Cadaver Organ Donation & Transplantation
in Asia – The Way Ahead
Dr. Sunil Shroff
Head of Department - Urology & Renal Transplantation,
Sri Ramachandra Medical College & Research Institution,
Managing Trustee, MOHAN Foundation, Chennai
shroff@mohanfoundation.org
Dr.Sunil Shroff,
www.mohanfoundation.org
Organ Shortage
Each day, about 60 people around the world
receive an organ transplant, while another 13 die
due to non-availability of organs.
Organ shortage — the main limitation to saving
lives of critically ill patients — is due to
individuals and their families not considering
organ donation out of fear, ignorance or
misunderstanding.
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Transplant in Asia – The Road Ahead
Overviewof Cadaver Transplants in Asia
Common Problems & Platforms
The Road Ahead
Dr.Sunil Shroff,
www.mohanfoundation.org
Overview of Asia
Asia World
Population 3.6 Billion 6.4 Billion
No Of Countries 51 235
Land Mass 44,390,000 Sq.Km 6,233,821,945 Sq.Km
Life Expectancy M 63 yr F 66yrs
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Transplants in Asia
Kidney
Liver
Heart
Heart Lung
Pancreas
Source: Asian Transplant Registry
Dr.Sunil Shroff,
www.mohanfoundation.org
PER CAPITA INCOME FOR ASIAN COUNTRIES ( In US Dollars)
High Per Capita Income 2500 Average Per Capita Income 1000 Low Per Capita Income - 1000
Sri Lanka 930
Japan 34,180 Thailand 2,190 Armenia 950
Hong Kong 25,860 Iran 2,010 Indonesia 810
Singapore 21,230 Kazakhstan 1,780 Azerbaijan 820
Kuwait 17,960 Jordan 1,850 Georgia 770
Israel 16,240 Syria 1,190 India 540
S Korea 12,030 Turkmenistan 1,120 Yemen 520
Taiwan 13,530 China 1,100 Pakistan 520
Saudi Arabia 9,240 Philippines 1,080 Mongolia 480
Lebanon 4,040 Vietnam 480
Malaysia 3,880 No Data - Afghanistan Bangladesh 400
Turkey 2,800 -Bhutan, Palestine, Bahrain, Uzbekistan 420
Maldives 2,510 Cyprus, Iraq, Qatar, UAE, Laos 340
Myanmar, Timor , Oman, Kyrgyzstan 340
Brunei, N.Korea Cambodia 300
Nepal 240
Dr.Sunil Shroff, Tajikistan 210
www.mohanfoundation.org
High per capita income & Successful Living
Transplant Programmes
Japan Taiwan
Hong Kong Saudi Arabia
Singapore Lebanon
Kuwait Malaysia
Israel Turkey
S Korea
Dr.Sunil Shroff,
www.mohanfoundation.org
High per capita income & Cadaver Tansplant
Programme
Hong Kong Iran
Singapore Lebanon
Taiwan Kuwait
Saudi Arabia Israel
Malaysia S Korea
Turkey Japan
Most of Asia is struggling with Cadaver Programme including regions with high
per capita
Dr.Sunil Shroff,
www.mohanfoundation.org
Kidney Tx Waiting List in Asia (2002)
Waiting Time
Japan – 12,974 Taiwan – 1.9 yrs
Taiwan – 7000 Korea – 2.2 yrs
Saudi Arabia – 4248 Hong Kong – 4.3 yrs
Korea – 4000 Singapore – 5.8 yrs
Pakistan - 1650
Hong Kong - 1018 No Waiting list in Iran for Kidney
Singapore – 666 Tx.
Bangladesh - 125
No figures available for China, India, Philipines, Indonesia
Dr.Sunil Shroff,
www.mohanfoundation.org
Transplant Expertise - Asia
Japan has - 352 transplant centres
Thailand - 27 kidney, 6 liver, & 6 Cardiac
transplantation centers
Iran has 22 centres – mainly kidneys
India has 110 centres for Kidney Tx 5
centres Liver, 6 – Cardiac. over 35 centres
have undertaken cadaver transplants
However only 6 centres do cadaver Tx.
