2015/2/3
1
Current Achievements and plans
in China
Yong Liu, M.D.
Ministry of Health, China
�Organ transplantation in China has taken
place since the 1960s, and is now one of
the largest organ transplant programmes
in the world.
�About 300,000 patients suffer organ
failure each year, but only around 10,000
transplants are performed annually due to
a lack of donors.
�Different from other medical
technologies, an organ transplant requires
a donated transplantable organ, and the
donation and allocation are embedded in
social issues such as culture, tradition,
ethics, and law.
�China strongly support and follow the
WHO Guiding Principles and the
Declaration of Istanbul.
� Stricter Management and supervision.
� Since the Consultation Meeting
on Transplantation with National
Health Authorities in the Western
Pacific Region, held by WHO in
Manila, Philippine on 2005. We
have faced squarely to Otx
practice relying on death-row
inmate’s organs and demonstrated
China’s political will and next-
steps in reforming Otx legislation
and practice.
The changes started from Transparency
Consultation Meeting on Transplantation with
National Health Authorities in the Western
Pacific Region
( Manila, Philippine on 2005)
� Regulations on Human
Organ Transplantation
(Mar. 21, 2007)Paved the
way for a legal framework
to guide the organ
transplantation in China.
Legal Framework
2015/2/3
2
Amendment(VIII) to the Criminal Law of
the People’s Republic of China
� In May of 2011, Eighth
Amendment of Criminal Law
passed, which eliminating
death penalty for 13 offenses,
but added a new crime under
criminal charge: organ trading.
China Organ Donation and Transplantation System
� Organ Donation Register System,
� Organ Procurement and Allocation Network,
� Organ Transplantation Clinical Service System,
� Post-Organ-Transplantation Register System.
The National Human Organ Transplantation WorkingMeeting was successfully held in Shanghai on August 25, 2009. Some key issues on organ transplantation, such as the source of organs, establishment of an organ donation system and organ allocation mechanism, were constituted.
Organ donation initiative
(August 25th, 2009 Shanghai China)
1. China Category I (C-I):
Organ Donation after Brain Death-DBD.
2. China Category II (C-II):
Organ Donation after Circulatory Death-DCD.
3. China Category III (C-III):
Organ Donation after Brain Death followed by
Circulatory Death-DBCD.
Classification of Deceased Organ Donation
in China
(MOH Hospital Administration Division, Issue(2011), No.62.Appendix I)
5912
85779001
77397417
8112
9116
0.24% 0.19% 0.21% 0.81%
3.47%
13.12%
24.22%
0%
5%
10%
15%
20%
25%
30%
0
2500
5000
7500
10000
2007 2008 2009 2010 2011 2012 2013
47.5%
The rising of deceased Organ Donation in China
The Number of Transplant in 2007-2013
Kick-off meeting for Nationwide DCD program
(Feb 25th, 2013 Beijing)
If China is to sustain
a successful program
of deceased organ
donation, the Chinese
people must trust a
national system that
must be clean, fair,
transparent and
equitable.
2015/2/3
3
� Any accredited transplant
hospital that fail to develop a
deceased organ donation
program will have their
transplant license and OPO
license revoked
� Doctors who use the organs
other than those obtained from
the centralized sharing network
will be disqualified.
� The local Health Authorities
have the compulsory
responsibly and mandate to
enforce the implementation of
the regulation.
11th OTC meeting of NHFPC
(Sep 17th, 2013 Beijing)
Picture of OTC meeting
The Regulation further enforce the
regulation of health authority on the follow
issues:
1. Mandatory enforcement of national
implementation of China national
organ allocation computer system,
namely China Organ Transplant
Response System (COTRS).
2. Defines qualification and
responsibilities of organ donation
coordinators.
3. Defines qualifications and
responsibilities of OPO
共五章24款The National Regulation on
Human Organ Procurement and Allocation21,August 2013
China Organ Transplant Response System
Media:More than 1500 DCD, a major breakthrough in the
development of China organ donation system
On February 25th, 2013, the
former Ministry of Health and
Res Cross Society of China
jointly initiated national-scale
deceased organ donation
program.
As of February 12nd, 2014, the
program has seen 4,065 organs
from 1,500 donors (including
1,222 livers, 2763 kidneys, 57
hearts, and 12 lungs, 9 pancreas,
2 intestines).
Challenges Ahead
�Amendment of the national Regulation on Otx(legal framework)
�National working structure and Mechanism for Otx
�OPO and Coordinator
�Community effort and reflection of deceased organ donation is a community effort and reflection of the solidarity of Chinese people to benefit their fellow man.
� China should refer to its own
traditional culture and present
socio-economic condition and
learn from the international
transplant community in
establishing China’s organ
transplantation system and
show “the responsible big
country” image on the world
stage.
The Future
2015/2/3
4
A Call to Action
� More than 450 years
before the birth of Christ,
Confucius said: ‘What I
hear, I forget; what I see,
I remember; what I do, I
understand.’
� Let’s do it together.
We’ve heard what we
have to do. We’ve seen
what we need to do. Now
is the time to do it.
Thank you!
03/02/2015
1
GENERAL INFORMATION – FOR ORGANSGENERAL INFORMATION – FOR ORGANS
COUNTRY: JAPAN
INFORMATION PROVIDED BY:
Name: Naoshi Shinozaki
Position: Executive Director
Organization: Japan Organ Transplant Network
Address: ORIX Akasaka Nichome Bldg. 2F, 2-9-11, Akasaka, Minato-ku, Tokyo, JAPAN
E-mail: [email protected]
- Is there a functioning* transplantation programme? Yes
- Is there a functioning* programme for organ donation from deceased persons? Yes
- Is there a functioning* programme for organ donation from living donors? Yes
*Functioning: programme performing or able to perform its regular function
ORGANIZATIONAL SYSTEM - ORGANS ORGANIZATIONAL SYSTEM - ORGANS
1. Is there a Government recognized authority responsible for overseeing donation and/or transplantation at national
level?
Yes
No
- If Yes, for Donation, Transplantation or Both? _____Both__________________
2. Is there a specific organization, institution or agency responsible for organ donation and/or transplantation matters
at national level?
