Cadaver Organ Donation

1
Cadaver Organ Donation Transplantation in Asia
The Way Ahead

• Sunil Shroff
• Head of Department - Urology Renal
  Transplantation,
• Sri Ramachandra Medical College Research
  Institution, Managing Trustee, MOHAN Foundation,
  Chennai

2
The Organ Shortage

• Each day, about 60 people around the world
  receive an organ transplant, while another 13 die
  due to non-availability of organs.
• 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.

3
Cadaver Transplant in Asia The Road Ahead

• Overview of Cadaver Transplants in Asia
• Common Problems Platforms
• The Road Ahead

4
Overview of Asia

• Asia World
• Population 3.6 Billion (1.7 inc) 6.4 Billion
• No Of Countries 51 235
• Land Mass 44,390,000 Sq.Km 6,233,821,945 Sq.Km
• Life Expectancy M 63 yr F 66yrs

5
Cadaver Transplants in Asia

• Kidney
• Liver
• Heart
• Heart Lung
• Pancreas

Source Asian Transplant Registry
6
PER CAPITA INCOME FOR ASIAN COUNTRIES ( In US
Dollars)
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 Average Per Capita Income 1200 Maldives 2,510 Thailand 2,190 Iran 2,010 Kazakhstan 1,780 Jordan 1,850 Syria 1,190 China 1,100 Turkmenistan 1,120 Philippines 1,080 No Data - Afghanistan -Bhutan, Palestine, Bahrain, Cyprus, Iraq, Qatar, UAE, Myanmar, Timor , Oman, Brunei, N.Korea 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
7
High per capita income Successful Transplant
Programmes
Japan Hong Kong Singapore Kuwait Israel S Korea Taiwan Saudi Arabia Lebanon Malaysia Turkey
8
High per capita income Cadaver Tansplant
Programme
Hong Kong Singapore Taiwan Saudi Arabia Malaysia Turkey Iran Lebanon Kuwait Israel S Korea Japan
Most of Asia is struggling with Cadaver Programme
including regions with high per capita
9
Kidney Tx Waiting List in Asia (2002)

• Waiting Time
• Taiwan 1.9 yrs
• Korea 2.2 yrs
• Hong Kong 4.3 yrs
• Singapore 5.8 yrs

• Japan 12,974
• Taiwan 7000
• Saudi Arabia 4248
• Korea 4000
• Pakistan - 1650
• Hong Kong - 1018
• Singapore 666
• Bangladesh - 125

No figures available for China, India,
Philipines, Indonesia
10
Transplant Expertise - Asia

• Japan has - 352 transplant centres
• Thailand - 27 kidney, 6 liver, and 6 Cardiac
  transplantation centers,
• India has 5 centres- Liver, 6 - Cardiac and over
  100 for Kidneys.
• 35 centres have undertaken cadaver transplants
• However only 6 do it regular frequency.

11
Historical Aspects Cadaver Transplantation -
India

• 1967 - First succeesful cadaver Kidney
  Transplant in India at KEM Hospital, Bombay
• 1994 - First successful heart transplant done at
  AIIMS, N.Delhi
• 1995 - First successful multi-organ transplant
  done at Apollo Hospital, Chennai
• 1998 First Successful Lung transplant, Madras
  Medical Mission Hospital, Chennai
• 1999 First Pancreas Transplant, Ahembdabad

12
Transplants - Japan

• Kidney Transplant since 1964 -15 113
• Liver transplants since 1989 - 2411
• Heart Transplants since 1998 - 17
• Lung transplants since 1998 - 39
• The organs have largely been obtained from
  living and to some extent from non-heart beating
  donors

Ref Shirakura -WHO/HTP/EHT/T-2003.1Ethics,
access and safety in tissue and organ
transplantationIssues of global concern. Madrid,
Spain, 6-9 October 2003
13
Cadaver Kidney Transplants in Asia

• India, Taiwan, Korea, Thailand, Iran, Saudi
  Arabia and Singapore Regularly are
  undertaking Kidney Cadaver Transplants
• Taiwan, Thailand, Singapore follow the western
  model and run the programme almost on the same
  line
• Japan is still struggling with the programme
  though their numbers are slowly rising
• India is emerging as one of the Key players
  despite still struggling with the programme
  logistics
• Very Little information from China is Available
  on their modus operandi

