Chapter 2REVIEW OF RELATED LITERATURE As the worldwide prevalence of end-stage renal disease increases it is important to evaluate the rate of living kidney donation in various countries; however there is no comprehensive global assessment of these rates. To measure this, Horvart reports in the literature, and national health ministry‘s from 69 countries and made estimates from regional weighted averages for an additional 25 countries where data could not be obtained. In 2006, about 27,000 related and unrelated legal living donor kidney transplants were performed worldwide, representing 39% of all kidney transplants. The number of living kidney donor transplants grew over the last decade, with 62% of countries reporting at least a 50% increase. The greatest numbers of living donor kidney transplants, on a yearly basis, were performed in the United States (6435), Brazil (1768), Iran (1615), Mexico (1459), and Japan (939). Saudi Arabia had the highest reported living kidney donor transplant rate at 32 procedures per million population (pmp), followed by Jordan (29), Iceland (26), Iran (23), and the United States (21). (Horvart, 2006). This situation has provided impetus for the search for various ways to increase the kidney donor pool and has fuelled discussions regarding the establishment of regulated organ markets. Although the debate among kidney donation and transplant facility in the world rages is on, no country in the world has actually established a kidney market. In the meantime, unregulated kidney markets have arisen at various time points in developing countries such as India, Pakistan and the Philippines (Lippincott W. & Lippincott W., 2009). Qualifying for a Kidney Transplant, doctors evaluate a patient to determine if she will be a good candidate for a kidney transplant. When a donor kidney is available, doctors run tests to verify organ compatibility. Once compatibility is verified, the patient is brought into surgery. Kidney transplantation is the preferred treatment option for end stage renal failure in terms of mortality , cost effectiveness, and improvement in quality of life. The average dialysis treatment cost per life year saved is estimated at approximately $55,000-80,000 , while for kidney transplantation it is estimated at approximately $10,000 per life year saved. Increased time on dialysis is related to higher rates of kidney failure twelve months after transplantation , and to decreased survival of transplant recipients ,(Symvolakis et. al,2009) As of September 21, 2012, there are 100,045 registered candidates on the kidney donor waiting list according to the Organ Procurement and Transplantation Network (OPTN); however, only 93,952 kidney transplant candidates are active, which means able to receive a transplant at the moment.1 With an overall tally of transplant waiting list candidates equaling 115,666, it is easy to see how the kidney is a most sought after organ. Age Living kidney donors usually range in age from 25-50 years, although there is limited experience beyond this range. Donors below 18 years of age are considered children and cannot usually provide informed consent without parental approval. In addition, the prediction of adult (and familial) kidney disease may be problematic in potential donors below 30 years of age, depending on the disease (ie, hypertension, However. patients who received older donated kidneys were no more likely to die within a decade of transplantation than those whose kidney donors were between 50 and 59. It seems that this conditioning could be a large part of why . and their community at large. particularly if they were unemployed.3 percent failure rate vs. Women generally are known to be more empathetic and altruistic than men and are more than willing to donate their organs. In the absence of other medical problems. age 56-65 selectively. Aging results in a gradual decline in kidney function such that the amount of transplanted kidney function becomes a limiting factor after age 60 years. physiologic age is more important than chronologic age. kidney size and function are acceptable in this age group. the cadaveric donor experience suggests that a child 6 years of age or older can safely donate a single kidney into an average sized adult. The study shines new light on a long-ignored potential source of additional organs that could address a profound national shortage.6 percent). but more likely to be donors of renal allografts. to their children.Although the study found that kidneys from older donors were more likely to fail within ten years of transplant when compared with kidneys from donors ages 50 to 59 (33.In the older population.diabetes mellitus. 21. Our society expects women to excel at being caregivers. polycystic kidney disease). Gender Females were significantly less likely to be recipients. kidney donation can be safely performed up to age 55 routinely. According to John Hopkins research. Kidney transplants performed using organs from live donors over the age of 70 are still safe for the donors and lifesaving for the recipients. and over age 65 rarely. On the flipside.(Times of India. With this statistical data he concludes that through the belief of the religion and the span of control or influence. Doctors in city's leading hospitals and NGOs working to promote organ donation estimate that more than 60% out of the total donors are females. and saving a life is placed very highly in the Qur‘an—‗Whosoever saves the life of one person it would be as if he saved the life of all mankind‘ (chapter 5:32). altruism is also an important principle of Islam.Other than any religious beliefs Catholicism are more into the idea of kidney donation. women step forward and show their kindness to help others. In Christianity. in which 130 million is from Brazil largest Roman Catholic community in the world. maybe men are prevented from donating as often as women. However.women donate more often. 