Presentation on theme: "Cadaver Organ Donation & Transplantation in Asia – The Way Ahead"— Presentation transcript:
1 Cadaver Organ Donation & Transplantation in Asia – The Way Ahead Dr. Sunil ShroffHead of Department - Urology & Renal Transplantation,Sri Ramachandra Medical College & Research Institution,Managing Trustee, MOHAN Foundation, Chennai
2 Organ ShortageEach day, about 60 people around the world receive an organ transplant, while another 13 die due to non-availability of organs.Organ shortage — the main limitation to saving lives of critically ill patients — is due to individuals and their families not considering organ donation out of fear, ignorance or misunderstanding.
3 Cadaver Transplant in Asia – The Road Ahead Overview of Cadaver Transplants in AsiaCommon Problems & PlatformsThe Road Ahead
4 Overview of Asia Asia World Population 3.6 Billion 6.4 Billion No Of CountriesLand Mass 44,390,000 Sq.Km 6,233,821,945 Sq.KmLife Expectancy M 63 yr F 66yrs
5 Cadaver Transplants in Asia KidneyLiverHeartHeart LungPancreasSource: Asian Transplant Registry
6 PER CAPITA INCOME FOR ASIAN COUNTRIES ( In US Dollars) High Per Capita IncomeJapan ,180Hong Kong ,860Singapore ,230Kuwait ,960Israel ,240S Korea ,030Taiwan ,530Saudi Arabia ,240Lebanon ,040Malaysia ,880Turkey ,800Maldives ,510Average Per Capita IncomeThailand ,190Iran ,010Kazakhstan ,780Jordan ,850Syria ,190Turkmenistan ,120China ,100Philippines ,080No Data - Afghanistan Bhutan, Palestine, Bahrain,Cyprus, Iraq, Qatar, UAE,Myanmar, Timor , Oman,Brunei, N.KoreaLow Per Capita IncomeSri LankaArmeniaIndonesiaAzerbaijanGeorgiaIndiaYemenPakistanMongoliaVietnamBangladeshUzbekistanLaosKyrgyzstanCambodiaNepalTajikistan
7 High per capita income & Successful Living Transplant Programmes JapanHong KongSingaporeKuwaitIsraelS KoreaTaiwanSaudi ArabiaLebanonMalaysiaTurkey
8 High per capita income & Cadaver Tansplant Programme Hong KongSingaporeTaiwanSaudi ArabiaMalaysiaTurkeyIranLebanonKuwaitIsraelS KoreaJapanMost of Asia is struggling with Cadaver Programme including regions with high per capita
9 Kidney Tx Waiting List in Asia (2002) Waiting TimeTaiwan – 1.9 yrsKorea – 2.2 yrsHong Kong – 4.3 yrsSingapore – 5.8 yrsNo Waiting list in Iran for Kidney Tx.Japan – 12,974Taiwan –Saudi Arabia –Korea –PakistanHong KongSingapore – 666BangladeshNo figures available for China, India, Philipines, Indonesia
10 Transplant Expertise - Asia Japan has transplant centresThailand - 27 kidney, 6 liver, & 6 Cardiac transplantation centersIran has 22 centres – mainly kidneysIndia has 110 centres for Kidney Tx 5 centres Liver, 6 – Cardiac. over 35 centres have undertaken cadaver transplantsHowever only 6 centres do cadaver Tx. regularly
11 Transplants - Japan Kidney Transplant since 1964 -15 113 Liver transplants sinceHeart Transplants sinceLung transplants sinceThe organs have largely been obtained from living and to some extent from non-heart beating donorsRef: Shirakura -WHO/HTP/EHT/T Ethics, access and safety in tissue and organ transplantation:Issues of global concern. Madrid, Spain, 6-9 October 2003
12 Cadaver Kidney Transplants in Asia India, Taiwan, Korea, Thailand, Iran, Saudi Arabia and Singapore – Regularly are undertaking Kidney Cadaver TransplantsTaiwan, Thailand, Singapore follow the western model and run the programme almost on the same lineJapan is still struggling with the programme though their numbers are slowly risingIndia is emerging as one of the Key players despite still struggling with the programme logisticsVery Little information from China is Available on their modus operandi
13 Cadaver Heart Transplants in Asia Hong Kong, India, Japan, Malaysia, Saudi Arabia, Singapore and Thailand are doing Heart transplantsTaiwan and Korea do the maximum heart transplants in Asia
14 Cadaver Liver Transplants in Asia Korea do the maximum living liver transplants and has high level of expertise in the field2,345 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 transplantsFour centres in India – located at Hyderabad, Vellore and Delhi have fair expertise with liver transplants and emerging as the key players in the country.
