In accordance with the scientific and jurisprudential development of the definition of death, the Saudi national protocol for brain death diagnosis was put in place in 1986, defining the medical criteria, clinical examinations and tests that have to be carried out to declare brain death, regardless of the issue of organ donation. The irreversibility of brain damage is recognized when after evaluation; there is an established cause of coma sufficient to account for the loss of brain function, exclusion of any brain function recovery and persistent cessation of all brain functions during an appropriate period of observation and/or a trial of therapy. Despite the issues raised from time to time regarding brain death and the doubt shed around the diagnosis or the occurrence of any malpractice, the SCOT follows up all the cases suspected of brain death that are reported in various hospitals in the Kingdom. It is the responsibility of a team of doctors, administratives and technicians in the SCOT to ensure the application of the adopted national protocol to document the death diagnosis lawfully (death documentation by brain function criteria), without any negligence, or giving permission to speak to the family about the subject of organ donation after death until they are sure that there is death documentation and the patient received the appropriate medical and surgical care before pronouncing bran death. Since the beginning of the national program for organ donation and transplantation in 1986 and until the end of 2019, there were a total of 13,731 cases reported to SCOT and of these cases, 53% were due to head trauma, 33% were due to brain hemorrhage and 11% due to anoxia. Of the possible cases, 62% were medically documented dead, 84% the family were approached and 33% consented for organ donation. The organ donors saved the lives of 5,498 patients (3,394 kidneys transplants, 1,145 livers, 449 hearts, 423 lungs, 80 pancreases and 7 small bowels). In addition to 2,152 tissues recovered such as heart for valves, corneas, bones and musculoskeletal tissues.

Conclusion

The follow-up of all of the brain death cases until cessation of heart and lung function and after death declaration in the hospitals regardless of the being subject to organ donation or not did not have any record of any restoration or recovery of brain function since 1986 to date. This confirms the validity of the applied national protocol which is periodically reviewed by the national committee for the death declaration by using the neurological criteria. Misconception about brain death, timing of death, soul departure and extended families involvement remain as the major obstacles in improving the donation rate from deceased donor.