regularly
Dr.Sunil Shroff,
www.mohanfoundation.org
Transplants - Japan
Kidney Transplant since 1964 -15 113
Liver transplants since 1989 - 2411
Heart Transplants since 1998 - 17
Lung transplants since 1998 - 39
The organs have largely been obtained from living and
to some extent from non-heart beating donors
Ref: Shirakura -WHO/HTP/EHT/T-2003.1Ethics, access and safety in tissue and organ
transplantation:Issues of global concern. Madrid, Spain, 6-9 October 2003
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Kidney Transplants in Asia
India, Taiwan, Korea, Thailand, Iran, Saudi Arabia and
Singapore – Regularly are undertaking Kidney Cadaver
Transplants
Taiwan, Thailand, Singapore follow the western model and
run the programme almost on the same line
Japan is still struggling with the programme though their
numbers are slowly rising
India is emerging as one of the Key players despite still
struggling with the programme logistics
Very Little information from China is Available on their
modus operandi Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Heart Transplants in Asia
Hong Kong, India, Japan, Malaysia, Saudi
Arabia, Singapore and Thailand are doing
Heart transplants
Taiwan and Korea do the maximum heart
transplants in Asia
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Liver Transplants in Asia
Korea do the maximum living liver transplants and has high
level of expertise in the field
2,345 LTs (1,860 from the living donor and 485 from the
deceased donor) were performed in 24 institutes from March
1988 to December 2004, although 5 institutes had performed
more than 10 LTs per year.
Japan, Hong Kong, Taiwan similarly have expertise in living
liver transplants
Four centres in India – located at Hyderabad, Vellore and
Delhi have fair expertise with liver transplants and emerging
as the key players in the country.
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Kidney Transplants Scene in India
In past ten years approx. 1000 Cadaver organ
transplants over 900 kidneys and 100 Livers and
heart have been performed
Almost 40% of the cadaver transplants in India done
in Tamil Nadu
Tamil Nadu Organ Sharing Network could become the
role model for rest of the country
Approx.110 centres in India do kidney Tx.however only 25 to 30
do over 25
centres Dr.Sunil Shroff, per year.
www.mohanfoundation.org
Historical Aspects – Cadaver Transplantation - India
1967 - First successful cadaver Kidney Transplant in
India at KEM Hospital, Bombay
1994 - First successful heart transplant done at AIIMS,
N.Delhi
1995 - First successful multi-organ transplant done at
Apollo Hospital, Chennai
1998 – First Successful Lung transplant, Madras
Medical Mission Hospital, Chennai
1999 – First Pancreas Transplant, Ahemdabad
Dr.Sunil Shroff,
www.mohanfoundation.org
Asian Countries Undertaking Transplants –
Kidneys alone (n-10)
Pakistan - K
Philippines – K
Indonesia – K
Malaysia – K,
Iran – K,
Israel – K
Turkey – K
Syria – K
Malaysia – K
Bangladesh – K
Some of these countries have done (eg Pakistan) occasional liver or heart
(eg Malaysia) transplant.
Dr.Sunil Shroff,
www.mohanfoundation.org
Asian Countries Undertaking Multi–organ
Transplants (n-9)
Hong Kong – K, H, Li, H-L
India – K, H, Li, H-L, P
Japan – K, H, L, L, K-P
Korea - K, H, Li, L, K-P
People Rep China – K, H, Li
Saudi Arabia –K, H, L, Li
Singapore – K, H, L, Li
Taiwan – K, H, H-L, Li
Thailand – K, H, H-L, Li
Legend: K-Kidneys, K-P - Kidneys & Pancreas, H-Heart, L-Lung,
H-L-Heart & Lung, Li- Liver
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Transplant in Asia – The Road Ahead
Overview of Cadaver Transplants in
Asia
Common Problems & Platforms
The Way Ahead
Dr.Sunil Shroff,
www.mohanfoundation.org
Common Problems & Platforms
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
Dr.Sunil Shroff,
www.mohanfoundation.org
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.
Dr.Sunil Shroff,
www.mohanfoundation.org
World Status of Transplants
Annual Number of kidney transplantations per million
population (pmp) per year -
USA - 52 Predominantly Cadaver Donors
Europe - 27 Predominantly Cadaver Donors
Asia - 3 Predominantly Living Donors
In last 10 to 15 years the rate of both kidney an liver transplants have
increased but heart has remained static. In 2000 approx. 15,000 kidneys
were transplanted in each region.
