1998 1998 2003 2004 2005 2007 2010 2011 2011
648 2,138 8 4 36 174 21 2 V 21 V 3,052
690 2 31 19 V 4 V V 2 0 4 752
1,338 2,140 39 23 36 178 21 2 2 21 4 3,804
35% 56% 1% 0.6% 1% 5% 0.5% 0.1% 0.1% 0.5% 0.1%
LT, liver transplantation; LDLT, living donor liver transplantation; DDLT, deceased donor liver transplantation; UAE, United Arab Emirates.
in the Arab world will ultimately necessitate such data to validate the ongoing expertise of the transplant programs. The Pan Arab Liver Transplant Society intends to develop a registry of outcome data and also include a recording of a relationship of the living donor to the recipient. This relationship is an important concern throughout the region but especially in Egypt, considering the high poverty rates in the country and noting that the largest percentage of LDLT has been performed by the transplant centers of Egypt (19, 20). Consequently, the Egyptian parliament has recently enacted a law banning the sale of human organs, imposing restrictions on transplant operations for foreigners, and stipulating jail sentences and fines for violation of the law. The absence of deceased organ donation in Egypt is troublesome but not surprising in view of the cultural barriers and the current political unrest (21). The Saudi Center of Organ Transplantation (SCOT) is a well-recognized national organ donation agency that has collaborated with the liver transplant programs of Saudi Arabia in propelling deceased organ donation (22). Because almost all of the deceased donors are derived from expatriate workers residing temporarily in Saudi Arabia, there have been ethical concerns that the inducement to donate is a result of a cash payment to the next of kin of the donor provided from the Saudi government and administered through SCOT (23). SCOT has responded that such payments constitute an expression of gratitude to the family for their donation. The assessment of deceased organ donor potential by the WHO Critical Pathway that was developed with SCOT leadership will be another component of data that will be a helpful reflection of Saudi contribution to the practice of deceased donation in the region. The SCOT program is to be commended for the opportunity of expatriate patients to undergo liver transplantation in Saudi Arabia. The transparent display of a waitlist with specific allocation to patients on the list based upon medical urgency becomes an
important model of ethical propriety for Saudi Arabia, for the region, and the rest of the world. The Qatar Center for Organ Donation is working closely with The Transplantation Society and the Declaration of Istanbul Custodian Group to develop a donation system that fulfills global standards in accordance with WHO Guiding Principles. This combined effort has led to the Doha Donation Accord in an attempt to encourage deceased donation and increase consent rates. The Accord provides a government sponsored support to the families of all potential deceased donors (3). The survey of this report clearly reveals the current necessity for both deceased and living donor liver transplantation to meet the patient needs of each country. The best rate in the region is being achieved by Saudi Arabia but only providing 25% of the demand. The high prevalence of HCV, for example in Egypt, also impacts both the deceased and living donor pool. Thus, patients from Arab countries are still traveling to foreign destinations to undergo transplantation entailing much cost and resulting in inadequate care. Poor outcomes are well known to be associated with commercial liver transplantation (24). In conclusion, both DDLT and LDLT are now routinely and successfully performed in the Arab World. As elsewhere, the organ shortage remains the biggest hurdle facing the increasing need for LT in most of the Arab countries. Although deceased organ donation has been legalized, implementation remains limited because of cultural and logistical barriers. The increasing demand and scarce supply of organs in the Arab World has generated appropriate concern related to organ trafficking and transplant tourism. These shared challenges can only be faced through continued collaboration between the liver transplant programs in the Arab World and the international transplant community.