14
Cadaver Heart Transplants in Asia

• Hong Kong, India, Japan, Malaysia, Saudi Arabia,
  Singapore and Thailand are doing Heart
  transplants
• Taiwan and Korea do the max heart transplants in
  Asia

15
Cadaver Liver Transplants in Asia

• Korea do the maximum living liver transplants and
  has high level of expertise in the field
• 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.
• Japan, Hong Kong, Taiwan similarly have expertise
  in living liver transplants
• Four centres in India located atHyderabad,
  Vellore and Delhi have fair expertise with liver
  transplants and emerging as the key players in
  the country.

16
Cadaver Kidney Transplants Scene in India

• In past seven years approx. 592 Cadaver organ
  transplants (518 kidneys, 35 Livers and 37
  Hearts) have been performed
• 35 Centres have undertaken Cadaver transplants
• Majority of these 35 centres are Private or trust
  hospitals
• Of these only half a dozen undertake cadaver
  transplants regularly
• Almost 50 of the cadaver transplants in India
  done in Tamil Nadu
• Tamil Nadu Organ Sharing Network could become the
  role model for rest of the country

Approx.200 centres in India have expertise to
undertake kidney transplants
17
Brain Death Legislation
Most countries have some law for tissue
procurement but not all have Brain Death
Legislation in Place
Singapore 1987 Philippine 1991 Thailand 1986 / 1996 India -1995 Japan 1997 S. Korea - 2000 Bangladesh 1999 Malaysia -1974 Iran Saudi Arabia Malaysia Taiwan Kuwait Turkey Sri Lanka - 1987
Over 20 countries in Asia do transplants
18
Asian Countries Undertaking Transplants Kidneys
alone

• Bangladesh K
• Pakistan - K
• Philippines K
• Indonesia K
• Malaysia K,
• Iran K,
• Israel K
• Turkey K
• Syria K
• Malaysia K

Some of these countries have done (eg Pakistan)
occasional liver or heart (eg Malaysia)
transplant.
19
Asian Countries Undertaking Multiorgan
Transplants

• Hong Kong K, H, Li, H-L
• India K, H, Li, H-L, P
• Japan K, H, L, L, K-P
• Korea - K, H, Li, L, K-P
• People Rep China K, H, Li
• Saudi Arabia K, H, L, Li
• Singapore K, H, L, Li
• Taiwan K, H, H-L, Li
• Thailand K, H, H-L, Li

Legend K-Kidneys, K-P - Kidneys Pancreas,
H-Heart, L-Lung, H-L-Heart Lung, Li- Liver
20

Cadaver Transplant in Asia The Road Ahead

• Overview of Cadaver Transplants in Asia
• Common Problems Platforms
• The Way Ahead

21
Common Problems Platforms

• Magnitude of the Problem
• Public and Professionals Attitude to Brain Death
  Organ Donation
• Religion Organ Donation
• Legal Aspects
• Media and Scandals
• Reporting of Brain Death
• Hospital Infrastructure
• Trained Transplant Co-ordinators /Counsellors

22
Incidence of ESRD In Asians Blacks

• Black and Asian people are three to four times
  more likely to develop end stage renal failure
  than white people
• This rises to eight times more likely for older
  Asians
• Diabetes five times the rate of the white
  population
• Hypertension was at least twice the rate of the
  white population.

