Cadaver Organ Donation

Dr.Sunil Shroff, www.mohanfoundation.org

Cadaver Organ Donation & Transplantation in Asia – The Way Ahead

Dr. Sunil ShroffDr. Sunil ShroffHead of Department - Urology & Renal Transplantation, Head of Department - Urology & Renal Transplantation,

Sri Ramachandra Medical College & Research Institution,Sri Ramachandra Medical College & Research Institution, Managing Trustee, MOHAN Foundation, ChennaiManaging Trustee, MOHAN Foundation, Chennai

[email protected]@mohanfoundation.org


Organ ShortageOrgan Shortage

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

Organ shortage — the main limitation to saving Organ shortage — the main limitation to saving lives of critically ill patients — is due to lives of critically ill patients — is due to individuals and their families not considering individuals and their families not considering organ donation out of fear, ignorance or organ donation out of fear, ignorance or misunderstanding.misunderstanding.


Cadaver Transplant in Asia – The Road AheadCadaver Transplant in Asia – The Road Ahead

Overview of Cadaver Transplants in AsiaOverview of Cadaver Transplants in Asia Common Problems & PlatformsCommon Problems & Platforms The Road AheadThe Road Ahead


Overview of AsiaOverview of Asia

AsiaAsia WorldWorld PopulationPopulation 3.6 Billion 3.6 Billion 6.4 Billion6.4 Billion

No Of CountriesNo Of Countries 5151 235235

Land MassLand Mass 44,390,000 Sq.Km44,390,000 Sq.Km 6,233,821,945 Sq.Km6,233,821,945 Sq.Km

Life Expectancy Life Expectancy M 63 yr F 66yrsM 63 yr F 66yrs


Cadaver Transplants in AsiaCadaver Transplants in Asia

KidneyKidney LiverLiver HeartHeart Heart LungHeart Lung PancreasPancreas

Source: Asian Transplant Registry


PER CAPITA INCOME FOR ASIAN COUNTRIES PER CAPITA INCOME FOR ASIAN COUNTRIES ( In US Dollars)( In US Dollars)

High Per Capita Income 2500High Per Capita Income 2500

JapanJapan 34,180 34,180

Hong KongHong Kong 25,860 25,860

Singapore 21,230Singapore 21,230

Kuwait 17,960Kuwait 17,960

Israel 16,240Israel 16,240

S Korea 12,030S Korea 12,030

Taiwan 13,530Taiwan 13,530

Saudi Arabia 9,240Saudi Arabia 9,240

LebanonLebanon 4,040 4,040

Malaysia 3,880Malaysia 3,880

Turkey 2,800Turkey 2,800

MaldivesMaldives 2,510 2,510

Average Per Capita Income 1000Average Per Capita Income 1000

Thailand 2,190Thailand 2,190

Iran Iran 2,010 2,010

Kazakhstan 1,780Kazakhstan 1,780

Jordan 1,850Jordan 1,850

Syria 1,190Syria 1,190

Turkmenistan 1,120Turkmenistan 1,120

ChinaChina 1,100 1,100

Philippines 1,080Philippines 1,080

No Data -No Data - Afghanistan Afghanistan -Bhutan, Palestine, Bahrain, -Bhutan, Palestine, Bahrain,

Cyprus, Iraq, Qatar, UAE, Cyprus, Iraq, Qatar, UAE,

Myanmar, Timor , Oman, Myanmar, Timor , Oman,

Brunei, N.KoreaBrunei, N.Korea

Low Per Capita Income -Low Per Capita Income - 10001000

Sri Lanka 930Sri Lanka 930

Armenia 950Armenia 950

Indonesia 810Indonesia 810

Azerbaijan 820Azerbaijan 820

Georgia 770Georgia 770

India 540India 540

Yemen 520Yemen 520

Pakistan 520Pakistan 520

MongoliaMongolia 480 480

Vietnam 480Vietnam 480

Bangladesh 400Bangladesh 400Uzbekistan 420Uzbekistan 420

Laos 340Laos 340

Kyrgyzstan 340Kyrgyzstan 340

Cambodia 300Cambodia 300

Nepal 240Nepal 240

Tajikistan 210Tajikistan 210


High per capita income & Successful Living High per capita income & Successful Living Transplant ProgrammesTransplant Programmes

JapanJapan

Hong KongHong Kong

Singapore Singapore

Kuwait Kuwait

Israel Israel

S Korea S Korea

TaiwanTaiwan

Saudi Arabia Saudi Arabia

LebanonLebanon

Malaysia Malaysia

Turkey Turkey


High per capita income & Cadaver Tansplant High per capita income & Cadaver Tansplant ProgrammeProgramme

Hong KongHong Kong

SingaporeSingapore

TaiwanTaiwan

Saudi Arabia Saudi Arabia

Malaysia Malaysia

TurkeyTurkey

IranIran

LebanonLebanon

Kuwait Kuwait

Israel Israel

S KoreaS Korea

JapanJapan

Most of Asia is struggling with Cadaver Programme including regions with high per capita


Kidney Tx Waiting List in Asia (2002)Kidney Tx Waiting List in Asia (2002)

Japan Japan – – 12,97412,974 TaiwanTaiwan – – 7000 7000 Saudi Arabia – Saudi Arabia – 4248 4248 KoreaKorea – – 4000 4000 PakistanPakistan - - 1650 1650 Hong KongHong Kong - - 1018 1018 SingaporeSingapore – – 666 666 BangladeshBangladesh - - 125 125

Waiting TimeWaiting Time Taiwan Taiwan – 1.9 yrs– 1.9 yrsKorea Korea – 2.2 yrs– 2.2 yrsHong KongHong Kong– 4.3 yrs– 4.3 yrsSingaporeSingapore – 5.8 yrs– 5.8 yrs

No Waiting list in Iran for Kidney No Waiting list in Iran for Kidney Tx.Tx.