2013) Religion This perspective violating the human body. Doctors say that when it comes to organ donation. In addition Catholic believes that organ donation is an extremely generous act and one that agrees with moral law.1 billion. faith appears to generally endorse transplantation. Most Angelican Catholic and Protestant seem to agree that kidney donation is an act of selflessness and endorse transplantation and donation . Stevener (2010) The largest religion in the world is Roman Catholic accounts for approximately 2. more of them also support donation and are kidney donors. is forbidden in Islam. it most likely that this group will outnumber other religion in . whether living or dead. Phillipines has 60-80% of it`s population was Catholic. although there are clearly different nuances in opinion. This could be because they are traditional breadwinners of the family. at least seventeen percent of the people in Asian communities trust that their religions said NO to it. or having an organ taken before one‘s actual death (Macnair. in allowing man to eat animal flesh Jehovah God did not grant permission for humans to try to perpetuate their lives by cannibalistically taking into their bodies human flesh. Education The simplest and most obvious way to improve the ability of nurses to help identify potential kidney donors and provide appropriate support to patients‘ families in the families‘ decision making. Christianity. That is cannibalistic. Meanwhile. 2010). However. John Paul II. such as the fear of being used for experimentation. even though Britain‘s main religions – Buddhism. The previous pope. the Black people are averse to kidney transplants because of fears.One act of support has gained particular publicity. Because behavior is the result of a complex interaction . 2009).terms of kidney donation. Those who submit to such operations are thus living off the flesh of another human. Similarly. and thirty percent are uncertain. Judaism and Sikhism – do not forbid kidney donation.(Woywodt. Hinduism. this is simply a shortcut. also publicly supported kidney donation. Islam. in which he praised kidney donation as a praiseworthy example of Christian love. When men of science conclude that this normal process will no longer work and they suggest removing the kidney and replacing it directly with another kidney from another human. namely the fact that the current pope Benedict XVI has publicly announced that he carries a donor card at all times. not least in the encyclical letter Evangelium Vitae. whether chewed or in the form of whole organs or body parts taken from others. The researchers analyzed the frequency of marital status with an outcome of likelihood of donating kidney. The researchers concluded that being married is associated with better outcome of donating organ compared to those who were not. al. end-of-life care is best addressed as a program.College graduates are more willing to donate their kidneys because of the knowledge they have regarding kidney donation. beliefs. rather than with sporadic activities. (2010) analyzed data about the patients with ESRD aged ≥27 (mean age of first marriage in the US). next to them are undergraduates because of the mere fact that money is always available in donation of their kidneys. (Daly. it implies that married individual had a higher likelihood of donating kidney. here people expressed a high motivation to donate. simply providing periodic classes or printed materials will be insufficient to affect the quality of care. After adjustments for the included independent variables and compared to individuals single (23. Effective measures should be taken to educate people with relevant information with the involvement of media. Like all aspects of nursing education. 2006). doctors and religious scholars. He also states that better knowledge may ultimately translate into the act of donation. and attitudes. and planning must begin with a needs assessment. Health Status Health status of a certain living donor has also made a great impact. for a donor to .5%) and married (76%) civil status.According to Emmanouil K SymvoulakKnowledge about organ donation was significantly associated with education and socioeconomic status. Civil Status The study conducted by Khattaket.among knowledge. Donors do not need to be genetically related. heart disease. However. diabetes. the relationship between the donor and the recipient often has a bearing on the donor‘s motivation for giving a kidney organ. al. someone who has cancer. a series of examination will be needed this must be accomplished first to assure the safety of the recipient against communicable or infectious diseases as well as to assure compatibility thus preventing kidney rejection. while . 2012) Donors should be in good general health. however if the donor has an underlying ailments it must be address to the healthcare team and the team will weight things or correct the problem if the operation will push through. kidney disease. Typically. Relationship to the Recipient Another factor is the degree of consanguinity of the donor and recipient. The living related donor is genetically related to the recipient and more relationship lies in being theirsiblings. these diseases are not all absolute contraindications to donation.2010). and healthy. but also most often used as live donors. liver disease. They are also more likely than other family donors to express positive reactions to the donation process (Stiller et. HIV or hepatitis will not qualify to be a donor. WHO.Of note. sickle cell disease. donor must be physically fit. Siblings are usually the best medical match for the kidney recipient and. are not only preferred. Every donor will be considered on an individual basis (University Of Maryland.be valid in donating his or her kidney. 