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

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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

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9/4/2018 1 ACTIVATION OF ORGAN DONATION IN KOREA

What we learned from neighbor countries and what we do now

WON-HYUN CHO, MD

President, Korea Organ Donation Agency (KODA) Emeritus professor, Keimyung University School of Medicine, Korea

09/20/2018 UCSF transplant 2018 1 09/20/2018 UCSF transplant 2018 1

Disclosure

  • I HAVE NO RELEVANT FINANCIAL RELATIONSHIPS

WITH ANY COMPANIES RELATED TO THE CONTENT OF THIS COURSE

09/20/2018 UCSF transplant 2018 2 1969:LDKT 1979:DDKT 1988:DDLT 1992:DDPT 1992:DDHT 1994: LDLT, multiorgan TPL 1996: DDLungT 2001:DDBT 2002: (1) 2:1 LDLT (2) Sen KT 2007: Laparoscopic donor hepatectomy 1991: NGOs for organ Promotion activity 1993: KMA guideline for BD 1995: Brain Death Seoul Declaration 1999: Transplantation law 2000: KONOS 2003:HOPO 2010: Revised Law & KoDoNet 출범 2011: KODA 1999: Islet cell TPL 2009: Vitallink

5.8 11.2

2016: Deceased D PMP LDKT: living donor Kidney TPL DDKT: deceased donor KT DDLT: Deceased donor Liver TPL LDLT: Living donor LT DDHT: Deceased donor heart T DDPT: Deceased donor pancreas T DDLungT: Deceased donor lung T DDBT: Deceased donor bowel T Sen KT: KT between sensitized D & R 2008: Istabbul Decaration

History of Organ Transplantation in Korea

5.3 3.4

09/20/2018 UCSF transplant 2018 3

7.2 10.1

2017: New KODA

2000 2010 1969 1988

Deceased and living donor pmp and transplantation of Korea

2005 2013 2016

Total population (million) 48.7 49.3 50.1

  • No. of Deceased D

91 416 573 Donation rate / pmp 1.87 8.43 11.2

  • No. of TPX from DD

285 1,364 1,888 TPX rate / pmp 5.85 27.7 37.7

  • No. of TPX from LD

1,270 1,834 2.143 TPX rate / pmp 26.1 37.2 42.8

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. . .

(case)

50 100 150 250 400 200 300 350 450 500 1500 66 162 52 36 68 91 141 148 256 261 268 368 409 416 446 501 573 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 550 600

01 Before legislation

Organ procure pmp >2.8

02

The introduction of

  • rgan donation system

03

Revised National Transplant Act IOPO system & Required reporting system

2017

515

Annual number of deceased donor, 1996-2017

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Living DT in 2017 : 2,272 Deceased DT in 2017: 1,693

Legislation Revision of law

 Living donor TPL  Possibility of trade  Deceased donor TPL under guideline of KMA

 KONOS for waiting list, allocation & campaign (Vitallink and NGOs)  OPO & HOPO system  Organ trade illegal Before legislation (~2000) After legislation (2000-2009)  Required reporting system  IOPO system  Data registry Reform the law (2010 ~) To Neighboring country

  • Organ and tissue

procurement

  • Assist legislation
  • Assist national transplant

framework

  • Living donor safety after

donation

  • Increasing transplant

tourism from Living to Deceased

  • Need transplant act
  • Need nationwide

waiting list

  • Need allocation center
  • Need to prohibit organ

trade

  • Need public campaign

09/20/2018 UCSF transplant 2018 6

What we focused at each period

1

Need coordination and cooperation

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As deceased donor and waiting list increased,

Problems before 2000 1

EVOLVING ORGAN TRADE

Individual trade (~’80)

Low income individual Personal

Systemized trade (~‘90)

Under ground

  • rganization

(domestic) Social

Web based trade (~2000)

Inter-countries (Neighboring countries) National

Oversea trade

Global problem Global

09/20/2018 UCSF transplant 2018 8

Problems before 2000 1

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Organ donation & transplantation Management system is urgent ! Need Recipient and Donor Registry Nationwide !! Poor communication between transplant centers cause to increase discard Rate of the procured organs !!! Necessity of Nationwide organ sharing and procurement system ; Reported on Newspaper, late 1990’

09/20/2018 UCSF transplant 2018 9

Problems before 2000 1

NEED BLUE PRINT

09/20/2018 UCSF transplant 2018 10

Problems before 2000 1

Legislation of transplant act in 2000

  • Need transplant act
  • Need nationwide

waiting list

  • Need allocation center
  • Need to prohibit organ

trade

  • Need public campaign

 Living donor TPL  Possibility of trade  Deceased donor TPL under guideline of KMA  KONOS for waiting list, allocation & campaign (Vitallink and NGOs)  OPO & HOPO system  Organ trade illegal Before legislation (~2000) After legislation (2000-2009)  Required reporting system  IOPO system  Data registry Reform the law (2010 ~) To Neighboring country