23
World Status of Transplants

• Annual Number of kidney transplantations per
  million population (pmp) -
• USA - 52 Predominantly Cadaver Donors
• Europe - 27 Predominantly Cadaver Donors
• Asia - 3 Predominantly Living Donors

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.
24
Cadaver Donor Rates

• The Cadaver donors per million population per
  year
• USA - 20.7
• Europe - 15.9
• Asia - 1.1
• South America - 2.6

25
Waiting List for Organs keep Growing

• Only about 2.5 of the Japanese carry donor
  cards, but more than 13,000 Japanese are waiting
  for transplants.
• In February 2000, a 44-year-old woman who was
  declared brain dead following a brain hemorrhage
  and stroke donated all four of the organs used in
  recent transplants. The woman's heart went to a
  man in his 40s

26
Physicians Attitude to Organ Donation

• Korean health professionals' attitudes and
  knowledge toward organ donation and
  transplantation. Kim JR, Elliott D, Hyde C. 2004
  Mar41(3)299-307.
• There was a lack of knowledge by Korean health
  professionals surrounding brain death and the
  organ procurement process.
• Participants' attitudes were mixed and somewhat
  negative, as they did not regard brain death as
  true death

Korea Organ donation rate below 2 per million
population per year.
27
Physicians Attitude to Organ Donation

• Outmoded attitudes toward organ donation among
  Turkish health care professionals. Topbas M, Can
  G, Can MA, Ozgun S.Transplant Proc. 2005
  Jun37(5)1998-2000.
• A large proportion of Physicians are indifferent
  to organ donation process. Reason cited for this
  were -
• Lack of information regarding the donation
  process (28.7),
• Concerns about the sale of organs (22.1),
• Islamic religious beliefs (21.6)

28
Public Attitude

• Turkey (n774) - 59.2 would consider donating
  organs
• Pakistan(n 367) 59.9 Willing to donate their
  organs
• Hong Kong - 60.3 of the respondents were are
  willing to donate organs
• Viet Nam - 66 urban Vietnamese surveyed were
  willing to donate organs or tissues after death

Ref - Turkey- Ozdag N. EDTNA ERCA J. 2004
Oct-Dec30(4)188-95 Pakistan - Artif Organs.
2005 Nov29(11)899-905. Ashraf O, Ali S, Li SA,
et al Hong Kong - Yeung I, Kong SH, Lee J. Soc
Sci Med. 2000 Jun50(11)1643-54 Viet Nam - Hai
TB, Eastlund T, Chien LA, Duc PT, Giang TH, Hoa
NT, Viet PH, Trung DQ.
29
Public Attitude - Singapore

• Social and cultural aspects of organ donation in
  Asia.
• Woo KT. Ann Acad Med Singapore. 1992 May21(3)
• Important misconceptions and fears were
• Fear of death,
• Belief that removal of organ violates sanctity of
  decreased
• Concern about being cut up after death,
• Desire to be buried whole,
• Dislike of idea of kidneys inside another person,
  
• Wrong concept of brain death,
• Idea of donation being against religious
  conviction

30
Public Attitude - China

• Investigation of understanding and willingness
  of organ transplantation in young people in
  Beijing, Shanghai, Wuhan. Zhonghua Yi Xue Za Zhi.
  1997 Jan77(1)22-7. Liu Y, Lei H, Qiu F. China
  Foundation of Organ Transplantation Development,
  Wuhan
• Cities of China
• Young people have a better understanding of organ
  transplantation
• Conventional attitudes and feudal habits are the
  major obstacle to the development of organ
  transplantation in China.

31
Public Attitude and Organ donation in India
SURVEY ON PUBLIC ATTITUDE TOWARDS ORGAN
DONATION TRANSPLANATATION  Shroff S, Shankar
R et al, Indian Medical Tribune, 1996 

• Results of the Survey
• Less than 50 overall positive response in
  favour of donating solid organs
• 72 were willing for Eye donation and carry a
  Donor Card
• All major religions were willing to consider
  organ donation

32
CONCLUSION - PUBLIC ATTITUDE SURVEY
HOW TO ASK FOR ORGANS IN THE EVENT OF BRAIN
DEATH PATIENT

• Request for EYES FIRST - SEE HOW FAMILY REACTS
  
• Family Willing Family Reluctant
• Ask For Solid Organs Abandon Efforts
• (Heart, Liver, Kidneys ..)
• Inform Transplant Co-coordinator

Above protocol called THE RAMACHANDRA
PROTOCOL to ask for organs
33
Singapore - Legal Aspects

• THE HUMAN ORGAN TRANSPLANT ACT (HOTA) OF 1987
  Singapore
• .. Kidneys can be procured from patients of
  road traffic accidentswho have been declared
  brain-dead unless they have OPTED OUT (
  Presumed Consent)
• (Muslims exempted)

34
Legal Aspects

• Malaysia - The LAWS OF MALAYSIA, ACT 130 1974
• - which provides for the use of parts of the
  human bodies of deceased persons for therapeutic
  purposes and for purposes of medical education
  and research.
• S.Korea - The Transplant Act was first passed in
  1999 and then reviewed in 2002.
• The Act covers organs and tissues (only bone
  marrow (BM) and corneas).

