Disclosure DONATION IN KOREA What we learned from neighbor - PDF document

9/4/2018 ACTIVATION OF ORGAN Disclosure DONATION IN KOREA What we learned from neighbor countries and what we do now • I HAVE NO RELEVANT FINANCIAL RELATIONSHIPS WITH ANY COMPANIES RELATED TO THE CONTENT OF THIS COURSE WON-HYUN CHO, MD President, Korea Organ Donation Agency (KODA) Emeritus professor, Keimyung University School of Medicine, Korea UCSF transplant 2018 UCSF transplant 2018 09/20/2018 09/20/2018 1 1 UCSF transplant 2018 09/20/2018 2 History of Organ Transplantation in Korea Deceased and living donor pmp and transplantation of Korea 1999: 2009: Vitallink 2011: KODA Transplantation law 1993: KMA 2016: Deceased D PMP 2010: Revised guideline 2000: KONOS for BD Law & 2017: New KODA 2005 2013 2016 KoDoNet 출범 1991: NGOs for organ 2003:HOPO 1995: Brain Death Promotion activity 2008: 11.2 Total population (million) 48.7 49.3 50.1 Seoul Declaration 10.1 Istabbul 5.8 Decaration 7.2 No. of Deceased D 91 416 573 5.3 3.4 2010 Donation rate / pmp 1.87 8.43 11.2 2000 No. of TPX from DD 285 1,364 1,888 LDKT: living donor Kidney TPL 1988 DDKT: deceased donor KT TPX rate / pmp 5.85 27.7 37.7 2001:DDBT DDLT: Deceased donor Liver TPL 1969 LDLT: Living donor LT 1992:DDPT 1992:DDHT DDHT: Deceased donor heart T No. of TPX from LD 1,270 1,834 2.143 2002: (1) 2:1 LDLT DDPT: Deceased donor pancreas T 1994: LDLT, (2) Sen KT DDLungT: Deceased donor lung T multiorgan TPX rate / pmp DDBT: Deceased donor bowel T 26.1 37.2 42.8 TPL 1999: Islet cell TPL Sen KT: KT between sensitized D & R 1979:DDKT 2007: Laparoscopic 1996: donor hepatectomy 1969:LDKT DDLungT 1988:DDLT 09/20/2018 UCSF transplant 2018 4 UCSF transplant 2018 09/20/2018 3 1

9/4/2018 1 Annual number of deceased donor, 1996-2017 What we focused at each period (case) 1500 . Living DT in 2017 : 2,272 . Before legislation After legislation Reform the law . Deceased DT in 2017: 1,693 (2000-2009) (2010 ~) (~2000) 600 573 550  Living donor TPL 501  KONOS for waiting 500 01 515  Possibility of trade  Required reporting 446 list, allocation & Before legislation 450 416  Deceased donor TPL 03 campaign (Vitallink system 409 Organ procure pmp >2.8 400 02 under guideline of and NGOs)  IOPO system 368 350  OPO & HOPO system  Data registry KMA The introduction of Revised National Transplant Act  Organ trade illegal 300 organ donation system IOPO system & 250 Required reporting system • Need transplant act To Neighboring country 268 256 261 • Living donor safety after • Need nationwide • Organ and tissue 200 Legislation donation waiting list procurement 162 • 150 Increasing transplant 148 141 • Need allocation center • Assist legislation Revision of law tourism 100 • Need to prohibit organ • Assist national transplant 91 from Living to Deceased 68 trade framework 50 66 36 • Need public campaign 52 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 09/20/2018 5 UCSF transplant 2018 UCSF transplant 2018 09/20/2018 6 1 Problems before 2000 1 Problems before 2000 As deceased donor and waiting list increased , EVOLVING ORGAN TRADE Individual trade (~’80) Systemized trade (~‘90) Low income Web based trade (~2000) individual Under ground Oversea trade organization Inter-countries (domestic) (Neighboring Global Personal countries) problem Social National Global Need coordination and cooperation UCSF transplant 2018 09/20/2018 8 UCSF transplant 2018 09/20/2018 7 2