2005). (Kidney Organ donation and transplantation. as a result. (2010) ensure that there are certain criteria that a donor must met and a series of examination both physical and laboratory test to prevent organ rejection. neighbors to classmates. Major ethical concerns about kidney donation by living related donors focus on the possibility of undue influence and emotional pressure and coercion. By contrast. and perfect strangers. as do emotional bonds within the family.g. In addition. Those who have difficulty paying their bills are more likely to talk about this subject or to give their consent to donation of their own kidneys or those of a deceased close family member. ( Kidney Organ donation and transplantation. overall. colleagues to teammates. children. Exactly. The living unrelated donor and recipient may be emotionally related (e.. Financial hardship appears to be a barrier to support for living donors. begin functioning in the recipient at a rate of 97 percent after transplant. or person with a significant relationship with the donor of either the donor or recipient can be either supportive or coercive. parent. duties and obligations associated with family relationships and roles often weigh heavily on the decision to donate.living kidney donor matches from siblings last on average at the highest rate of 20 to 35 years. 2012) Family Influences Spouse. the living unrelated donor lacks genetic ties to the recipient. who are those non-related living donors who contribute? Unrelated living donors have included a wide spectrum from spouses to friends. Family members are an integral part of the decision-making process they will be affected regardless of . Half of living donors fall between the ages of 35 and 49 with the majority of living kidney donors being female. a spouse). because the living related donor is usually also an emotionally related one as well. living kidney donor matches. Living donors who are exposed to financial risk are more likely to donate their kidneys just to pay their hospital bills. more often. Socio Economic Status Of the many socio-economic factors that have been associated with willingness to donate kidney.(ANA. education attainment is consistently one of the most explanatory. al.2011). In the study made by the kidney organ donation and transplantation (2012). The living related donor is genetically related to the recipient.whether the decision is to donate or not to donate. the result only shows that Filipinos has strong intact of family relationship.Some also felt that a definite decision. because the living related donor is usually also an emotionally related one as well.Views regarding organ donation were often shaped by theparticipants‘ families. furthermore Filipinos are well known for being a family oriented individuals.(Irving et. while the decision to donate could have a direct impact on the donor and his or her immediate family. as do emotional bonds within the family. This is the most integral part that impactly affects an individual to either donate or not. The decision not to donate could impact another family member‘s fate. duties and obligations associated with family relationships and roles often weigh heavily on the decision to donate. Some feltthat organ donation would interfere with the grieving process forfamilies. Some felt they had to ask permission from family members. Such influences could have either apositive or. negative influence on individuals‘decisions. . Factor under family influence base on the degree of consanguinity of the donor and recipient.2004). In addition. would ensure that loved oneswere not burdened later with a difficult choice. from familymembers regarding donation. implies that it has a bearing on the donor‘s motivation for giving a kidney organ. found that females.Education might stand as a proxy for knowledge about health related issues. younger potential donors. Compensation for lost income is generally accepted to be within ethical boundaries. more affluent individuals are less likely to donate while higher income is associated with higher willingness to donate in Canada.000 for lost income and livelihood assistance exceeded the national average income for the whole family for an entire year that was reported to be PhP 172 000 in 2006. They also found that a potential donor who described themselves as having stronger religious beliefs and those with poor knowledge had less favorable attitudes towards kidney donation. 2012). but PhP 175. In UK.(Kidney Organ donation and transplantation.(Medical Observer. PhP 75. 10-year membership with the government health insurance system and free annual check up for 10 years. Therefore. socioeconomic status is a more important barrier to living kidney donation than any other factors. "These results suggest that for African Americans. 2010). this amount is valuable consideration indeed for the average Filipino family. According to HOPE(2005). (2013) Income status was strongly associated with living kidney donation: low income populations had higher rates of living kidney donation compared with higher income populations among both African Americans and Whites.000 for livelihood assistance. The findings are surprising and will have significant implications on strategies to . the government approved a 'gratuity package' for not related donors. Wakefield et al. and those with higher knowledge levels were more likely to have attitudes that favored kidney donation. This consisted of Php (Philippine peso) 100 000 for reimbursement of lost income for 4 months. Journal of the American Society of Nephrology. a PhP100 000 life insurance. Another study reported the various aspects of 104 kidney vendors in Pakistan.increase living kidney donation in the United States. paid donation makes up 50% of all transplants in Pakistan . is forbidden in Islam. Their monthly income was US$ 15. efforts to increase living kidney donation should target the barriers that are specific to lower socioeconomic populations. However. whether living or dead. its faith appears to generally endorse