No figures available for China, India, Philipines, Indonesia


Transplant Expertise - AsiaTransplant Expertise - Asia

Japan has - 352 transplant centresJapan has - 352 transplant centres Thailand - 27 kidney, 6 liver, & 6 Cardiac Thailand - 27 kidney, 6 liver, & 6 Cardiac

transplantation centerstransplantation centers Iran has 22 centres – mainly kidneysIran has 22 centres – mainly kidneys India has 110 centres for Kidney Tx 5 India has 110 centres for Kidney Tx 5

centres Liver, 6 – Cardiac. over 35 centres centres Liver, 6 – Cardiac. over 35 centres have undertaken cadaver transplantshave undertaken cadaver transplantsHowever However only 6 centres do cadaver Txonly 6 centres do cadaver Tx. .

regularly regularly


Transplants - JapanTransplants - Japan

Kidney Transplant since 1964 Kidney Transplant since 1964 -15 113 -15 113 Liver transplants since 1989 Liver transplants since 1989 - 2411 - 2411 Heart Transplants since 1998 Heart Transplants since 1998 - 17 - 17 Lung transplants since 1998 Lung transplants since 1998 - 39 - 39

The organs have largely been obtained from living and The organs have largely been obtained from living and to some extent from non-heartto some extent from non-heart beating donors beating donors

Ref: Shirakura -WHO/HTP/EHT/T-2003.1Ethics, access and safety in tissue and organ 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 2003transplantation:Issues of global concern. Madrid, Spain, 6-9 October 2003


Cadaver Kidney Transplants in AsiaCadaver Kidney Transplants in Asia

India, Taiwan, Korea, Thailand, Iran, Saudi Arabia and Singapore India, Taiwan, Korea, Thailand, Iran, Saudi Arabia and Singapore

– Regularly are undertaking Kidney Cadaver Transplants – Regularly are undertaking Kidney Cadaver Transplants

Taiwan, Thailand, Singapore follow the western model and run Taiwan, Thailand, Singapore follow the western model and run

the programme almost on the same linethe programme almost on the same line

Japan is still struggling with the programme though their Japan is still struggling with the programme though their

numbers are slowly risingnumbers are slowly rising

India is emerging as one of the Key players despite still India is emerging as one of the Key players despite still

struggling with the programme logisticsstruggling with the programme logistics

Very Little information from China is Available on their modus Very Little information from China is Available on their modus

operandioperandi


Cadaver Heart Transplants in AsiaCadaver Heart Transplants in Asia

Hong Kong, India, Japan, Malaysia, Saudi Hong Kong, India, Japan, Malaysia, Saudi Arabia, Singapore and Thailand are doing Arabia, Singapore and Thailand are doing Heart transplants Heart transplants

Taiwan and Korea do the maximum heart Taiwan and Korea do the maximum heart transplants in Asiatransplants in Asia


Cadaver Liver Transplants in AsiaCadaver Liver Transplants in Asia

Korea do the maximum living liver transplants and has high Korea do the maximum living liver transplants and has high level of expertise in the fieldlevel of expertise in the field

2,345 LTs (1,860 from the living donor and 485 from the 2,345 LTs (1,860 from the living donor and 485 from the deceased donor) were performed in 24 institutes from March deceased donor) were performed in 24 institutes from March 1988 to December 2004, although 5 institutes had performed 1988 to December 2004, although 5 institutes had performed more than 10 LTs per year. more than 10 LTs per year.

Japan, Hong Kong, Taiwan similarly have expertise in living Japan, Hong Kong, Taiwan similarly have expertise in living liver transplantsliver transplants

Four centres in India – located at Hyderabad, Vellore and Four centres in India – located at Hyderabad, Vellore and Delhi have fair expertise with liver transplants and emerging Delhi have fair expertise with liver transplants and emerging as the key players in the country.as the key players in the country.


Cadaver Kidney Transplants Scene in IndiaCadaver Kidney Transplants Scene in India

In past ten years approx. 1000 Cadaver organ In past ten years approx. 1000 Cadaver organ transplants over 900 kidneys and 100 Livers and transplants over 900 kidneys and 100 Livers and heart have been performedheart have been performed

Almost 40% of the cadaver transplants in India done Almost 40% of the cadaver transplants in India done in Tamil Naduin Tamil Nadu

Tamil Nadu Organ Sharing Network could become the Tamil Nadu Organ Sharing Network could become the role model for rest of the countryrole model for rest of the country

Approx.110 centres in India do kidney Tx.however only 25 to 30 centres do over 25 per year.


Historical Aspects – Cadaver Transplantation - IndiaHistorical Aspects – Cadaver Transplantation - India

1967 - First successful cadaver Kidney Transplant in 1967 - First successful cadaver Kidney Transplant in India at KEM Hospital, BombayIndia at KEM Hospital, Bombay

1994 - First successful heart transplant done at AIIMS, 1994 - First successful heart transplant done at AIIMS, N.DelhiN.Delhi

1995 - First successful multi-organ transplant done at 1995 - First successful multi-organ transplant done at Apollo Hospital, ChennaiApollo Hospital, Chennai

1998 – First Successful Lung transplant, Madras 1998 – First Successful Lung transplant, Madras Medical Mission Hospital, ChennaiMedical Mission Hospital, Chennai

1999 – First Pancreas Transplant, Ahemdabad1999 – First Pancreas Transplant, Ahemdabad


Asian Countries Undertaking Transplants – Asian Countries Undertaking Transplants – Kidneys alone (n-10)Kidneys alone (n-10)

Pakistan - KPakistan - K Philippines – KPhilippines – K Indonesia – KIndonesia – K Malaysia – K, Malaysia – K, Iran – K, Iran – K, Israel – KIsrael – K Turkey – KTurkey – K Syria – KSyria – K Malaysia – KMalaysia – K Bangladesh – KBangladesh – K

Some of these countries have done (eg Pakistan) occasional liver or heart (eg Malaysia) transplant.


