Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Cadaver Organ Donation & Transplantation in Asia – The Way Ahead
Sunil ShroffSunil Shroff
Head of Department - Urology & Renal Transplantation, Head of Department - Urology & Renal Transplantation,
Sri Ramachandra Medical College & Research Institution, Managing Trustee, Sri Ramachandra Medical College & Research Institution, Managing Trustee, MOHAN Foundation, ChennaiMOHAN Foundation, Chennai
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
The Organ ShortageThe Organ 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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Overview of AsiaOverview of Asia
AsiaAsia WorldWorld PopulationPopulation 3.6 Billion (1.7% inc)3.6 Billion (1.7% inc) 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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Cadaver Transplants in AsiaCadaver Transplants in Asia
KidneyKidney LiverLiver HeartHeart Heart LungHeart Lung PancreasPancreas
Source: Asian Transplant Registry
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Average Per Capita Income 1200Average Per Capita Income 1200
MaldivesMaldives 2,510 2,510
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
ChinaChina 1,100 1,100
Turkmenistan 1,120Turkmenistan 1,120
Philippines 1,080Philippines 1,080
No DataNo 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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
High per capita income & Successful Transplant High per capita income & Successful Transplant ProgrammesProgrammes
JapanJapan
Hong KongHong Kong
Singapore Singapore
Kuwait Kuwait
Israel Israel
S Korea S Korea
TaiwanTaiwan
Saudi Arabia Saudi Arabia
LebanonLebanon
Malaysia Malaysia
Turkey Turkey
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
High per capita income & Cadaver Tansplant High per capita income & Cadaver Tansplant ProgrammeProgramme
Hong KongHong Kong
SingaporeSingapore
TaiwanTaiwan
Saudi ArabiaSaudi Arabia
MalaysiaMalaysia
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 figures available for China, India, Philipines, Indonesia
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Transplant Expertise - AsiaTransplant Expertise - Asia
Japan has - 352 transplant centresJapan has - 352 transplant centres Thailand - 27 kidney, 6 liver, and 6 Cardiac Thailand - 27 kidney, 6 liver, and 6 Cardiac
transplantation centers, transplantation centers, India has 5 centres- Liver, 6 - Cardiac and over 100 for India has 5 centres- Liver, 6 - Cardiac and over 100 for
Kidneys. Kidneys. 35 centres have undertaken cadaver transplants35 centres have undertaken cadaver transplantsHowever only 6 do it regular frequency.However only 6 do it regular frequency.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Historical Aspects – Cadaver Transplantation - IndiaHistorical Aspects – Cadaver Transplantation - India
1967 - First succeesful cadaver Kidney Transplant in India 1967 - First succeesful cadaver Kidney Transplant in India at KEM Hospital, Bombayat 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 Medical 1998 – First Successful Lung transplant, Madras Medical Mission Hospital, ChennaiMission Hospital, Chennai
1999 – First Pancreas Transplant, Ahembdabad 1999 – First Pancreas Transplant, Ahembdabad
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 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 2003organ transplantation:Issues of global concern. Madrid, Spain, 6-9 October 2003
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 numbers Japan is still struggling with the programme though their numbers are slowly risingare slowly rising
India is emerging as one of the Key players despite still struggling India is emerging as one of the Key players despite still struggling with the programme logisticswith the programme logistics
Very Little information from China is Available on their modus Very Little information from China is Available on their modus operandioperandi
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Cadaver Heart Transplants in AsiaCadaver Heart Transplants in Asia
Hong Kong, India, Japan, Malaysia, Saudi Arabia, Hong Kong, India, Japan, Malaysia, Saudi Arabia, Singapore and Thailand are doing Heart transplants Singapore and Thailand are doing Heart transplants
Taiwan and Korea do the max heart transplants in AsiaTaiwan and Korea do the max heart transplants in Asia
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Cadaver Liver Transplants in AsiaCadaver Liver Transplants in Asia
Korea do the maximum living liver transplants and has high level of Korea do the maximum living liver transplants and has high level of expertise in the fieldexpertise in the field
2,345 LTs (1,860 from the living donor and 485 from the deceased 2,345 LTs (1,860 from the living donor and 485 from the deceased donor) were performed in 24 institutes from March 1988 to donor) were performed in 24 institutes from March 1988 to December 2004, although 5 institutes had performed more than 10 December 2004, although 5 institutes had performed more than 10 LTs per year. LTs per year.