TABLE 2. Liver transplant activity in Egypt until August 2013 arranged according to date of the first liver transplant Center National Liver Institute National Cancer Institute Wadi El-Nile Dar El-Foad Maadi Hospital Cairo University Al-Mansoura University nternational Medical Center El-Sahel Hospital Egypt Air Al-Azhar University Ain Shams University Other Total
First LT LDLT DDLT Total 1991 1992 2001 2001 2003 2004 2004 2005 2007 2007 2008 2008 V
205 V 400 350 131 129 267 170 115 160 25 155 31 2,138
V 2 V V V V V V V V V V V 2
%
205 9.6% 2 0.1% 400 18.7% 350 16.4% 131 6.1% 129 6% 267 12.5% 170 7.9% 115 5.4% 160 7.5% 25 1.2% 155 7.2% 31 1.4% 2,140
LT, liver transplantation; LDLT, living donor liver transplantation; DDLT, deceased donor liver transplantation.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Transplantation
ACKNOWLEDGMENT The authors wish to express their appreciation to Francis L. Delmonico, President of The Transplantation Society, for his editorial review and suggestions and his support for the Pan Arab Liver Transplant Society.
11.
REFERENCES
14.
1. 2. 3.
4. 5. 6. 7. 8. 9. 10.
Huang J, Wang H, Fan ST, et al. The national program for deceased organ donation in China. Transplantation 2013; 96: 5. Broumand B, Delmonico FL. Commendable developments in deceased organ donation and transplantation in Iran. Transplantation 2013; 96: 765. Alkuwari H, Fadhil R, Almaslamani Y, et al. The Doha Donation Accord aligned with the Declaration of Istanbul: implementations to develop deceased organ donation and combat commercialism. Transplantation 2014; 97: 3. Gasim GI. Hepatitis B virus in the Arab world: where do we stand? Arab J Gastroenterol 2013; 14: 35. Daw MA, Dau AA. Hepatitis C virus in Arab world: a state of concern. ScientificWorldJournal 2012; 2012: 719494. Jawdat M, Qattan N, al Karawi M, et al. The first liver transplant in Saudi Arabia and the Arab world. Transplantation 1992; 54: 766. Habib NA, Higgs BD, Marwan I, et al. Living-related liver transplantation in Africa. Int Surg 1993; 78: 121. Khalaf H, El-Meteini M, El-Sefi T, et al. Evolution of living donor liver transplantation in Egypt. Saudi Med J 2005; 26: 1394. Yosry A, Esmat G, El-Serafy M, et al. Outcome of living donor liver transplantation for Egyptian patients with hepatitis C (genotype 4)related cirrhosis. Transplant Proc 2008; 40: 1481. El-Meteini M, Hamza A, Abdalaal A, et al. Biliary complications including single-donor mortality: experience of 207 adult-to-adult living donor liver transplantations with right liver grafts. HPB (Oxford) 2010; 12: 109.
12. 13.
15. 16. 17. 18. 19. 20. 21. 22. 23. 24.
& Volume 97, Number 7, April 15, 2014
Salah T, Sultan AM, Fathy OM, et al. Outcome of right hepatectomy for living liver donors: a single Egyptian center experience. J Gastrointest Surg 2012; 16: 1181. Kamel E, Abdullah M, Hassanin A, et al. Live donor hepatectomy for liver transplantation in Egypt: lessons learned. Saudi J Anaesth 2012; 6: 234. Mohamoud YA, Mumtaz GR, Riome S, et al. The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis. BMC Infect Dis 2013; 13: 288. Al-Sebayel M, Khalaf H, Al-Sofayan M, et al. Experience with 122 consecutive liver transplant procedures at King Faisal Specialist Hospital and Research Center. Ann Saudi Med. 2007; 27: 333. Khalaf H, Al-Sofayan M, El-Sheikh Y, et al. Donor outcome after living liver donation: a single-center experience. Transplant Proc 2007; 39: 829. Faraj W, Deborah Mukherji D, Fakih H, et al. Liver transplantation in Lebanon: a hard lesson to learn. Ann Transplant 2010; 15: 25. Bentabak K, Graba A, Boudjema