Adib Rizvi - Pakistan - Monday 28 - Strategies to increase the number of cadaveric donors

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Adib Rizvi - Pakistan - Monday 28 - Strategies to increase the number of cadaveric donors

  1. 1. Societal Factors influencing Deceased Donor Programs Sindh Institute of Urology and Transplantation Dow Medical College, Karachi
  2. 2. Free Partly Free Not Free Understanding the Developing World <ul><li>USA Pakistan </li></ul><ul><li>Income per capita ($) 47,094 2,678 </li></ul><ul><li>Poverty <2$ (% pop) - 74% </li></ul><ul><li>Adult literacy (%) 98% 54% </li></ul><ul><li>Public Health exp (%) GDP 7% 0.8% </li></ul>www.freedomhouse.org Human Development Report 2010 <ul><li>Political rights </li></ul><ul><li>Civil liberties </li></ul><ul><li>Poor governance </li></ul><ul><li>Corruption </li></ul><ul><li>Unemployment </li></ul><ul><li>Gender bias </li></ul>Freedom ranking Developed 1 & 2 Developing 6 & 7
  3. 3. Pillars of Stable Society <ul><li>Economics </li></ul><ul><li>Knowledge </li></ul><ul><li>Cultural norms </li></ul><ul><li>Religion </li></ul><ul><li>Social Structure </li></ul>Baalbek, Circa 27 BC
  4. 4. <ul><li>Pakistan Malaysia India </li></ul><ul><li>Knowledge of organ donation 65% 3±1.4 (max 6) 95% </li></ul><ul><li>Knowledge of brain death 60% - 23% </li></ul><ul><li>Willing to donate 59% 35% 89% </li></ul>Knowledge and attitudes towards organ donation Pakistan: Adult Population (Ashraf O, Artificial Organs 2005) Malaysia: (Adult Population (Wong LP, Clin Transplant 2011) India: Postgraduate Medical Students (Bapat U, SJKT 2009)
  5. 5. <ul><li>Tribal and feudal societies where the family patriarch decides on life and death issues </li></ul><ul><li>Reverence for the dead </li></ul><ul><li>Mistrust of the medical profession including “brain death” </li></ul><ul><li>Moral calculations weighing benefits against harms about treatment options in the face of life-threatening illness </li></ul><ul><li>These factors are mostly operational in low income countries with some exceptions in high income countries e.g. Italy, Greece, Japan and East Europe </li></ul>Cultural Factors affecting Deceased Donor Programs Oliver M, et al. NDT 2011, Wong LP Transplant Proc 2010 Hamdy S Revue Internationale Interdisciplinaire 2010
  6. 6. Religious Factors affecting Deceased Donor Programs <ul><li>Factors operational in Islamic Societies </li></ul><ul><li>Body belongs to God </li></ul><ul><li>Intact body concept </li></ul><ul><li>Fear of disfigurement </li></ul><ul><li>Quick burial </li></ul><ul><li>The Local Imam No hierarchical structure in Suni Islam. This gives considerable autonomy to individual religious leaders to issue rulings (Fatwa). </li></ul>All religions have sanctioned deceased organ donation Al-Khader et al. Exp Clin Transplant. 2003, Oliver M, et al. NDT 2011, Alkhawari FS et al. AJT 2005
  7. 7. Social Factors Commercialism and Medical Profession <ul><li>To further worsen the situation professionals got involved in organ trade creating the largest organ bazaar in the world </li></ul>The Grim Set Back Rizvi SAH, Naqiv SAA, Zafar MN, et al. Int J Org Transplant Med 2010
  8. 8. Outcome of Commercialism Deceased Donors Activity (pmp) Countries with commercial transplants Countries with altruistic donor transplants WHO. Global Observatory on Donation & Transplantation 2008
  9. 9. Society Motivated Promulgation of Transplant Law Unanimous Approval by the Parliament Efforts with the help of media, judiciary and the society to implement the law
  10. 10. A new era of ethical living related transplant activity in Pakistan ? ? ? ? Transplant Ordinance ? ? Bile KM, Qureshi JARH, Rizvi SAH, Naqvi SAA et al . East Med Health J 2010
  11. 11. Way Forward: Hurdles to overcome <ul><li>Economics </li></ul><ul><ul><li>Access to transplantation </li></ul></ul><ul><li>Knowledge </li></ul><ul><ul><li>Awareness program </li></ul></ul><ul><li>Cultural norms </li></ul><ul><ul><li>Adaptation </li></ul></ul><ul><li>Social Structure </li></ul><ul><ul><li>Development </li></ul></ul><ul><li>Religion </li></ul><ul><ul><li>Maximizing awareness </li></ul></ul>

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