  • Organ and tissue

procurement

  • Assist legislation
  • Assist national transplant

framework

  • Living donor care after

donation

  • Increasing transplant

tourism from Living to Deceased

  • Public awareness
  • Need transplant act
  • Need nationwide

waiting list

  • Need allocation center
  • Need to prohibit organ

trade

  • Need public campaign

09/20/2018 UCSF transplant 2018 11

What we focused at each period

2 Organ Procurem ent OPO ( KODA)

System of shared responsibilities

Allocation ( KONOS) Transplantation ( Transplant center)

um brella

  • f transplantation

Law Efforts to activate organ donation (NGOs)

Regulation & coordination Data registry & quality (KOTRY)

National & Academic society

We built national system & infrastructure for DD transplantation

09/20/2018 UCSF transplant 2018 12

2.1

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For public awareness about organ transplantation and donation : translation

  • 1991. Lee Gutkind

Many sleepless nights

  • 2015. Reg Green

Nicholas effect

2.2

  • 2013. Organ donation,

Opportunities for action ; Committee on increasing rate

  • f organ donation

09/20/2018 UCSF transplant 2018 14

For public awareness about organ transplantation and donation Also to medical professionals, government, congress people

  • 1997. Ota Kazuo,

Tokyo Women University Hospital

  • 2014. Understanding organ

donation. Applied behavioral science perspectives

  • 2011. Vitallink

Understanding whole process

  • f organ donation

2.2

World Transplant Games for public awareness

  • 2011. Gotebory, Sweden

Korea Transplant Games

09/20/2018 15

2.2

UCSF transplant 2018

Ambassador, Congressman & Actor

09/20/2018 UCSF transplant 2018 16

For public awareness : campaigning

Rotarian congress Donor sound

2.2

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For Establishing OPO

09/20/2018 UCSF transplant 2018 17

For establishing national structures such as OPO and KONOS

2.3

DONOR SAFETY AND CARE AFTER ORGAN DONATION

09/20/2018 UCSF transplant 2018 18

For legislation of transplant law : Living donor safety

2.4  Living donor TPL  Possibility of trade  Deceased donor TPL under guideline of KMA  KONOS for waiting list, allocation & campaign (Vitallink and NGOs)  OPO & HOPO system  Organ trade illegal Before legislation (~2000) After legislation (2000-2009)

For more donation  Required reporting system  IOPO system  Data registry

Reform the law (2010 ~) To Neighboring country

  • Organ and tissue

procurement

  • Assist legislation
  • Assist national transplant

framework

  • Living donor safety

after donation

  • Increasing oversea

transplantation

  • Public awareness
  • Need transplant act
  • Need nationwide

waiting list

  • Need allocation center
  • Need to prohibit organ

trade

  • Need public campaign

09/20/2018 UCSF transplant 2018 19

Another obstacle we had experienced were…

3

09/20/2018 UCSF transplant 2018 20

Revision of transplant law : IOPO / Required reporting system / Data registry

3.1

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Established Independent OPO (KODA)

  • 2011. 6. 27

Non-profit, professional, ethical, NGO

09/20/2018 UCSF transplant 2018 21

Establishing Independent OPO (KODA) 3.2

FUNERAL CULTURE

09/20/2018 UCSF transplant 2018 22

Rate of Cremation : from 30 to 80 % Also increase donation number !

Campaign to change the culture

3.3

DONOR CARD IN KOREA

But still 3% of total population

09/20/2018 UCSF transplant 2018 23

To increase public awareness and realization

3.4

. . .

(case)

50 100 150 250 400 200 300 350 450 500 1500 66 162 52 36 68 91 141 148 256 261 268 368 409 416 446 501 573 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 550 600

01 Before legislation

02

The introduction of

  • rgan donation system

03

Revised National Transplant Act OPO system

2017

515

Positive effect of revised law and negative effect by ?

4

  • Merging between organ & tissue OPOs
  • Decreasing donor number
  • Attitude of procure team
  • Change of brain death cause
  • New breakthrough

04

To Neighbor country

  • Organ and tissue

procurement

  • Assist legislation
  • Assist national

transplant framework

09/20/2018 UCSF transplant 2018 24

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9/4/2018 7

Medical eval. Consent

Consent Processing Distribution Storage Organ Tissue Family care program KODA KPTB Brain death declaration Procurement Procurement KODA: Korea Organ Donation Agency KPTB: Korea Public Tissue Bank

Call

Allocation by KONOS KODA Lab

Disharmony after merging organ & tissue OPO

09/20/2018 UCSF transplant 2018 25

4.1

WERTHER EFFECT ? NICHOLAS EFFECT !

10 20 30 40 50 60 70 80 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2007 2008 2009 2014 2015 2016 2017

2007 2008 2009 2014 2017 2016 2015 2016 2008 2009

“ I regret my son’s donation …..”

(2017.10.9 SBS report)

2018?