Japan, Hong Kong, Taiwan similarly have expertise in living liver Japan, Hong Kong, Taiwan similarly have expertise in living liver transplantstransplants
Four centres in India – located atHyderabad, Vellore and Delhi have Four centres in India – located atHyderabad, Vellore and Delhi have fair expertise with liver transplants and emerging as the key players fair expertise with liver transplants and emerging as the key players in the country.in the country.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Cadaver Kidney Transplants Scene in IndiaCadaver Kidney Transplants Scene in India In past seven years approx. 592 Cadaver organ transplants (518 In past seven years approx. 592 Cadaver organ transplants (518
kidneys, 35 Livers and 37 Hearts) have been performedkidneys, 35 Livers and 37 Hearts) have been performed 35 Centres have undertaken Cadaver transplants 35 Centres have undertaken Cadaver transplants Majority of these 35 centres are Private or trust hospitalsMajority of these 35 centres are Private or trust hospitals Of these only half a dozen undertake cadaver transplants regularlyOf these only half a dozen undertake cadaver transplants regularly Almost 50% of the cadaver transplants in India done in Tamil NaduAlmost 50% of the cadaver transplants in India done in Tamil Nadu Tamil Nadu Organ Sharing Network could become the role model Tamil Nadu Organ Sharing Network could become the role model
for rest of the countryfor rest of the country
Approx.200 centres in India have expertise to undertake kidney transplants
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Brain Death LegislationBrain Death Legislation
Over 20 countries in Asia do transplants
Singapore – 1987Singapore – 1987
Philippine Philippine – 1991– 1991
Thailand – 1986 / 1996Thailand – 1986 / 1996
India -1995India -1995
Japan – 1997Japan – 1997
S. Korea - 2000S. Korea - 2000
Bangladesh – 1999Bangladesh – 1999
Malaysia -1974Malaysia -1974
Iran Iran
Saudi ArabiaSaudi Arabia
MalaysiaMalaysia
TaiwanTaiwan
KuwaitKuwait
TurkeyTurkey
Sri Lanka - 1987Sri Lanka - 1987
Most countries have some law for tissue procurement but not Most countries have some law for tissue procurement but not all have Brain Death Legislation in Place all have Brain Death Legislation in Place
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Asian Countries Undertaking Transplants – Asian Countries Undertaking Transplants – Kidneys aloneKidneys alone
Bangladesh – KBangladesh – K 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
Some of these countries have done (eg Pakistan) occasional liver or heart (eg Malaysia) transplant.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Asian Countries Undertaking Multi–organ Asian Countries Undertaking Multi–organ TransplantsTransplants
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Common Problems & PlatformsCommon Problems & Platforms
Magnitude of the ProblemMagnitude of the Problem 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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
World Status of Transplants World Status of Transplants
Annual Number of kidney transplantations per million Annual Number of kidney transplantations per million population (pmp) -population (pmp) -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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Waiting List for Organs keep GrowingWaiting List for Organs keep Growing
Only about 2.5% of the Japanese carry donor cards, but Only about 2.5% of the Japanese carry donor cards, but more than 13,000 Japanese are waiting for transplants.more than 13,000 Japanese are waiting for transplants.
In February 2000, a 44-year-old woman who was In February 2000, a 44-year-old woman who was declared brain dead following a brain hemorrhage and declared brain dead following a brain hemorrhage and stroke donated all four of the organs used in recent stroke donated all four of the organs used in recent transplants. The woman's heart went to a man in his transplants. The woman's heart went to a man in his 40s 40s
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 professionalslack of knowledge by Korean health professionals surrounding brain death and the organ procurement process. surrounding brain death and the organ procurement process.