K, et al. Adult-to-adult living related liver transplantation: preliminary results of the Hepatic Transplantation Group in Algiers. Transplant Proc 2005; 37: 2873. Khalaf H, Derballa M, Elmasry M, et al. First liver transplant in Qatar: an evolving program facing many challenges. Exp Clin Transplant 2013; 11: 423. Danovitch GM, Chapman J, Capron AM, et al. Organ trafficking and transplant tourism: the role of global professional ethical standardsVthe 2008 Declaration of Istanbul. Transplantation 2013; 95: 1306. Budiani-Saberi D, Mostafa A. Care for commercial living donors: the experience of an NGO’s outreach in Egypt. Transpl Int 2011; 24: 317. Hamdy S. Not quite dead: why Egyptian doctors refuse the diagnosis of death by neurological criteria. Theor Med Bioeth 2013; 34: 147. Shaheen FA, Souqiyyeh MZ, Attar MB, et al. The Saudi Center for Organ Transplantation: an ideal model for Arabic countries to improve treatment of end-stage organ failure. Transplant Proc 1996; 28: 247. Arnold R, Bartlett S, Bernat J, et al. Financial incentives for cadaver organ donation: an ethical reappraisal. Transplantation 2002; 73: 1361. Allam N, Al Saghier M, El Sheikh Y, et al. Clinical outcomes for Saudi and Egyptian patients receiving deceased donor liver transplantation in China. Am J Transplant 2010; 10: 1834.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Status of Liver Transplantation in the Arab World Hatem Khalaf,1,17 Ibrahim Marwan,2 Mohammed Al-Sebayel,3 Mahmoud El-Meteini,4 Adel Hosny,5 Mohamed Abdel-Wahab,6 Khaled Amer,7 Mohamed El-Shobari,6 Refaat Kamel,4 Mohammed Al-Qahtani,8 Iftikhar Khan,8 Abdulla Bashir,9 Saeb Hammoudi,9 Sameer Smadi,10 Mohamad Khalife,11 Walid Faraj,11 Kamel Bentabak,12 Tahar Khalfallah,13 Assad Hassoun,14 Asem Bukrah,15 and Ibrahim Mustafa16 Keywords: Arab, Egypt, Saudi Arabia, Doha Donation Accord, Deceased donation, Living donation. (Transplantation 2014;97: 722Y724)
he liver transplantation experience of 11 countries in the League of Arab States is presented in this Regional Perspective and provided in an ongoing series of such perspectives through the auspices of The Transplantation Society (1Y3). The history and current experience of 27 liver transplant centers throughout these 11 countries is a seminal recording of both deceased (DDLT) and living donor (LDLT) liver transplantation in the Arab World. The data of this report were assembled by responses to an email questionnaire from 26 of the 27 centers with information regarding the date of the first liver transplant (LT), the total number of LT (including DDLT and LDLT), and the most common indication for LT in those centers.
T
The authors declare no fundng or conflicts of interest. 1 Hamad Medical Corporation, Doha, Qatar. 2 National Liver Institute, Minoufiya University, Minoufiya, Egypt. 3 King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 4 Ain Shams University, Cairo, Egypt. 5 Cairo University, Cairo, Egypt. 6 Mansoura University, Mansoura, Egypt. 7 International Medical Center (IMC), Cairo, Egypt. 8 King Fahad Specialist Hospital, Dammam, Saudi Arabia. 9 Jordan Hospital, Amman, Jordan. 10 King Hussein Medical Center, Amman, Jordan. 11 American University of Beirut, Beirut, Lebanon. 12 Centre Pierre et Marie Curie, University of Algiers, Algiers, Algeria. 13 Mongi Slim University Hospital, Tunis, Tunisia. 14 Zheen International Hospital, Erbil, Iraq. 15 National Organ Transplant Program, Tripoli Central Hospital, Tripoli, Libya. 16 Theodor Bilharz Research Institute, Cairo, Egypt. 17 Address Correspondence to: Hatem Khalaf, M.Sc., Ph.D., F.E.B.S., Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. E-mail: [email protected] H.K. initiated the research and wrote the article. All other authors participated in data analysis and performance of the research. From the Pan Arab Liver Transplantation Society (PALTS). Received 27 December 2013. Accepted 8 January 2014. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0041-1337/14/9707-722 DOI: 10.1097/TP.0000000000000062
