Cadaver Organ Donation

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  • Are you in debt? Do you need to raise cash for health care costs or paying debts or in a state of financial breakdown? Wait! Consider selling your kidney as an Option. If you wish to sell your kidney today. Message us immediately. A kidney is bought for a maximum amount of $750,000.00US Dollars. The National foundation is currently buying healthy kidney. My name is Dr Faisal Naeem, am a Nephrologist in the kidney National hospital. Columbia Asia Hospital is specialized in Kidney Surgery and we also deal with buying and transplantation of kidneys with a living an corresponding donor. We are located in Indian, Canada, UK, Turkey, USA, Malaysia, South Africa etc. If you are interested in selling or buying kidney’s please don’t hesitate to contact us via Email: columbiaasiahospital.in@gmail.com Need Geniune Donors Waiting for your responds... Best Regards Dr Faisal Naeem Contact: +91-8454-893-909
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  • Thanks for the statistics. Over five lakh patients in India require kidney transplants according to Indian Council of Medical Research (ICMR). However, doctors say in reality only 300-400 transplants are done annually.
    India is estimated to add about 1.5 lakh new knidney patients every year.
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Cadaver Organ Donation

  1. 1. Cadaver Organ Donation & Transplantation in Asia – The Way Ahead Dr. Sunil Shroff Head of Department - Urology & Renal Transplantation, Sri Ramachandra Medical College & Research Institution, Managing Trustee, MOHAN Foundation, Chennai [email_address]
  2. 2. Organ Shortage <ul><li>Each day, about 60 people around the world receive an organ transplant, while another 13 die due to non-availability of organs. </li></ul><ul><li>Organ shortage — the main limitation to saving lives of critically ill patients — is due to individuals and their families not considering organ donation out of fear, ignorance or misunderstanding. </li></ul>
  3. 3. Cadaver Transplant in Asia – The Road Ahead <ul><li>Overview of Cadaver Transplants in Asia </li></ul><ul><li>Common Problems & Platforms </li></ul><ul><li>The Road Ahead </li></ul>
  4. 4. Overview of Asia <ul><ul><ul><ul><ul><li>Asia World </li></ul></ul></ul></ul></ul><ul><li>Population 3.6 Billion 6.4 Billion </li></ul><ul><li>No Of Countries 51 235 </li></ul><ul><li>Land Mass 44,390,000 Sq.Km 6,233,821,945 Sq.Km </li></ul><ul><li>Life Expectancy M 63 yr F 66yrs </li></ul>
  5. 5. Cadaver Transplants in Asia <ul><li>Kidney </li></ul><ul><li>Liver </li></ul><ul><li>Heart </li></ul><ul><li>Heart Lung </li></ul><ul><li>Pancreas </li></ul>Source: Asian Transplant Registry
  6. 6. PER CAPITA INCOME FOR ASIAN COUNTRIES ( In US Dollars) Low Per Capita Income - 1000 Sri Lanka 930 Armenia 950 Indonesia 810 Azerbaijan 820 Georgia 770 India 540 Yemen 520 Pakistan 520 Mongolia 480 Vietnam 480 Bangladesh 400 Uzbekistan 420 Laos 340 Kyrgyzstan 340 Cambodia 300 Nepal 240 Tajikistan 210 Average Per Capita Income 1000 Thailand 2,190 Iran 2,010 Kazakhstan 1,780 Jordan 1,850 Syria 1,190 Turkmenistan 1,120 China 1,100 Philippines 1,080 No Data - Afghanistan -Bhutan, Palestine, Bahrain, Cyprus, Iraq, Qatar, UAE, Myanmar, Timor , Oman, Brunei, N.Korea High Per Capita Income 2500 Japan 34,180 Hong Kong 25,860 Singapore 21,230 Kuwait 17,960 Israel 16,240 S Korea 12,030 Taiwan 13,530 Saudi Arabia 9,240 Lebanon 4,040 Malaysia 3,880 Turkey 2,800 Maldives 2,510
  7. 7. High per capita income & Successful Living Transplant Programmes Taiwan Saudi Arabia Lebanon Malaysia Turkey Japan Hong Kong Singapore Kuwait Israel S Korea
  8. 8. High per capita income & Cadaver Tansplant Programme Most of Asia is struggling with Cadaver Programme including regions with high per capita Iran Lebanon Kuwait Israel S Korea Japan Hong Kong Singapore Taiwan Saudi Arabia Malaysia Turkey