Yes
No
- If Yes, Does it report to the Ministry of Health? Yes No
3. Are organ procurement and / or transplantation expenses covered by? :
State
Private Health Insurance
Recipients
Other specify: _____Social Health Insurance of the patients and parts of donation i_______
4. Are recipients paying for post - transplant care and drugs?
Yes If yes: Total or Partial Social Health Insurance system
No
ORGANIZATIONAL SYSTEM - ORGANS ORGANIZATIONAL SYSTEM - ORGANS
Transplants performed abroad:
5. Is there any cooperation framework or agreement to allow patients to be transplanted abroad?
Yes
No
If yes, comment under which programmes and specify the countries:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
6. In case of recipients travelling abroad to be transplanted (under a cooperation framework or not): Is the recipients’
follow-up assured in the country of origin upon their return?
Yes
No
7. Do recipients and living donors travel abroad together?
Yes, always
Yes, sometimes
No
8. Is the living donor follow-up assured upon his/her return?
Yes
No
ORGAN LEGISLATION ORGAN LEGISLATION
9. Are any aspects of organ donation and /or transplantation covered by any legal requirement?
Yes Time of Enactment:_____1996、2009________________________
No
If Yes, Does it cover the following aspects?
Organ donation from deceased persons �
Organ donation from living persons � (Society)
Allocation �
Organ Transplantation �
Organ Trafficking �
10. The government is currently intending to adopt new or revise any legal requirement on these subjects and/or on
missing/unforeseen subjects:
Yes
No
11. Is there a legal requirement to report to the government the transplants performed within the country and the
deceased donors?
Yes
No
12. Is the type of consent required for donations from deceased persons specified in any legal requirement?
Yes
No
ORGAN LEGISLATION ORGAN LEGISLATION
13. Are incentives to obtain the consent of the families of the deceased person (in the form of any monetary payment or
other reward of monetary value), legally permitted?
Yes
No
Living donation:
14. Is unrelated living donation legally permitted?
Yes
No
15. Are financial incentives legally permitted for living organ donation?
Yes; Are they specifically regulated by the government?
No; Are they nonetheless offered or provided to potential living donors?
Comment: ____Monetary incentives are prohibited by law______
16. Is there any kind of explicit prohibition of organ trafficking / transplant commercialism?
Yes. Are there penalties? 5 years in sentences and/or 5,000,000 yen (~$50,000-) fine
No
What is specifically prohibited?___
__Organ trafficking, failing post-mortem inspection by physician________
DONATION &TRANSPLANTATION ACTIVITY DATA FOR ORGANS
(data for 2012)
DONATION &TRANSPLANTATION ACTIVITY DATA FOR ORGANS
(data for 2012)
ACTUAL DECEASED DONORS
- Total actual deceased organ donors:_110__
- Actual DBD donors: _45__
- Actual DCD donors: _65__
KIDNEY Tx
- Total Kidney from deceased donors:_193__
- Kidney from DBD:_ 77
- Kidney from DCD:_116
- Total Kidney from Living donors:_1412_
- Unrelated kidney :____ (less than 1% )
- Related kidney :____
LIVER Tx:
- Total Liver From deceased donors:__40 (including
1 liver-kidney)
- Liver from DBD:__40_
- Liver from DCD:__ 0 _
- Liver From Living donors:______
HEART Tx: __28___
LUNG Tx:___33__
PANCREAS Tx:___27_(including 18 kidney-pancreas)__
SMALL BOWEL Tx:__0___
TRANSPLANTS ABROAD
- Number of resident patients, known to have been
transplanted abroad:______
Destination country/ies:_____________________
- Number of resident living donors, known to have
travelled abroad to donate:____
Destination country/ies:_____________________
WAITING LIST
Number of patients with (ESRD) on dialysis
treatment:_309,946______
03/02/2015
2
DONATION &TRANSPLANTATION ACTIVITY DATA FOR ORGANS
(data for 2013)
DONATION &TRANSPLANTATION ACTIVITY DATA FOR ORGANS
(data for 2013)
ACTUAL DECEASED DONORS
- Total actual deceased organ donors:_84__
- Actual DBD donors: _47__
- Actual DCD donors: _37__
KIDNEY Tx
- Total Kidney from deceased donors:_155__
- Kidney from DBD:_ 88
- Kidney from DCD:_ 67
- Total Kidney from Living donors:____
- Unrelated kidney :____
- Related kidney :____
LIVER Tx:
- Total Liver From deceased donors:__38 (including
1 liver-kidney)
- Liver from DBD:__38_
- Liver from DCD:__ 0 _
- Liver From Living donors:______
HEART Tx: __38_(including 1 heart-lung)__
LUNG Tx:___41_(including 1 heart-lung)
PANCREAS Tx:___33 (including 24 kidney-pancreas)___
SMALL BOWEL Tx:__0___
TRANSPLANTS ABROAD
- Number of resident patients, known to have been
transplanted abroad:______
Destination country/ies:_____________________
- Number of resident living donors, known to have
travelled abroad to donate:____
Destination country/ies:_____________________
WAITING LIST
Number of patients with (ESRD) on dialysis
treatment:_309,946______
“Plans for increasing organ donation in Japan “ “Plans for increasing organ donation in Japan “ “Plans for increasing organ donation in Japan “ “Plans for increasing organ donation in Japan “ “Plans for increasing organ donation in Japan “ “Plans for increasing organ donation in Japan “ “Plans for increasing organ donation in Japan “ “Plans for increasing organ donation in Japan “ Naoshi ShinozakiNaoshi ShinozakiNaoshi ShinozakiNaoshi ShinozakiExecutive Director; Japan Organ Transplant Network (JOT), Executive Director; Japan Organ Transplant Network (JOT), Executive Director; Japan Organ Transplant Network (JOT), Executive Director; Japan Organ Transplant Network (JOT), Secretariat;Secretariat;Secretariat;Secretariat; JapaneseJapaneseJapaneseJapanese SocietySocietySocietySociety forforforfor TransplantTransplantTransplantTransplant (JST(JST(JST(JST))))Medical Advisory Board; Eye Bank Association of AmericaMedical Advisory Board; Eye Bank Association of AmericaMedical Advisory Board; Eye Bank Association of AmericaMedical Advisory Board; Eye Bank Association of America ((((EBAA)EBAA)EBAA)EBAA)Expert Advisory Panel; World Heal Organization (WHO) Expert Advisory Panel; World Heal Organization (WHO) Expert Advisory Panel; World Heal Organization (WHO) Expert Advisory Panel; World Heal Organization (WHO)
International Technical Consultation on Cell, Tissue and Organ
JAPANJAPANJAPANJAPANJAPANJAPANJAPANJAPAN
Population;126,000,000
JOTHQEast branchMiddle branchWest branch
Legislation in JapanLegislation in JapanLegislation in JapanLegislation in JapanLegislation in JapanLegislation in JapanLegislation in JapanLegislation in Japan1964 First Kidney, Lung Transplant1964 First Kidney, Lung Transplant1964 First Kidney, Lung Transplant1964 First Kidney, Lung Transplant1968196819681968 First Heart Transplant First Heart Transplant First Heart Transplant First Heart Transplant 1996199619961996 Law for Organ TransplantationLaw for Organ TransplantationLaw for Organ TransplantationLaw for Organ Transplantation2009200920092009 Revise the law Revise the law Revise the law Revise the law HistoryHistoryHistoryHistory ofofofof TransplantTransplantTransplantTransplantHistoryHistoryHistoryHistory ofofofof TransplantTransplantTransplantTransplant
■■■■ 1963196319631963 First Liver, Lung First Liver, Lung First Liver, Lung First Liver, Lung TxTxTxTx....