35
Thailand - Legal Aspects

• There is no law to directly govern transplant
  procedures in Thailand.
• The Medical Council is responsible in regulating
  human organ transplantation. They decide the
  criteria from time to time.
• Medical Council in Thailand determines whether
  any punitive action should be taken against the
  doctors

36
S.Korea Legal Aspects
37
PHILIPPINES - LEGAL ASPECTS

• REPUBLIC ACT 7170, 1991 -
• which authorizes the legacy or donation of all
  or part of the human body after death for
  specified purposes

38
VIETNAM - LEGAL ASPECTS

• THE CIVIL CODE, ARTICLE 32, CHAPTER 2
• - requiring consent from donor or next-of-kin.
• THE PEOPLES HEALTH PROTECTION CODE, CHAPTER 4
  providing for tissue transplantation.

39
INDONESIA - LEGAL ASPECTS

• THE INDONESIA 1992 HEALTH REGULATION
• - provides for procurement of tissues from
  living donors only.
• FATWA FOR BONE, SKIN AMNION
• - introduced in JUNE 1997 by religious council
  permitting tissue procurement from cadaveric
  donors.

40
BANGLADESH - LEGAL ASPECTS

• TISSUE DONATION TRANSPLANTATION
• 1999 ACT
• - passed recently permitting donation from both
  living and cadaveric donors.

41
SRI LANKA - Legal Aspects

• LEGAL ASPECTS THE HUMAN TISSUE
  TRANSPLANTATION ACT NO 48 OF 1987
• which requires consent from donor or
  next-of-kin.

42
India Legal Aspects

• Transplantation of Human Organs Act, 1994
• Aims
• Regulate removal, storage and transplantation of
  human organs for therapeutic purposes
• To prevent commercial dealings in organs
• Recognise Brain Death

43
RELIGIOUS CULTURAL ASPECTS

• Religion plays major role in promoting Organ
  Donation. Major religions in Asia Pacific include
  -
• Islam
• Buddhism
• Christianity
• Hinduism
• Sikhism
• Judaism

44
Religion and Organ Donation

• Common thread that binds all religions of the
  world
• Saving of life overrides all objections
• There is no religions that is against organ
  donation
• What holds back is cultural reservations,
• Ignorance of the process of organ donation,
• Fear of mutilation,
• Lack of emotional support at time of tragedy,
• Fear that organs will be sold or used only by the
  rich
• Mistrust of hospitals and health professionals
• Myths.

45
Religious Attitude to Donation

• ChineseAmericans are influenced by Confucian
  values, and to a lesser extent, Buddhist, Daoist
  spiritual beliefs
• - associate an intact body with respect for
  ancestors or nature.
• The subjects were most willing to donate their
  organs after their deaths 1st to close
  relatives , then in descending order
• distant relatives, people from their home
  country and strangers
• Influence of religious and spiritual values on
  the willingness of ChineseAmericans to donate
  organs for transplantation. Wilbur Aaron Lama
  Laurence B McCulloughb .Clinical
  TransplantationVolume 14 Issue 5 Page 449  -
  October 2000 doi10.1034/j.1399-0012.2000.140502.x
  
•   

46
Buddhism Organ Donation

• 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
• - The Late Dr Hudson Silva

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. Guajrat in India with high no. of
Jains gets 4000 corneas - highest in India.
47
Buddhism Organ Donation

• Predominantly Buddhist Countries
• Sri Lanka
• Thailand
• Vietnam
• Myanmar

• Less Dominant
• Korea (30)
• Singapore (30)

48
Buddhism Organ Donation

• In countries where Buddhism is predominant there
  is no shortage of Tissue / ? Organ donors -
• Sri Lanka
• Thailand
• Vietnam
• Myanmar

49
Buddhism Organ Donation

• Even in countries where Buddhism is less dominant
• Singapore and Korea - Buddhists are main source
  of tissue donors.
• Success of NUH Tissue Bank in Singapore, entirely
  due to strong support by Buddhist Community. All
  donors Buddhists.

