DONATION, ALLOCATION AND ETHICS

M.A. Bin abd-wahab¹, F.Z.L.Y. Mansor¹, J. Kario¹, O. Sulaiman², H. Ismail^3
1National Transplant Resource Centre, HOSPITAL KUALA LUMPUR, KUALA LUMPUR/MALAYSIA, ²Anaesthesia, HOSPITAL SULTANAH AMINAH, JOHOR BHARU/MALAYSIA, ³Transplantation Unit, MEDICAL DEVELOPMENT DIVISION, PUTRAJAYA/MALAYSIA

Body: Introduction Over the past three decades, organ transplantation in Malaysia has made a slow but steady progress despite the various constraints. Ever since the first kidney transplant in 1975, followed by the first cadaveric organ donation in the subsequent year, the rate of cadaveric organ and tissue donations in Malaysia remains low. Until 2008, the cadaveric organ and tissue donation rate stood at less than one donor per million population. Moreover, less than two kidney transplants per million population are performed locally from both cadaveric and live related donors. Previously, the various recipient transplant teams had managed the organ procurement on an ad hoc basis. This was until early 1999, when the formation of several “Tissue and Organ Procurement (TOP) Teams” played a vital role in facilitating the coordination of cadaveric organ and tissue donations at local hospital level. Since then, more TOP Teams have been set up, with a subsequent increasing number of cadaveric donations over the subsequent years. Eventually in 2001, the Health Ministry established the “National Transplantation Procurement Management Unit” (NTPMU), which comprises of full time transplant coordinators and is responsible for the central coordination of the cadaveric donor management, in addition to the procurement of organs and tissues throughout the country. NTPMU works in tandem with the local TOP teams, the organ and tissue retrieval teams, and the recipient transplant teams. The unit arranges the logistics of transporting the retrieval teams to the donor and delivering the organs or tissues to the respective transplantation centres. NTPMU is also responsible for the promotion of public awareness on organ donation and central registration of donor pledges, as well as the training of clinical staff. Furthermore, the unit has put in place relevant standard operating procedures and workflows, in addition to ensuring better data collection and recording. Methods This is a descriptive analysis of the data and information collected to examine the impact of active intervention by the Government and the establishment of structured procurement units on organ and tissue donation patterns in the country. Results The numbers of both potential and actual donors have steadily risen, with an improving conversion rate of medically suitable potential donors to actual donors. Additionally, there are more potential donors being approached and a higher overall consent rate. Whereas the main reason for the refusal to donate is differing opinions between relatives. Conclusion The establishment of the NTPMU together with the active intervention from the Government has improved donor management, procurement coordination, staff training, awareness promotion and data collection. Concomitantly, the awareness on organ and tissue donation among the Malaysian public have also increased, leading to wider acceptance and higher expectations. Although there is the occasional surge of interest, there has not been an associated increase in the donation rate as expected. Many factors continue to challenge the development of organ transplantation in Malaysia. Hence, there are further recommendations to improve the various aspects of donor management and organ procurement, as well as increasing public awareness on organ and tissue donation.

Disclosure: All authors have declared no conflicts of interest.