■■■■ 1964196419641964 First Kidney First Kidney First Kidney First Kidney TxTxTxTx. in Japan. in Japan. in Japan. in Japan
■■■■ 1964196419641964 First Liver First Liver First Liver First Liver TxTxTxTx. In Japan. In Japan. In Japan. In Japan
■■■■ 1967196719671967 First Heart First Heart First Heart First Heart TxTxTxTx....
■■■■ 1968196819681968 First Heart First Heart First Heart First Heart TxTxTxTx. In Japan. In Japan. In Japan. In Japan
(Wada (Wada (Wada (Wada TxTxTxTx.).).).)
■■■■ 1963196319631963 First Liver, Lung First Liver, Lung First Liver, Lung First Liver, Lung TxTxTxTx....
■■■■ 1964196419641964 First Kidney First Kidney First Kidney First Kidney TxTxTxTx. in Japan. in Japan. in Japan. in Japan
■■■■ 1964196419641964 First Liver First Liver First Liver First Liver TxTxTxTx. In Japan. In Japan. In Japan. In Japan
■■■■ 1967196719671967 First Heart First Heart First Heart First Heart TxTxTxTx....
■■■■ 1968196819681968 First Heart First Heart First Heart First Heart TxTxTxTx. In Japan. In Japan. In Japan. In Japan
(Wada (Wada (Wada (Wada TxTxTxTx.).).).)
Legislation in JapanLegislation in JapanLegislation in JapanLegislation in JapanLegislation in JapanLegislation in JapanLegislation in JapanLegislation in Japan1964 First Kidney, Lung Transplant1964 First Kidney, Lung Transplant1964 First Kidney, Lung Transplant1964 First Kidney, Lung Transplant1968196819681968 First Heart Transplant First Heart Transplant First Heart Transplant First Heart Transplant 1996199619961996 Law for Organ TransplantationLaw for Organ TransplantationLaw for Organ TransplantationLaw for Organ Transplantation2009200920092009 Revise the law Revise the law Revise the law Revise the law
03/02/2015
3
Dialysis Patients in JapanDialysis Patients in JapanDialysis Patients in JapanDialysis Patients in JapanDialysis Patients in JapanDialysis Patients in JapanDialysis Patients in JapanDialysis Patients in Japan
215301949182836316149924513069180102257927048322313639742223479785301759911663107253780553886348322110329611630312392613429814370915441316719217598819532219721320513421918322953923771024816525776526447300005000050000500005000010000010000010000010000015000015000015000015000020000020000020000020000025000025000025000025000030000030000030000030000068686868 69696969 70707070 71717171 72727272 73737373 74747474 75757575 76767676 77777777 78787878 79797979 80808080 81818181 82828282 83838383 84848484 85858585 86868686 87878787 88888888 89898989 90909090 91919191 92929292 93939393 94949494 95959595 96969696 97979797 98989898 99999999 0000 1111 2222 3333 4444 5555 6666(社)日本透析医学会統計調査委員会調べ
東京歯科大学市川総合病院東京歯科大学市川総合病院東京歯科大学市川総合病院東京歯科大学市川総合病院 角膜センター角膜センター角膜センター角膜センター
Kidney Transplantation per Country pmpversus Human Development Index (HDI)
Medium HighLow
8% 66% 26% Population
0,02% 31% 69% Kidneytransplants
0
10
20
30
40
50
60
70
0.4 0.5 0.6 0.7 0.8 0.9 1
HDI
kid
ney t
x /p
mp AFRO
AMRO
EMRO
EURO
SEARO
WPRO
Japan Organ Transplant NetworkJapan Organ Transplant NetworkJapan Organ Transplant NetworkJapan Organ Transplant Network
539539539539 423423423423 520520520520 516516516516 495495495495273273273273 226226226226 277277277277 279279279279 280280280280180180180180 153153153153 190190190190 191191191191 439439439439253253253253177177177177 147147147147128128128128127127127127136136136136122122122122134134134134 9696969600001001001001002002002002003003003003004004004004005005005005006006006006002008200820082008 2009200920092009 2010201020102010 2011201120112011 2012201220122012 2013201320132013 47474747454545454444444413131313 7777 32323232 373737376565656568686868818181819898989896969696
Donor info. IC # and Donation #((((2008~~~~2013))))(year)
(cases)All info.
Effective info.
I.C. family
Donation
DBDDCD
Council for promotion of organ transplantationCouncil for promotion of organ transplantationCouncil for promotion of organ transplantationCouncil for promotion of organ transplantationCouncil for promotion of organ transplantationCouncil for promotion of organ transplantationCouncil for promotion of organ transplantationCouncil for promotion of organ transplantationThe Ministry of Health, Labour & WelfareThe Minister of Health, Labour and Welfare appointment;Discussing & make decisions how to promote organ transplantation.