Participants' attitudes were mixed and somewhat negative, as Participants' attitudes were mixed and somewhat negative, as they did they did not regard brain death as true death not regard brain death as true death
Korea – Organ donation rate below 2 per million population per year.Korea – Organ donation rate below 2 per million population per year.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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%)
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
““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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 be procured from patients of road .. Kidneys can be procured from patients of road traffic accidentswho have been declared “brain-dead” traffic accidentswho have been declared “brain-dead” unless they have OPTED OUT ( Presumed Consent)unless they have OPTED OUT ( Presumed Consent)(Muslims exempted)(Muslims exempted)
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Legal Aspects Legal Aspects
Malaysia -Malaysia - The “LAWS OF MALAYSIA, ACT 130 1974 The “LAWS OF MALAYSIA, ACT 130 1974
- which provides for the use of parts of the human - which provides for the use of parts of the human bodies of deceased persons for therapeutic bodies of deceased persons for therapeutic purposes and for purposes of medical education purposes and for purposes of medical education and research.and research.
S.Korea -S.Korea - The Transplant Act was first passed in 1999 The Transplant Act was first passed in 1999 and then reviewed in 2002. and then reviewed in 2002.
The Act covers organs and tissues (only bone The Act covers organs and tissues (only bone marrow (BM) and corneas).marrow (BM) and corneas).
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Thailand - Legal AspectsThailand - Legal Aspects
There is no law to directly govern transplant procedures There is no law to directly govern transplant procedures in Thailand.in Thailand.
The Medical Council is responsible in regulating human The Medical Council is responsible in regulating human organ transplantation. They decide the criteria from time organ transplantation. They decide the criteria from time to 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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
S.Korea – Legal AspectsS.Korea – Legal Aspects
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
PHILIPPINES - LEGAL ASPECTS PHILIPPINES - LEGAL ASPECTS
REPUBLIC ACT 7170, 1991 -REPUBLIC ACT 7170, 1991 -which authorizes the legacy or donation of all or part of which authorizes the legacy or donation of all or part of the human body after death for specified purposesthe human body after death for specified purposes
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
VIETNAM - LEGAL ASPECTS VIETNAM - LEGAL ASPECTS
THE CIVIL CODE, ARTICLE 32, CHAPTER 2THE CIVIL CODE, ARTICLE 32, CHAPTER 2- requiring consent from donor or next-of-kin.- requiring consent from donor or next-of-kin.
““THE PEOPLE’S HEALTH PROTECTION CODE, THE PEOPLE’S HEALTH PROTECTION CODE, CHAPTER 4” providing for tissue transplantation.CHAPTER 4” providing for tissue transplantation.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
INDONESIA - LEGAL ASPECTS :INDONESIA - LEGAL ASPECTS :
THE INDONESIA 1992 HEALTH REGULATIONTHE INDONESIA 1992 HEALTH REGULATION- provides for procurement of tissues from living donors - provides for procurement of tissues from living donors only.only.
FATWA FOR BONE, SKIN & AMNIONFATWA FOR BONE, SKIN & AMNION- introduced in JUNE 1997 by religious council - introduced in JUNE 1997 by religious council permitting tissue procurement from cadaveric donors.permitting tissue procurement from cadaveric donors.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
BANGLADESH - LEGAL ASPECTS BANGLADESH - LEGAL ASPECTS
TISSUE DONATION & TRANSPLANTATION TISSUE DONATION & TRANSPLANTATION 1999 ACT1999 ACT- passed recently permitting donation from both living and - passed recently permitting donation from both living and
cadaveric donors.cadaveric donors.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
SRI LANKA - Legal Aspects SRI LANKA - Legal Aspects
LEGAL ASPECTS : “THE HUMAN TISSUE LEGAL ASPECTS : “THE HUMAN TISSUE TRANSPLANTATION ACT NO 48 OF 1987TRANSPLANTATION ACT NO 48 OF 1987which requires consent from donor or next-of-kin.which requires consent from donor or next-of-kin.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
India – Legal AspectsIndia – 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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
RELIGIOUS & CULTURAL ASPECTSRELIGIOUS & CULTURAL ASPECTS
Religion plays major role in promoting Organ Donation. Religion plays major role in promoting Organ Donation. Major religions in Asia Pacific include -Major religions in Asia Pacific include -
Islam Islam Buddhism Buddhism ChristianityChristianity HinduismHinduism SikhismSikhism JudaismJudaism
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 objections There is no religions that is against organ donation There is no religions that is against organ donation What holds back is cultural reservations, What 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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Religious Attitude to DonationReligious Attitude to Donation
Chinese–Americans are influenced by Confucian values, and to a Chinese–Americans are influenced by Confucian values, and to a lesser extent, Buddhist, Daoist spiritual beliefs lesser extent, Buddhist, Daoist spiritual beliefs - - associate an intact body with respect for ancestors or nature.associate an intact body with respect for ancestors or nature.