transplantation. and saving a life is placed very highly in the Qur‘an—‗Whosoever saves the life of one person it would be as if he saved the life of all mankind‘ (chapter 5:32). Specifically. Organ trade is an important emerging issue that should be tackled with appropriate legislation.4 ± 8. According to World Health Organization (WHO). about kidney vendors d in Punjab. Catholic and Protestant . Ninety three percent of these individuals had vended their kidneys for the purpose of debt repayment . Most Angelican. In the survey conducted by Saleemet.this perspective violating the human body. (2010). Ethico Moral In the study of Woywodt. Pakistan showed that 34% were living below the poverty line. altruism is also an important principle of Islam.7% and 27% respectively . organ trafficking may be accounting for up to 5– 10% of the kidney transplants performed annual. al. 69% were bonded laborers. Hepatitis B and C positivity was seen in 5.9. 67% were bonded laborers earning < $ 50 per month. According to estimates. In Christianity. Most of these kidney vendors were illiterate. although there are clearly different nuances in opinion.Wider public awareness of this Ordinance is important for its reinforcement and implementation. (2008). Emerging concerns intertwined with it include the burgeoning trend of transplantation. (2009). (2007). to make this possible donors personal data will be falsified and present that they are at least on the 4th degree of consanguinity and this act is considered immoral by the catholic church. also publicly supported kidney donation. Some people . Kidney donation by living donors clearly saves lives. Any close relative can be a donor according to it but must donate voluntarily and without duress or coercion. not least in the encyclical letter Evangelium Vitae. According to National Kidney Institute. Almost 60% believed that the basic aim of organ donation is to save someone's life. organ transplantation has recently drawn attention as a bioethical issue for robust debate in Pakistan. The previous pope. lack of legislation to govern it and exploitation of human rights. improves transplantation outcomes under some circumstances. Saleem. John Paul II. But some donors specially the oppressed individuals (those who are in part of Northern Mindanao) has another motives aside from donating their kidney they also sell it in exchange for the incentive either cash or special grants that will be given by the recipient. in which he praised kidney donation as a praiseworthy example of Christian love.scholars seem to agree that kidney donation is an act of selflessness and endorse transplantation. et. and reduces recipients‘ waiting times. al. One act of support has gained particular publicity. namely the fact that the current pope Benedict XVI has publicly announced that he carries a donor card at all times. These efforts led to the promulgation of an Ordinance in 2007 to regulate the transplantation of human organs and tissues This ordinance mentions living donors of at least eighteen years of age. including decisions about kidney donation. and planned opportunities to observe expert clinicians in meetings with patients‘ families are essential for learning and will not occur without a well-developed educational plan Numerous factors can act as barriers to kidney donation. These studies have indicated that families of potential kidney donors are more likely to consent to kidney donation when transplant coordinators are specifically trained to provide information and support the family during the decision-making process. particular attention must be paid in helping nurses develop and improve skills in this area.responded that organ donation can be done out of compassion/sympathy while others cited monetary benefits as the leading motivation behind organ donation. In 2008 American Medical Association Council on Scientific Affairs for physicians‘ intended to address failures on the part of healthcare professionals specially in establishing a therapeutic communication to persuade potential donors to donate their kidneys.Rodriguez and colleagues conducted interviews with families after the donation request and found that although most . feedback on performance. Past research on communication during donation requests has overwhelmingly been conducted in settings examining kidney donation. Still some others though that organs are donated as a responsibility Communication This is a critical element of supporting patients‘ families and rendering health care services. Role playing. This step requires more than didactic sessions. Among the most widely acknowledged are failure on the part of healthcare professionals to identify potential donors and initiate the referral and request process and beliefs and attitudes of the families of potential donors. being less controlling. such as establishing credibility or referring to how donation could potentially help others. those who consented were more likely to describe the requester in this way and were more likely to report being satisfied with the request. About 15% of those who declined to donate cited negative perceptions of the request/donation process as a contributing reason for refusal. using a higher quality of communication. Regarding persuasion. and using more conformational messages. expressing empathy. (Stephens. donors were more likely to consent to donation when they perceived the requesters as being more caring and concerned. Many people need more of . They found that donors were more likely to consent if physician discussed key topics such as costs associated with donation and ability to have an open casket funeral after donation. and the time to transplantation just gets longer. although the total number of persuasive statements was not a significant predictor of consent. Its past time to face the fact that altruism is just not enough. Siminoff and colleagues used observational coding of the interaction between the requester and the donors as well as post request interviews with donors about their perceptions and recall of the request. or making statements aimed at building partnership between themselves and donors. such as providing reassurance. Finally.2004) Altruistic Behavior Despite decades and decades of public education about the virtues of organ donation.respondents felt that the requesters were caring and compassionate. the waiting list just gets longer. donors were more likely to consent when requesters used specific types of persuasive statements. and donors were less likely to donate when they held incorrect or negative assumptions about donation. they also stressed their personal benefits in donating a kidney.