Driver’s LicenseDriver’s LicenseDriver’s LicenseDriver’s LicenseDriver’s LicenseDriver’s LicenseDriver’s LicenseDriver’s LicenseSince 2010Since 2010Since 2010Since 2010BBBBack of the license is ack of the license is ack of the license is ack of the license is used to show the will used to show the will used to show the will used to show the will of organ donationof organ donationof organ donationof organ donationBy 2015, ALL the By 2015, ALL the By 2015, ALL the By 2015, ALL the license become IClicense become IClicense become IClicense become ICcard with donor cardcard with donor cardcard with donor cardcard with donor cardSocial Health Insurance CardSocial Health Insurance CardSocial Health Insurance CardSocial Health Insurance CardSocial Health Insurance CardSocial Health Insurance CardSocial Health Insurance CardSocial Health Insurance CardThe most of health care The most of health care The most of health care The most of health care insurance group is changing insurance group is changing insurance group is changing insurance group is changing to IC card to IC card to IC card to IC card Back side of IC card is used Back side of IC card is used Back side of IC card is used Back side of IC card is used to show the will for organ to show the will for organ to show the will for organ to show the will for organ donation.donation.donation.donation.
03/02/2015
4
Installation of InInstallation of InInstallation of InInstallation of In----house coordinatorhouse coordinatorhouse coordinatorhouse coordinatorInstallation of InInstallation of InInstallation of InInstallation of In----house coordinatorhouse coordinatorhouse coordinatorhouse coordinator1. Hospital Audit Organization of Japan1. Set the donor information flow standards2. On site inspection questionnaire2. MOH research group1. In-house coordinator education 2. Quality Management Seminar
May 16, 2012 第25回日本脳死脳蘇生学会 シンポジウムQuality Management seminarQuality Management seminarQuality Management seminarQuality Management seminarQuality Management seminarQuality Management seminarQuality Management seminarQuality Management seminarAimAimAimAimTo establish donor detection system in each hospital, educating inTo establish donor detection system in each hospital, educating inTo establish donor detection system in each hospital, educating inTo establish donor detection system in each hospital, educating in----house house house house Coordinators and managing the system in hospitals.Coordinators and managing the system in hospitals.Coordinators and managing the system in hospitals.Coordinators and managing the system in hospitals.2012201220122012----2014 MOH research group form the seminar2014 MOH research group form the seminar2014 MOH research group form the seminar2014 MOH research group form the seminarCorroborators; Corroborators; Corroborators; Corroborators; Japan Emergency Medicine SocietyJapan Emergency Medicine SocietyJapan Emergency Medicine SocietyJapan Emergency Medicine SocietyClinical Emergency Medicine Society of JapanClinical Emergency Medicine Society of JapanClinical Emergency Medicine Society of JapanClinical Emergency Medicine Society of JapanJapan Neurological Medicine SocietyJapan Neurological Medicine SocietyJapan Neurological Medicine SocietyJapan Neurological Medicine SocietyEmergency Nurse SocietyEmergency Nurse SocietyEmergency Nurse SocietyEmergency Nurse SocietyJapan Organ Transplant Japan Organ Transplant Japan Organ Transplant Japan Organ Transplant NetworkNetworkNetworkNetwork4 days seminar; 4 days seminar; 4 days seminar; 4 days seminar; TPM Japan, National Committee to support individual hospitalTPM Japan, National Committee to support individual hospitalTPM Japan, National Committee to support individual hospitalTPM Japan, National Committee to support individual hospital
Education of Hospital Management Education of Hospital Management Education of Hospital Management Education of Hospital Management Education of Hospital Management Education of Hospital Management Education of Hospital Management Education of Hospital Management
May 16, 2012 第25回日本脳死脳蘇生学会 シンポジウム
Quality Management SeminarQuality Management SeminarQuality Management SeminarQuality Management SeminarQuality Management SeminarQuality Management SeminarQuality Management SeminarQuality Management Seminar
May 16, 2012 第25回日本脳死脳蘇生学会 シンポジウム
Quality Management SeminarQuality Management SeminarQuality Management SeminarQuality Management SeminarQuality Management SeminarQuality Management SeminarQuality Management SeminarQuality Management Seminar
May 16, 2012 第25回日本脳死脳蘇生学会 シンポジウム2222
ndndndndSeminar 2013Seminar 2013Seminar 2013Seminar 20132222
ndndndndSeminar 2013Seminar 2013Seminar 2013Seminar 2013
03/02/2015
5
May 16, 2012 第25回日本脳死脳蘇生学会 シンポジウム
2222
ndndndndSeminar 2013Seminar 2013Seminar 2013Seminar 20132222
ndndndndSeminar 2013Seminar 2013Seminar 2013Seminar 2013
May 16, 2012 第25回日本脳死脳蘇生学会 シンポジウム2222
ndndndndSeminar 2013Seminar 2013Seminar 2013Seminar 20132222
ndndndndSeminar 2013Seminar 2013Seminar 2013Seminar 2013
Education of InEducation of InEducation of InEducation of In----house Coordinatorhouse Coordinatorhouse Coordinatorhouse CoordinatorEducation of InEducation of InEducation of InEducation of In----house Coordinatorhouse Coordinatorhouse Coordinatorhouse Coordinator
TPM Japan seminar 2013TPM Japan seminar 2013TPM Japan seminar 2013TPM Japan seminar 2013TPM Japan seminar 2013TPM Japan seminar 2013TPM Japan seminar 2013TPM Japan seminar 2013
NeedsNeedsNeedsNeeds forforforfor ProfessionalProfessionalProfessionalProfessional EducationEducationEducationEducationNeedsNeedsNeedsNeeds forforforfor ProfessionalProfessionalProfessionalProfessional EducationEducationEducationEducation
Medical Staff
Attitudes towards donation: all CCU staff
92%
84%92%
52%
70%69%
35%
45%
14% 11%
0
20
40
60
80
100
'supportdonation, in
general'
'would donateown organs'
'would donateadult relative's
organs'
'would donatechild's organs'
'donation helpsfamilies coping
with grief'
%
Europe Japan
P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001
03/02/2015
6
Confidence levels -all CCU staff*
54%
40%
31% 31%
23%
12%7% 9% 6% 4%
0
10
20
30
40
50
'comfortinggrieving
families..'
'notifying aTC..'
'explainingbrain death..'
'introducing thesubject ofdonation..'