Asian Countries Undertaking Multi–organ Asian Countries Undertaking Multi–organ Transplants (n-9)Transplants (n-9)

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

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


Overview of Cadaver Transplants in Overview of Cadaver Transplants in AsiaAsia

Common Problems & PlatformsCommon Problems & Platforms The Way AheadThe Way Ahead

Cadaver Transplant in Asia – The Road AheadCadaver Transplant in Asia – The Road Ahead


Common Problems & PlatformsCommon Problems & Platforms

Incidence of organ failure in AsiaIncidence of organ failure in Asia Public and Professionals Attitude to Brain Death & Public and Professionals Attitude to Brain Death &

Organ DonationOrgan Donation Religion & Organ DonationReligion & Organ Donation Legal AspectsLegal Aspects Media and ScandalsMedia and Scandals Reporting of Brain DeathReporting of Brain Death Hospital InfrastructureHospital Infrastructure Trained Transplant Co-ordinators /CounsellorsTrained Transplant Co-ordinators /Counsellors


Incidence of ESRD In Asians & BlacksIncidence of ESRD In Asians & Blacks

Black and Asian people are Black and Asian people are three to four timesthree to four times more more likely to develop end stage renal failure than white likely to develop end stage renal failure than white peoplepeople

This rises to This rises to eight timeseight times more likely for older Asians more likely for older Asians Diabetes five timesDiabetes five times the rate of the white population the rate of the white population Hypertension was at leastHypertension was at least twice the rate of the white twice the rate of the white

population. population.


World Status of Transplants World Status of Transplants

Annual Number of kidney transplantations per million Annual Number of kidney transplantations per million population (pmp) per year -population (pmp) per year -USA - USA - 52 52 Predominantly Cadaver DonorsPredominantly Cadaver DonorsEurope -Europe - 27 27 Predominantly Cadaver DonorsPredominantly Cadaver DonorsAsia - Asia - 3 3 Predominantly Living DonorsPredominantly 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.


Cadaver Donor RatesCadaver Donor Rates

The Cadaver donors per million population per year The Cadaver donors per million population per year

USA - USA - 20.720.7 Europe - Europe - 15.9 15.9 Asia - Asia - 1.1 1.1 South America -South America - 2.6 2.6


Physicians Attitude to Organ DonationPhysicians Attitude to Organ Donation

Korean health professionals' attitudes and knowledge toward Korean health professionals' attitudes and knowledge toward organ donation and transplantationorgan donation and transplantation. . Kim JR, Elliott D, Hyde C. 2004 Kim JR, Elliott D, Hyde C. 2004 Mar;41(3):299-307. Mar;41(3):299-307.

There was a There was a lack of knowledge by Korean health lack of knowledge by Korean health professionalsprofessionals surrounding brain death and the organ surrounding brain death and the organ procurement process. procurement process.

Participants' attitudes were mixed and somewhat Participants' attitudes were mixed and somewhat negative, as they did negative, as they did not regard brain death as true not regard brain death as true deathdeath

Korea – Organ donation rate below 2 per million population per year.Korea – Organ donation rate below 2 per million population per year.


Physicians Attitude to Organ DonationPhysicians Attitude to Organ Donation

Outmoded attitudes toward organ donation among Turkish health Outmoded attitudes toward organ donation among Turkish health care professionals. care professionals. Topbas M, Can G, Can MA, Ozgun S.Transplant Proc. 2005 Topbas M, Can G, Can MA, Ozgun S.Transplant Proc. 2005 Jun;37(5):1998-2000.Jun;37(5):1998-2000.

A large proportion of Physicians are indifferent to organ A large proportion of Physicians are indifferent to organ donation process. Reason cited for this were -donation process. Reason cited for this were -

Lack of information regarding the donation process (28.7%), Lack of information regarding the donation process (28.7%), Concerns about the sale of organs (22.1%), Concerns about the sale of organs (22.1%), Islamic religious beliefs (21.6%)Islamic religious beliefs (21.6%)


Public AttitudePublic Attitude

Turkey Turkey (n=774)(n=774) - 59.2% would consider donating organs - 59.2% would consider donating organs Pakistan(n 367) – Pakistan(n 367) – 59.9% Willing to donate their organs59.9% Willing to donate their organs Hong KongHong Kong - - 60.3% of the respondents were are willing 60.3% of the respondents were are willing

to donate organsto donate organs Viet NamViet Nam - - 66% urban Vietnamese surveyed were 66% urban Vietnamese surveyed were

willing to donate organs or tissues after deathwilling to donate organs or tissues after death

Ref -Ref -Turkey- Ozdag N. EDTNA ERCA J. 2004 Oct-Dec;30(4):188-95Turkey- Ozdag N. EDTNA ERCA J. 2004 Oct-Dec;30(4):188-95Pakistan - Artif Organs. 2005 Nov;29(11):899-905. Ashraf O, Ali S, Li SA, et al Pakistan - Artif Organs. 2005 Nov;29(11):899-905. Ashraf O, Ali S, Li SA, et al Hong Kong - Hong Kong - Yeung I, Kong SH, Lee J. Soc Sci Med. 2000 Jun;50(11):1643-54Yeung 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.Viet Nam - Hai TB, Eastlund T, Chien LA, Duc PT, Giang TH, Hoa NT, Viet PH, Trung DQ.


Public Attitude - SingaporePublic Attitude - Singapore

Social and cultural aspects of organ donation in Asia. Social and cultural aspects of organ donation in Asia. Woo KT. Ann Acad Med Singapore. 1992 May;21(3)Woo KT. Ann Acad Med Singapore. 1992 May;21(3)

Important misconceptions and fears were –Important misconceptions and fears were – Fear of death, Fear of death, Belief that removal of organ violates sanctity of decreasedBelief that removal of organ violates sanctity of decreased Concern about being cut up after death, Concern about being cut up after death, Desire to be buried whole, Desire to be buried whole, Dislike of idea of kidneys inside another person, Dislike of idea of kidneys inside another person, Wrong concept of brain death, Wrong concept of brain death, Idea of donation being against religious conviction Idea of donation being against religious conviction


Public Attitude - ChinaPublic Attitude - China

Investigation of understanding and willingness of organ transplantation Investigation of understanding and willingness of organ transplantation in young people in Beijing, Shanghai, Wuhanin young people in Beijing, Shanghai, Wuhan. . Zhonghua Yi Xue Za Zhi. 1997 Zhonghua Yi Xue Za Zhi. 1997 Jan;77(1):22-7. Liu Y, Lei H, Qiu F. China Foundation of Organ Transplantation Development, Jan;77(1):22-7. Liu Y, Lei H, Qiu F. China Foundation of Organ Transplantation Development, WuhanWuhan

Cities of China – Cities of China – Young people have a better understanding of organ transplantationYoung people have a better understanding of organ transplantation Conventional attitudes and feudal habits are the major obstacle to the Conventional attitudes and feudal habits are the major obstacle to the

development of organ transplantation in China.development of organ transplantation in China.