50
Muslims Organ Donation

• Muslims the most controversial group -
• Koran does not forbid tissue donation
• 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.
• Different interpretations by different religious
  leaders, ustazs and ulamas
• Muslims must bury the body as soon as possible
  after death the sooner the better usually less
  than 8 hours.

51
Muslims Organ Donation

• Less Dominant
• China (200 million)
• India
• Singapore (20)

• Predominantly
• Saudi Arabia
• Iran
• Iraq
• Kuwait
• Turkey
• Pakistan
• Bangladesh
• Malaysia
• Brunei
• Indonesia (Secular-PANCASILA)

52
Muslims Organ Donation

• Each country has its own MUFTI -religious
  official appointed by Govt to deal with Islamic
  matters
• FATWAS are religious rulings made by Fatwa
  Committee as official stand by Govt. on various
  issues.
• Fatwa Committee chaired by MUFTI includes
  prominent religious leaders, lawyers, doctors and
  other members of public
• Fatwas are not legal binding.

53
Muslims Organ Donation

• Fatwas declared in several countries
• Saudi Arabia 1985 - permit both living related
  and cadaveric donation of organs
• Pakistan,
• Bangladesh,
• Malaysia - 1995
• Indonesia

54
POWER OF FATWA

• Merely states governments position by MUFTI
• Not necessary to follow Fatwa
• Left to individual opinion and choice
• No consensus among various religious leaders,
  ustazs and ulamas each with strong influence
  on their followers

55
CULTURAL PRACTICES OF MUSLIMS

• Despite Fatwas Muslims reluctant to donate organs
• God created them whole. They prefer to return to
  him whole.
• Many Muslims bury amputated limbs, foreskin from
  circumcision, amnion from delivery.
• Not religious requirement but cultural practice.
  Not all Muslims do this

56
Christianity - Organ Donation

• Predominantly -
• Philippines

• Less Dominant
• Singapore (30)
• Korea (30)
• Malaysia
• India

No bar to organ donation - Shortage of Donors in
Philippines, Singapore and Korea due to cultural
factors.
57
Christianity - Organ Donation

• STATEMENT BY POPE JOHN PAUL II
• Full support of organ and tissue donation
  concluded with words of Jesus narrated by
  evangelist and physician LUKE
• 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).
• We shall receive our supreme reward from God
  according to the genuine and effective love we
  have shown to our neighbour.

58
Hinduism and Organ Donation

• Predominantly
• India

• LESS DOMINANT
• Sri Lanka (lt10)
• Singapore (5)
• Malaysia
• Indonesia
• Thailand
• Veitnam

59
Jainism Sikhism
60
Religions against organ donation

• Greek Orthodox, Shinto and Gypsies are three
  religions that do not encourage body donation
• Jehovahs witness is another Christian sect that
  is against such acts

61
Television, Films and Organ Donation

• TV programmes and Films that have projected
  donation as potentially harmful Expoitative.
  TV programs like
• The X-Files
• ER
• Voyager
• Law and Order
• Chicago Hope
• Strange Luck
• Movie Coma

62
Media and Scandals - Thailand

• Doctors May Face Murder Charge
• The New Straits Times, September 1, 2000
• 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.
• 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.

63
Media Scandals - Japan

• The Washington Post April 25, 1997
• 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

64
Media Organ Donation

• The power of the press can also be demonstrated
  in the so-called "Nicholas Green effect.
• Nicholas was a 7-year-old American child, shot
  dead by bandits in Italy in 1994
• His parents agreed to donate his organs
• Italian press reported it extensively
• The positives impact kick started the Italian
  cadaver programme

65
Under-reporting of Brain death

• The efficiency of utilization of potential
  donors for organ transplantation in Saudi Arabia
  a pilot study. Al Sebayel MI, Khalaf HA.
  Transplant Proc. 2004 Sep36(7)1881
• Data 2001 to 2003 - 114 out of 542 deaths
  were due to Brain Death 54 - occurred in one
  hospital.

