Problems and Steps Forward

Problems and Steps forward in Organ Transplantation

Hurdles in organ transplantation

While going through Bimal Karmakar’s incidencet I realized,

  • to dream of a noble idea is easy, but to make it real is no piece of cake
  • It’s in no way a ‘one man’s job’
  • Many individuals, professionals, experts need to work in unity to fulfill the mission.

Common Problems & Platforms

  • High incidence of organ failure in Asia
  • Public and Professionals Attitude to Brain Death & Organ Donation
  • Religion & Organ Donation
  • Legal Aspects
  • Media and Scandals
  • Reporting of Brain Death
  • Hospital Infrastructure
  • Trained Transplant Co-ordinators / Counsellors

Incidence of ESRD in Asians & Blacks

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

Under-reporting of Brain death

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

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

Encouraging People to Discuss Organ Donation

  • When the wishes of the deceased are not known, only 50% of people will agree to organ retrieval from their relatives
  • Encouraging people to speak about organ donation and transplantation and to make their wishes known to their relatives could change the picture resulting in 93-94% of people allowing donation.

Presence of Family Member during Brain Death Testing

  • Most families faced with brain stem death of a relative find the concept difficult to understand and have trouble in accepting that their relative is actually dead
  • Family members were given choice to be or not to be present during brain stem death testing
  • It is suggested that presence of family members during brain stem death testing not only helps families to accept this concept of death but also promotes the grieving process.

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

Project Positive Aspects

  • Many donor relatives have stated that donating their loved one's organs does not make the pain of their death disappear
  • Bereaved families can experience comfort that their loved one's gift gave another person a second chance at life.

Consent for Donation

  • Pre-mortem – via Donor Cards, Driving License
  • Consent of his family following death
  • Some form of a combination of the two are necessary
  • ‘Supererogatory permission’ - Underlying premise of such a consent would be that “organs of dead people are public goods”, and donation must be considered “similar to other compulsory civil obligations” within society. The permission is a moral rather than a legal requirement.

Required Request Law

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

Religion & Organ Donation

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

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

  • What is Required NGO or Groups involved in Organ donation in any part of the Asia have to tackle various issues in the field of cadaver organ donation and transplantation simultaneously
  • More Support groups with common objectives are needed
  • More resources necessary to Kick start such an Initiative

Promote Organ Donation among Blood Donors

  • Study shows that blood donors have better knowledge of organ donation and are more willing to donate their organs and sign an Donor card than general public.
  • A substantial proportion of blood donors have not signed a Donor Card.
  • It would be useful to design promotion programs to facilitate blood donors' participation in organ donation.

Attitudes about organ and tissue donation among the general public and blood donors in Hong Kong. Li PK, Lin CK, Lam PK, Szeto CC, Lau JT, Cheung L, Wong M, Chan AY, Ko WM. Prog Transplant. 2001 Jun;11(2):98-103. Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong.

Organ Trade

  • Most organ trade involves kidney or liver transplants. (wikipedia)
  • The shortage of an “supply” of organs (WHO)
  • The most common way to trade organs across national borders---“transplant tourism” (WHO)
  • 1/5 of the 70,000 kidneys transplanted worldwide every year come from the black market (WHO)

Organ Trade in India: (source WHO)

  • passed legislation banning the sale of organs in 1994
  • the underground organ market is still existent
  • about 2000 Indians sell a kidney every year (Voluntary Health Association of India)

Organ Selling-Pros & Cons

Pros:

  1. Save more lives
  2. People have their rights to harvest and sell their organs

Cons:

  1. The poor would be exploited
  2. The possibility that the donor's health may be affected
  3. We should not put a price on human organs

Conclusion

Organ Shortage is a Crisis, however the Crisis has a Cure

  1. In Asia we need to Network and start thinking of sharing resources, expertise and organs
  2. Set up Collaborative projects
  3. Use Television Media for Promotion
  4. Get Religious heads to Participate regularly
  5. Have Transparency in programme
  6. Set up regional Transplant co-ordinators’ Forums.