  9. 9. Kidney Tx Waiting List in Asia (2002) <ul><li>Japan – 12,974 </li></ul><ul><li>Taiwan – 7000 </li></ul><ul><li>Saudi Arabia – 4248 </li></ul><ul><li>Korea – 4000 </li></ul><ul><li>Pakistan - 1650 </li></ul><ul><li>Hong Kong - 1018 </li></ul><ul><li>Singapore – 666 </li></ul><ul><li>Bangladesh - 125 </li></ul><ul><li>Waiting Time </li></ul><ul><li>Taiwan – 1.9 yrs </li></ul><ul><li>Korea – 2.2 yrs </li></ul><ul><li>Hong Kong – 4.3 yrs </li></ul><ul><li>Singapore – 5.8 yrs </li></ul><ul><li>No Waiting list in Iran for Kidney Tx. </li></ul>No figures available for China, India, Philipines, Indonesia
  10. 10. Transplant Expertise - Asia <ul><li>Japan has - 352 transplant centres </li></ul><ul><li>Thailand - 27 kidney, 6 liver, & 6 Cardiac transplantation centers </li></ul><ul><li>Iran has 22 centres – mainly kidneys </li></ul><ul><li>India has 110 centres for Kidney Tx 5 centres Liver, 6 – Cardiac. over 35 centres have undertaken cadaver transplants </li></ul><ul><ul><li>However only 6 centres do cadaver Tx . regularly </li></ul></ul>
  11. 11. Transplants - Japan <ul><li>Kidney Transplant since 1964 -15 113 </li></ul><ul><li>Liver transplants since 1989 - 2411 </li></ul><ul><li>Heart Transplants since 1998 - 17 </li></ul><ul><li>Lung transplants since 1998 - 39 </li></ul><ul><li>The organs have largely been obtained from living and to some extent from non-heart beating donors </li></ul>Ref: Shirakura -WHO/HTP/EHT/T-2003.1Ethics, access and safety in tissue and organ transplantation:Issues of global concern. Madrid, Spain, 6-9 October 2003
  12. 12. Cadaver Kidney Transplants in Asia <ul><li>India, Taiwan, Korea, Thailand, Iran, Saudi Arabia and Singapore – Regularly are undertaking Kidney Cadaver Transplants </li></ul><ul><li>Taiwan, Thailand, Singapore follow the western model and run the programme almost on the same line </li></ul><ul><li>Japan is still struggling with the programme though their numbers are slowly rising </li></ul><ul><li>India is emerging as one of the Key players despite still struggling with the programme logistics </li></ul><ul><li>Very Little information from China is Available on their modus operandi </li></ul>
  13. 13. Cadaver Heart Transplants in Asia <ul><li>Hong Kong, India, Japan, Malaysia, Saudi Arabia, Singapore and Thailand are doing Heart transplants </li></ul><ul><li>Taiwan and Korea do the maximum heart transplants in Asia </li></ul>
  14. 14. Cadaver Liver Transplants in Asia <ul><li>Korea do the maximum living liver transplants and has high level of expertise in the field </li></ul><ul><li>2,345 LTs (1,860 from the living donor and 485 from the deceased donor) were performed in 24 institutes from March 1988 to December 2004, although 5 institutes had performed more than 10 LTs per year. </li></ul><ul><li>Japan, Hong Kong, Taiwan similarly have expertise in living liver transplants </li></ul><ul><li>Four centres in India – located at Hyderabad, Vellore and Delhi have fair expertise with liver transplants and emerging as the key players in the country. </li></ul>
  15. 15. Cadaver Kidney Transplants Scene in India <ul><li>In past ten years approx. 1000 Cadaver organ transplants over 900 kidneys and 100 Livers and heart have been performed </li></ul><ul><li>Almost 40% of the cadaver transplants in India done in Tamil Nadu </li></ul><ul><li>Tamil Nadu Organ Sharing Network could become the role model for rest of the country </li></ul>Approx.110 centres in India do kidney Tx.however only 25 to 30 centres do over 25 per year.
  16. 16. Historical Aspects – Cadaver Transplantation - India <ul><li>1967 - First successful cadaver Kidney Transplant in India at KEM Hospital, Bombay </li></ul><ul><li>1994 - First successful heart transplant done at AIIMS, N.Delhi </li></ul><ul><li>1995 - First successful multi-organ transplant done at Apollo Hospital, Chennai </li></ul><ul><li>1998 – First Successful Lung transplant, Madras Medical Mission Hospital, Chennai </li></ul><ul><li>1999 – First Pancreas Transplant, Ahemdabad </li></ul>
  17. 17. Asian Countries Undertaking Transplants – Kidneys alone (n-10) <ul><li>Pakistan - K </li></ul><ul><li>Philippines – K </li></ul><ul><li>Indonesia – K </li></ul><ul><li>Malaysia – K, </li></ul><ul><li>Iran – K, </li></ul><ul><li>Israel – K </li></ul><ul><li>Turkey – K </li></ul><ul><li>Syria – K </li></ul><ul><li>Malaysia – K </li></ul><ul><li>Bangladesh – K </li></ul>Some of these countries have done (eg Pakistan) occasional liver or heart (eg Malaysia) transplant.
