china strongly support and follow the current …2015/2/3 1 current achievements and plans in china...

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)


(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:____


WAITING LIST

Number of patients with (ESRD) on dialysis

treatment:_309,946______

03/02/2015

2


(data for 2013)


(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:______


- Number of resident living donors, known to have

travelled abroad to donate:____


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


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


03/02/2015

5


2222



May 16, 2012 第25回日本脳死脳蘇生学会シンポジウム2222



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


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.


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


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


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


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


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.


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

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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


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






2012 GKT/ GODT








77818 23986 5935 4359 2423


2012 GKT/ GODT








77818 23986 5935 4359 2423

Living Donor

32350

Living Donor

4222

42,5% 17,8%

03/02/2015

3



Risks of living donations



� 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



03/02/2015

4



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


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.



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


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





76118 23721 5741 4278 2564

Living Donor

32350

Living Donor

4222

42,5% 17,8%

2008 GKT/ GODT









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





10000

15000

20000

25000

30000

35000

40000

45000

2008 2009 2010 2011

3730039303

40985

43768

3200032797

32194 32350

Year

n

DD

LD

Absolute number





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



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





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





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





8

9

10

11

12

13

14

15

16

17

18

2008 2009 2010 2011

1515.48

14.42

17.8

Living donors

Year

%



03/02/2015

7



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


Legal framework

Opting in

Opting out


Legal framework

Opting in

Opting out

Legal framework

Opting in

Opting out

Type of donor

Living

Deceased

03/02/2015

8


Legal framework

Opting in

Opting out

Type of donor

Living

Deceased

Organizational Structure

National

OPO



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”.


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


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


COORDINATION

NETWORK

SPECIAL PROFILE

INSIDE THE HOSPITALS

BRAIN DEATH AUDIT

HOSPITAL REIMBURSEMENT

TRAINING OF PROFESSIONALS

ATENTION TO THE MEDIA

03/02/2015

9


Actual donors from deceased persons, 2012


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 %


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


“ To improve is to change;

to be perfect is to change often ”

Winston Churchill

53Service Delivery

Strengthening

Health Systems

and Innovation

Thank you

[email protected]

[email protected]

http://www.who.int/transplantation/en/