722
www.transplantjournal.com
The Arab World is composed of 22 countries in the League of Arab States founded in 1945. It has a combined population of approximately 350 million people and is united by Arabic language, culture, Islamic religion, and geographic contiguity. Additionally, certain Arab countries share a high prevalence of viral hepatitis with an increasing need for LT in those countries (4, 5). The first DDLT in the Arab World was performed in 1990 at Riyadh Military Hospital in Saudi Arabia (6). The first LDLTwas performed in 1991 at the National Liver Institute in Egypt (7). Between 1990 and August 2013, 3,804 liver transplants (3,052 [80%] LDLT and 752 [20%] DDLT) were performed at the 27 in 11 Arab countries (Table 1). The largest percentage of liver transplantation has been performed by 13 transplant centers in Egypt (56%) followed by four transplant centers in Saudi Arabia (35%) and two transplant centers in Jordan (5%). In the remaining eight Arab countries, liver transplant activity has been limited to one program in each country. The most common indication for LT in this series was end-stage liver cirrhosis caused by hepatitis C virus or hepatitis B virus, with or without hepatocellular carcinoma. More than 70% of the LDLT in this series were performed by the transplant centers in Egypt (Table 2) with five living donor deaths reported (0.2% rate of mortality) (8Y12). Egypt has the highest prevalence of hepatitis C virus (HCV) worldwide, estimated to be 15% and 26% of the population (13). More than 90% of the DDLT in this series were performed in Saudi Arabia; four liver transplant centers in Saudi Arabia have collectively performed 1,338 LT (52% DDLT and 48% LDLT), including 13 split LT procedures. There were no reported living donor deaths in Saudi Arabia (14, 15). A small number of transplants have been performed in Algeria, Tunisia, and Lebanon (16, 17). The initial transplant programs in Libya, Kuwait, and United Arab Emirates performed a few liver transplants, but they were subsequently suspended because of logistical and technical reasons. A program for LDLT has recently been developed in Iraq with a potential of performing 15 LDLT per year; also, a DDLT program has begun in Qatar with four transplants performed to date (18). Missing in this report are the current annual data of patient and allograft survival. The progress of liver transplantation Transplantation
& Volume 97, Number 7, April 15, 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
723
Khalaf et al.
* 2014 Lippincott Williams & Wilkins
TABLE 1. Liver transplant activity in the Arab world until August 2013 arranged according to date of the first liver transplant Country
First LT
LDLT
DDLT
Total
%
Saudi Egypt Tunisia Lebanon Algeria Jordan Libya UAE Kuwait Iraq Qatar Total
1990 1991 1998 1998 2003 2004 2005 2007 2010 2011 2011
648 2,138 8 4 36 174 21 2 V 21 V 3,052
690 2 31 19 V 4 V V 2 0 4 752
1,338 2,140 39 23 36 178 21 2 2 21 4 3,804
35% 56% 1% 0.6% 1% 5% 0.5% 0.1% 0.1% 0.5% 0.1%
LT, liver transplantation; LDLT, living donor liver transplantation; DDLT, deceased donor liver transplantation; UAE, United Arab Emirates.