Results of the SurveyResults of the Survey Less than 50% overall positive response in favour Less than 50% overall positive response in favour

of donating solid organsof donating solid organs 72% were willing for “Eye” donation and carry a 72% were willing for “Eye” donation and carry a

“Donor Card” “Donor Card” All major religions were willing to consider organ All major religions were willing to consider organ

donationdonation

Results of the SurveyResults of the Survey Less than 50% overall positive response in favour Less than 50% overall positive response in favour

of donating solid organsof donating solid organs 72% were willing for “Eye” donation and carry a 72% were willing for “Eye” donation and carry a

“Donor Card” “Donor Card” All major religions were willing to consider organ All major religions were willing to consider organ

donationdonation

SURVEY ON “PUBLIC ATTITUDE TOWARDS ORGAN DONATION & TRANSPLANATATION”

Shroff S, Shankar R et al, Indian Medical Tribune, 1996

SURVEY ON “PUBLIC ATTITUDE TOWARDS ORGAN DONATION & TRANSPLANATATION”

Shroff S, Shankar R et al, Indian Medical Tribune, 1996

Public Attitude and Organ donation in IndiaPublic Attitude and Organ donation in India


““Request for EYES” FIRST” - SEE HOW FAMILY REACTS Request for EYES” FIRST” - SEE HOW FAMILY REACTS

Family Willing Family Willing Family Family ReluctantReluctant

Ask For Solid OrgansAsk For Solid Organs Abandon Abandon EffortsEfforts

(Heart, Liver, Kidneys ..)(Heart, Liver, Kidneys ..)

Inform Transplant Co-coordinatorInform Transplant Co-coordinator

““Request for EYES” FIRST” - SEE HOW FAMILY REACTS Request for EYES” FIRST” - SEE HOW FAMILY REACTS

Family Willing Family Willing Family Family ReluctantReluctant

Ask For Solid OrgansAsk For Solid Organs Abandon Abandon EffortsEfforts

(Heart, Liver, Kidneys ..)(Heart, Liver, Kidneys ..)

Inform Transplant Co-coordinatorInform Transplant Co-coordinator

Above protocol called “THE RAMACHANDRA PROTOCOL”“THE RAMACHANDRA PROTOCOL” to ask for organs

CONCLUSION - CONCLUSION - “PUBLIC ATTITUDE SURVEY”

HOW TO ASK FOR ORGANS IN THE EVENT OF “BRAIN DEATH” PATIENTHOW TO ASK FOR ORGANS IN THE EVENT OF “BRAIN DEATH” PATIENT


Brain Death – Law & GuidelinesBrain Death – Law & Guidelines

CountiresCountires LawLaw GuidelinesGuidelines Apnea Apnea TestTest

PhysiciansPhysicians Obv Obv TimeTime

Conf, Conf, TestTest

ArmeniaArmenia AA AA AA AA AA OptionalOptional

BangladeshBangladesh PP PP DVODVO 33 AA OptionalOptional

ChinaChina AA AA AA AA AA OptionalOptional

GeorgiaGeorgia PP PP DVODVO 33 2424 MandatoryMandatory

Hong KongHong Kong PP PP PCOPCO22 11 AA OptionalOptional

IndiaIndia

IranIran

PPPPPP

PP

pp

DVODVO

--

44

--

AA

--

MandatoryMandatory

--

IndonesiaIndonesia AA PP PCOPCO22 33 2424 OptionalOptional


Brain Death – Law & GuidelinesBrain Death – Law & Guidelines

CountriesCountries LawLaw GuidelinesGuidelines Apnea Apnea TestTest

PhysiciansPhysicians Obv Obv TimeTime

Conf, Conf, TestTest

JapanJapan PP PP PCOPCO22 11 AA MandatoryMandatory

Korea (S)Korea (S) PP PP PCOPCO22 11 66 OptionalOptional

MalaysiaMalaysia PP PP PCOPCO22 22 1212 MandatoryMandatory

Pakistan A A A A A Not known

PhilippinesPhilippines AA PP DVODVO 11 2424 OptionalOptional

SingaporeSingapore PP PP PCOPCO22 22 AA OptionalOptional

TaiwanTaiwan AA PP PCOPCO22 11 66 OptionalOptional

ThailandThailand PP PP DVODVO 33 66 OptionalOptional

VietnamVietnam AA AA DVODVO AA AA OptionalOptional


Singapore - Legal Aspects Singapore - Legal Aspects

THE HUMAN ORGAN TRANSPLANT ACT (HOTA) OF THE HUMAN ORGAN TRANSPLANT ACT (HOTA) OF 1987 – Singapore1987 – Singapore“…“….. Kidneys can.. Kidneys can be procured from patients of road be procured from patients of road traffic accidents who have been declared “brain-traffic accidents who have been declared “brain-dead” unless they have dead” unless they have OPTED OUT ( Presumed OPTED OUT ( Presumed Consent)Consent)(Muslims exempted)(Muslims exempted)


Thailand - Legal AspectsThailand - Legal Aspects

There is no law to directly govern transplant There is no law to directly govern transplant procedures in Thailand.procedures in Thailand.

The Medical Council is responsible in regulating The Medical Council is responsible in regulating human organ transplantationhuman organ transplantation. They decide the . They decide the criteria from time to time. criteria from time to time.

Medical Council in Thailand determines whether any Medical Council in Thailand determines whether any punitive action should be taken against the doctors punitive action should be taken against the doctors


India – Legal AspectsIndia – Legal Aspects

Transplantation of Human Organs Act, 1994Transplantation 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


RELIGIOUS & CULTURAL ASPECTSRELIGIOUS & CULTURAL ASPECTS

Religion plays major role in promoting Organ Religion plays major role in promoting Organ Donation. Donation.