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Donor Rates
The Cadaver donors per million population per year
USA - 20.7
Europe - 15.9
Asia - 1.1
South America - 2.6
Dr.Sunil Shroff,
www.mohanfoundation.org
Physicians Attitude to Organ Donation
Korean health professionals' attitudes and knowledge toward
organ donation and transplantation. Kim JR, Elliott D, Hyde C. 2004
Mar;41(3):299-307.
There was a lack of knowledge by Korean health
professionals surrounding brain death and the organ
procurement process.
Participants' attitudes were mixed and somewhat
negative, as they did not regard brain death as true
death
Korea – Organ donation rate below 2 per million population per year.
Dr.Sunil Shroff,
www.mohanfoundation.org
Physicians Attitude to Organ Donation
Outmoded attitudes toward organ donation among Turkish health
care professionals. Topbas M, Can G, Can MA, Ozgun S.Transplant Proc. 2005
Jun;37(5):1998-2000.
A large proportion of Physicians are indifferent to organ
donation process. Reason cited for this were -
Lack of information regarding the donation process (28.7%),
Concerns about the sale of organs (22.1%),
Islamic religious beliefs (21.6%)
Dr.Sunil Shroff,
www.mohanfoundation.org
Public Attitude
Turkey (n=774) - 59.2% would consider donating organs
Pakistan(n 367) – 59.9% Willing to donate their organs
Hong Kong - 60.3% of the respondents were are willing
to donate organs
Viet Nam - 66% urban Vietnamese surveyed were
willing to donate organs or tissues after death
Ref -
Turkey- Ozdag N. EDTNA ERCA J. 2004 Oct-Dec;30(4):188-95
Pakistan - Artif Organs. 2005 Nov;29(11):899-905. Ashraf O, Ali S, Li SA, et al
Dr.Sunil Shroff,
Hong Kong - Yeung I, Kong SH, Lee J. Soc Sci Med. 2000 Jun;50(11):1643-54
www.mohanfoundation.org
Viet Nam - Hai TB, Eastlund T, Chien LA, Duc PT, Giang TH, Hoa NT, Viet PH, Trung DQ.
Public Attitude - Singapore
Social and cultural aspects of organ donation in Asia.
Woo KT. Ann Acad Med Singapore. 1992 May;21(3)
Important misconceptions and fears were –
Fear of death,
Belief that removal of organ violates sanctity of decreased
Concern about being cut up after death,
Desire to be buried whole,
Dislike of idea of kidneys inside another person,
Wrong concept of brain death,
Idea of donation being against religious conviction
Dr.Sunil Shroff,
www.mohanfoundation.org
Public Attitude - China
Investigation of understanding and willingness of organ
transplantation in young people in Beijing, Shanghai, Wuhan.
Zhonghua Yi Xue Za Zhi. 1997 Jan;77(1):22-7. Liu Y, Lei H, Qiu F. China Foundation of
Organ Transplantation Development, Wuhan
Cities of China –
Young people have a better understanding of organ
transplantation
Conventional attitudes and feudal habits are the major obstacle
to the development of organ transplantation in China.
Dr.Sunil Shroff,
www.mohanfoundation.org
Public Attitude and Organ donation in India
SURVEY ON “PUBLIC ATTITUDE TOWARDS ORGAN DONATION &
TRANSPLANATATION”
Shroff S, Shankar R et al, Indian Medical Tribune, 1996
Results of the Survey
Less than 50% overall positive response in favour
of donating solid organs
72% were willing for “Eye” donation and carry a
“Donor Card”
All major religions were willing to consider organ
donation
Dr.Sunil Shroff,
www.mohanfoundation.org
CONCLUSION - “PUBLIC ATTITUDE SURVEY”
HOW TO ASK FOR ORGANS IN THE EVENT OF “BRAIN DEATH” PATIENT
“Request for EYES” FIRST” - SEE HOW FAMILY REACTS
Family Willing Family Reluctant
Ask For Solid Organs Abandon Efforts
(Heart, Liver, Kidneys ..)
