Majd’s family accuses KFSHRC of negligence

Although Majd Al-Hassan suffered from an autoimmune disease that severely damaged her liver, her family claims it was negligence and rigid regulations that ultimately led to the 18-year-old’s death.
“She was diagnosed at King Khaled University Hospital with advanced liver damage that requires a quick liver transplant," said her sister, Aseel. That is when KKUH transferred her to King Faisal Specialist Hospital to start the process of evaluating donors for a liver transplant.
According to Majd’s family, the doctors at KFSHRC decided to treat her with medication before starting the transplant process. When they eventually began evaluating donation prospects, the family was surprised to learn that regulations allowed only one potential donor to be evaluated at a time. The evaluation process for living liver donations usually take from two to four weeks, according to the American Society of Transplantation. However, one of their publications states that “in an emergency, tests can be done in as little as 48 hours.” A similar statement can also be found on the Colombia University Department of Surgery website.
In Majd’s case, her family says the evaluation process took almost two months for her elder sister, who was ultimately found unsuitable. According to the family, it took almost another two months to evaluate her other two sisters respectively. During this time, Majd’s condition was deteriorating. Two of Majd’s sisters maintain that the team of doctors overseeing her case didn’t inform the family of the severity of her deterioration but rather comforted them by saying that her condition was normal. The family considers this as clear deception since they were ready to take Majd abroad if the doctors told them nothing could be done in Saudi Arabia.
The family also points to what they characterize as an “unjustifiable” regulation that insists that only one potential donor be evaluated at a time, since this is a waste of invaluable time in their opinion. “Many family members were ready to donate. So if the hospital had tested several people at once, they could have saved time and she would not have deteriorated so badly that she could not accept a transplant anymore,” Majd’s sister, Adeem, told Arab News. The hospital only offered to test several people at once after Majd had been admitted to Intensive Care and was beyond any intervention. She died the same day.
The family filed a formal complaint of negligence at KFSHRC and another one at the Ministry of Health. The complaints are pending investigation at the moment.
“Our only goal is that the people responsible for this negligence be held accountable and punished accordingly, and that this doesn’t happen to anyone else,” said Aseel Al-Hassan.
Arab News talked to Dr. Muhammad Al-Sbayyil, head of the Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery at KFSHRC, who expressed his condolences to the family of the deceased and said that the hospital and his department are prepared to accept the results of the ongoing investigation.
He then went on to explain the process of living donor evaluation which has several phases, including tests that determine blood type, liver function and overall health, as well as an EKG and a CT scan to evaluate liver anatomy.
Al-Sbayyil pointed out that around 300 to 500 living liver donor evaluations are done in KFSHRC annually. This amounts to almost 3 to 4 evaluations daily.
Al-Sbayyil also noted that the patient’s life is the ultimate priority at all times. Nonetheless, there are other practical considerations that need to be taken into account such as logistics and cost. It is simply unsustainable to do many living donor evaluations for each and every patient. Therefore, the doctors assess each case and plan the evaluations accordingly.
He added: ”It is true that there are certain protocols that doctors have to adhere to, but in many cases it comes down to the assessment of a team of doctors as to whether a certain patient can survive for another 2-3 months or not.”
He explained that sometimes doctors’ assessments turn out to be inaccurate for many reasons, one of them being the nature of liver conditions. These types of conditions, said Al-Sbayyil, are very quick to deteriorate unexpectedly.
This is what happened in Majd’s case, he said, and unfortunately the deterioration was swift and her other organs started to fail.
"The night before her passing we got a full liver from a deceased — since by that time a partial liver wouldn’t be suitable anymore — and we immediately assessed to see if we could perform the transplant.
Sadly, the assessment was that we could not perform the operation,” he added. “Certainly , we can perform donor evaluations in a short amount of time, even as little as 6 hours, but this is a decision that the team takes after assessing the case and determining whether it’s an emergency or not."
He also stressed the importance of raising awareness of organ donation in Saudi Arabia, as well as putting in place systems and regulations that are helpful in this. For example, hospitals around the country should report any case of brain death, which is not the current policy. Only a third of these cases are reported, according to Dr. Al-Sbayyil.
He also noted that many people have religious reservations about organ donation, even though brain death is irreversible and donating saves another person’s life, which is a great virtue in Islam. "When we have around 15,000 kidney patients who are undergoing dialysis — a costly and uncomfortable procedure — we have to seriously work on providing organs for those patients through an organ donation system. This will save money as well as restore health to these patients in a more permanent way,” he said.