(Satel. they hoped the transplantation would make the recipient less dependent and thus could participate more in household activities and family life. The importance of understanding attitudes derives from a rich body of empirical.Under altruistic behaviour is Good Samaritan donation.an incentive to give. 2012)For some donors. with nearly two-thirds of participants either agreeing or strongly agreeing with donating an organ for transplantation and almost 90% agreeing or strongly agreeing with receiving one. it was an altruistic and natural decision meant to improve the recipient's health and quality of life but this decision could also be more philosophical or spiritual in nature. However. Chains are a major breakthrough in transplantation and are revolutionizing the process by eliminating incompatibility as a barrier to donation and providing a way for all recipients to find very well matched donors. Unlike other voluntary health . Attitudes towards donation were generally positive. theory-based literature which substantiates a positive relationship between attitude toward a voluntary behavior and behavioral performance. And that‘s why we need to be able to compensate people who are willing to give a kidney to a stranger. Chains are a way for one Good Samaritan donor to help many patients get transplants instead of just one person. Most recently. Good Samaritan donors have begun initiating chains which are facilitating hundreds of additional living donor transplants at much higher compatibility levels. to save a life. donors mostly offered a kidney motivated by the progression of the recipients‘ disease and/or the prospect of dialysis in the (near) future (45%). The donor is giving to a stranger. In the recent study of Laura (2013). " SEC.An act authorizing the legacy of donation of all or part of a Human Body after death for specific purposes. and includes a still-born infant or fetus.A. by precisely defining the concept of organ donation in the nation. considering the statistics from DOH that living donor accounts for almost 95% while deceased donor is only 5% it means that healthy and useful organ that supposed to be procured for future transplant was wasted and buried and this is one of the reasons in formulation of this act. deceased donor is the key to compensate the increasing need of organ donors ."This act aims to widened or extend the coverage of the donors. approaches to influence a favorable attitude toward donation have measured key intermediate behaviors such as family discussion about organ donation and donor registration. (b) "Decedent" .. 7170 also known as "Organ Donation Act of 1991. Thus.This Act shall be known as the "Organ Donation Act of 1991. R.A 7170 “ORGAN DONATION ACT OF 1991” An act was enacted by the Senate and House of Representatives of the Philippines 8TH Congress under the administration of the late president Corazon Aquino called R. . translating favorable attitudes toward organ donation directly into acts of donation is not acutely possible in cases other than living donation. With the nation‘s rapid population explosion. Definition of terms a) "Organ Bank Storage Facility" . (c) "Testator" .behaviors. accredited or approved under the law for storage of human bodies or parts thereof.a facility licensed. 2. 1.a deceased individual. SECTION.an individual who makes a legacy of all or part of his body. Title. (j) "Death" . or any other legal entity. the Government or any of its subdivisions. other fluids and other portions of the human body.a physician or surgeon licensed or authorized to practice medicine under the laws of the Republic of the Philippines. The death shall be recorded in the patient's medical record. bones. (h) "Physician" or "Surgeon" . and includes. A person shall be medically and legally dead if either: May be confirm by the attending physician and consulting physician.1awphilŸalf (e) "Hospital" . estate. corporation.an individual.a hospital licensed. eyes. (i) "Immediate Family" of the decedent . (g) "Person" .the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain. including the brain stem. tissues. both of whom must be appropriately qualified and suitably experienced in the care of such parties.an individual authorized under this Act to donate all or part of the body of a decedent.includes transplantable organs. blood. accredited or approval under the law. a hospital operated by the Government. arteries.(d) "Donor" . . (f) "Part" .the persons enumerated in Section 4(a) of this Act. agencies or instrumentalities. including government-owned or -controlled corporations. The death of the person shall be determined in accordance with the acceptable standards of medical practice and shall be diagnosed separately by the attending physician and another consulting physician. association. partnership. trust. 3: Person Who May Execute Legacy.Any individual. 5) Guardian over the person of the decedent at the time of his death. SEC.5:Examination of Human Body or Part thereof: For purposes of this Act. all or part of his body for any purpose specified in Section 6 hereof.SEC. 2) Son or Daughter of legal age: 3) Either parent. SEC. . or other medico-legal cases immediately after the pronouncement of death. 