15 Cadaver Kidney Transplants Scene in India In past ten years approx Cadaver organ transplants over 900 kidneys and 100 Livers and heart have been performedAlmost 40% of the cadaver transplants in India done in Tamil NaduTamil Nadu Organ Sharing Network could become the role model for rest of the countryApprox.110 centres in India do kidney Tx.however only 25 to 30 centres do over 25 per year.
16 Historical Aspects – Cadaver Transplantation - India First successful cadaver Kidney Transplant in India at KEM Hospital, BombayFirst successful heart transplant done at AIIMS, N.DelhiFirst successful multi-organ transplant done at Apollo Hospital, Chennai1998 – First Successful Lung transplant, Madras Medical Mission Hospital, Chennai1999 – First Pancreas Transplant, Ahemdabad
17 Asian Countries Undertaking Transplants – Kidneys alone (n-10) Pakistan - KPhilippines – KIndonesia – KMalaysia – K,Iran – K,Israel – KTurkey – KSyria – KMalaysia – KBangladesh – KSome of these countries have done (eg Pakistan) occasional liver or heart (eg Malaysia) transplant.
19 Overview of Cadaver Transplants in Asia Common Problems & Platforms Cadaver Transplant in Asia – The Road AheadOverview of Cadaver Transplants in AsiaCommon Problems & PlatformsThe Way Ahead
20 Common Problems & Platforms Incidence of organ failure in AsiaPublic and Professionals Attitude to Brain Death & Organ DonationReligion & Organ DonationLegal AspectsMedia and ScandalsReporting of Brain DeathHospital InfrastructureTrained Transplant Co-ordinators /Counsellors
21 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 peopleThis rises to eight times more likely for older AsiansDiabetes five times the rate of the white populationHypertension was at least twice the rate of the white population.
22 World Status of Transplants Annual Number of kidney transplantations per million population (pmp) per year -USA Predominantly Cadaver DonorsEurope Predominantly Cadaver DonorsAsia Predominantly Living DonorsIn 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.
23 Cadaver Donor Rates The Cadaver donors per million population per year USAEuropeAsiaSouth America
24 Physicians Attitude to Organ Donation Korean health professionals' attitudes and knowledge toward organ donation and transplantation. Kim JR, Elliott D, Hyde C Mar;41(3):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 deathKorea – Organ donation rate below 2 per million population per year.
25 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 Jun;37(5):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%)
26 Public Attitude Turkey (n=774) - 59.2% would consider donating organs Pakistan(n 367) – 59.9% Willing to donate their organsHong Kong % of the respondents were are willing to donate organsViet Nam - 66% urban Vietnamese surveyed were willing to donate organs or tissues after deathRef -Turkey- Ozdag N. EDTNA ERCA J Oct-Dec;30(4):188-95Pakistan - Artif Organs Nov;29(11): Ashraf O, Ali S, Li SA, et alHong Kong - Yeung I, Kong SH, Lee J. Soc Sci Med Jun;50(11):Viet Nam - Hai TB, Eastlund T, Chien LA, Duc PT, Giang TH, Hoa NT, Viet PH, Trung DQ.
27 Public Attitude - Singapore Social and cultural aspects of organ donation in Asia.Woo KT. Ann Acad Med Singapore May;21(3)Important misconceptions and fears were –Fear of death,Belief that removal of organ violates sanctity of decreasedConcern 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
28 Public Attitude - China Investigation of understanding and willingness of organ transplantation in young people in Beijing, Shanghai, Wuhan. Zhonghua Yi Xue Za Zhi Jan;77(1): Liu Y, Lei H, Qiu F. China Foundation of Organ Transplantation Development, WuhanCities of China –Young people have a better understanding of organ transplantationConventional attitudes and feudal habits are the major obstacle to the development of organ transplantation in China.