Inform Transplant Co-coordinator
Dr.Sunil Shroff,
Above protocol called “THE RAMACHANDRA PROTOCOL” to ask for organs
www.mohanfoundation.org
Brain Death – Law & Guidelines
Countires Law Guidelines Apnea Physicians Obv Conf,
Test Time Test
Armenia A A A A A Optional
Bangladesh P P DVO 3 A Optional
China A A A A A Optional
Georgia P P DVO 3 24 Mandatory
Hong Kong P P PCO2 1 A Optional
India P P DVO 4 A Mandatory
P
Iran P p - - - -
Indonesia A P PCO2 3 24 Optional
Dr.Sunil Shroff,
www.mohanfoundation.org
Brain Death – Law & Guidelines
Countries Law Guidelines Apnea Physicians Obv Conf,
Test Time Test
Japan P P PCO2 1 A Mandatory
Korea (S) P P PCO2 1 6 Optional
Malaysia P P PCO2 2 12 Mandatory
Pakistan A A A A A Not known
Philippines A P DVO 1 24 Optional
Singapore P P PCO2 2 A Optional
Taiwan A P PCO2 1 6 Optional
Thailand P P DVO 3 6 Optional
Vietnam A A DVO A A Optional
Dr.Sunil Shroff,
www.mohanfoundation.org
Singapore - Legal Aspects
THE HUMAN ORGAN TRANSPLANT ACT (HOTA) OF
1987 – Singapore
“….. Kidneys can be procured from patients of road
traffic accidents who have been declared “brain-
dead” unless they have OPTED OUT ( Presumed
Consent)
(Muslims exempted)
Dr.Sunil Shroff,
www.mohanfoundation.org
Thailand - Legal Aspects
There is no law to directly govern transplant
procedures in Thailand.
The Medical Council is responsible in regulating
human organ transplantation. They decide the
criteria from time to time.
Medical Council in Thailand determines whether
any punitive action should be taken against the
doctors
Dr.Sunil Shroff,
www.mohanfoundation.org
India – Legal Aspects
Transplantation of Human Organs Act, 1994
Aims
Regulate removal, storage and
transplantation of human organs for
therapeutic purposes
To prevent commercial dealings in
organs
Recognise Brain Death
Dr.Sunil Shroff,
www.mohanfoundation.org
RELIGIOUS & CULTURAL ASPECTS
Religion plays major role in promoting Organ
Donation.
Major religions in Asia Pacific include -
Islam
Buddhism
Christianity
Hinduism
Sikhism
Judaism
Dr.Sunil Shroff,
www.mohanfoundation.org
Religion and Organ Donation
Common thread that binds all religions of the world –
Saving of life overrides all objections
There is no religion that is against organ donation
What holds back is cultural reservations -
• Ignorance of the process of organ donation,
• Fear of mutilation,
• Lack of emotional support at time of tragedy,
• Fear that organs will be sold or used only by the rich
• Mistrust of hospitals and health professionals
• Myths
Dr.Sunil Shroff,
www.mohanfoundation.org
Religious Attitude to Donation
Chinese–Americans are influenced by Confucian
values, and to a lesser extent, Buddhist, Daoist spiritual
beliefs
- associate an intact body with respect for ancestors or
nature.
The subjects were most willing to donate their organs
after their deaths – 1st to close relatives , then in
descending order –
distant relatives, people from their home country and
strangers
Influence of religious and spiritual values on the willingness of Chinese–
Americans to donate organs for transplantation. Wilbur Aaron Lama & Laurence B
McCulloughb .Clinical TransplantationVolume 14 Issue 5 Page 449 - October 2000 doi:10.1034/j.1399-0012.2000.140502.x
Dr.Sunil Shroff,
www.mohanfoundation.org
Buddhism & Organ Donation
“The attitude of Buddhism is in perfect agreement with
organ and tissue donation; and in Buddhist Scriptures
there are stories where donation of tissues have been
referred to as an act of charity earning merits”
- The Late Dr Hudson Silva
World renowned success of the Eye Donation Society of Sri Lanka led by
late Dr. Hudson Silva: target of 40,000 eyes procurement reached in May
1999.
Gujarat in India has high number of eye donations (Jains) gets
4000 corneas - highest in India.
Dr.Sunil Shroff,
www.mohanfoundation.org
Buddhism & Organ Donation
Predominantly Buddhist Less Dominant
Countries Korea (30%)
Sri Lanka Singapore (30%)
Thailand
Vietnam
Myanmar
Dr.Sunil Shroff,
www.mohanfoundation.org
Buddhism & Organ Donation
Even in countries where Buddhism is less dominant
Singapore and Korea - Buddhists are main source of
tissue donors.
Success of NUH Tissue Bank in Singapore, entirely
due to strong support by Buddhist Community. All
donors Buddhists.