'askingrelatives to
make adecision..'
%
Europe Japan
P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001
*with exclusion of those not involved in donation related tasks
Received specific training -all CCU staff
26%
21%
16%
10%
5% 3%
2% 2%
0
5
10
15
20
25
brain death donormanagement
family griefcounseling
making donationrequest
%
Europe Japan
P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001
69.3
8
22.7
11.6
30.6
57.8
0
10
20
30
40
50
60
70
% yes % no % don't know, noanswer
%
Europe Japan
“Donation helps families coping with grief”
Presented at 3rd International DA meeting (5th Sep. 2004/ Vienna)
30% of people don’t believedonation helps families coping with grief
Medical Staff
NeedsNeedsNeedsNeeds forforforfor ProfessionalProfessionalProfessionalProfessional EducationEducationEducationEducationNeedsNeedsNeedsNeeds forforforfor ProfessionalProfessionalProfessionalProfessional EducationEducationEducationEducation
Transplant Coordinators
Transplant CoordinatorTheir human skills and donation rate
Consent rate on Routine Referral System (RRS)
Co # IC # Cons. # Cons. Rate
1 762 114 15.0 %
2 28 7 25.0 %
3 806 113 14.7 %
4 485 36 7.4 %
5 110 7 6.4 %
ABCDE-20-20-20-20000020202020404040406060606080808080100100100100120120120120140140140140160160160160 140-160
120-140
100-120
80-100
60-80
40-60
20-40
0-20
-20-0
Human skillsScores of Recognition factors
03/02/2015
7
Scores for high consent rate staff
A
0
20
40
60
80
100
120
140
160
A
B
C
Ave.1
Scores and average for low consent rate staff
0
20
40
60
80
100
120
140
160 D
E
Ave.2
New Project from 2014New Project from 2014New Project from 2014New Project from 2014New Project from 2014New Project from 2014New Project from 2014New Project from 2014Major Change in itemsMajor Change in itemsMajor Change in itemsMajor Change in itemsActivity fund for each pref. Co was cutActivity fund for each pref. Co was cutActivity fund for each pref. Co was cutActivity fund for each pref. Co was cutNew project fund for New project fund for New project fund for New project fund for ・・・・ Prefectural committee forPrefectural committee forPrefectural committee forPrefectural committee for1111) supervise prefecture activities) supervise prefecture activities) supervise prefecture activities) supervise prefecture activities2222) local PR ) local PR ) local PR ) local PR ・・・・ Individual Hospital developmentIndividual Hospital developmentIndividual Hospital developmentIndividual Hospital development
Japan Organ Transplant NetworkJapan Organ Transplant Network
Japan Organ Transplant Network
Executive Director; Naoshi Shinozaki
Japan Organ Transplant Network
Feb. 6, 2014
2014 Business plan
Prefectural Promotion Committee and In house system establishement
Japan Organ Transplant NetworkJapan Organ Transplant Network
Promotion of pref. activities
• Each pref. committee will supervise multiple authorized donating institution
• Local government, Pref. Co. Kidney Bank, eye bank, Volunteer groups will link public and hospitals.
• Data collection with Uniform platform for target hospitals and JOT will manage the data to make action plans with medical societies.
Japan Organ Transplant NetworkJapan Organ Transplant Network
Sharma of Pref. promotion
JOT branch JOTbranch JOTbranch
JOT HQ
Pref. Co
KB Co EB Co
Local gov.
In-house com. In-house com.
Branch Co.
Volunteers
In-house Co
03/02/2015
8
Japan Organ Transplant NetworkJapan Organ Transplant Network
Pref. Committee model
JOT HQ
JOT branch
Public Education
Hospital Education
Local Gov.
Kidney Bank
Pref. Co
Eye Bank
Eye Bank Co
Volunteer
Local Gov.
Pref. Co
Kidney Bank
Bank Co.
In-house Co
Tx. Support office
Local PR
Official
Institute
Evants
Hospital
Information
In ward
patients infor.
Donor detection
Donor
management
Japan Organ Transplant NetworkJapan Organ Transplant Network
Transplant Services Support Project
JOT HQ JOT branches
Pref. Organ Transplant PromotionPublic education
Local action plan and monitoring the action
Cooperation with local government, the team will produce effective PR
Periodic committee for evaluation
Plan the events and do
With the Volunteer group, public education will be planed and monitor
Pref. Team
Japan Organ Transplant NetworkJapan Organ Transplant Network
Produce Action Plan for hospital development in Pref.
Hospital and potential donor information will be collected in uniform format and
install the donor detection system for each hospitals
Routine meetings by the team to;
1. Update the hospital information and process of hospital development2. Identify the milestone for each step and monitor
3. Evaluating the patients flow in hospital and make action plan
Transplant Services Support Project
Pref. Organ Transplant PromotionPublic education
JOT HQ JOT branches
Pref. Team
Japan Organ Transplant NetworkJapan Organ Transplant Network
Hospital Development Program
• JOT HQ produce the uniform platform for data base on patients flow in hospitals. Local member will work together with JOT HQ & branch to furnish in-house system.
• Each institute will use uniform platform, but detection and/or management could be tailor-made.
• Each institute must be evaluated their activities by local committee in statistical manner.
Japan Organ Transplant NetworkJapan Organ Transplant Network
Pref. Co
In-house Co
Emergency
Tx support
office
Boards
Admin.
Nurse dep.
