1. RELATION BETWEEN DONATION AND TRANSPLANTATION PRACTICES AND SOME DEVELOPMENT INDICATORS: DATA FROM THE GLOBAL OBSERVATORY ON DONATION AND TRANSPLANTATION (2009) Mahillo B, Carmona M, Alvarez M, Calvo R, Sánchez- Bercedo S, Noel L, Matesanz R

2. The Global Observatory on Donation and Transplantation (GODT):  The most comprehensive source of worldwide data  Principle of transparency  Data available through the website Introduction & Objective To study the relation between selected development indicators and donation and transplantation activities, legislation and organizational structures. Introduction Objective

3. Materials & Methods Field: 193 Member States in the six WHO Regions. Data Collection: Ad hoc questionnaire: questions on legislation, organization and aggregated transplantation data.  Source of data: health authorities or officially designated by them United Nations Population Fund 2009 report:  Population size  Human Development Index (HDI)  Total expenditure on Health as % of Gross Domestic Product (GDP) Statistical analysis: Spss 15.0 Descriptive statistics Inferential statistics  Chi squared test  Mann-Whitney test  Spearman Coefficient

4. Materials & Methods Organizational systems: Number of countries with:  Official body responsible for overseeing donation and transplantation at national level or Specific organization or institution responsible for national coordination  Systems for the collection and analysis of data  Surveillance system of adverse events in organ transplants recipients  Surveillance system of donation complications in live organ donors  Mechanisms to ensure donor safety and follow up Legislative aspects: Number of countries with:  Specific legislation for donation and transplantation  Explicit prohibition of organ trafficking in the legal framework Activity data:  Kidney transplant from deceased and living donors  Liver transplants from deceased and living donors Development:  Human Development Index (HDI). *HDI low to medium (<0.8) or HDI high (≥ 0.8)  Total expenditure on Health as % of Gross Domestic Product (GDP) Selected variables

5. Results (I). Organizational systems vs HDI and Health Expenditure Of the 98 countries providing information, 84.7% reported a structure supervising or coordinating donation and transplantation. Differences (Chi squared test p < 0.000) were found depending on HDI (low to medium and high) for the variables: Donation and transplantation organizational structure: Systems for the collection and analysis of data: Also differences depending on the Total Health Expenditure for the variable: Systems for the collection and analysis of data: Mann Whitney test p=0.044 HDI Total Health Expenditure Organiz. structureHDI low to mediumHDI high No13 (34.2%)2 (3.3%) yes25 (65.8%)58 (96.7%) Data collection systemHDI low to mediumHDI high No18 (48.6%)3 (5.0%) yes19 (51.4%)57 (95.0%)

6. Results (II). Legislative system 91% of 99 countries with information on legislation have specific law for organ donation and transplantation. Differences were found (Chi squared test p = 0.025) depending on HDI for the variable specific law for organ donation and transplantation. Specific law HDI low to medium HDI high No 7 (18.4%) 2 (3.3%) yes 31 (81.6%) 59 (96.7%) Differences were found (Chi squared test p = 0.025) depending on HDI for the variable specific law for organ donation and transplantation. Specific law HDI low to medium HDI high No 7 (18.4%) 2 (3.3%) yes 31 (81.6%) 59 (96.7%) We did not find differences between countries with explicit prohibition for organ trafficking depending on HDI or Total Health Expenditure.

7. Results (IV). Activity Data vs HDI Statistical differences were found in rates of kidney and liver transplantation, especially from deceased donor, in countries with a high HDI or with a low to medium HDI (Mann Whitney test p < 0.000). Kidney transplants from deceased donors were more common than from living donors in highly developed countries. However, in countries with low to medium HDI, kidney transplants from living donors were more frequent. A similar trend was observed for liver transplants (Mann Whitney test p ≤ 0.002).

8. Results (IV). Activity Data vs Total Health Expenditure Spearman Coefficient: 0.668 (p< 0.000) Spearman Coefficient: 0.609 (p< 0.000) Total health expenditure as % of GDP vs: Living Kidney transplants: Spearman Coef. 0.232 (p= 0.021) Living Liver transplants: Spearman Coef. 0.325 (p=0.004)

9. Conclusions  Development level and health resources availability may contribute to: - country variability in organizational systems - legislation - transplants from living donors versus deceased donors  Organizational structures can also contribute to country variability in living versus deceased donors transplantation.

10. Thank you! www.transplant-observatory.org Beatriz Mahillo bmahillo@mspsi.es