• 38 cases were reported to the Saudi Center for
  Organ Transplantation in 23 Documentation was
  completed
• 4 Cases became actual donors
• Conclusion There is underreporting of brain
  death cases.

66
Problems with Cadaver Organ Donation Programme
in Asia

• Govt. Problem
• No Funding for programme
• Hospital problem
• No efforts to identify maintain Brain Dead
  donors
• Community Problem
• No Awareness of Brain-Death Concept

Spain has the highest number of brain death
patients going on to organ donation 32 per
million population
67
Common Problems - Awareness

• Lack of awareness of Brain death both public
  healthcare professionals
• Religious diversity with some religions though
  accepting the broad concept, are still reluctant
  to give their full support to the programme.
• Govt. inertia in implementation of policies to
  push the programme forward.
• Lack of trained personnel to run the
  infra-structural logistics of the programme.
• Lack of a common platform to structure some
  collaborative work
• Lack of Organ sharing network within the region
• Lack of resources in some instances to push the
  programme forward

68
Hospital Infra-Structural Support Logistics
Trained transplant Co-coordinators
Qualified Intensivists in ICUs
Successful Retrieval TX
Support Organisation to Network Keep Registries
Packing Transport of organs
HLA Tissue typing and Cross-match Facility
69
Hospital Infra-Structural Support Logistics
Qualified Trained transplant Co-coordinators
Adequate No. of Qualified Intensivists in ICUs
Well qualified Surgeons to undertake Retrieval
TX
Support Organisation to Network
Transport of organs between cities
HLA Tissue typing and Cross-match
70
Cadaver Transplants Scene in Asia The Way
Forward

• Overview of Cadaver Transplants in Asia
• Common Problems Platforms
• The Way Ahead

71
The Way Forward

• Strengthen the Asian Transplant Network
• Establish a common programme similar to
  Euro-transplant Network
• Start sharing organs that are not used locally
• Use technology effectively
• Evolve a Spanish style co-ordinators course for
  Asian countries
• Do our own Asian Transplant Games to build
  patient fellowship
• Have more frequent Asian Transplant Society
  meeting

72
Organisational changes

• Model National Transplant Service
• Like a network to share organs that is linked
  to a
• Asian Network for Organ Sharing (ANOS)
• Employing and training more transplant
  co-ordinators and having a separate body in Asia
  for Tx. Co-ordinators
• Regular Courses to impart expertise to the
  co-ordinators
• Training and sensitising ICU staff on brain-death

73
Cadaveric Donation

• For cadaveric donation -
• society remains a crucial aspect in a
  transplant programme
• Strategies to decrease refusal rates by families
  include efforts at education -
• the general population,
• Religious heads opinion leaders
• health care workers individually
• through the mass media

74
Encouraging People to Discuss Organ Donation

• 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
• When the wishes of the deceased are not known,
  only 50 of people will agree to organ retrieval
  from their relatives

75
Presence of Family Member During Brain Death
Testing

• 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
• Family members were given choice to be or not to
  be present during brain stem death testing
• 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
• The presence of family during brain stem death
  testing. Doran M. Intensive Crit Care Nurs. 2004
  Feb20(1)32-7

76
Project Positive Aspects

• Many donor relatives have stated that donating
  their loved one's organs does not make the pain
  of their death disappear
• But that it gives their death meaning that
  something so positive comes from tragedy.
• Bereaved families can experience comfort that
  their loved one's gift gave another person a
  second chance at life

77
Consent for Donation

• Pre-mortem via Donor Cards, Driving License
• Consent of his family following death
• Some form of a combination of the two are
  necessary
• 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
• The permission is a moral rather than a legal
  requirement