  18. 18. Asian Countries Undertaking Multi–organ Transplants (n-9) <ul><li>Hong Kong – K, H, Li, H-L </li></ul><ul><li>India – K, H, Li, H-L, P </li></ul><ul><li>Japan – K, H, L, L, K-P </li></ul><ul><li>Korea - K, H, Li, L, K-P </li></ul><ul><li>People Rep China – K, H, Li </li></ul><ul><li>Saudi Arabia –K, H, L, Li </li></ul><ul><li>Singapore – K, H, L, Li </li></ul><ul><li>Taiwan – K, H, H-L, Li </li></ul><ul><li>Thailand – K, H, H-L, Li </li></ul>Legend: K-Kidneys, K-P - Kidneys & Pancreas, H-Heart, L-Lung, H-L-Heart & Lung, Li- Liver
  19. 19. <ul><li>Overview of Cadaver Transplants in Asia </li></ul><ul><li>Common Problems & Platforms </li></ul><ul><li>The Way Ahead </li></ul>Cadaver Transplant in Asia – The Road Ahead
  20. 20. Common Problems & Platforms <ul><li>Incidence of organ failure in Asia </li></ul><ul><li>Public and Professionals Attitude to Brain Death & Organ Donation </li></ul><ul><li>Religion & Organ Donation </li></ul><ul><li>Legal Aspects </li></ul><ul><li>Media and Scandals </li></ul><ul><li>Reporting of Brain Death </li></ul><ul><li>Hospital Infrastructure </li></ul><ul><li>Trained Transplant Co-ordinators /Counsellors </li></ul>
  21. 21. Incidence of ESRD In Asians & Blacks <ul><li>Black and Asian people are three to four times more likely to develop end stage renal failure than white people </li></ul><ul><li>This rises to eight times more likely for older Asians </li></ul><ul><li>Diabetes five times the rate of the white population </li></ul><ul><li>Hypertension was at least twice the rate of the white population. </li></ul>
  22. 22. World Status of Transplants <ul><li>Annual Number of kidney transplantations per million population (pmp) per year - </li></ul><ul><li>USA - 52 Predominantly Cadaver Donors </li></ul><ul><li>Europe - 27 Predominantly Cadaver Donors </li></ul><ul><li>Asia - 3 Predominantly Living Donors </li></ul>In last 10 to 15 years the rate of both kidney an liver transplants have increased but heart has remained static. In 2000 approx. 15,000 kidneys were transplanted in each region .
  23. 23. Cadaver Donor Rates <ul><li>The Cadaver donors per million population per year </li></ul><ul><li>USA - 20.7 </li></ul><ul><li>Europe - 15.9 </li></ul><ul><li>Asia - 1.1 </li></ul><ul><li>South America - 2.6 </li></ul>
  24. 24. Physicians Attitude to Organ Donation <ul><li>Korean health professionals' attitudes and knowledge toward organ donation and transplantation . Kim JR, Elliott D, Hyde C. 2004 Mar;41(3):299-307. </li></ul><ul><li>There was a lack of knowledge by Korean health professionals surrounding brain death and the organ procurement process. </li></ul><ul><li>Participants' attitudes were mixed and somewhat negative, as they did not regard brain death as true death </li></ul>Korea – Organ donation rate below 2 per million population per year.
  25. 25. Physicians Attitude to Organ Donation <ul><li>Outmoded attitudes toward organ donation among Turkish health care professionals. Topbas M, Can G, Can MA, Ozgun S.Transplant Proc. 2005 Jun;37(5):1998-2000. </li></ul><ul><li>A large proportion of Physicians are indifferent to organ donation process. Reason cited for this were - </li></ul><ul><li>Lack of information regarding the donation process (28.7%), </li></ul><ul><li>Concerns about the sale of organs (22.1%), </li></ul><ul><li>Islamic religious beliefs (21.6%) </li></ul>
  26. 26. Public Attitude <ul><li>Turkey (n=774) - 59.2% would consider donating organs </li></ul><ul><li>Pakistan(n 367) – 59.9% Willing to donate their organs </li></ul><ul><li>Hong Kong - 60.3% of the respondents were are willing to donate organs </li></ul><ul><li>Viet Nam - 66% urban Vietnamese surveyed were willing to donate organs or tissues after death </li></ul>Ref - Turkey- Ozdag N. EDTNA ERCA J. 2004 Oct-Dec;30(4):188-95 Pakistan - Artif Organs. 2005 Nov;29(11):899-905. Ashraf O, Ali S, Li SA, et al Hong Kong - Yeung I, Kong SH, Lee J. Soc Sci Med. 2000 Jun;50(11):1643-54 Viet Nam - Hai TB, Eastlund T, Chien LA, Duc PT, Giang TH, Hoa NT, Viet PH, Trung DQ.