4) Brother or sister of legal age.4: Person Who May Execute a Donation 1) Spouse. an autopsy shall be conducted on the cadaver of accident. Any organ bank storage facility. colleges or university.6:Persons Who May Become Legatee or Donee: Any hospital.7:Day of Hospitals . to take effect after his death.may give by way of legacy. at least eighteen (18) years of age and of sound mind . Any specified individual. SEC. to determine qualified and healthy human organs for transplantation and/or in furtherance of medical science. physician or surgeon Any accredited medical or dental school. SEC. trauma. is nevertheless valid and effective SEC..9:Manner of Executing a Donation (a) A member of the team of medical practitioners who will affect the removal of the organ from the body. or it is a declared invalid for testamentary purposes. the will. SEC.8:Manner of Executing a Legacy (a) Legacy of all or part of the human body under Section 3 hereof maybe made by will. nor (b) The physician attending to the recipient of the organ to be removed. to the legatee or donee to expedite the appropriate procedures immediately after death . or his authorized representative . If the will is not probated. SEC.10.A hospital authorized to receive organ donation or to conduct transplantation shall train qualified personnel and their staff to handle the task of introducing the organ donation program in a humane and delicate manner SEC. to the extent that it was executed in good health. . card or other document.Only authorized medical practitioners in a hospital shall remove and/or transplant any organ which is authorized to be remove and/or transplanted pursuant to Section 5 hereof. or an executed copy thereof. nor (c) The head of hospital or the designated officer authorizing the removal of the organ. The legacy becomes effective upon the death of the testator without waiting for probate of the will.11:Delivery of Document of Legacy or Donation If the legacy or donation is made to a specified legatee or donee. Person(s) Authorized to Remove Transplantable Organs. maybe delivered by the testator or donor. that foreign organs or tissue bank storage facilities and .Sharing of human organs or tissues shall be made only through exchange programs duly approved by the Department of Health: Provided. (b) Any person who acts in good faith in accordance with the terms of this Act shall not be liable for damages in any civil action or subject to prosecution in any criminal proceeding of this Act. SEC. .SEC. If the legacy or donation is a part of the body. upon the death of testator and prior to embalming.14:International Sharing of Human Organs or Tissues. next of the kin or other persons under obligation to dispose of the body of the decedent. shall effect the removal of the part. The legatee or donee may accept or reject the legacy or donation as the case may be. the legatee or donee. avoiding unnecessary mutilation. custody of the remainder of the body vests in the surviving spouse. or (3) A statement to that effect during a terminal illness or injury addressed to an attending physician and communicated to the legatee or donee . or (4) A signed card or document to that effect found on the person or effects of the testator or donor. (2) An oral statement to that effect made in the presence of two or other persons and communicated to the legatee or donee. After removal of the part.12:Amendment or Revocation of Legacy or Donation (1) The execution and delivery to the legatee or donee of signed statement to that effect.13:Rights and Duties after Death. SEC. .16:Rules and Regulations. civic and non-government health organizations and other health related agencies.1991) . in cooperation with institutions.19: Effectivity. both government and private. SEC. both government and private. rules and regulations executive or administrative orders.15:Information Drive. SEC. the remaining provisions shall remain in full force and effect.similar establishments grant reciprocal rights to their Philippine counterparts to draw human organs or tissues at any time. The Secretary of Health. are hereby repealed amended or modified accordingly.The provisions of this Act are hereby deemed separable. . such as the National Kidney Institute. (Philippine Laws and Jurisprudence Databank . SEC. to make an appeal to human organ donation. and other presidential issuance inconsistent with this Act. . after consultation with all health professionals. the Department of Health. SEC. after consultation with all health professionals. . decrees. involved in the donation and transplantation of human organs.All laws. If any provision hereof should be declared invalid or unconstitutional.The Secretary of Health. shall undertake a public information program.In order that the public will obtain the maximum benefits from this Act.This Act shall take effect after fifteen (15) days following its publication in the Official Gazette or in at least two (2) newspapers of general circulation.17:Repealing Clause. .18:Separability Clause. and non-government health organizations shall promulgate such rules and regulations as may be necessary or proper to implement this Act. ordinances. SEC. payment for kidney donation and selling of kidneys through organ vendors are prohibited. REDCOP's activities are done mostly on a national scale through its network of Regional Coordinators throughout the country. it now considers and screens living donors. service and quality assurance. it works closely with the Renal Disease Control Program (REDCOP) following strict implementing guidelines set by the Department of Health‘s Philippine Organ Donation Program(PODP) The Renal Disease Control Program (REDCOP) This is the office in-charge of implementing the NKTI's public health projects on the prevention and control of renal and other related diseases. equitable. Philippine Organ Donation Program (PODP) PODP sets up policies. the