29 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 SurveyLess than 50% overall positive response in favour of donating solid organs72% were willing for “Eye” donation and carry a “Donor Card”All major religions were willing to consider organ donation
30 CONCLUSION - “PUBLIC ATTITUDE SURVEY” HOW TO ASK FOR ORGANS IN THE EVENT OF “BRAIN DEATH” PATIENT“Request for EYES” FIRST” - SEE HOW FAMILY REACTSFamily Willing Family ReluctantAsk For Solid Organs Abandon Efforts(Heart, Liver, Kidneys ..)Inform Transplant Co-coordinatorAbove protocol called “THE RAMACHANDRA PROTOCOL” to ask for organs
31 Brain Death – Law & Guidelines CountiresLawGuidelinesApnea TestPhysiciansObv TimeConf, TestArmeniaAOptionalBangladeshPDVO3ChinaGeorgia24MandatoryHong KongPCO21IndiaIranp-4Indonesia
32 Brain Death – Law & Guidelines CountriesLawGuidelinesApnea TestPhysiciansObv TimeConf, TestJapanPPCO21AMandatoryKorea (S)6OptionalMalaysia212PakistanNot knownPhilippinesDVO24SingaporeTaiwanThailand3Vietnam
33 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)
34 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
35 India – Legal Aspects Aims Transplantation of Human Organs Act, 1994AimsRegulate removal, storage and transplantation of human organs for therapeutic purposesTo prevent commercial dealings in organsRecognise Brain Death
36 RELIGIOUS & CULTURAL ASPECTS Religion plays major role in promoting Organ Donation.Major religions in Asia Pacific include -IslamBuddhismChristianityHinduismSikhismJudaism
37 Religion and Organ Donation Common thread that binds all religions of the world –Saving of life overrides all objectionsThere is no religion that is against organ donationWhat 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 richMistrust of hospitals and health professionalsMyths
38 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 strangersInfluence 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: /j x
39 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 SilvaWorld 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.
40 Buddhism & Organ Donation Predominantly Buddhist CountriesSri LankaThailandVietnamMyanmarLess DominantKorea (30%)Singapore (30%)
41 Buddhism & Organ Donation Even in countries where Buddhism is less dominantSingapore 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.
42 Muslims & Organ Donation Muslims the most controversial group -Koran does not forbid tissue donationKoran 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.
43 Muslims & Organ Donation Less Dominant –China (200 million)IndiaSingapore (20%)Predominantly –Saudi ArabiaIranIraqKuwaitTurkeyPakistanBangladeshMalaysiaBruneiIndonesia (Secular-PANCASILA)
44 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 publicFatwas are not legal binding.
45 Muslims & Organ Donation Fatwas declared in several countriesSaudi Arabia : permit both living related and cadaveric donation of organsPakistan,Bangladesh,MalaysiaIndonesia
46 CULTURAL PRACTICES OF MUSLIMS Despite Fatwas Muslims reluctant to donate organsGod 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
47 Christianity - Organ Donation Predominantly -PhilippinesLess Dominant –Singapore (30%)Korea (30%)MalaysiaIndiaNo bar to organ donation - Shortage of Donors in Philippines, Singapore and Korea due to cultural factors.
48 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.
49 Hinduism and Organ Donation PredominantlyIndiaLESS DOMINANTSri Lanka (<10%)Singapore (5%)MalaysiaIndonesiaThailandVeitnam
50 Religions against organ donation Greek Orthodox, Shinto and Gypsies are three religions that do not encourage body donationJehovah’s witness is another Christian sect that is against such acts
51 Media and Scandals - Thailand Doctors May Face Murder ChargeThe New Straits Times, September 1, 2000Three 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.
52 Media & Scandals - Japan The Washington Post: April 25, 1997A 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
53 Media & Organ DonationThe 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 1994His parents agreed to donate his organsItalian press reported it extensivelyThe positives impact kick started the Italian cadaver programme
54 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 Sep;36(7):1881Data – 2001 to 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 completed4 Cases became actual donorsConclusion – There is underreporting of brain death cases.