  27. 27. Public Attitude - Singapore <ul><li>Social and cultural aspects of organ donation in Asia. </li></ul><ul><li>Woo KT. Ann Acad Med Singapore. 1992 May;21(3) </li></ul><ul><li>Important misconceptions and fears were – </li></ul><ul><li>Fear of death, </li></ul><ul><li>Belief that removal of organ violates sanctity of decreased </li></ul><ul><li>Concern about being cut up after death, </li></ul><ul><li>Desire to be buried whole, </li></ul><ul><li>Dislike of idea of kidneys inside another person, </li></ul><ul><li>Wrong concept of brain death, </li></ul><ul><li>Idea of donation being against religious conviction </li></ul>
  28. 28. Public Attitude - China <ul><li>Investigation of understanding and willingness of organ transplantation in young people in Beijing, Shanghai, Wuhan . Zhonghua Yi Xue Za Zhi. 1997 Jan;77(1):22-7. Liu Y, Lei H, Qiu F. China Foundation of Organ Transplantation Development, Wuhan </li></ul><ul><li>Cities of China – </li></ul><ul><li>Young people have a better understanding of organ transplantation </li></ul><ul><li>Conventional attitudes and feudal habits are the major obstacle to the development of organ transplantation in China. </li></ul>
  29. 29. <ul><li>Results of the Survey </li></ul><ul><li>Less than 50% overall positive response in favour of donating solid organs </li></ul><ul><li>72% were willing for “Eye” donation and carry a “Donor Card” </li></ul><ul><li>All major religions were willing to consider organ donation </li></ul>SURVEY ON “PUBLIC ATTITUDE TOWARDS ORGAN DONATION & TRANSPLANATATION”   Shroff S, Shankar R et al, Indian Medical Tribune, 1996   Public Attitude and Organ donation in India
  30. 30. <ul><li>“ Request for EYES” FIRST” - SEE HOW FAMILY REACTS </li></ul><ul><li>Family Willing Family Reluctant </li></ul><ul><li>Ask For Solid Organs Abandon Efforts </li></ul><ul><li>(Heart, Liver, Kidneys ..) </li></ul><ul><li>Inform Transplant Co-coordinator </li></ul>Above protocol called “THE RAMACHANDRA PROTOCOL” to ask for organs CONCLUSION - “PUBLIC ATTITUDE SURVEY” HOW TO ASK FOR ORGANS IN THE EVENT OF “BRAIN DEATH” PATIENT
  31. 31. Brain Death – Law & Guidelines Optional 24 3 PCO 2 P A Indonesia Mandatory - A - 4 - DVO - P p P P P India Iran Optional A 1 PCO 2 P P Hong Kong Mandatory 24 3 DVO P P Georgia Optional A A A A A China Optional A 3 DVO P P Bangladesh Optional A A A A A Armenia Conf, Test Obv Time Physicians Apnea Test Guidelines Law Countires
  32. 32. Brain Death – Law & Guidelines Optional 6 1 PCO 2 P A Taiwan Optional A 2 PCO 2 P P Singapore Optional A A DVO A A Vietnam Optional 6 3 DVO P P Thailand Optional 24 1 DVO P A Philippines Not known A A A A A Pakistan Mandatory 12 2 PCO 2 P P Malaysia Optional 6 1 PCO 2 P P Korea (S) Mandatory A 1 PCO 2 P P Japan Conf, Test Obv Time Physicians Apnea Test Guidelines Law Countries
  33. 33. Singapore - Legal Aspects <ul><li>THE HUMAN ORGAN TRANSPLANT ACT (HOTA) OF 1987 – Singapore </li></ul><ul><li>“… .. Kidneys can be procured from patients of road traffic accidents who have been declared “brain-dead” unless they have OPTED OUT ( Presumed Consent) </li></ul><ul><li>(Muslims exempted) </li></ul>
  34. 34. Thailand - Legal Aspects <ul><li>There is no law to directly govern transplant procedures in Thailand. </li></ul><ul><li>The Medical Council is responsible in regulating human organ transplantation . They decide the criteria from time to time. </li></ul><ul><li>Medical Council in Thailand determines whether any punitive action should be taken against the doctors </li></ul>
  35. 35. India – Legal Aspects <ul><li>Transplantation of Human Organs Act, 1994 </li></ul><ul><li>Aims </li></ul><ul><li>Regulate removal, storage and transplantation of human organs for therapeutic purposes </li></ul><ul><li>To prevent commercial dealings in organs </li></ul><ul><li>Recognise Brain Death </li></ul>
  36. 36. RELIGIOUS & CULTURAL ASPECTS <ul><li>Religion plays major role in promoting Organ Donation. </li></ul><ul><li>Major religions in Asia Pacific include - </li></ul><ul><ul><li>Islam </li></ul></ul><ul><ul><li>Buddhism </li></ul></ul><ul><ul><li>Christianity </li></ul></ul><ul><ul><li>Hinduism </li></ul></ul><ul><ul><li>Sikhism </li></ul></ul><ul><ul><li>Judaism </li></ul></ul>
  37. 37. Religion and Organ Donation <ul><li>Common thread that binds all religions of the world – </li></ul><ul><ul><li>Saving of life overrides all objections </li></ul></ul><ul><ul><li>There is no religion that is against organ donation </li></ul></ul><ul><ul><li>What holds back is cultural reservations - </li></ul></ul><ul><ul><ul><li>Ignorance of the process of organ donation, </li></ul></ul></ul><ul><ul><ul><li>Fear of mutilation, </li></ul></ul></ul><ul><ul><ul><li>Lack of emotional support at time of tragedy, </li></ul></ul></ul><ul><ul><ul><li>Fear that organs will be sold or used only by the rich </li></ul></ul></ul><ul><ul><ul><li>Mistrust of hospitals and health professionals </li></ul></ul></ul><ul><ul><ul><li>Myths </li></ul></ul></ul>
  38. 38. Religious Attitude to Donation <ul><li>Chinese–Americans are influenced by Confucian values, and to a lesser extent, Buddhist, Daoist spiritual beliefs </li></ul><ul><li>- associate an intact body with respect for ancestors or nature. </li></ul><ul><li>The subjects were most willing to donate their organs after their deaths – 1 st to close relatives , then in descending order – </li></ul><ul><li>distant relatives, people from their home country and strangers </li></ul><ul><li>Influence of religious and spiritual values on the willingness of Chinese–Americans to donate organs for transplantation . Wilbur Aaron Lama & Laurence B McCulloughb . Clinical TransplantationVolume 14 Issue 5 Page 449  - October 2000 doi:10.1034/j.1399-0012.2000.140502.x </li></ul><ul><li>   </li></ul>
  39. 39. Buddhism & Organ Donation <ul><li>“ The attitude of Buddhism is in perfect agreement with organ and tissue donation; and in Buddhist Scriptures there are stories where donation of tissues have been referred to as an act of charity earning merits” </li></ul><ul><li>- The Late Dr Hudson Silva </li></ul>World renowned success of the Eye Donation Society of Sri Lanka led by late Dr. Hudson Silva: target of 40,000 eyes procurement reached in May 1999. Gujarat in India has high number of eye donations (Jains) gets 4000 corneas - highest in India.