The subjects were most willing to donate their organs after their The subjects were most willing to donate their organs after their deaths – 1deaths – 1stst to close relatives , then in descending order – to close relatives , then in descending order –distant relatives, people from their home country and strangersdistant relatives, people from their home country and strangers
Influence 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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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.
Guajrat in India with high no. of Jains gets 4000 corneas - highest in India.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Buddhism & Organ DonationBuddhism & Organ Donation
Predominantly Buddhist Predominantly Buddhist CountriesCountries
Sri LankaSri Lanka ThailandThailand VietnamVietnam MyanmarMyanmar
Less Dominant Less Dominant Korea (30%)Korea (30%) Singapore (30%)Singapore (30%)
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Buddhism & Organ DonationBuddhism & Organ Donation
In countries where Buddhism is predominant there is no In countries where Buddhism is predominant there is no shortage of Tissue / ? Organ donors -shortage of Tissue / ? Organ donors -
Sri LankaSri Lanka ThailandThailand VietnamVietnam MyanmarMyanmar
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Buddhism & Organ DonationBuddhism & Organ Donation
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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 donate. It is allowed for an emergency to save life. donate. 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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Muslims & Organ DonationMuslims & Organ Donation
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%)
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Muslims & Organ DonationMuslims & Organ Donation
Each country has its own ‘MUFTI’ -religious official appointed by Each country has its own ‘MUFTI’ -religious official appointed by Govt to deal with Islamic mattersGovt 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 publicreligious leaders, lawyers, doctors and other members of public
Fatwas are not legal bindingFatwas are not legal binding..
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Muslims & Organ DonationMuslims & Organ Donation
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
POWER OF FATWAPOWER OF FATWA
Merely states government’s position by MUFTIMerely states government’s position by MUFTI Not necessary to follow FatwaNot necessary to follow Fatwa Left to individual opinion and choiceLeft to individual opinion and choice No consensus among various religious leaders, ‘ustazs’ No consensus among various religious leaders, ‘ustazs’
and ‘ulamas’ each with strong influence on their and ‘ulamas’ each with strong influence on their followers followers
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 - Shortage of Donors in Philippines, No bar to organ donation - Shortage of Donors in Philippines, Singapore and Korea due to cultural factors.Singapore and Korea due to cultural factors.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Jainism & Sikhism Jainism & Sikhism
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Television, Films and Organ DonationTelevision, Films and Organ Donation
TV programmes and Films that have projected donation as TV programmes and Films that have projected donation as potentially harmful & Expoitative. TV programs like –potentially harmful & Expoitative. TV programs like –
The X-FilesThe X-Files ER ER Voyager Voyager Law and Order Law and Order Chicago Hope Chicago Hope Strange LuckStrange Luck
Movie – ComaMovie – Coma
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 studytransplantation in Saudi Arabia: a pilot study.. Al Sebayel MI, Al Sebayel MI, Khalaf HA. Transplant Proc. 2004 Sep;36(7):1881Khalaf HA. Transplant 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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Problems with Cadaver Organ Donation Programme in AsiaProblems with Cadaver Organ Donation Programme in Asia
Govt. ProblemGovt. Problem
No Funding for programmeNo Funding for programme
Hospital problemHospital problem
No efforts to identify & maintain “Brain Dead” donorsNo efforts to identify & maintain “Brain Dead” donors
Community ProblemCommunity Problem
No Awareness of “Brain-Death” ConceptNo Awareness of “Brain-Death” Concept
Spain has the highest number of brain death patients going on to organ donation – 32 per million population
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Common Problems - AwarenessCommon Problems - Awareness
Lack of awareness of Brain death both public & healthcare Lack of awareness of Brain death both public & healthcare professionalsprofessionals
Religious diversity with some religions though accepting the broad Religious diversity with some religions though accepting the broad concept, are still reluctant to give their full support to the concept, are still reluctant to give their full support to the programme.programme.
