1. 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

2. 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.

3. Cadaver Transplant in Asia – The Road Ahead
Overview of Cadaver Transplants in Asia
Common Problems & Platforms
The Road Ahead

4. Overview of Asia Asia World Population 3.6 Billion 6.4 Billion
No Of Countries
Land Mass 44,390,000 Sq.Km 6,233,821,945 Sq.Km
Life Expectancy M 63 yr F 66yrs

5. Cadaver Transplants in Asia
Kidney
Liver
Heart
Heart Lung
Pancreas
Source: Asian Transplant Registry

6. PER CAPITA INCOME FOR ASIAN COUNTRIES ( In US Dollars)
High Per Capita Income
Japan ,180
Hong Kong ,860
Singapore ,230
Kuwait ,960
Israel ,240
S Korea ,030
Taiwan ,530
Saudi Arabia ,240
Lebanon ,040
Malaysia ,880
Turkey ,800
Maldives ,510
Average Per Capita Income
Thailand ,190
Iran ,010
Kazakhstan ,780
Jordan ,850
Syria ,190
Turkmenistan ,120
China ,100
Philippines ,080
No Data - Afghanistan Bhutan, Palestine, Bahrain,
Cyprus, Iraq, Qatar, UAE,
Myanmar, Timor , Oman,
Brunei, N.Korea
Low Per Capita Income
Sri Lanka
Armenia
Indonesia
Azerbaijan
Georgia
India
Yemen
Pakistan
Mongolia
Vietnam
Bangladesh
Uzbekistan
Laos
Kyrgyzstan
Cambodia
Nepal
Tajikistan

7. High per capita income & Successful Living Transplant Programmes
Japan
Hong Kong
Singapore
Kuwait
Israel
S Korea
Taiwan
Saudi Arabia
Lebanon
Malaysia
Turkey

8. High per capita income & Cadaver Tansplant Programme
Hong Kong
Singapore
Taiwan
Saudi Arabia
Malaysia
Turkey
Iran
Lebanon
Kuwait
Israel
S Korea
Japan
Most of Asia is struggling with Cadaver Programme including regions with high per capita

9. Kidney Tx Waiting List in Asia (2002)
Waiting Time
Taiwan – 1.9 yrs
Korea – 2.2 yrs
Hong Kong – 4.3 yrs
Singapore – 5.8 yrs
No Waiting list in Iran for Kidney Tx.
Japan – 12,974
Taiwan –
Saudi Arabia –
Korea –
Pakistan
Hong Kong
Singapore – 666
Bangladesh
No figures available for China, India, Philipines, Indonesia

10. Transplant Expertise - Asia
Japan has 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

11. Transplants - Japan Kidney Transplant since 1964 -15 113
Liver transplants since
Heart Transplants since
Lung transplants since
The organs have largely been obtained from living and to some extent from non-heart beating donors
Ref: 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 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

13. 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

14. 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.

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 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 centres do over 25 per year.

16. Historical Aspects – Cadaver Transplantation - India
First successful cadaver Kidney Transplant in India at KEM Hospital, Bombay
First successful heart transplant done at AIIMS, N.Delhi
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

17. 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.

18. 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

19. Overview of Cadaver Transplants in Asia Common Problems & Platforms
Cadaver Transplant in Asia – The Road Ahead
Overview of Cadaver Transplants in Asia
Common Problems & Platforms
The Way Ahead

20. 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

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 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.

22. World Status of Transplants
Annual Number of kidney transplantations per million population (pmp) per year -
USA Predominantly Cadaver Donors
Europe Predominantly Cadaver Donors
Asia 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.

23. Cadaver Donor Rates The Cadaver donors per million population per year
USA
Europe
Asia
South 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 death
Korea – 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 organs
Hong Kong % 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 Oct-Dec;30(4):188-95
Pakistan - Artif Organs Nov;29(11): Ashraf O, Ali S, Li SA, et al
Hong 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 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

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, 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.

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 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

30. 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
Above protocol called “THE RAMACHANDRA PROTOCOL” to ask for organs

31. Brain Death – Law & Guidelines
Countires
Law
Guidelines
Apnea Test
Physicians
Obv Time
Conf, Test
Armenia A
Optional
Bangladesh P
DVO 3
China
Georgia 24
Mandatory
Hong Kong
PCO2 1
India
Iran p - 4
Indonesia

32. Brain Death – Law & Guidelines
Countries
Law
Guidelines
Apnea Test
Physicians
Obv Time
Conf, Test
Japan P
PCO2 1 A
Mandatory
Korea (S) 6
Optional
Malaysia 2 12
Pakistan
Not known
Philippines
DVO 24
Singapore
Taiwan
Thailand 3
Vietnam

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, 1994
Aims
Regulate removal, storage and transplantation of human organs for therapeutic purposes
To prevent commercial dealings in organs
Recognise Brain Death

36. RELIGIOUS & CULTURAL ASPECTS
Religion plays major role in promoting Organ Donation.
Major religions in Asia Pacific include -
Islam
Buddhism
Christianity
Hinduism
Sikhism
Judaism

37. 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

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 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: /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 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.

40. Buddhism & Organ Donation
Predominantly Buddhist Countries
Sri Lanka
Thailand
Vietnam
Myanmar
Less Dominant
Korea (30%)
Singapore (30%)

41. 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.

42. 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.

43. Muslims & Organ Donation
Less Dominant –
China (200 million)
India
Singapore (20%)
Predominantly –
Saudi Arabia
Iran
Iraq
Kuwait
Turkey
Pakistan
Bangladesh
Malaysia
Brunei
Indonesia (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 public
Fatwas are not legal binding.

45. Muslims & Organ Donation
Fatwas declared in several countries
Saudi Arabia : permit both living related and cadaveric donation of organs
Pakistan,
Bangladesh,
Malaysia
Indonesia

46. 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

47. Christianity - Organ Donation
Predominantly -
Philippines
Less Dominant –
Singapore (30%)
Korea (30%)
Malaysia
India
No 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
Predominantly
India
LESS DOMINANT
Sri Lanka (<10%)
Singapore (5%)
Malaysia
Indonesia
Thailand
Veitnam

50. 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

51. 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.

52. 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

53. 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

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):1881
Data – 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 completed
4 Cases became actual donors
Conclusion – There is underreporting of brain death cases.

55. 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
Spain has the highest number of brain death patients going
on to organ donation – 32 per million population

56. Hospital Infra-Structural & Support Logistics
Qualified
Trained transplant
Co-coordinators
Adequate No. of Qualified Intensivists in ICUs
Well qualified Surgeons to undertake Retrieval & TX
Support Organisation to Network
Transport of organs –between cities
HLA Tissue typing and Cross-match

57. Cadaver Transplants Scene in Asia – The Way Forward
Overview of Cadaver Transplants in Asia
Common Problems & Platforms
The Way Ahead

58. 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

59. 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

60. 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

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 leaders
health care workers individually
through 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 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

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 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 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 disappear
Bereaved 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 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

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 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

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 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

69. 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

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 donation
Fatwas 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 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:

73. 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

74. 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 movement, this will generate better publicity for the cause”

75. 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

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 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

78. 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

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 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

80. ORGAN DONATION RATE
Current organ donation rate - India is 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, 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

81. 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

82. In Asia we have failed to explore all the options
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

83. In my end is my beginning - T.S.Eliot, Four Quartets
MOHAN Foundation –INOS Mission Statement
“ORGANS WASTED ARE LIVES LOST”
THANK YOU
In my end is my beginning                     T.S.Eliot, Four Quartets