  40. 40. Buddhism & Organ Donation <ul><li>Predominantly Buddhist Countries </li></ul><ul><li>Sri Lanka </li></ul><ul><li>Thailand </li></ul><ul><li>Vietnam </li></ul><ul><li>Myanmar </li></ul><ul><li>Less Dominant </li></ul><ul><li>Korea (30%) </li></ul><ul><li>Singapore (30%) </li></ul>
  41. 41. Buddhism & Organ Donation <ul><li>Even in countries where Buddhism is less dominant </li></ul><ul><li>Singapore and Korea - Buddhists are main source of tissue donors. </li></ul><ul><li>Success of NUH Tissue Bank in Singapore, entirely due to strong support by Buddhist Community. All donors Buddhists. </li></ul>
  42. 42. Muslims & Organ Donation <ul><li>Muslims the most controversial group - </li></ul><ul><li>Koran does not forbid tissue donation </li></ul><ul><li>Koran states that if by not transplanting an organ or tissue, the person will die, then it is permissible to donate . It is allowed for an emergency to save life. </li></ul><ul><li>Different interpretations by different religious leaders, ‘ustazs’ and ‘ulamas’ </li></ul><ul><li>Muslims must bury the body as soon as possible after death – the sooner the better usually less than 8 hours. </li></ul>
  43. 43. Muslims & Organ Donation <ul><li>Predominantly – </li></ul><ul><li>Saudi Arabia </li></ul><ul><li>Iran </li></ul><ul><li>Iraq </li></ul><ul><li>Kuwait </li></ul><ul><li>Turkey </li></ul><ul><li>Pakistan </li></ul><ul><li>Bangladesh </li></ul><ul><li>Malaysia </li></ul><ul><li>Brunei </li></ul><ul><li>Indonesia (Secular-PANCASILA) </li></ul><ul><li>Less Dominant – </li></ul><ul><li>China (200 million) </li></ul><ul><li>India </li></ul><ul><li>Singapore (20%) </li></ul>
  44. 44. Muslims & Organ Donation <ul><li>Each country has its own ‘MUFTI’ -religious official appointed by Govt to deal with Islamic matters </li></ul><ul><li>‘ FATWAS’ are religious rulings made by ‘Fatwa Committee’ as official stand by Govt. on various issues. </li></ul><ul><li>‘ Fatwa Committee’ chaired by MUFTI includes prominent religious leaders, lawyers, doctors and other members of public </li></ul><ul><li>Fatwas are not legal binding . </li></ul>
  45. 45. Muslims & Organ Donation <ul><li>Fatwas declared in several countries </li></ul><ul><li>Saudi Arabia : 1985 - permit both living related and cadaveric donation of organs </li></ul><ul><li>Pakistan, </li></ul><ul><li>Bangladesh, </li></ul><ul><li>Malaysia - 1995 </li></ul><ul><li>Indonesia </li></ul>
  46. 46. CULTURAL PRACTICES OF MUSLIMS <ul><li>Despite Fatwas Muslims reluctant to donate organs </li></ul><ul><li>God created them whole. They prefer to return to him whole. </li></ul><ul><li>Many Muslims bury amputated limbs, foreskin from circumcision, amnion from delivery. </li></ul><ul><li>Not religious requirement but cultural practice. Not all Muslims do this </li></ul>
  47. 47. Christianity - Organ Donation <ul><li>Predominantly - </li></ul><ul><li>Philippines </li></ul><ul><li>Less Dominant – </li></ul><ul><li>Singapore (30%) </li></ul><ul><li>Korea (30%) </li></ul><ul><li>Malaysia </li></ul><ul><li>India </li></ul>No bar to organ donation - Shortage of Donors in Philippines, Singapore and Korea due to cultural factors.