Govt. inertia in implementation of policies to push the programme Govt. inertia in implementation of policies to push the programme forward. forward.
Lack of trained personnel to run the infra-structural logistics of the Lack of trained personnel to run the infra-structural logistics of the programme. programme.
Lack of a common platform to structure some collaborative workLack of a common platform to structure some collaborative work Lack of Organ sharing network within the regionLack of Organ sharing network within the region Lack of resources in some instances to push the programme Lack of resources in some instances to push the programme
forwardforward
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Packing & Transport of organs
Packing & Transport of organs
Qualified Intensivists in ICUs
Qualified Intensivists in ICUs
Successful Retrieval & TX Successful Retrieval & TX
HLA Tissue typing and Cross-match FacilityHLA Tissue typing and Cross-match Facility
Trained transplant Co-coordinatorsTrained transplant Co-coordinators
Support Organisation to Network & Keep
Registries
Support Organisation to Network & Keep
Registries
Hospital Infra-Structural & Support LogisticsHospital Infra-Structural & Support Logistics
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Encouraging People to Discuss Organ Encouraging People to Discuss Organ Donation Donation
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
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 relatives relatives
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 the Most families faced with brain stem death of a relative find the concept difficult to understand and have trouble in accepting that concept difficult to understand and have trouble in accepting that their relative is actually dead their relative is actually dead
Family members were given choice to be or not to be present during Family members were given choice to be or not to be present during brain stem death testingbrain stem death testing
It is suggested that presence of family members during brain stem It is suggested that presence of family members during brain stem death testing not only helps families to accept this concept of death death testing not only helps families to accept this concept of death but also promotes the grieving process but also promotes the grieving process
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 disappear death disappear
But that it gives their death meaning: that something so But that it gives their death meaning: that something so positive comes from tragedy. positive comes from tragedy.
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 a consent would be that Underlying premise of such a consent would be that
“organs of dead people are public goods”, and donation “organs of dead people are public goods”, and donation must be considered “similar to other compulsory civil must be considered “similar to other compulsory civil obligations” within societyobligations” within societyThe permission is a moral rather than a legal The permission is a moral rather than a legal
requirementrequirement
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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’ when filing some state of ’willingness to donate or not’ 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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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.
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Action Required – Muslim CountriesAction Required – Muslim Countries
More public education needed to change cultural More public education needed to change cultural beliefs and practices although Islam does not forbid beliefs and practices although Islam does not forbid Organ or tissue donation Organ or tissue donation
Fatwas alone will not work.Fatwas alone will not work. Constantly addressing masses through media by Constantly addressing masses through media by
religious head may help to improve sentimentsreligious head may help to improve sentiments
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
Religion & Organ Donation Religion & Organ Donation
Plan major conferences of religious heads on organ donation Plan major conferences of religious heads on organ donation and transplantation in all regions of Asiaand transplantation in all regions of Asia . .
Most people are ill- informed about their religions attitude Most people are ill- informed about their religions attitude towards organ donation.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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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 – Cabale of organizing the programmeChina – Cabale 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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
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
Cadaver Transplant - Conclusion
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
THANK YOUTHANK YOU
Our Mission StatementOur Mission Statement““ORGANS WASTED ARE LIVES LOST” ORGANS WASTED ARE LIVES LOST”
In my end is my beginning -
T.S.Eliot, Four Quartets
This presentation has been created using 100% recycled electrons!!
Recycle yourself and become an organ donor
Dr.Sunil Shroff, IV International Congress of Kidney Diseases, Ahembdabad. 11-13 th Nov 2005
4646
484888
183183
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6868
55
66
Source: Indian Transplant Newsletter
Mohan Foundation
Source: Indian Transplant Newsletter
Mohan Foundation
• 35 Hospitals have undertaken Cadaver transplants • However only 10 of 35 undertake it on regular basis
3737
3232
88
Cadaver Cadaver TransplantsTransplants 1995 1995 to 2001to 2001