・ system audit・ will check at patients admission・ manuals for severe patients・Quality Management seminar・ Donor Action & TPM Japan・ Brain Deaths tests simulation・ setting-up Tx support office in hsp.・ manual for ICU round・ RRS install・ setting up committee and stair
ICU・CCU
Hospital Development Program
JOT branch JOTbranch JOTbranch
JOT HQ
Uniform formattingUniform formattingUniform formattingUniform formattingUniform formattingUniform formattingUniform formattingUniform formatting
03/02/2015
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49
北多摩北部北多摩北部北多摩北部北多摩北部北多摩南部北多摩南部北多摩南部北多摩南部
北多摩西部北多摩西部北多摩西部北多摩西部南多摩南多摩南多摩南多摩
西多摩西多摩西多摩西多摩区東部区東部区東部区東部
東葛北部東葛北部東葛北部東葛北部東葛南部東葛南部東葛南部東葛南部区東北部区東北部区東北部区東北部区区区区西西西西北部北部北部北部区区区区西南西南西南西南部部部部
区区区区西西西西部部部部区区区区中央中央中央中央部部部部区区区区南南南南部部部部
General Hospital (>200 beds)
3
8
6 7
8
12 13 13
10
20
6
9
16
11 平均:10.1
0
5
10
15
20
25
Univ. Hospital
0
3
0 0
2
4
3 3
4
12
2
1
3
2
平均:2.8
0
2
4
6
8
10
12
14
Emergency & Trauma Center
1
2
1 1
3
2 2 2 2
4
1 1
2
1
平均:1.8
0
1
2
3
4
5
Cancer Center
1 1
0 0
2 2
1 1
2
6
0 0
3 3平均:1.6
0
1
2
3
4
5
6
7
54
03/02/2015
10
55
56
57
過去過去過去過去のののの提供数提供数提供数提供数などのなどのなどのなどの実績実績実績実績病院基本情報病院基本情報病院基本情報病院基本情報病院特化情報病院特化情報病院特化情報病院特化情報
58
59
Electric registry for Kidney Transplant
Sample view
Electric registry for Kidney Transplant
Sample view Sept. 2008
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11
Japan Renal Transplantation Registry System (JARTRE)
Registry forms(donor・recipient)
03/02/2015
12
Follow-up registry(for recipients)
Follow-up registry(for Living donor)
03/02/2015
13
MOH research group
2007 – 2009 “Promotion of Social Infrastructure for Organ Transplant” suggested the transparency & registry system of OTC.
2009 – 2011 “1st phase” of Takahara group started kidney transplant registry by web system.
2011 – 2013 “2nd phase” of Takahara group finalize the registry system for ALL organ transplant
Keys to the success of global systemKeys to the success of global systemKeys to the success of global systemKeys to the success of global systemKeys to the success of global systemKeys to the success of global systemKeys to the success of global systemKeys to the success of global system• WHO leadership with TTS• Uniform system on OTC and any medical products of human origin • Corroboration between societies and entities• Clear & simple rules of data input• Global agreement of use & analyze data• Authorization & support from the Health authoritiesGlobal coding systemGlobal coding systemGlobal coding systemGlobal coding systemGlobal coding systemGlobal coding systemGlobal coding systemGlobal coding systemwwwwill provideill provideill provideill provide1.1.1.1. pppprohibition of unethical donation and rohibition of unethical donation and rohibition of unethical donation and rohibition of unethical donation and transplantationtransplantationtransplantationtransplantation2.2.2.2. bbbbest practice on transplantation est practice on transplantation est practice on transplantation est practice on transplantation 3.3.3.3. Safe guards for transplantation with Safe guards for transplantation with Safe guards for transplantation with Safe guards for transplantation with realrealrealreal----time traceability time traceability time traceability time traceability
Thank you Thank you Thank you Thank you Thank you Thank you Thank you Thank you • For more informationNaoshi [email protected]
03/02/2015
1
Service Delivery and Safety4
Service Delivery and Safety5
Kidney Liver Heart Lung Pancreas
77818 23986 5935 4359 2423
2012 GKT/ GODT
Global Observatory on Donation and Transplantation
Organs Transplanted Globally in 2012Global Observatory on Donation and Transplantation
Organs Transplanted Globally in 2012
≈ 114,690 organs transplanted(≈ 10% of estimated global needs)
≈ 1.81 % increase over 2011
109 countries reported to the Global Observatory on Organ Donation and Transplantation
South Africa, India and China - are 2010 estimates
Transplants & Waiting List in the EU, 2012(Newsletter Transplant, 2013)
TRANSPLANTS W.L.
19.085 50.397
6.973 6.603
2.143 3.273
1.756 2.005
--------------------------------------
29.957 62.278TOTAL
For many, the waiting continues
…more than 3.773 patients died
while wating to be transplanted
in 2012
Newsletter Transplant 2013 http://www.ont.es/publicaciones/Documents/NEWSLETTER2013.pdf
03/02/2015
2
Service Delivery and Safety7
Service Delivery and Safety8
Service Delivery and Safety9
Service Delivery and Safety10
Service Delivery and Safety11
2012 GKT/ GODT
Global Observatory on Donation and Transplantation
Organs Transplanted Globally in 2012Global Observatory on Donation and Transplantation
Organs Transplanted Globally in 2012
≈ 114,690 organs transplanted(≈ 10% of estimated global needs)
109 countries reported to the Global Observatory on Organ Donation and Transplantation
South Africa, India and China - are 2010 estimates
Kidney Liver Heart Lung Pancreas
77818 23986 5935 4359 2423
Service Delivery and Safety12
2012 GKT/ GODT
Global Observatory on Donation and Transplantation
Organs Transplanted Globally in 2012Global Observatory on Donation and Transplantation
Organs Transplanted Globally in 2012
≈ 114,690 organs transplanted(≈ 10% of estimated global needs)
109 countries reported to the Global Observatory on Organ Donation and Transplantation
South Africa, India and China - are 2010 estimates
Kidney Liver Heart Lung Pancreas
77818 23986 5935 4359 2423
Living Donor
32350
Living Donor
4222
42,5% 17,8%
03/02/2015
3
Service Delivery and Safety13
Service Delivery and Safety14
Risks of living donations
Service Delivery and Safety15
Service Delivery and Safety16
� Reduction in waiting time 22 vs 344 days
� Better outcomes
� Reduction in mortality (HC)
Lo CM, Fan ST, Liu CL, Chan SC, Ng IO, Wong J.
Living donor versus deceased donor liver transplantation for early irresectable hepatocellular carcinoma.
Br. J. Surg. 2007; 94: 78–86.
� Shorter Cold Ischemic times
Shaked A, Ghobrial RM, Merion RM et al.
Incidence and severity of acute cellular rejection in recipients undergoing adult living donor or deceased
donor liver transplantation.
Am. J. Transplant. 2009; 9:301–8.