  48. 48. Christianity - Organ Donation <ul><li>STATEMENT BY POPE JOHN PAUL II – </li></ul><ul><li>Full support of organ and tissue donation concluded with words of Jesus narrated by evangelist and physician LUKE: </li></ul><ul><li>“ give…, and it will be given to you; good measure, pressed down, shaken together, running over, will be put into your lap (Luke 6 : 38).” </li></ul><ul><li>We shall receive our supreme reward from God according to the genuine and effective love we have shown to our neighbour. </li></ul>
  49. 49. Hinduism and Organ Donation <ul><li>Predominantly </li></ul><ul><li>India </li></ul><ul><li>LESS DOMINANT </li></ul><ul><li>Sri Lanka (<10%) </li></ul><ul><li>Singapore (5%) </li></ul><ul><li>Malaysia </li></ul><ul><li>Indonesia </li></ul><ul><li>Thailand </li></ul><ul><li>Veitnam </li></ul>
  50. 50. Religions against organ donation <ul><li>Greek Orthodox, Shinto and Gypsies are three religions that do not encourage body donation </li></ul><ul><li>Jehovah’s witness is another Christian sect that is against such acts </li></ul>
  51. 51. Media and Scandals - T hailand <ul><li>Doctors May Face Murder Charge </li></ul><ul><li>The New Straits Times, September 1, 2000 </li></ul><ul><li>Three doctors from a Bangkok private hospital allegedly killed patients in 1997, harvested the kidneys and sold their kidneys to rich transplant patients will face murder charges. faking paperwork to cover their crime. </li></ul><ul><li>A police inquiry into the scandal said - the organs were removed from patients who were pronounced brain dead, a condition not accepted as legally dead in Thailand. </li></ul>
  52. 52. Media & Scandals - Japan <ul><li>The Washington Post: April 25, 1997 </li></ul><ul><li>A Japanese surgeon who performed the operation was investigated in connection with the alleged murder of the donor. He was not indicted, but the lengthy criminal proceedings blocked all further operations </li></ul>
  53. 53. Media & Organ Donation <ul><li>The power of the press can also be demonstrated in the so-called &quot;Nicholas Green effect.“ </li></ul><ul><li>Nicholas was a 7-year-old American child, shot dead by bandits in Italy in 1994 </li></ul><ul><li>His parents agreed to donate his organs </li></ul><ul><li>Italian press reported it extensively </li></ul><ul><li>The positives impact kick started the Italian cadaver programme </li></ul>
  54. 54. Under-reporting of Brain death <ul><li>The efficiency of utilization of potential donors for organ transplantation in Saudi Arabia: a pilot study. Al Sebayel MI, Khalaf HA. Transplant Proc. 2004 Sep;36(7):1881 </li></ul><ul><li>Data – 2001 to 2003 - 114 out of 542 deaths were due to Brain Death & 54% - occurred in one hospital. </li></ul><ul><li>38 cases were reported to the Saudi Center for Organ Transplantation & in 23 Documentation was completed </li></ul><ul><li>4 Cases became actual donors </li></ul><ul><li>Conclusion – There is underreporting of brain death cases. </li></ul>
  55. 55. Problems with Cadaver Organ Donation Programme in Asia <ul><li>Govt. Problem No Funding for programme </li></ul><ul><li>Hospital problem No efforts to identify & maintain “Brain Dead” donors </li></ul><ul><li>Community Problem No Awareness of “Brain- Death” Concept </li></ul>Spain has the highest number of brain death patients going on to organ donation – 32 per million population
  56. 56. Transport of organs –between cities Adequate No. of Qualified Intensivists in ICUs Well qualified Surgeons to undertake Retrieval & TX HLA Tissue typing and Cross-match Qualified Trained transplant Co-coordinators Support Organisation to Network Hospital Infra-Structural & Support Logistics
  57. 57. Cadaver Transplants Scene in Asia – The Way Forward <ul><li>Overview of Cadaver Transplants in Asia </li></ul><ul><li>Common Problems & Platforms </li></ul><ul><li>The Way Ahead </li></ul>
  58. 58. The Way Forward <ul><li>Strengthen the Asian Transplant Network </li></ul><ul><li>Establish a common programme similar to Euro-transplant Network </li></ul><ul><li>Start sharing organs that are not used locally </li></ul><ul><li>Use technology effectively </li></ul><ul><li>Evolve a Spanish style co-ordinators course for Asian countries </li></ul><ul><li>Do our own Asian Transplant Games to build patient fellowship </li></ul><ul><li>Have more frequent Asian Transplant Society meeting </li></ul>
  59. 59. Organisational changes <ul><li>Model National Transplant Service </li></ul><ul><li>– Like a network to share organs that is linked to a </li></ul><ul><li>Asian Network for Organ Sharing (ANOS) </li></ul><ul><li>Employing and training more transplant co-ordinators and having a separate body in Asia for Tx. Co-ordinators </li></ul><ul><li>Regular Courses to impart expertise to the co-ordinators </li></ul><ul><li>Training and sensitising ICU staff on brain-death </li></ul>
  60. 60. Organisation helping with organ donation & Transplants programmes in India MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh, Maharastra 236 Organs shared . ( 212-Kidneys, 9-Hearts, 15-Liver ) FORTE, BANGALORE – 32 Organs Shared ( 32 - Kidneys, 1- Heart, 1- Liver ) ZTCC, Mumbai – 55 Organs Shared - all kidneys ORBO, N.Delhi – Few organs shared SORT, Cochin – 4 organs shared