Major religions in Asia Pacific include -Major religions in Asia Pacific include - Islam Islam Buddhism Buddhism ChristianityChristianityHinduismHinduismSikhismSikhismJudaismJudaism


Religion and Organ Donation Religion and Organ Donation

Common thread that binds all religions of the world – Common thread that binds all religions of the world – Saving of life overrides all objectionsSaving of life overrides all objectionsThere is no religion that is against organ donation There is no religion that is against organ donation What holds back is cultural reservationsWhat holds back is cultural reservations - -

• Ignorance of the process of organ donation, Ignorance of the process of organ donation, • Fear of mutilation,Fear of mutilation,• Lack of emotional support at time of tragedy, Lack of emotional support at time of tragedy, • Fear that organs will be sold or used only by the richFear that organs will be sold or used only by the rich• Mistrust of hospitals and health professionals Mistrust of hospitals and health professionals • Myths Myths


Religious Attitude to DonationReligious Attitude to Donation

Chinese–Americans are influenced by Confucian values, Chinese–Americans are influenced by Confucian values, and to a lesser extent, Buddhist, Daoist spiritual beliefs and to a lesser extent, Buddhist, Daoist spiritual beliefs - - associate an intact body with respect for ancestors or associate an intact body with respect for ancestors or nature.nature.

The subjects were most willing to donate their organs after The subjects were most willing to donate their organs after their deaths – 1their deaths – 1stst to close relatives , then in descending to close relatives , then in descending order –order –distant relatives, people from their home country and distant relatives, people from their home country and strangersstrangersInfluence of religious and spiritual values on the willingness of Chinese–Influence of religious and spiritual values on the willingness of Chinese–Americans to donate organs for Americans to donate organs for transplantationtransplantation.. Wilbur Aaron Lama & Laurence B Wilbur Aaron Lama & Laurence B McCulloughb .McCulloughb .Clinical TransplantationVolume 14 Issue 5 Page 449 - October 2000 doi:10.1034/j.1399-0012.2000.140502.xClinical TransplantationVolume 14 Issue 5 Page 449 - October 2000 doi:10.1034/j.1399-0012.2000.140502.x


Buddhism & Organ DonationBuddhism & Organ Donation

““The attitude of Buddhism is in perfect agreement with The attitude of Buddhism is in perfect agreement with organ and tissue donation; and in Buddhist Scriptures organ and tissue donation; and in Buddhist Scriptures there are stories where donation of tissues have been there are stories where donation of tissues have been referred to as an act of charity earning merits”referred to as an act of charity earning merits”

- The Late Dr Hudson Silva- 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.

Gujarat in India has high number of eye donations (Jains) gets 4000 corneas - highest in India.



Predominantly Buddhist Predominantly Buddhist CountriesCountries

Sri LankaSri Lanka ThailandThailand VietnamVietnam MyanmarMyanmar

Less Dominant Less Dominant Korea (30%)Korea (30%) Singapore (30%)Singapore (30%)



Even in countries where Buddhism is less dominantEven in countries where Buddhism is less dominant Singapore and Korea - Buddhists are main source of Singapore and Korea - Buddhists are main source of

tissue donors. tissue donors. Success of NUH Tissue Bank in Singapore, entirely Success of NUH Tissue Bank in Singapore, entirely

due to strong support by Buddhist Community. All due to strong support by Buddhist Community. All donors Buddhists.donors Buddhists.


Muslims & Organ DonationMuslims & Organ Donation

Muslims the most controversial group -Muslims the most controversial group - Koran does not forbid tissue donationKoran does not forbid tissue donation Koran states that if by not transplanting an organ or Koran states that if by not transplanting an organ or

tissue, the person will die, then it is permissible to tissue, the person will die, then it is permissible to donatedonate. It is allowed for an emergency to save life. . It is allowed for an emergency to save life.

Different interpretations by different religious leaders, Different interpretations by different religious leaders, ‘ustazs’ and ‘ulamas’‘ustazs’ and ‘ulamas’

Muslims must bury the body as soon as possible after Muslims must bury the body as soon as possible after death – the sooner the better usually less than 8 hours. death – the sooner the better usually less than 8 hours.



Predominantly –Predominantly – Saudi ArabiaSaudi Arabia IranIran IraqIraq KuwaitKuwait TurkeyTurkey Pakistan Pakistan Bangladesh Bangladesh Malaysia Malaysia Brunei Brunei Indonesia (Secular-Indonesia (Secular-

PANCASILA)PANCASILA)

Less Dominant –Less Dominant – China (200 million)China (200 million) IndiaIndia Singapore (20%)Singapore (20%)



Each country has its own ‘MUFTI’ -religious official appointed Each country has its own ‘MUFTI’ -religious official appointed by Govt to deal with Islamic mattersby Govt to deal with Islamic matters

‘‘FATWAS’ are religious rulings made by ‘Fatwa Committee’ as FATWAS’ are religious rulings made by ‘Fatwa Committee’ as official stand by Govt. on various issues.official stand by Govt. on various issues.

‘‘Fatwa Committee’ chaired by MUFTI includes prominent Fatwa Committee’ chaired by MUFTI includes prominent religious leaders, lawyers, doctors and other members of religious leaders, lawyers, doctors and other members of publicpublic

Fatwas are not legal bindingFatwas are not legal binding..



Fatwas declared in several countriesFatwas declared in several countries Saudi Arabia : 1985 - permit both living related and Saudi Arabia : 1985 - permit both living related and

cadaveric donation of organscadaveric donation of organs Pakistan, Pakistan, Bangladesh,Bangladesh, Malaysia - 1995 Malaysia - 1995 Indonesia Indonesia


CULTURAL PRACTICES OF MUSLIMSCULTURAL PRACTICES OF MUSLIMS

Despite Fatwas Muslims reluctant to donate organsDespite Fatwas Muslims reluctant to donate organs God created them whole. They prefer to return to him God created them whole. They prefer to return to him

whole.whole. Many Muslims bury amputated limbs, foreskin from Many Muslims bury amputated limbs, foreskin from

circumcision, amnion from delivery.circumcision, amnion from delivery. Not religious requirement but cultural practice. Not all Not religious requirement but cultural practice. Not all

Muslims do thisMuslims do this


Christianity - Organ DonationChristianity - Organ Donation

Predominantly -Predominantly - PhilippinesPhilippines

Less Dominant –Less Dominant – Singapore (30%)Singapore (30%) Korea (30%)Korea (30%) Malaysia Malaysia IndiaIndia

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


Christianity - Organ DonationChristianity - Organ Donation

STATEMENT BY POPE JOHN PAUL II –STATEMENT BY POPE JOHN PAUL II –Full support of organ and tissue donation concluded Full support of organ and tissue donation concluded with words of Jesus narrated by evangelist and with words of Jesus narrated by evangelist and physician LUKE:physician LUKE:““give…, and it will be given to you;give…, and it will be given to you; good measure, good measure, pressed down, shaken together, running over, will be pressed down, shaken together, running over, will be put into your lap (Luke 6 : 38).”put into your lap (Luke 6 : 38).”We shall receive our supreme reward from God We shall receive our supreme reward from God according to the genuine and effective love we have according to the genuine and effective love we have shown to our neighbour.shown to our neighbour.