Dr.Sunil Shroff,
www.mohanfoundation.org
Muslims & Organ Donation
Muslims the most controversial group -
Koran does not forbid tissue donation
Koran states that if by not transplanting an organ or
tissue, the person will die, then it is permissible to
donate. It is allowed for an emergency to save life.
Different interpretations by different religious leaders,
‗ustazs‘ and ‗ulamas‘
Muslims must bury the body as soon as possible after
death – the sooner the better usually less than 8 hours.
Dr.Sunil Shroff,
www.mohanfoundation.org
Muslims & Organ Donation
Predominantly – Less Dominant –
Saudi Arabia China (200 million)
Iran India
Iraq Singapore (20%)
Kuwait
Turkey
Pakistan
Bangladesh
Malaysia
Brunei
Indonesia (Secular-
PANCASILA)
Dr.Sunil Shroff,
www.mohanfoundation.org
Muslims & Organ Donation
Each country has its own ‗MUFTI‘ -religious official
appointed by Govt to deal with Islamic matters
‗FATWAS‘ are religious rulings made by ‗Fatwa
Committee‘ as official stand by Govt. on various issues.
‗Fatwa Committee‘ chaired by MUFTI includes
prominent religious leaders, lawyers, doctors and other
members of public
Fatwas are not legal binding.
Dr.Sunil Shroff,
www.mohanfoundation.org
Muslims & Organ Donation
Fatwas declared in several countries
Saudi Arabia : 1985 - permit both living related and
cadaveric donation of organs
Pakistan,
Bangladesh,
Malaysia - 1995
Indonesia
Dr.Sunil Shroff,
www.mohanfoundation.org
CULTURAL PRACTICES OF MUSLIMS
Despite Fatwas Muslims reluctant to donate organs
God created them whole. They prefer to return to him
whole.
Many Muslims bury amputated limbs, foreskin from
circumcision, amnion from delivery.
Not religious requirement but cultural practice. Not all
Muslims do this
Dr.Sunil Shroff,
www.mohanfoundation.org
Christianity - Organ Donation
Predominantly - Less Dominant –
Philippines Singapore (30%)
Korea (30%)
Malaysia
India
No bar to organ donation - Shortage of Donors in Philippines,
Singapore and Korea due to cultural factors.
Dr.Sunil Shroff,
www.mohanfoundation.org
Christianity - Organ Donation
STATEMENT BY POPE JOHN PAUL II –
Full support of organ and tissue donation concluded
with words of Jesus narrated by evangelist and
physician LUKE:
“give…, and it will be given to you; good measure,
pressed down, shaken together, running over, will be
put into your lap (Luke 6 : 38).‖
We shall receive our supreme reward from God
according to the genuine and effective love we have
shown to our neighbour.
Dr.Sunil Shroff,
www.mohanfoundation.org
Hinduism and Organ Donation
Predominantly LESS DOMINANT
India Sri Lanka (<10%)
Singapore (5%)
Malaysia
Indonesia
Thailand
Veitnam
Dr.Sunil Shroff,
www.mohanfoundation.org
Religions against organ donation
Greek Orthodox, Shinto and Gypsies are three religions
that do not encourage body donation
Jehovah‘s witness is another Christian sect that is
against such acts
Dr.Sunil Shroff,
www.mohanfoundation.org
Media and Scandals - Thailand
Doctors May Face Murder Charge
The New Straits Times, September 1, 2000
Three doctors from a Bangkok private hospital allegedly killed
patients in 1997, harvested the kidneys and sold their kidneys to
rich transplant patients will face murder charges. faking
paperwork to cover their crime.
A police inquiry into the scandal said - the organs were removed
from patients who were pronounced brain dead, a condition not
accepted as legally dead in Thailand.
Dr.Sunil Shroff,
www.mohanfoundation.org
Media & Scandals - Japan
The Washington Post: April 25, 1997
A Japanese surgeon who performed the operation was
investigated in connection with the alleged murder of
the donor. He was not indicted, but the lengthy criminal
proceedings blocked all further operations
Dr.Sunil Shroff,
www.mohanfoundation.org
Media & Organ Donation
The power of the press can also be demonstrated in the
so-called "Nicholas Green effect.―
Nicholas was a 7-year-old American child, shot dead by
bandits in Italy in 1994
His parents agreed to donate his organs
Italian press reported it extensively
The positives impact kick started the Italian cadaver
programme
Dr.Sunil Shroff,
www.mohanfoundation.org
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
Data – 2001 to 2003 - 114 out of 542 deaths were due to
Brain Death & 54% - occurred in one hospital.