Positive and negative effect by media report

09/20/2018 UCSF transplant 2018 26

Negative effect to public by media reports

4.2

EDUCATE MEDICAL STAFFS

  • 1. Conflict between transplant surgeon and attending physician
  • 2. About organ procure team (impolite action between medical persons)
  • 3. Hospital staffs who contact the donor and family

vs

09/20/2018 UCSF transplant 2018 27

Attitude of medical staffs in ICU, OR.

4.3

Pre-congress course for young transplant surgeons and staffs

Decreasing death rate by traffic accident & CVA

09/20/2018 UCSF transplant 2018 28 Death number, Car number Traffic Accident number Death by traffic accident Number of registered Carx103 Number of traffic accident

4.4

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9/4/2018 8

09/20/2018 UCSF transplant 2018 29

Trend of 5 major death cause, 2005-2015 cancer CVA

Cardiac ds

Suicide

Pneumonia Per 105 population

Death number by age, 2005 - 2015

 Decreasing DBD source

  • Mortality by TA
  • Mortality by CVA

 Increased ECD source

  • Old age donor

(44.5 in 2013 48.2 in 2017)

4.5 Increasing old age donor and death by cardiac disease

WE NEED A BREAKTHROUGH IN 2018

  • Increasing public recognition

about organ donation

  • Expand donor source : ECD, DCD
  • Revision of transplant law :
  • Brain death = death
  • Respect deceased will

(first person consent)

  • And more …

09/20/2018 UCSF transplant 2018 30

 Protect people from organ trade  Prohibit organ trafficking  Ask national self-sufficiency

  • 2. Share our experience with

neighboring countries

5

  • 1. Activate organ donation

inside Korea

Share our experience with neighboring countries, why?

  • We realized that organ shortage and trafficking in neighbor

countries are not an individual problem, but A family problem, A social & national problem & A global problem

09/20/2018 UCSF transplant 2018 31

5.2

09/20/2018 UCSF transplant 2018 1

Most of victims(seller) are poor, weak, illiterate people

  • f our neighboring countries

5.2

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9/4/2018 9

WHO & VITALLINK WORKSHOP SUPPORT UNDERDEVELOPED COUNTRY

ORGAN, TISSUE, CELL DONATION & TRANSPLANTATION

09/20/2018 UCSF transplant 2018 33

What we are doing recently : to neighbor country and support national transplant & donation system

5.2

POINTS WHAT THEY WANT TO !

  • LEARN :
  • About ethical transplantation and donation, necessity of law
  • How to increase organ donor ?
  • Necessity of recipient registry
  • How to allocate donated organs
  • Why data registry is necessary
  • How to approach donor family
  • Medical and surgical skills (D&R)

09/20/2018 UCSF transplant 2018 34

5.2

09/20/2018 UCSF transplant 2018 35

Educational program, Come and Go

5.2

Realize organ shortage is a global issue & ethical organ donation, transplantation is necessary

09/20/2018 36

  • 2016. TTS, HongKong
  • 2015. Mongolia
  • 2017. Bangladesh
  • 2018. Myanmar

5.2

UCSF transplant 2018

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9/4/2018 10

09/20/2018 UCSF transplant 2018 37

Finally, they reform the transplant law in Mongolia and activate

5.2

FOR ACTIVATION OF DOMESTIC ORGAN DONATION

  • COOPERATION FOR NEW BREAKTHROUGH WITH
  • Transplant society & coordinator association
  • KONOS and KODA with MoH
  • With Congress for revision of transplant law
  • NGOs for national campaign
  • Medical association and Hospital association
  • MORE EFFORT TO DETECT Potential Brain Death
  • MORE POSITIVE NEWS TO THE PUBLIC
  • STUDENT EDUCATION BY TRAINED TEACHER

09/20/2018 UCSF transplant 2018 38

Summary 6.1

CONTINUE OUR WORKS IN NEIGHBOR COUNTRIES

  • VITALLINK WORKSHOP -
  • HUMAN RESOURCES : Education And training (skill, knowledge, ethics)
  • Medical staffs & coordinators education
  • HOSPITAL ENVIRONMENT AND FACILITIES : for immunologic lab, pathology
  • MEDICAL INSURANCE SYSTEM AND GOVERNMENT WILL : contact government
  • LEGISLATION OF BRAIN DEATH & TRANSPLANT LAW & GIFT OF LIFE :contact government
  • National system and organization for registration of waiting, allocation
  • Prohibit organ trade, Trafficking
  • INTEREST OF TRANSPLANTATION TO PUBLIC and medical staffs of related field

09/20/2018 UCSF transplant 2018 39

Summary 6.2

09/20/2018 UCSF transplant 2018 40

 Protect Asian people & Medical Professionals from circle of organ laundry and activate ethical transplantation  Preparing a new breakthrough to activate our domestic organ donation

Buyer Organ bank Transporter Recruiter Seller

Medical professional

Summary S