Hinduism and Organ DonationHinduism and Organ Donation

Predominantly Predominantly IndiaIndia

LESS DOMINANTLESS DOMINANT Sri Lanka (<10%)Sri Lanka (<10%) Singapore (5%)Singapore (5%) MalaysiaMalaysia IndonesiaIndonesia ThailandThailand VeitnamVeitnam


Religions against organ donationReligions against organ donation

Greek Orthodox, Shinto and Gypsies are three religions Greek Orthodox, Shinto and Gypsies are three religions that do not encourage body donationthat do not encourage body donation

Jehovah’s witness is another Christian sect that is Jehovah’s witness is another Christian sect that is against such actsagainst such acts


Media and Scandals - Media and Scandals - TThailandhailand

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

Three doctors from a Bangkok private hospital allegedly killed Three doctors from a Bangkok private hospital allegedly killed patients in 1997, harvested the kidneys and sold their kidneys to patients in 1997, harvested the kidneys and sold their kidneys to rich transplant patients will face murder charges. faking rich transplant patients will face murder charges. faking paperwork to cover their crime. paperwork to cover their crime.

A police inquiry into the scandal said - the organs were removed A police inquiry into the scandal said - the organs were removed from patients who were pronounced brain dead, a condition not from patients who were pronounced brain dead, a condition not accepted as legally dead in Thailand. accepted as legally dead in Thailand.


Media & Scandals - JapanMedia & Scandals - Japan

The Washington Post: April 25, 1997 The Washington Post: April 25, 1997

A Japanese surgeon who performed the operation was A Japanese surgeon who performed the operation was investigated in connection with the alleged murder of investigated in connection with the alleged murder of the donor. He was not indicted, but the lengthy criminal the donor. He was not indicted, but the lengthy criminal proceedings blocked all further operationsproceedings blocked all further operations


Media & Organ DonationMedia & Organ Donation

The power of the press can also be demonstrated in the The power of the press can also be demonstrated in the so-called "Nicholas Green effect.“so-called "Nicholas Green effect.“

Nicholas was a 7-year-old American child, shot dead by Nicholas was a 7-year-old American child, shot dead by bandits in Italy in 1994bandits in Italy in 1994

His parents agreed to donate his organs His parents agreed to donate his organs Italian press reported it extensivelyItalian press reported it extensively The positives impact kick started the Italian cadaver The positives impact kick started the Italian cadaver

programmeprogramme


Under-reporting of Brain deathUnder-reporting of Brain death

The efficiency of utilization of potential donors for organ The efficiency of utilization of potential donors for organ transplantation in Saudi Arabia: a pilot study.transplantation in Saudi Arabia: a pilot study. Al Sebayel MI, Khalaf HA. Al Sebayel MI, Khalaf HA. Transplant Proc. 2004 Sep;36(7):1881Transplant Proc. 2004 Sep;36(7):1881

Data – 2001 to 2003 - Data – 2001 to 2003 - 114 out of 542 deaths were due to 114 out of 542 deaths were due to Brain DeathBrain Death & 54% - occurred in one hospital. & 54% - occurred in one hospital.

• 38 cases were reported to the Saudi Center for Organ 38 cases were reported to the Saudi Center for Organ Transplantation & in 23 Documentation was completedTransplantation & in 23 Documentation was completed• 4 Cases became actual donors4 Cases became actual donorsConclusion – Conclusion – There is underreporting of brain death There is underreporting of brain death cases. cases.


Problems with Cadaver Organ Donation Programme in AsiaProblems with Cadaver Organ Donation Programme in Asia

Govt. ProblemGovt. Problem No Funding for programme No Funding for programme

Hospital problemHospital problem No efforts to identify & No efforts to identify &

maintain “Brain Dead” donors maintain “Brain Dead” donors

Community ProblemCommunity Problem No Awareness of “Brain- No Awareness of “Brain-

Death” Concept Death” Concept

Spain has the highest number of brain death patients going on to organ donation – 32 per million population


Transport of organs –between cities

Transport of organs –between cities

Adequate No. of Qualified Intensivists in ICUs

Adequate No. of Qualified Intensivists in ICUs

Well qualified Surgeons to undertake Retrieval & TX

Well qualified Surgeons to undertake Retrieval & TX

HLA Tissue typing and Cross-matchHLA Tissue typing and Cross-match

Qualified

Trained transplant

Co-coordinators

Qualified

Trained transplant

Co-coordinators

Support Organisation to Network

Support Organisation to Network

Hospital Infra-Structural & Support LogisticsHospital Infra-Structural & Support Logistics


Cadaver Transplants Scene in Asia – The Way Cadaver Transplants Scene in Asia – The Way ForwardForward

Overview of Cadaver Transplants in Overview of Cadaver Transplants in AsiaAsia

Common Problems & PlatformsCommon Problems & Platforms The Way AheadThe Way Ahead


The Way ForwardThe Way Forward

Strengthen the Asian Transplant NetworkStrengthen the Asian Transplant Network Establish a common programme similar to Euro-Establish a common programme similar to Euro-

transplant Networktransplant Network Start sharing organs that are not used locallyStart sharing organs that are not used locally Use technology effectivelyUse technology effectively Evolve a Spanish style co-ordinators course for Asian Evolve a Spanish style co-ordinators course for Asian

countries countries Do our own Asian Transplant Games to build patient Do our own Asian Transplant Games to build patient

fellowshipfellowship Have more frequent Asian Transplant Society meetingHave more frequent Asian Transplant Society meeting


Organisational changesOrganisational changes

Model National Transplant Service Model National Transplant Service – – Like a network to share organs that is linked to a Like a network to share organs that is linked to a Asian Network for Organ Sharing (ANOS) Asian Network for Organ Sharing (ANOS) Employing and training more transplant co-ordinators Employing and training more transplant co-ordinators

and having a separate body in Asia for Tx. Co-and having a separate body in Asia for Tx. Co-ordinatorsordinators