55 Problems with Cadaver Organ Donation Programme in Asia Govt. Problem No Funding for programmeHospital problem No efforts to identify & maintain “Brain Dead” donorsCommunity Problem No Awareness of “Brain Death” ConceptSpain has the highest number of brain death patients goingon to organ donation – 32 per million population
56 Hospital Infra-Structural & Support Logistics QualifiedTrained transplantCo-coordinatorsAdequate No. of Qualified Intensivists in ICUsWell qualified Surgeons to undertake Retrieval & TXSupport Organisation to NetworkTransport of organs –between citiesHLA Tissue typing and Cross-match
57 Cadaver Transplants Scene in Asia – The Way Forward Overview of Cadaver Transplants in AsiaCommon Problems & PlatformsThe Way Ahead
58 The Way Forward Strengthen the Asian Transplant Network Establish a common programme similar to Euro-transplant NetworkStart sharing organs that are not used locallyUse technology effectivelyEvolve a Spanish style co-ordinators course for Asian countriesDo our own Asian Transplant Games to build patient fellowshipHave more frequent Asian Transplant Society meeting
59 Organisational changes Model National Transplant Service– Like a network to share organs that is linked to aAsian Network for Organ Sharing (ANOS)Employing and training more transplant co-ordinators and having a separate body in Asia for Tx. Co-ordinatorsRegular Courses to impart expertise to the co-ordinatorsTraining and sensitising ICU staff on brain-death
60 Organisation helping with organ donation & Transplants programmes in India MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh, Maharastra236 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 kidneysORBO, N.Delhi – Few organs sharedSORT, Cochin – 4 organs shared
61 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 leadershealth care workers individuallythrough the mass media
62 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 relativesEncouraging 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
63 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 deadFamily members were given choice to be or not to be present during brain stem death testingIt 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 processThe presence of family during brain stem death testing. Doran M. Intensive Crit Care Nurs Feb;20(1):32-7
64 Project Positive Aspects Many donor relatives have stated that donating their loved one's organs does not make the pain of their death disappearBereaved families can experience comfort that their loved one's gift gave another person a second chance at life
65 Consent for Donation Pre-mortem – via Donor Cards, Driving License Consent of his family following deathSome 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 societyThe permission is a moral rather than a legal requirement
66 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 FoundationHospitals in Andhra Pradesh- Nizam’s Institute of Medical Sciences, Global Hospitals, Kamanneini Hosp, Apollo Hospital, Care HospitalMany Affiliate hospitals from other parts of country
67 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 By the end of 1990, the number of patients receiving kidneys was nearly the same as the number on the waiting list
68 Required Request LawRequires 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
69 Mandated ChoiceMandated 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
70 Mandated Choice & Driving License 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.
71 Action Required – Muslim Countries More public education needed to change cultural beliefs and practices although Islam does not forbid Organ or tissue donationFatwas alone will not work.Constantly addressing masses through media by religious head may help to improve sentiments
72 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 thisAn 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:
73 What is RequiredNGO 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 simultaneouslyMore Support groups with common objectives are neededMore resources necessary to Kick start such an Initiative
74 Patient Support GroupPurpose of the group - to provide emotional support to organ failure & transplant patientsMeeting held every two months between doctors, dietician and counselors and patients to discuss their problemsProvide subsidized investigation and a few selected drugsWe have about 250 members from Mumbai and Chennai“Patients should be the advocate of cadaver organ movement, this will generate better publicity for the cause”
75 Patient Support GroupWe have held Eight meetings in Chennai, four in Mumbai and one in HyderabadSome of them keen to help out with cadaver organ donation programmeThe group held ‘All India Transplant Games’ in Dec 2003
76 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 Jun;11(2): Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
77 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 problemsPoor Retrieval Technique – 2No Blood for Cross Match – 2Poor Packing of Organ - 2INOS- Initiative for Organ Sharing facilitated by MOHAN Foundation in Tamil Nadu
78 Retrieval Surgery & Packing of Organs MOHAN in its INOS Group of hospitals have made:Attempts to standardize retrieval techniquesCD made on kidney Retrieval to be circulated to all the hospitals in the groupPacking of organs being standardised for transportation
79 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 donationIran – Has a logistic approachSaudi Arabia – Has the lawsTurkey – Liberal Muslim CountryTaiwan – Well organized SkillsChina – Capable of organizing the programmeSri Lanka – High Buddhist community. Eye programme successMynamar - High Buddhist community
80 ORGAN DONATION RATECurrent organ donation rate - India is per million population per yearIf in India - 1 per million donation rate we would have 1100 organ donors – 2200 kidneys,1000 hearts, 1100 Livers, 2200 EyesAt 3 per million Donation rate we would have 3300 organ donors – 6600 kidneys,3300 hearts, Livers, 6600 EyesAt 10 per million donation rate- 11,000 organ donors22,000 kidneys, 11,000 hearts, 11,000 Livers, 22,000 Eyes20 per million donation rate - 22,000 organ donors44,000 kidneys, 22,000 hearts, 22,000 Livers, 22,400 EyesSource: Indian Transplant Newsletter Issue no.19 Feb 2006
81 Cadaver Transplant - Conclusion Organ Shortage is a Crisis, however the Crisis has a CureIn Asia we need to Network and start thinking of sharing resources, expertise and organsSet up Collaborative projectsUse Television Media for PromotionGet Religious heads to Participate regularlyHave Transparency in programmeSet up regional Transplant co-ordinators Forums
82 In Asia we have failed to explore all the options Cadaver Transplant - ConclusionIn Asia we have failed to explore all the optionsand simple steps and changes can make all the difference for our patients
83 In my end is my beginning - T.S.Eliot, Four Quartets MOHAN Foundation –INOS Mission Statement“ORGANS WASTED ARE LIVES LOST”THANK YOUIn my end is my beginning T.S.Eliot, Four Quartets