Improving cadaveric organ donation rates in kidney and liver transplantation in Asia

In the year 2001, cadaveric kidney and liver transplant rates (CadTx) in countries with well-established transplant programs such as the United States and Spain ranged from 51 to 61.9 and 18.7 to 31.3 per million population (pmp), respectively. However, overall kidney and liver transplant rates in Asia are significantly lower at 4.3 and 0.3 pmp, respectively. Improving CadTx rates to meet the needs of organ failure patients poses several unique challenges in Asia. Across Asia, there is a wide disparity in prehospital emergency services and intensive care facilities that allow victims of cerebrovascular accident or trauma to be sent to hospitals for optimal management. Identification of the brain-dead victim in an intensive care setting, donor referral to an organ procurement coordinator/network, making the request for organ donation, and obtaining consent for organ donation from the family are other critical issues that impact on successful cadaveric donation. While affirmative legislation regarding organ donation is existent in most Asian countries, religious, ethnic, and cultural influences on concepts of death and the sanctity of the human body remain major barriers to obtaining consent for cadaveric donation. Although there are no overt objections to CadTx among the major religions of Asia, perceptions to the contrary largely limit consent for organ donation from potential donor families. Development of transportation and communication networks, public and donor hospital education programs, legislative initiatives such as presumed consent, and establishment of effective organ procurement practices are all key initiatives that will improve CadTx rates. Broadening donor criteria as with the use of expanded criteria donors, including non-heart-beating and older donors, may further improve cadaveric donation rates by as much as 20%. Finally, ethical transplant practices that prohibit trade in organs will promote an environment conducive to cadaveric donation. Together with efforts to increase living donor TX transplant rates, it is hoped that these measures will increase the supply of organs so as to meet the needs of organ failure patients in Asia.