Regular Courses to impart expertise to the co-ordinatorsRegular Courses to impart expertise to the co-ordinators Training and sensitising ICU staff on brain-death Training and sensitising ICU staff on brain-death


Organisation helping with organ donation & Organisation helping with organ donation & Transplants programmes in IndiaTransplants programmes in India

MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh, Maharastra

236 Organs shared236 Organs shared. ( 212-Kidneys, 9-Hearts, 15-Liver )

MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh, Maharastra

236 Organs shared236 Organs shared. ( 212-Kidneys, 9-Hearts, 15-Liver )

FORTE, BANGALORE – 32 Organs Shared

( 32 - Kidneys, 1- Heart, 1- Liver )

FORTE, BANGALORE – 32 Organs Shared

( 32 - Kidneys, 1- Heart, 1- Liver )

ZTCC, Mumbai – 55 Organs Shared - all kidneysZTCC, Mumbai – 55 Organs Shared - all kidneys

ORBO, N.Delhi – Few organs sharedORBO, N.Delhi – Few organs shared

SORT, Cochin – 4 organs sharedSORT, Cochin – 4 organs shared


Cadaveric DonationCadaveric Donation

For cadaveric donation - For cadaveric donation - ““society remains a crucial aspect in a transplant society remains a crucial aspect in a transplant programme” programme”

Strategies to decrease refusal rates by families include Strategies to decrease refusal rates by families include efforts at education - efforts at education - the general population, the general population, Religious heads & opinion leadersReligious heads & opinion leadershealth care workers individually health care workers individually through the mass media through the mass media


Encouraging People to Discuss Organ Encouraging People to Discuss Organ Donation Donation

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

Encouraging people to speak about organ donation and Encouraging people to speak about organ donation and transplantation and to make their wishes known to their transplantation and to make their wishes known to their relatives could change the picture resulting in 93-94% of relatives could change the picture resulting in 93-94% of people allowing donationpeople allowing donation


Presence of Family Member During Brain Death Presence of Family Member During Brain Death TestingTesting

Most families faced with brain stem death of a relative find Most families faced with brain stem death of a relative find the concept difficult to understand and have trouble in the concept difficult to understand and have trouble in accepting that their relative is actually dead accepting that their relative is actually dead

Family members were given choice to be or not to be Family members were given choice to be or not to be present during brain stem death testingpresent during brain stem death testing

It is suggested that presence of family members during It is suggested that presence of family members during brain stem death testing not only helps families to accept brain stem death testing not only helps families to accept this concept of death but also promotes the grieving this concept of death but also promotes the grieving processprocess

The presence of family during brain stem death testing. The presence of family during brain stem death testing. Doran M. Intensive Crit Doran M. Intensive Crit Care Nurs. 2004 Feb;20(1):32-7Care Nurs. 2004 Feb;20(1):32-7


Project Positive AspectsProject Positive Aspects

Many donor relatives have stated that donating their Many donor relatives have stated that donating their loved one's organs does not make the pain of their loved one's organs does not make the pain of their death disappeardeath disappear

Bereaved families can experience comfort that their Bereaved families can experience comfort that their loved one's gift gave another person a second chance loved one's gift gave another person a second chance at life at life


Consent for DonationConsent for Donation

Pre-mortem – via Donor Cards, Driving LicensePre-mortem – via Donor Cards, Driving License Consent of his family following deathConsent of his family following death Some form of aSome form of a combination of the two are necessary combination of the two are necessary ‘‘Supererogatory permission’Supererogatory permission’ - Underlying premise of such - Underlying premise of such

a consent would be that “organs of dead people are a consent would be that “organs of dead people are public goods”, and donation must be considered “similar to public goods”, and donation must be considered “similar to other compulsory civil obligations” within societyother compulsory civil obligations” within societyThe permission is a moral rather than a legal The permission is a moral rather than a legal

requirementrequirement


Essence of INOS – Essence of INOS – “Not to Waste Any “Not to Waste Any

Organ. Organs should be treated like Organ. Organs should be treated like

National Resource”National Resource” Hospital in group includes – Apollo, CMC Hospital in group includes – Apollo, CMC

Vellore, Sri Ramachandra Hospital and Vellore, Sri Ramachandra Hospital and

Sundaram Medical Foundation Sundaram Medical Foundation Hospitals in Andhra Pradesh- Nizam’s Hospitals in Andhra Pradesh- Nizam’s

Institute of Medical Sciences, Global Institute of Medical Sciences, Global

Hospitals, Kamanneini Hosp, Apollo Hospitals, Kamanneini Hosp, Apollo

Hospital, Care Hospital Hospital, Care Hospital Many Affiliate hospitals from other parts Many Affiliate hospitals from other parts

of countryof country

Mohan Foundation Intiatives – Mohan Foundation Intiatives – INOS ( Indian Network for Organ Sharing)INOS ( Indian Network for Organ Sharing)


Presumed Consent & Organ DonationPresumed Consent & Organ Donation

Belgium, Austria, Finland, France, Norway, Spain, and Singapore Belgium, Austria, Finland, France, Norway, Spain, and Singapore implemented "presumed consent" implemented "presumed consent"

France's presumed consent (PC) law has produced increases in France's presumed consent (PC) law has produced increases in organ donation approaching 5,000%. organ donation approaching 5,000%.

Belgium passed its version of PC in 1986, and organ donation Belgium passed its version of PC in 1986, and organ donation climbed by 183%, with multi-organ retrieval significantly climbed by 183%, with multi-organ retrieval significantly increased to 119% for kidneys. increased to 119% for kidneys. TThe donor rate increased from 10 he donor rate increased from 10 to 22 donors per million population between 1986 and 1997.to 22 donors per million population between 1986 and 1997.

Austria passed its PC law in 1982. By the end of 1990, the 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 of patients receiving kidneys was nearly the same as the number on the waiting list number on the waiting list


Required Request LawRequired Request Law

Requires that formal request for organ donation be Requires that formal request for organ donation be made of the families of all potential donors in the ICU. made of the families of all potential donors in the ICU. The rationale is that a statutory approach would The rationale is that a statutory approach would

overcome hesitancy by healthcare professionals at a overcome hesitancy by healthcare professionals at a time of such emotional distress. time of such emotional distress.