9/4/2018 1 Problems before 2000 1 Problems before 2000 NEED BLUE PRINT • Need transplant act Poor communication between • Need nationwide transplant centers cause to increase discard Rate of the procured organs !!! waiting list • Need allocation center • Need to prohibit organ trade Need Recipient and Donor • Need public campaign Registry Nationwide !! Necessity of Nationwide organ Legislation of transplant act in 2000 sharing and procurement system ; Organ donation & transplantation Reported on Newspaper, late 1990’ Management system is urgent ! UCSF transplant 2018 09/20/2018 9 UCSF transplant 2018 09/20/2018 10 National & Academic society 2 What we focused at each period We built national system & infrastructure for DD transplantation 2.1 um brella Before legislation After legislation Reform the law of transplantation (~2000) (2000-2009) (2010 ~) Law  Living donor TPL  KONOS for waiting  Possibility of trade list, allocation &  Required reporting Regulation & coordination Data registry & quality (KOTRY)  Deceased donor TPL campaign (Vitallink system under guideline of and NGOs)  IOPO system System of shared responsibilities KMA  OPO & HOPO system  Data registry  Organ trade illegal • Need transplant act • Living donor care after To Neighboring country • Need nationwide • donation Organ and tissue waiting list • Increasing transplant procurement • Need allocation center tourism • Assist legislation • Need to prohibit organ from Living to Deceased • Assist national transplant Organ Procurem ent Allocation Transplantation trade • Public awareness framework ( Transplant center) • Need public campaign OPO ( KODA) ( KONOS) Efforts to activate organ donation (NGOs) UCSF transplant 2018 09/20/2018 11 UCSF transplant 2018 09/20/2018 12 3

9/4/2018 2.2 For public awareness about organ transplantation and donation : translation 2.2 For public awareness about organ transplantation and donation Also to medical professionals, government, congress people 1991. Lee Gutkind 2015. Reg Green 1997. Ota Kazuo, 2013. Organ donation, 2014. Understanding organ 2011. Vitallink Many sleepless nights Nicholas effect Tokyo Women University Opportunities for action ; donation. Understanding whole process Hospital Committee on increasing rate Applied behavioral science of organ donation of organ donation perspectives UCSF transplant 2018 09/20/2018 14 UCSF transplant 2018 09/20/2018 13 World Transplant Games for public awareness 2.2 For public awareness : campaigning 2.2 2011. Gotebory, Sweden Ambassador, Congressman & Actor Rotarian congress Donor sound Korea Transplant Games UCSF transplant 2018 09/20/2018 15 UCSF transplant 2018 09/20/2018 16 4

9/4/2018 2.3 For establishing national structures such as OPO and KONOS For legislation of transplant law : Living donor safety 2.4 DONOR SAFETY AND CARE AFTER ORGAN DONATION For Establishing OPO UCSF transplant 2018 09/20/2018 17 UCSF transplant 2018 09/20/2018 18 3 Another obstacle we had experienced were… 3.1 Revision of transplant law : IOPO / Required reporting system / Data registry Before legislation After legislation Reform the law (~2000) (2000-2009) (2010 ~)  Living donor TPL  KONOS for waiting For more donation  Possibility of trade list, allocation &  Required reporting  Deceased donor TPL campaign (Vitallink system under guideline of and NGOs)  IOPO system KMA  OPO & HOPO system  Data registry  Organ trade illegal • Need transplant act • Living donor safety To Neighboring country • Need nationwide • Organ and tissue after donation waiting list procurement • Increasing oversea • Need allocation center • Assist legislation transplantation • Need to prohibit organ • Assist national transplant • Public awareness trade framework • Need public campaign UCSF transplant 2018 09/20/2018 20 UCSF transplant 2018 09/20/2018 19 5

9/4/2018 3.2 Establishing Independent OPO (KODA) 3.3 Campaign to change the culture Established Independent OPO (KODA) FUNERAL CULTURE 2011. 6. 27 Rate of Cremation : from 30 to 80 % Non-profit, professional, ethical, NGO Also increase donation number ! UCSF transplant 2018 09/20/2018 21 UCSF transplant 2018 09/20/2018 22 Positive effect of revised law and negative effect by ? 3.4 To increase public awareness and realization 4 (case) 1500 . DONOR CARD IN KOREA 03 . To Neighbor country . 600 • Organ and tissue Revised National 573 But still 3% of total population Transplant Act 550 procurement OPO system 501 • Assist legislation 500 515 446 • Assist national 450 416 409 transplant framework 400 02 368 01 350 Before legislation The introduction of 04 300 organ donation system 250 268 261 • Merging between organ & tissue OPOs 256 200 • Decreasing donor number 162 • Attitude of procure team 150 148 141 • Change of brain death cause 100 91 • New breakthrough 68 50 66 36 52 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 UCSF transplant 2018 09/20/2018 23 UCSF transplant 2018 09/20/2018 24 6