safety of both donor and recipient are guaranteed. ethical. and accessible renal health care program in the country. who voluntarily donate their kidneys to patients on the list in the spirit of true altruism. This Program supports a rational. guidelines and ethical principles whereby the act of organ donation and conduct of transplantation from living non-related organ donors (LNRDs) shall be managed and regulated. training.It is there to ensure that Filipino patients are prioritized in the organ-recipient waiting list.Agencies that regulate organ donation HOPE (Human Organ Preservation Effort) Initially. advocacy. and kidney transplantation is not offered as a form of . In this aspect. HOPE‘s thrust was focused on deceased organ recovery. But as the dilemma of the scarcity of donors continuously haunt the entire nation. It plans. implements and monitors projects for research. the department actively participates in various advocacy programs of the Institute.medical tourism. kidney-pancreas transplantation in the country. undoubtedly the center for transplantation in the country. Hand in hand with Human Organ Preservation Effort (HOPE) and Renal Disease Control Program (REDCOP). liver. in promoting organ donation. liver.Aside from the foregoing activities in transplantation. pancreas. the department assists to increase the public awareness in organ donation and the acceptance of organ transplantation as a therapeutic modality in all key cities and provinces in the country. To date. heart. almost all vital organs can be successfully transplanted: kidney. and has pioneered kidney. almost 14. non-living related and cadaver donors) to date were performed and still counting. Almost 2500 transplant (living related. Local Literature For the year 2010. NKTI(National Kidney and Transplant Institute) Organ transplantation is an accepted life saving therapy for patient with end stage organ diseases.The Department of Organ Transplantation of the National Kidney and Transplant Institute is dedicated and grounded in a patient-centered philosophy in helping patients with end stage renal diseases and other end stage organ failures through transplantation. lungs.000 Filipinos suffer from end-stage renal disease (8th leading cause of death of Filipino) and are undergoing dialysis and 1 Filipino die each . The department was first established in 1983. and small bowels. in many countries. Although the Organ Donation Act was passed in 1981 to pave the way for deceased organ donation. bones. but fortunately. it can be prevented. the progression to Chronic Kidney Disease. as is the need to ensure that acute cases avoid. It recovers mainly kidneys. 2000 and 2007 kidney transplantation activity in the Philippines has shown a continuous upward trend . although very extensive can achieve significant benefits for the public. According to the Annual Report of the PRDR. Early detection and prevention of kidney failure is vital. 2010). representing 0. It also provides a network for tissues such as corneas. and skin. kidney disease often cannot be cured. pancreas and liver but may include other vital organs like the lungs. there were only 29 kidney transplants using a deceased organ. the deceased donation program has never taken off. Prevention and early management. Human Organ Preservation Effort (HOPE) Asia`s leading kidney transplant formerly the Cadaver Organ Retrieval Effort (CORE) was established in 1983. heart when the proper program is put in place.the total number of kidney transplants has jumped from just 276 in year 2000 to 1046 in year 2007 Living donors have consistently accounted for over 95% of all kidney transplants. It is the organ retrieval arm of the Institute tasked to advocate organ and tissue donation and to source out transplantable organs from deceased organ donors thru its network of various government and private hospitals in the country. The recovered organs are placed among patients in the .week due to Kidney failure. deceased donation rates in Europe and North America are in the vicinity of 30 per million population per year. if possible. This has generally become a responsibility for the Human Organ Preservation Effort. (Eyes Under Pressure. Unfortunately. In contrast. and in 2007.34 per million population per year. heart valves. "Cabral expressed confidence that "with this program. equitable and ethical. "The program aims to serve the needs of mainly 9. as it formally established a national program for the "sharing of organs from deceased donors. the international medical community will once again recognize that our country is indeed serious in curtailing illegal organ donation and at the same time. Before a person can become a cadaver donor." A HOPE donor card is the "equivalent of a legal consent document" allowing an individual to donate any of his body organs shortly after his death.000 Filipinos suffering from kidney failure each year. but also to assure that the illegal traffic of organs that has victimized many of our countrymen for many years will not be repeated. he or she must be certified . The DOH initiative was made "in response to the Philippine commitment to the 2008 Declaration of Istanbul on Organ Trafficking and Transplant Tourism and the 63rd World Health Assembly Resolution on Organ Donation for governments to take appropriate actions in increasing the transplant of kidneys and other organs from deceased donors. the non-government group Human Organ Preservation Effort.waiting list." Cabral said. The DOH head issued an administrative order on the program. a call came from the Department of Health. according to Health Secretary Esperanza Cabral. We seek not only to improve an important service to many patients in need of organ transplantation.