< ACR and Graft loss
Service Delivery and Safety17
Service Delivery and Safety18
03/02/2015
4
Service Delivery and Safety19
Service Delivery and Safety20
Complications of Living Donor Hepatic LobectomyM. M. Abecassis, R. A. Fisher, K. M. Olthoff, C. E. Freise, D. R. Rodrigo, B. Samstein, I. Kam, R. M. Merion, the A2ALL Study Group
American Journal of Transplantation, 12: 1208–1217. doi: 10.1111/j.1600-6143.2011.03972.x
Complications of Living Donor Hepatic LobectomyM. M. Abecassis, R. A. Fisher, K. M. Olthoff, C. E. Freise, D. R. Rodrigo, B. Samstein, I. Kam, R. M. Merion, the A2ALL Study Group
American Journal of Transplantation, 12: 1208–1217. doi: 10.1111/j.1600-6143.2011.03972.x
� 760 living donors A2ALL cohort study Donor morbidity assessed over a 12-year period
� 20 procedures aborted - 740 completed
� 40% had complications (557 complications among 296 donors),
• grade 1 (minor, n = 232)
• grade 2 (possibly life-threatening, n = 269)
• grade 3 (residual disability, n = 5)
• grade 4 (leading to death, n = 3)
� Hernias (7%) and psychological complications (3%) occurred >1 year postdonation.
� Complications risk did not decline with the increased center experience with LLD.
� The probability of complication resolution within 1 year was overall 95%, but only 75% for
hernias and 42% for psychological complications
Service Delivery and Safety21
It has been estimated that early and delayed death fromtransplant-related causes can be expected of approximately
one in every 200–500 right lobe donors, with permanentdisability of a significant number of others.
Service Delivery and Safety22
Service Delivery and Safety23
Chain Donation Following Good Samaritan http://www.nytimes.com/2012/02/19/health/lives-forever-linked-through-kidney-transplant-chain-124.html?_r=2&nl=todaysheadlines&emc=tha2
February 2012
Chain Donation Following Good Samaritan http://www.nytimes.com/2012/02/19/health/lives-forever-linked-through-kidney-transplant-chain-124.html?_r=2&nl=todaysheadlines&emc=tha2
February 2012
Service Delivery and Safety24
Safety of the Living Donorhttp://www.nypost.com/p/news/local/bronx/montefiore_transplant_nightmare_PVO4SBjhXjgX3LGynvMRbJ?utm_medium=rss&utm_content=Bronx
6 June 2012
Safety of the Living Donorhttp://www.nypost.com/p/news/local/bronx/montefiore_transplant_nightmare_PVO4SBjhXjgX3LGynvMRbJ?utm_medium=rss&utm_content=Bronx
6 June 2012
03/02/2015
5
Service Delivery and Safety25
Service Delivery and Safety26
Service Delivery and Safety27
Kidney Liver Heart Lung Pancreas
76118 23721 5741 4278 2564
Living Donor
32350
Living Donor
4222
42,5% 17,8%
2008 GKT/ GODT
≈ 112,600 organs transplanted(≈ 10% of estimated global needs)
103 countries reported to the Global Observatory on Organ Donation and Transplantation
South Africa, India and China - are 2010 estimates
Global Observatory on Donation and Transplantation
Organs Transplanted Globally in 2011Global Observatory on Donation and Transplantation
Organs Transplanted Globally in 2011
Service Delivery and Safety28
Global Observatory on Donation and Transplantation
Kidneys Transplanted Globally 2008-11Global Observatory on Donation and Transplantation
Kidneys Transplanted Globally 2008-11
64000
66000
68000
70000
72000
74000
76000
78000
2008 2009 2010 2011
Service Delivery and Safety29
Global Observatory on Donation and Transplantation
Kidneys Transplanted Globally 2008-11Global Observatory on Donation and Transplantation
Kidneys Transplanted Globally 2008-11
10000
15000
20000
25000
30000
35000
40000
45000
2008 2009 2010 2011
3730039303
40985
43768
3200032797
32194 32350
Year
n
DD
LD
Absolute number
Service Delivery and Safety30
Global Observatory on Donation and Transplantation
Kidneys Transplanted Globally 2008-11Global Observatory on Donation and Transplantation
Kidneys Transplanted Globally 2008-11
30
35
40
45
50
55
60
2008 2009 2010 2011
53.854.6
56.157.5
46.2 45.443.9
42.5
Year
% Percentage
DD
LD
03/02/2015
6
Service Delivery and Safety31
Global Observatory on Donation and Transplantation
Livers Transplanted Globally 2008-11Global Observatory on Donation and Transplantation
Livers Transplanted Globally 2008-11
18000
19000
20000
21000
22000
23000
24000
2008 2009 2010 2011
n
Year
Service Delivery and Safety32
Global Observatory on Donation and Transplantation
Livers Transplanted Globally 2008-11Global Observatory on Donation and Transplantation
Livers Transplanted Globally 2008-11
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
2008 2009 2010 2011
1726517896 18486
19499
3035 3279 31164222
Year
Absolute numbern
DD
LD
Service Delivery and Safety33
Global Observatory on Donation and Transplantation
Livers Transplanted Globally 2008-11Global Observatory on Donation and Transplantation
Livers Transplanted Globally 2008-11
0
10
20
30
40
50
60
70
80
90
2008 2009 2010 2011
85 84.52 85.48 82.2
15 15.48 14.4217.8
Year
Pecentage%
DD
LD
Service Delivery and Safety34
Global Observatory on Donation and Transplantation
Livers Transplanted Globally 2008-11Global Observatory on Donation and Transplantation
Livers Transplanted Globally 2008-11
8
9
10
11
12
13
14
15
16
17
18
2008 2009 2010 2011
1515.48
14.42
17.8
Living donors
Year
%
Service Delivery and Safety35
Service Delivery and Safety36
03/02/2015
7
Service Delivery and Safety37
Service Delivery and Safety38
ELIGIBLE DCDDONOR
A medically suitable person who has been
declared dead based on the irreversible absence
of circulatory and respiratory functions as
stipulated by the law of the relevant jurisdiction,
within a time frame that enables organ recovery.
POTENTIAL DBDDONOR
A person whose clinical condition is suspected to
fulfill brain death criteria.
ELIGIBLE DBDDONOR
A medically suitable person who has been
declared dead based on neurologic criteria as
stipulated by the law of the relevant jurisdiction.
Critical pathways for organ donation*
POSSIBLE DECEASED ORGAN DONORA patient with a devastating brain injury or lesion OR a patient with circulatory failure
AND apparently medically suitable for organ donation
UTILIZED DCDDONOR
An actual donor from whom at least one organ
was transplanted.