Required Request Law has been introduced into many Required Request Law has been introduced into many states in the USA by legislation and helped improve states in the USA by legislation and helped improve organ donation rateorgan donation rate


Mandated Choice Mandated Choice

Mandated choice: This requires people to state their Mandated choice: This requires people to state their ’willingness to donate or not’’willingness to donate or not’ when filing some state of when filing some state of institutional return such as a driving licence or income institutional return such as a driving licence or income tax form. tax form. The information would be kept on a central register, The information would be kept on a central register,

accessible at time of deathaccessible at time of death


Mandated Choice & Driving LicenseMandated Choice & Driving License

1996 - Sweden instituted a mandated choice law. 1996 - Sweden instituted a mandated choice law. There was an immediate increase of 600,000 potential There was an immediate increase of 600,000 potential donors.donors.

A similar 1990 law in Denmark increased their donor A similar 1990 law in Denmark increased their donor registry by 150,000.registry by 150,000.


Action Required – Muslim CountriesAction Required – Muslim Countries

More public education needed to change More public education needed to change cultural beliefs and practices although Islam cultural beliefs and practices although Islam does not forbid Organ or tissue donation does not forbid Organ or tissue donation

Fatwas alone will not work.Fatwas alone will not work. Constantly addressing masses through media Constantly addressing masses through media

by religious head may help to improve by religious head may help to improve sentimentssentiments


Religion & Organ Donation Religion & Organ Donation

Plan major conferences of religious heads on organ Plan major conferences of religious heads on organ donation and transplantation in all regions of Asiadonation and transplantation in all regions of Asia . .

Most people are ill- informed about their religions Most people are ill- informed about their religions attitude towards organ donation.attitude towards organ donation.Major initiative required to correct thisMajor initiative required to correct this

An Exploratory Study Examining the Influence of Religion on Attitudes Towards An Exploratory Study Examining the Influence of Religion on Attitudes Towards Organ Donation Among the Asian Population in Luton,UK Organ Donation Among the Asian Population in Luton,UK Nephrology Dialysis and Nephrology Dialysis and Transplantation (1998) Volume 13: 1949-1954Transplantation (1998) Volume 13: 1949-1954


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

What is Required


Patient Support GroupPatient Support Group

Purpose of the group - to provide emotional support to organ failure & transplant patients

Meeting held every two months between doctors, dietician and counselors and patients to discuss their problems

Provide subsidized investigation and a few selected drugs

We have about 250 members from Mumbai and Chennai

““Patients should be the advocate of cadaver organ Patients should be the advocate of cadaver organ movement, this will generate better publicity for the movement, this will generate better publicity for the

cause” cause”


Patient Support GroupPatient Support Group

We have held Eight meetings in Chennai, four in We have held Eight meetings in Chennai, four in Mumbai and one in HyderabadMumbai and one in Hyderabad

Some of them keen to help out with cadaver Some of them keen to help out with cadaver organ donation programmeorgan donation programme

The group held ‘All India Transplant Games’ in The group held ‘All India Transplant Games’ in Dec 2003Dec 2003


Promote Organ Donation Among Blood DonorsPromote Organ Donation Among Blood Donors

Study shows that blood donors have better Study shows that blood donors have better knowledge of organ donation and are more willing to knowledge of organ donation and are more willing to donate their organs and sign an Donor card than donate their organs and sign an Donor card than general public.general public.

A substantial proportion of blood donors have not A substantial proportion of blood donors have not signed a Donor Card. signed a Donor Card.

It would be useful to design promotion programs to It would be useful to design promotion programs to facilitate blood donors' participation in organ donation.facilitate blood donors' participation in organ donation.

Attitudes about organ and tissue donation among the general public and Attitudes about organ and tissue donation among the general public and blood donors in Hong Kong.blood donors in Hong Kong. Li PK, Lin CK, Lam PK, Szeto CC, Lau JT, 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. 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 KongDepartment of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong


Make Local Sharing ProtocolsMake 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 – 2Poor Retrieval Technique – 2 No Blood for Cross Match – 2No Blood for Cross Match – 2 Poor Packing of Organ - 2Poor Packing of Organ - 2

INOS- Initiative for Organ Sharing facilitated by MOHAN Foundation in Tamil

Nadu


Retrieval Surgery & Packing of OrgansRetrieval Surgery & Packing of Organs

MOHAN in its INOS Group of MOHAN in its INOS Group of hospitals have made:hospitals have made:

Attempts to standardize retrieval Attempts to standardize retrieval techniquestechniques

CD made on kidney Retrieval to CD made on kidney Retrieval to be circulated to all the hospitals be circulated to all the hospitals in the groupin the group

Packing of organs being Packing of organs being standardised for transportationstandardised for transportation


Potential Countries That can Succeed with Programme Potential Countries That can Succeed with Programme

Countries that can have success with Cadaver Transplant Countries that can have success with Cadaver Transplant programmes in Asia and make a difference -programmes in Asia and make a difference -

India – No Religious bar to donationIndia – No Religious bar to donation Iran – Has a logistic approachIran – Has a logistic approach Saudi Arabia – Has the lawsSaudi Arabia – Has the laws Turkey – Liberal Muslim CountryTurkey – Liberal Muslim Country Taiwan – Well organized SkillsTaiwan – Well organized Skills China – Capable of organizing the programmeChina – Capable of organizing the programme Sri Lanka – High Buddhist community. Eye programme successSri Lanka – High Buddhist community. Eye programme success Mynamar - High Buddhist communityMynamar - High Buddhist community


ORGAN DONATION RATEORGAN 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 donors44,000 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


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 Collaborative projects Use Television Media for Promotion Get Religious heads to Participate regularly Have Transparency in programme Set up regional Transplant co-ordinators Forums

Cadaver Transplant - Conclusion


In Asia we have failed to explore all the optionsand simple steps and changes can make all the

difference for our patients

Cadaver Transplant - Conclusion


THANK YOUTHANK YOU

MOHAN Foundation –INOS Mission MOHAN Foundation –INOS Mission StatementStatement

““ORGANS WASTED ARE LIVES LOST” ORGANS WASTED ARE LIVES LOST”

In my end is my beginning -

T.S.Eliot, Four Quartets

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