78
Presumed Consent Organ Donation

• Belgium, Austria, Finland, France, Norway, Spain,
  and Singapore implemented "presumed consent"
• France's presumed consent (PC) law has produced
  increases in organ donation approaching 5,000.
• Belgium passed its version of PC in 1986, and
  organ donation climbed by 183, with multi-organ
  retrieval significantly increased to 119 for
  kidneys. The donor rate increased from 10 to 22
  donors per million population between 1986 and
  1997.
• 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

79
Required Request Law

• Requires that formal request for organ donation
  be made of the families of all potential donors
  in the ICU.
• The rationale is that a statutory approach would
  overcome hesitancy by healthcare professionals at
  a time of such emotional distress.
• Required Request Law has been introduced into
  many states in the USA by legislation and helped
  improve organ donation rate

80
Mandated Choice

• 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.
• The information would be kept on a central
  register, accessible at time of death

81
Mandated Choice Driving License

• 1996 - Sweden instituted a mandated choice law.
  There was an immediate increase of 600,000
  potential donors.
• A similar 1990 law in Denmark increased their
  donor registry by 150,000.

82
Action Required Muslim Countries

• More public education needed to change cultural
  beliefs and practices although Islam does not
  forbid Organ or tissue donation
• Fatwas alone will not work.
• Constantly addressing masses through media by
  religious head may help to improve sentiments

83
Religion Organ Donation

• Plan major conferences of religious heads on
  organ donation and transplantation in all
  regions of Asia .
• Most people are ill- informed about their
  religions attitude towards organ donation.
• Major initiative required to correct this
• 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

84
What is Required

• 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
• More Support groups with common objectives are
  needed
• More resources necessary to Kick start such an
  Initiative

85
Promote Organ Donation Among Blood Donors

• 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.
• A substantial proportion of blood donors have
  not signed a Donor Card.
• It would be useful to design promotion programs
  to facilitate blood donors' participation in
  organ donation.
• 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
  Jun11(2)98-103. Department of Medicine and
  Therapeutics, Prince of Wales Hospital, Hong Kong

86
Make Local Sharing Protocols

• 6 Kidneys have been wasted in the last four
  years of the 112 Kidneys shared in the INOS
  network due to these problems
• Poor Retrieval Technique 2
• No Blood for Cross Match 2
• Poor Packing of Organ - 2

INOS- Initiative for Organ Sharing facilitated by
MOHAN Foundation in Tamil Nadu
87
Potential Countries That can Succeed with
Programme

• Countries that can have success with Cadaver
  Transplant programmes in Asia and make a
  difference -
• India No Religious bar to donation
• Iran Has a logistic approach
• Saudi Arabia Has the laws
• Turkey Liberal Muslim Country
• Taiwan Well organized Skills
• China Cabale of organizing the programme
• Sri Lanka High Buddhist community. Eye
  programme success
• Mynamar - High Buddhist community

88
ORGAN DONATION RATE
Current organ donation rate - India is 0.05 per
million population per year
If in India - 1 per million donation rate we
would have 1100 organ donors 2200 kidneys,1000
hearts, 1100 Livers, 2200 Eyes
At 3 per million Donation rate we would have 3300
organ donors 6600 kidneys,3300 hearts, 33001
Livers, 6600 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
89
Cadaver Transplant - Conclusion

• Organ Shortage is a Crisis, however the Crisis
  has a Cure
• In Asia we need to Network and start thinking of
  sharing resources, expertise and organs
• Set up some Collaborative projects
• Use Television Media for Promotion
• Get Religious heads to Participate regularly
• Have Transparency in programme
• Set up regional Transplant co-ordinators Forums
• In Asia we have failed to explore all the
  options
• Simple changes can make all the difference

90
Our Mission Statement ORGANS WASTED ARE LIVES
LOST
THANK YOU
This presentation has been created using 100
recycled electrons!! Recycle yourself and
become an organ donor
In my end is my beginning                    
- T.S.Eliot, Four Quartets
91
Cadaver Transplants 1995 to 2001

• 35 Hospitals have undertaken Cadaver transplants
  
• However only 10 of 35 undertake it on regular
  basis

10
68
5
46
48
8
32
183
Source Indian Transplant Newsletter Mohan
Foundation
8
37
6
12