• 38 cases were reported to the Saudi Center for Organ
Transplantation & in 23 Documentation was completed
• 4 Cases became actual donors
Conclusion – There is underreporting of brain death
cases.
Dr.Sunil Shroff,
www.mohanfoundation.org
Problems with Cadaver Organ Donation Programme in Asia
Govt. Problem No Funding for programme
Hospital problem No efforts to identify &
maintain “Brain Dead” donors
Community Problem No Awareness of “Brain-
Death” Concept
Dr.Sunil Shroff,
Spain has the highest number of brain death patients going
www.mohanfoundation.org
on to organ donation – 32 per million population
Hospital Infra-Structural & Support Logistics
Qualified
Adequate No. of Qualified Trained transplant
Intensivists in ICUs
Co-coordinators
Well qualified Surgeons to
undertake Retrieval & TX
Support Organisation
Transport of organs –
to Network
between cities
HLA Tissue typing and Cross-match
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Transplants Scene in Asia – The Way
Forward
Overview of Cadaver Transplants in
Asia
Common Problems & Platforms
The Way Ahead
Dr.Sunil Shroff,
www.mohanfoundation.org
The Way Forward
Strengthen the Asian Transplant Network
Establish a common programme similar to Euro-
transplant Network
Start sharing organs that are not used locally
Use technology effectively
Evolve a Spanish style co-ordinators course for Asian
countries
Do our own Asian Transplant Games to build patient
fellowship
Have more frequent Asian Transplant Society meeting
Dr.Sunil Shroff,
www.mohanfoundation.org
Organisational changes
Model National Transplant Service
– Like a network to share organs that is linked to a
Asian Network for Organ Sharing (ANOS)
Employing and training more transplant co-ordinators
and having a separate body in Asia for Tx. Co-
ordinators
Regular Courses to impart expertise to the co-
ordinators
Training and sensitising ICU staff on brain-death
Dr.Sunil Shroff,
www.mohanfoundation.org
Organisation helping with organ donation &
Transplants programmes in India
MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh,
Maharastra
236 Organs shared. ( 212-Kidneys, 9-Hearts, 15-Liver )
FORTE, BANGALORE – 32 Organs Shared
( 32 - Kidneys, 1- Heart, 1- Liver )
ZTCC, Mumbai – 55 Organs Shared - all kidneys
ORBO, N.Delhi – Few organs shared
SORT, Cochin – 4 organs shared
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaveric Donation
For cadaveric donation -
“society remains a crucial aspect in a transplant
programme”
Strategies to decrease refusal rates by families include
efforts at education -
the general population,
Religious heads & opinion leaders
health care workers individually
through the mass media
Dr.Sunil Shroff,
www.mohanfoundation.org
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
Dr.Sunil Shroff,
www.mohanfoundation.org
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
Dr.Sunil Shroff,
www.mohanfoundation.org
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
Dr.Sunil Shroff,
www.mohanfoundation.org
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
Dr.Sunil Shroff,
www.mohanfoundation.org
Mohan Foundation Intiatives –
INOS ( Indian Network for Organ Sharing)
Essence of INOS – “Not to Waste Any Organ.
Organs should be treated like National Resource”
Hospital in group includes – Apollo, CMC Vellore,
Sri Ramachandra Hospital and Sundaram Medical
Foundation
Hospitals in Andhra Pradesh- Nizam’s Institute
of Medical Sciences, Global Hospitals, Kamanneini
Hosp, Apollo Hospital, Care Hospital
Many Affiliate hospitals from other parts of
country
Dr.Sunil Shroff,
www.mohanfoundation.org
Presumed Consent & Organ Donation
Belgium, Austria, Finland, France, Norway, Spain, and
Singapore implemented "presumed consent"
France's presumed consent (PC) law has produced increases in
organ donation approaching 5,000%.
Belgium passed its version of PC in 1986, and organ donation
climbed by 183%, with multi-organ retrieval significantly
increased to 119% for kidneys. The donor rate increased from 10
to 22 donors per million population between 1986 and 1997.