in the Arab world will ultimately necessitate such data to validate the ongoing expertise of the transplant programs. The Pan Arab Liver Transplant Society intends to develop a registry of outcome data and also include a recording of a relationship of the living donor to the recipient. This relationship is an important concern throughout the region but especially in Egypt, considering the high poverty rates in the country and noting that the largest percentage of LDLT has been performed by the transplant centers of Egypt (19, 20). Consequently, the Egyptian parliament has recently enacted a law banning the sale of human organs, imposing restrictions on transplant operations for foreigners, and stipulating jail sentences and fines for violation of the law. The absence of deceased organ donation in Egypt is troublesome but not surprising in view of the cultural barriers and the current political unrest (21). The Saudi Center of Organ Transplantation (SCOT) is a well-recognized national organ donation agency that has collaborated with the liver transplant programs of Saudi Arabia in propelling deceased organ donation (22). Because almost all of the deceased donors are derived from expatriate workers residing temporarily in Saudi Arabia, there have been ethical concerns that the inducement to donate is a result of a cash payment to the next of kin of the donor provided from the Saudi government and administered through SCOT (23). SCOT has responded that such payments constitute an expression of gratitude to the family for their donation. The assessment of deceased organ donor potential by the WHO Critical Pathway that was developed with SCOT leadership will be another component of data that will be a helpful reflection of Saudi contribution to the practice of deceased donation in the region. The SCOT program is to be commended for the opportunity of expatriate patients to undergo liver transplantation in Saudi Arabia. The transparent display of a waitlist with specific allocation to patients on the list based upon medical urgency becomes an
important model of ethical propriety for Saudi Arabia, for the region, and the rest of the world. The Qatar Center for Organ Donation is working closely with The Transplantation Society and the Declaration of Istanbul Custodian Group to develop a donation system that fulfills global standards in accordance with WHO Guiding Principles. This combined effort has led to the Doha Donation Accord in an attempt to encourage deceased donation and increase consent rates. The Accord provides a government sponsored support to the families of all potential deceased donors (3). The survey of this report clearly reveals the current necessity for both deceased and living donor liver transplantation to meet the patient needs of each country. The best rate in the region is being achieved by Saudi Arabia but only providing 25% of the demand. The high prevalence of HCV, for example in Egypt, also impacts both the deceased and living donor pool. Thus, patients from Arab countries are still traveling to foreign destinations to undergo transplantation entailing much cost and resulting in inadequate care. Poor outcomes are well known to be associated with commercial liver transplantation (24). In conclusion, both DDLT and LDLT are now routinely and successfully performed in the Arab World. As elsewhere, the organ shortage remains the biggest hurdle facing the increasing need for LT in most of the Arab countries. Although deceased organ donation has been legalized, implementation remains limited because of cultural and logistical barriers. The increasing demand and scarce supply of organs in the Arab World has generated appropriate concern related to organ trafficking and transplant tourism. These shared challenges can only be faced through continued collaboration between the liver transplant programs in the Arab World and the international transplant community.
TABLE 2. Liver transplant activity in Egypt until August 2013 arranged according to date of the first liver transplant Center National Liver Institute National Cancer Institute Wadi El-Nile Dar El-Foad Maadi Hospital Cairo University Al-Mansoura University nternational Medical Center El-Sahel Hospital Egypt Air Al-Azhar University Ain Shams University Other Total
First LT LDLT DDLT Total 1991 1992 2001 2001 2003 2004 2004 2005 2007 2007 2008 2008 V
205 V 400 350 131 129 267 170 115 160 25 155 31 2,138
V 2 V V V V V V V V V V V 2
%
205 9.6% 2 0.1% 400 18.7% 350 16.4% 131 6.1% 129 6% 267 12.5% 170 7.9% 115 5.4% 160 7.5% 25 1.2% 155 7.2% 31 1.4% 2,140
LT, liver transplantation; LDLT, living donor liver transplantation; DDLT, deceased donor liver transplantation.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
724
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Transplantation
ACKNOWLEDGMENT The authors wish to express their appreciation to Francis L. Delmonico, President of The Transplantation Society, for his editorial review and suggestions and his support for the Pan Arab Liver Transplant Society.
11.
REFERENCES
14.
1. 2. 3.
4. 5. 6. 7. 8. 9. 10.