Reasons why a potential donor does not become a utilized donor
System
• Failure to identify/refer a potential or eligible donor
• Brain death diagnosis not confirmed
(e.g. does not fulfill criteria) or completed
(e.g. lack of technical resources or clinician to make diagnosis or perform confirmatory tests)
• Circulatory death not declared within the appropriate
time frame.
• Logistical problems (e.g. no recovery team)
• Lack of appropriate recipient (e.g. child, blood type, serology positive)
Donor/Organ
• Medical unsuitability (e.g. serology positive, neoplasia)
• Haemodynamic instability / unanticipated cardiac
arrest
• Anatomical, histological and/or functional
abnormalities of organs
• Organs damaged during recovery
• Inadequate perfusion of organs or thrombosis
Permission
• Expressed intent of deceased not to be donor
• Relative’s refusal of permission for organ donation
• Refusal by coroner or other judicial officer to allow
donation for forensic reasons
POTENTIAL DCD DONOR
A. A person whose circulatory and respiratory
functions have ceased and resuscitative
measures are not to be attempted or continued.
or
B. A person in whom the cessation of circulatory
and respiratory functions is anticipated to occur
within a time frame that will enable organ
recovery.
Donation after BrainDeath (DBD)Treating physician
to identify/refer a potential donor
ACTUAL DBDDONOR
A consented eligible donor:
A. In whom an operative incision was made
with the intent of organ recovery for the
purpose of transplantation.
or
B. From whom at least one organ was
recovered for the purpose of transplantation.
UTILIZED DBDDONOR
An actual donor from whom at least one organ
was transplanted.
ACTUAL DCDDONOR
A consented eligible donor:
A. In whom an operative incision was made
with the intent of organ recovery for the
purpose of transplantation.
or
B. From whom at least one organ was
recovered for the purpose of transplantation.
Donation after Circulatory Death (DCD)
*The “dead donor rule” must be respected. That is, patients may only become donors after death, and the recovery of organs must not cause a donor’s death.
40Service Delivery
Strengthening
Health Systems
and Innovation
40
Professionals Authorities
The Magnificent Seven, John Sturges,1960
Service Delivery and Safety41
Legal framework
Opting in
Opting out
Service Delivery and Safety42
Legal framework
Opting in
Opting out
Legal framework
Opting in
Opting out
Type of donor
Living
Deceased
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Service Delivery and Safety43
Legal framework
Opting in
Opting out
Type of donor
Living
Deceased
Organizational Structure
National
OPO
Service Delivery and Safety44
Service Delivery and Safety45
Participants in the Madrid Consultation urged WHO, its Member States and professionals
in the field to regard organ donation and transplantation as part of every nation’s
responsibility to meet the health needs of the population in a comprehensive manner,
addressing the conditions leading to transplantation from prevention to treatment.
Every country, in light of its own level of economic and health system development,
should progress towards the global goal of meeting patients' needs on the basis of
resources obtained within the country, for that country’s population, and through
regulated and ethical regional or international cooperation when needed.
The strategy of striving for self-sufficiency encompasses the following features: actions
should (i) begin locally; (ii) include broad public health measures both to decrease the
disease burden in a population and to increase the availability of organ transplantation;
(iii) enhance cooperation among the stakeholders involved and (iv) be carried out on the
basis of the WHO Guiding Principles and the Declaration of Istanbul, in particular
emphasizing voluntary donation, non-commercialization, maximization of donation from
the deceased, support for living kidney donation, and meeting the needs of the local
population in preference to “transplant tourists”.
Service Delivery and Safety46
Deceased donors per million population vs Human Development IndexGODT 2012
Self-Sufficiencybegins locally and isadapted to the local
reality
Croatia Spain
US
Canada
Paraguay
Uruguay
South Africa Thailand
Iran
BrasilBelarus
Service Delivery and Safety47
EVERY COUNTRY SHOULD MAKE A DIAGNOSIS
OF ITS SITUATION AND FIND THE MOST ADEQUATE WAY
TOWARDS SELF - SUFFICIENCY
WELL PROVEN SUCCESSFUL MODELS
(BIG AREAS – SUSTAINED INCREASE)
MAY BE TAKEN AS A REFERENCE
…THERE IS NO UNIQUE FORMULA
Delmonico FL, Domínguez-Gil B et al. Lancet 2011
Service Delivery and Safety48
COORDINATION
NETWORK
SPECIAL PROFILE
INSIDE THE HOSPITALS
BRAIN DEATH AUDIT
HOSPITAL REIMBURSEMENT
TRAINING OF PROFESSIONALS
ATENTION TO THE MEDIA
03/02/2015
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Service Delivery and Safety49
Actual donors from deceased persons, 2012
Service Delivery and Safety50
22409
22905
24280
25776
26523
20000
21000
22000
23000
24000
25000
26000
27000
2008 2009 2010 2011 2012
DECEASED DONORS (ABSOLUTE NUMBERS)
VARIATION BETWEEN 2008 AND 2012 = 18.4 %
Service Delivery and Safety51
3.66
18.5
0.48
12.1
9.71
15.28
13.04
4.48
3.33
11.21
6.67
1.26
7.2
18.86
1.7
2.81
3.06
2.12
1.82
0.76
4.63
23.5
0.61
15.46
12.42
20
17.27
6.21
4.68
16.06
10
1.95
12.35
34.77
3.62
6.98
9.44
7.46
6.67
3.16
0 5 10 15 20 25 30 35 40
Turkey
Slovenia
Malaysia
Australia
Lithuania
Finland
Latvia
Kuwait
Venezuela (Bolivarian Republic of)
Poland
Iceland
Thailand
Brazil
Croatia
Ecuador
Iran (Islamic Republic of)
Republic of Korea
Paraguay
Panama
PeruDDPMP2012 DDPMP2008
DECEASED DONORS PMP: YEARS 2008 AND 2012COUNTRIES WITH THE BIGGEST INCREASE
Service Delivery and Safety52
“ To improve is to change;
to be perfect is to change often ”
Winston Churchill
53Service Delivery
Strengthening
Health Systems
and Innovation
Thank you
http://www.who.int/transplantation/en/