  61. 61. Cadaveric Donation <ul><li>For cadaveric donation - </li></ul><ul><li>“ society remains a crucial aspect in a transplant programme” </li></ul><ul><li>Strategies to decrease refusal rates by families include efforts at education - </li></ul><ul><ul><li>the general population, </li></ul></ul><ul><ul><li>Religious heads & opinion leaders </li></ul></ul><ul><ul><li>health care workers individually </li></ul></ul><ul><ul><li>through the mass media </li></ul></ul>
  62. 62. Encouraging People to Discuss Organ Donation <ul><li>When the wishes of the deceased are not known, only 50% of people will agree to organ retrieval from their relatives </li></ul><ul><li>Encouraging people to speak about organ donation and transplantation and to make their wishes known to their relatives could change the picture resulting in 93-94% of people allowing donation </li></ul>
  63. 63. Presence of Family Member During Brain Death Testing <ul><li>Most families faced with brain stem death of a relative find the concept difficult to understand and have trouble in accepting that their relative is actually dead </li></ul><ul><li>Family members were given choice to be or not to be present during brain stem death testing </li></ul><ul><li>It is suggested that presence of family members during brain stem death testing not only helps families to accept this concept of death but also promotes the grieving process </li></ul><ul><li>The presence of family during brain stem death testing. Doran M. Intensive Crit Care Nurs. 2004 Feb;20(1):32-7 </li></ul>
  64. 64. Project Positive Aspects <ul><li>Many donor relatives have stated that donating their loved one's organs does not make the pain of their death disappear </li></ul><ul><li>Bereaved families can experience comfort that their loved one's gift gave another person a second chance at life </li></ul>
  65. 65. Consent for Donation <ul><li>Pre-mortem – via Donor Cards, Driving License </li></ul><ul><li>Consent of his family following death </li></ul><ul><li>Some form of a combination of the two are necessary </li></ul><ul><li>‘ Supererogatory permission’ - Underlying premise of such a consent would be that “organs of dead people are public goods”, and donation must be considered “similar to other compulsory civil obligations” within society </li></ul><ul><ul><li>The permission is a moral rather than a legal requirement </li></ul></ul>
  66. 66. <ul><li>Essence of INOS – “Not to Waste Any Organ. Organs should be treated like National Resource” </li></ul><ul><li>Hospital in group includes – Apollo, CMC Vellore, Sri Ramachandra Hospital and Sundaram Medical Foundation </li></ul><ul><li>Hospitals in Andhra Pradesh- Nizam’s Institute of Medical Sciences, Global Hospitals, Kamanneini Hosp, Apollo Hospital, Care Hospital </li></ul><ul><li>Many Affiliate hospitals from other parts of country </li></ul>Mohan Foundation Intiatives – INOS ( Indian Network for Organ Sharing)
  67. 67. Presumed Consent & Organ Donation <ul><li>Belgium, Austria, Finland, France, Norway, Spain, and Singapore implemented &quot;presumed consent&quot; </li></ul><ul><li>France's presumed consent (PC) law has produced increases in organ donation approaching 5,000%. </li></ul><ul><li>Belgium passed its version of PC in 1986, and organ donation climbed by 183%, with multi-organ retrieval significantly increased to 119% for kidneys. T he donor rate increased from 10 to 22 donors per million population between 1986 and 1997. </li></ul><ul><li>Austria passed its PC law in 1982. By the end of 1990, the number of patients receiving kidneys was nearly the same as the number on the waiting list </li></ul>
  68. 68. Required Request Law <ul><li>Requires that formal request for organ donation be made of the families of all potential donors in the ICU. </li></ul><ul><ul><li>The rationale is that a statutory approach would overcome hesitancy by healthcare professionals at a time of such emotional distress. </li></ul></ul><ul><li>Required Request Law has been introduced into many states in the USA by legislation and helped improve organ donation rate </li></ul>
  69. 69. Mandated Choice <ul><li>Mandated choice: This requires people to state their ’willingness to donate or not’ when filing some state of institutional return such as a driving licence or income tax form. </li></ul><ul><ul><li>The information would be kept on a central register, accessible at time of death </li></ul></ul>
  70. 70. Mandated Choice & Driving License <ul><li>1996 - Sweden instituted a mandated choice law. There was an immediate increase of 600,000 potential donors. </li></ul><ul><li>A similar 1990 law in Denmark increased their donor registry by 150,000. </li></ul>
  71. 71. Action Required – Muslim Countries <ul><li>More public education needed to change cultural beliefs and practices although Islam does not forbid Organ or tissue donation </li></ul><ul><li>Fatwas alone will not work. </li></ul><ul><li>Constantly addressing masses through media by religious head may help to improve sentiments </li></ul>