Huang J, Wang H, Fan ST, et al. The national program for deceased organ donation in China. Transplantation 2013; 96: 5. Broumand B, Delmonico FL. Commendable developments in deceased organ donation and transplantation in Iran. Transplantation 2013; 96: 765. Alkuwari H, Fadhil R, Almaslamani Y, et al. The Doha Donation Accord aligned with the Declaration of Istanbul: implementations to develop deceased organ donation and combat commercialism. Transplantation 2014; 97: 3. Gasim GI. Hepatitis B virus in the Arab world: where do we stand? Arab J Gastroenterol 2013; 14: 35. Daw MA, Dau AA. Hepatitis C virus in Arab world: a state of concern. ScientificWorldJournal 2012; 2012: 719494. Jawdat M, Qattan N, al Karawi M, et al. The first liver transplant in Saudi Arabia and the Arab world. Transplantation 1992; 54: 766. Habib NA, Higgs BD, Marwan I, et al. Living-related liver transplantation in Africa. Int Surg 1993; 78: 121. Khalaf H, El-Meteini M, El-Sefi T, et al. Evolution of living donor liver transplantation in Egypt. Saudi Med J 2005; 26: 1394. Yosry A, Esmat G, El-Serafy M, et al. Outcome of living donor liver transplantation for Egyptian patients with hepatitis C (genotype 4)related cirrhosis. Transplant Proc 2008; 40: 1481. El-Meteini M, Hamza A, Abdalaal A, et al. Biliary complications including single-donor mortality: experience of 207 adult-to-adult living donor liver transplantations with right liver grafts. HPB (Oxford) 2010; 12: 109.
12. 13.
15. 16. 17. 18. 19. 20. 21. 22. 23. 24.
& Volume 97, Number 7, April 15, 2014
Salah T, Sultan AM, Fathy OM, et al. Outcome of right hepatectomy for living liver donors: a single Egyptian center experience. J Gastrointest Surg 2012; 16: 1181. Kamel E, Abdullah M, Hassanin A, et al. Live donor hepatectomy for liver transplantation in Egypt: lessons learned. Saudi J Anaesth 2012; 6: 234. Mohamoud YA, Mumtaz GR, Riome S, et al. The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis. BMC Infect Dis 2013; 13: 288. Al-Sebayel M, Khalaf H, Al-Sofayan M, et al. Experience with 122 consecutive liver transplant procedures at King Faisal Specialist Hospital and Research Center. Ann Saudi Med. 2007; 27: 333. Khalaf H, Al-Sofayan M, El-Sheikh Y, et al. Donor outcome after living liver donation: a single-center experience. Transplant Proc 2007; 39: 829. Faraj W, Deborah Mukherji D, Fakih H, et al. Liver transplantation in Lebanon: a hard lesson to learn. Ann Transplant 2010; 15: 25. Bentabak K, Graba A, Boudjema K, et al. Adult-to-adult living related liver transplantation: preliminary results of the Hepatic Transplantation Group in Algiers. Transplant Proc 2005; 37: 2873. Khalaf H, Derballa M, Elmasry M, et al. First liver transplant in Qatar: an evolving program facing many challenges. Exp Clin Transplant 2013; 11: 423. Danovitch GM, Chapman J, Capron AM, et al. Organ trafficking and transplant tourism: the role of global professional ethical standardsVthe 2008 Declaration of Istanbul. Transplantation 2013; 95: 1306. Budiani-Saberi D, Mostafa A. Care for commercial living donors: the experience of an NGO’s outreach in Egypt. Transpl Int 2011; 24: 317. Hamdy S. Not quite dead: why Egyptian doctors refuse the diagnosis of death by neurological criteria. Theor Med Bioeth 2013; 34: 147. Shaheen FA, Souqiyyeh MZ, Attar MB, et al. The Saudi Center for Organ Transplantation: an ideal model for Arabic countries to improve treatment of end-stage organ failure. Transplant Proc 1996; 28: 247. Arnold R, Bartlett S, Bernat J, et al. Financial incentives for cadaver organ donation: an ethical reappraisal. Transplantation 2002; 73: 1361. Allam N, Al Saghier M, El Sheikh Y, et al. Clinical outcomes for Saudi and Egyptian patients receiving deceased donor liver transplantation in China. Am J Transplant 2010; 10: 1834.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