‖ Here. Manila. strengthen our deceased donors program which has been known to be effective in other countries. has launched what it calls "Organ Donor Card Project. or HOPE. which she said "shall set the policies and guidelines for a deceased donors program for our country that will be feasible. as brain dead. otherwise known as the "AntiTrafficking of Persons Act of 2003." said Cabral. then social welfare and development secretary. The report on the proposed ―international standards‖ for financial incentives for organ donation in the February issue of the AJT stated that ―until there are trials. we have no means of knowing under precisely what circumstances such a proposal would best succeed‖. pancreas. 9208." The regulations "stopped organ trafficking in its tracks and were seen by international organizations as an important step in the fight against organ trafficking and transplant tourism. In 2008. the liver. The program offered a sizable ―gratuity package‖ while mandating . coordinated with the Department of Justice and DOH in strengthening the implementing rules and regulations of Republic Act No." according to Cabral. such as bogus marriages between foreigners and Filipinos just the locals can be kidney donors. provided they would not cause any danger to the donor's life or cause any alteration to his physical activities. lungs. cornea. bone marrow." The same regulations "became our protection against attempts to exploit our countrymen." "Organ traders have long learned that putting together patients desperate for a kidney transplant and persons desperate enough to sell a kidney can be a lucrative business. Cabral. bone marrow and a part of the liver. The only organs that can be donated under "living-related organ donations" are one kidney. and the heart.On Thursday Cabral noted that "patients with kidney failure who need a transplant are increasing all over the world. Permit us to report that a regulated system of incentives for living organ donors was already implemented in the Philippines from 2002 to 2008. Among the organs that can be harvested from such a donor are the kidneys. but this was hardly convincing as poor follow-up allowed reporting of data in only 81 of 164 participants (Romina Danguilan et al. where the poor have been exploited in organ trafficking before and a large sector of the population remains vulnerable. The black market was not eliminated and organ brokers continued to be involved (Roberto Tanchanco et al. monitoring of transplant facilities and a donor registry.The first kidney transplant in region 1 Medical Center was performed last September 30. where many patients have a potential related donor but cannot afford to pay for a transplant.systems and procedures for transparency. A study limited to the donors within the government-regulated program reported better economic outcomes. unpublished cross-sectional study. our experience leads us to believe that the Matas article underestimates the problems related to the approach they recommend. Pangasinan. 2010).. 2011). 29 year old nurse from Bonuan Gueset. lack of economic improvement in the donors‘ lives and poor rate of medical follow-up (Roberto Tanchanco et al. as there was failure of informed consent. The reality was different from the intended outcomes. Thus. A system of incentives for living unrelated donors which is difficult to differentiate from a disguised organ market is totally inappropriate for a country like the Philippines. A regulation that transplants to foreigners should comprise no more than 10% of total transplants proved unenforceable and transplant tourism flourished . Donors were not protected. In Region 1. creation of ethical guidelines.. The kidney donor was Isagani . 2012 on Maria Govinda Onruvia. Dagupan City. much like what this article proposes. unpublished cohort study.. unpublished cohort study. Dagupan City . 2011). where the deceased donor program is still very infantile. the recipient‘s 32 year old cousin. Meanwhile.Patungan. Two months after. Abraham Coquia of the perfusion team and Dr. The successful operation was spearheaded by Dr. donors are usually recipient‘s family members. Kidney donation has evolved significantly from an experimental procedure to acceptable medical treatment for terminal illnesses. Region 1 Medical Center started the first step to becoming an organ transplant facility last year by sending five selected nurses namely FroilanFabia. Manuelito Fernandez. Quezon city.Parayno and Dr. Therefore there is a need to explore the complex interplay of these factors in this arena. there has been a relatively slow .Coquia in cadaveric organ retrievals from organ donors. Joseph Roland Mejia. The retrieved organs were transported to Manila for transplantation. 2012. R1MC Medical Center Chief. Adolfo Parayno of the transplant vascular team. The researchers believe that various factors may contribute to decision process of kidney donors. After the traning. Ilocos Training and Regional Medical Center first performed and organ transplant and procurement on kidney in 1997 to 2006 were a total of 44 cases was recorded. R1MC was accredited as a transplant facility by the DOH through the Bureau of Health Facilities and Services on May 24. Christy Palaganas. The hospital was accredited by the Department of Health as an Organ Procurement Organization last March 9. Susan Parayno and Alicia Viloria to attend the Specialty Program on Organ Procurement and Transplantation on January 10-March 5. 2011 at the National Kidney and Transplant Institute.Paquito Fuentes of the donor team. and was led by the following doctors: Dr.(The Podium2012). Despite these contemporary advances. the five nurses started to assist Dr. Dr. 2012 which allows R1MC to do cadaveric retrievals for organ transplant. . There is a paucity of literature about the relationship between knowledge and attitudes toward organ kidney.progress in the supply of kidney for transplantation. This has resulted in global shortage of organs available for transplantation. these items can be targeted for change. If barriers to the willingness for kidney donation can be identified.