  72. 72. Religion & Organ Donation <ul><li>Plan major conferences of religious heads on organ donation and transplantation in all regions of Asia . </li></ul><ul><li>Most people are ill- informed about their religions attitude towards organ donation. </li></ul><ul><ul><li>Major initiative required to correct this </li></ul></ul><ul><li>An Exploratory Study Examining the Influence of Religion on Attitudes Towards Organ Donation Among the Asian Population in Luton,UK Nephrology Dialysis and Transplantation (1998) Volume 13: 1949-1954 </li></ul>
  73. 73. <ul><li>NGO or Groups involved in Organ donation in any part of the Asia have to tackle various issues in the field of cadaver organ donation and transplantation simultaneously </li></ul><ul><li>More Support groups with common objectives are needed </li></ul><ul><li>More resources necessary to Kick start such an Initiative </li></ul>What is Required
  74. 74. Patient Support Group <ul><li>Purpose of the group - to provide emotional support to organ failure & transplant patients </li></ul><ul><li>Meeting held every two months between doctors, dietician and counselors and patients to discuss their problems </li></ul><ul><li>Provide subsidized investigation and a few selected drugs </li></ul><ul><li>We have about 250 members from Mumbai and Chennai </li></ul>“ Patients should be the advocate of cadaver organ movement, this will generate better publicity for the cause”
  75. 75. Patient Support Group <ul><li>We have held Eight meetings in Chennai, four in Mumbai and one in Hyderabad </li></ul><ul><li>Some of them keen to help out with cadaver organ donation programme </li></ul><ul><li>The group held ‘All India Transplant Games’ in Dec 2003 </li></ul>
  76. 76. Promote Organ Donation Among Blood Donors <ul><li>Study shows that blood donors have better knowledge of organ donation and are more willing to donate their organs and sign an Donor card than general public. </li></ul><ul><li>A substantial proportion of blood donors have not signed a Donor Card. </li></ul><ul><li>It would be useful to design promotion programs to facilitate blood donors' participation in organ donation. </li></ul><ul><li>Attitudes about organ and tissue donation among the general public and blood donors in Hong Kong. Li PK, Lin CK, Lam PK, Szeto CC, Lau JT, Cheung L, Wong M, Chan AY, Ko WM. Prog Transplant. 2001 Jun;11(2):98-103. Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong </li></ul>
  77. 77. Make Local Sharing Protocols <ul><li>6 Kidneys have been wasted in the last four years of the 112 Kidneys shared in the INOS network due to these problems </li></ul><ul><li>Poor Retrieval Technique – 2 </li></ul><ul><li>No Blood for Cross Match – 2 </li></ul><ul><li>Poor Packing of Organ - 2 </li></ul>INOS- Initiative for Organ Sharing facilitated by MOHAN Foundation in Tamil Nadu
  78. 78. Retrieval Surgery & Packing of Organs <ul><li>MOHAN in its INOS Group of hospitals have made: </li></ul><ul><li>Attempts to standardize retrieval techniques </li></ul><ul><li>CD made on kidney Retrieval to be circulated to all the hospitals in the group </li></ul><ul><li>Packing of organs being standardised for transportation </li></ul>
  79. 79. Potential Countries That can Succeed with Programme <ul><li>Countries that can have success with Cadaver Transplant programmes in Asia and make a difference - </li></ul><ul><li>India – No Religious bar to donation </li></ul><ul><li>Iran – Has a logistic approach </li></ul><ul><li>Saudi Arabia – Has the laws </li></ul><ul><li>Turkey – Liberal Muslim Country </li></ul><ul><li>Taiwan – Well organized Skills </li></ul><ul><li>China – Capable of organizing the programme </li></ul><ul><li>Sri Lanka – High Buddhist community. Eye programme success </li></ul><ul><li>Mynamar - High Buddhist community </li></ul>
  80. 80. ORGAN DONATION RATE If in India - 1 per million donation rate we would have 1100 organ donors – 2200 kidneys,1000 hearts, 1100 Livers, 2200 Eyes At 10 per million donation rate- 11,000 organ donors 22,000 kidneys, 11,000 hearts, 11,000 Livers, 22,000 Eyes 20 per million donation rate - 22,000 organ donors 44,000 kidneys, 22,000 hearts, 22,000 Livers, 22,400 Eyes Current organ donation rate - India is 0.05 per million population per year At 3 per million Donation rate we would have 3300 organ donors – 6600 kidneys,3300 hearts, 33001 Livers, 6600 Eyes Source: Indian Transplant Newsletter Issue no.19 Feb 2006
  81. 81. <ul><li>Organ Shortage is a Crisis, however the Crisis has a Cure </li></ul><ul><li>In Asia we need to Network and start thinking of sharing resources, expertise and organs </li></ul><ul><li>Set up Collaborative projects </li></ul><ul><li>Use Television Media for Promotion </li></ul><ul><li>Get Religious heads to Participate regularly </li></ul><ul><li>Have Transparency in programme </li></ul><ul><li>Set up regional Transplant co-ordinators Forums </li></ul>Cadaver Transplant - Conclusion
  82. 82. In Asia we have failed to explore all the options and simple steps and changes can make all the difference for our patients Cadaver Transplant - Conclusion
  83. 83. THANK YOU MOHAN Foundation –INOS Mission Statement “ ORGANS WASTED ARE LIVES LOST” In my end is my beginning                      - T.S.Eliot, Four Quartets

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