Austria passed its PC law in 1982. By the end of 1990, the
number of patients receiving kidneys was nearly the same as the
number on the waiting list
Dr.Sunil Shroff,
www.mohanfoundation.org
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
Dr.Sunil Shroff,
www.mohanfoundation.org
Mandated Choice
Mandated choice: This requires people to state their
‘willingness to donate or not‘ when filing some state of
institutional return such as a driving licence or income
tax form.
The information would be kept on a central register,
accessible at time of death
Dr.Sunil Shroff,
www.mohanfoundation.org
Mandated Choice & Driving License
1996 - Sweden instituted a mandated choice law.
There was an immediate increase of 600,000 potential
donors.
A similar 1990 law in Denmark increased their donor
registry by 150,000.
Dr.Sunil Shroff,
www.mohanfoundation.org
Action Required – Muslim Countries
More public education needed to change
cultural beliefs and practices although Islam
does not forbid Organ or tissue donation
Fatwas alone will not work.
Constantly addressing masses through media
by religious head may help to improve
sentiments
Dr.Sunil Shroff,
www.mohanfoundation.org
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
Dr.Sunil Shroff,
www.mohanfoundation.org
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
Dr.Sunil Shroff,
www.mohanfoundation.org
Patient 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
Dr.Sunil Shroff,
www.mohanfoundation.org
movement, this will generate better publicity for the cause”
Patient Support Group
We have held Eight meetings in Chennai, four in
Mumbai and one in Hyderabad
Some of them keen to help out with cadaver
organ donation programme
The group held „All India Transplant Games‟ in
Dec 2003
Dr.Sunil Shroff,
www.mohanfoundation.org
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
Dr.Sunil Shroff,
www.mohanfoundation.org
Make Local Sharing Protocols
6 Kidneys have been wasted in the last four
years of the 112 Kidneys shared in the INOS
network due to these problems
Poor Retrieval Technique – 2
No Blood for Cross Match – 2
Poor Packing of Organ - 2
INOS- Initiative for Organ Sharing facilitated
by MOHAN Foundation in Tamil Nadu
Dr.Sunil Shroff,
www.mohanfoundation.org
Retrieval Surgery & Packing of Organs
MOHAN in its INOS Group of
hospitals have made:
Attempts to standardize retrieval
techniques
CD made on kidney Retrieval to
be circulated to all the hospitals
in the group
Packing of organs being
standardised for transportation
Dr.Sunil Shroff,
www.mohanfoundation.org
Potential Countries That can Succeed with
Programme
Countries that can have success with Cadaver Transplant
programmes in Asia and make a difference -
India – No Religious bar to donation
Iran – Has a logistic approach
Saudi Arabia – Has the laws
Turkey – Liberal Muslim Country
Taiwan – Well organized Skills
China – Capable of organizing the programme
Sri Lanka – High Buddhist community. Eye programme success
Mynamar - High Buddhist community
Dr.Sunil Shroff,
www.mohanfoundation.org
ORGAN DONATION RATE
Current organ donation rate - India is 0.05 per million
population per year
If in India - 1 per million donation rate we would have 1100 organ donors
– 2200 kidneys,1000 hearts, 1100 Livers, 2200 Eyes
At 3 per million Donation rate we would have 3300 organ donors – 6600
kidneys,3300 hearts, 33001 Livers, 6600 Eyes
At 10 per million donation rate- 11,000 organ donors
22,000 kidneys, 11,000 hearts, 11,000 Livers, 22,000 Eyes
20 per million donation rate - 22,000 organ donors
44,000 kidneys, 22,000 hearts, 22,000 Livers, 22,400 Eyes
Source: Indian Transplant Newsletter Issue no.19 Feb 2006
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Transplant - Conclusion
Organ Shortage is a Crisis, however the Crisis
has a Cure
In Asia we need to Network and start thinking
of sharing resources, expertise and organs
Set up Collaborative projects
Use Television Media for Promotion
Get Religious heads to Participate regularly
Have Transparency in programme
Set up regional Transplant co-ordinators
Forums
Dr.Sunil Shroff,
www.mohanfoundation.org
Cadaver Transplant - Conclusion
In Asia we have failed to explore all the options
and simple steps and changes can make all the
difference for our patients
Dr.Sunil Shroff,
www.mohanfoundation.org
MOHAN Foundation –INOS Mission Statement
“ORGANS WASTED ARE LIVES LOST”
THANK YOU
In my end is my beginning
- T.S.Eliot, Four Quartets
Dr.Sunil Shroff,
www.mohanfoundation.org