Faissal Shaheen - Kingdom of Suadi Arabia - Monday 28 - Financing the Donation and Transplantation Process
- 1. Faissal A.M. Shaheen Consultant in Medicine and Nephrology MBBCH, Facharzt, FRCP Director General Saudi Center for Organ Transplantation and Jeddah Kidney Center Kingdom Saudi Arabia
- 2. 1985 National Kidney Foundation Established 1986 Start of Deceased Organ Donation Program 1993 NKF upgraded as Saudi Center for Organ Transplantation
- 3. Organ Transplantation Centers in the Kingdom of Saudi Arabia Kidney 17 Cornea 10 Heart 3 Liver 4 Lung 2 Pancreas 2
- 4. Renal Transplantation Centers in the Kingdom of Saudi Arabia * Tabuk - KAAMHT Dhahran * -KFMMCD * Madinah -- KFSH-D * * Riyadh - KFHM * - RAFH - KFSH ** - KFNGH ** Jeddah - KFHJ * Taif - KAAHJ - AHMHT - KFMHJ - KFSHJ * Khamis Mushayt - KMMH
- 5. Brain-Death Cases Possible, Eligible, Consented and Actual 1986 – 2010 8110 4352 1444 1311 POSSIBLE ELIGIBLE CONSENTED ACTUAL
- 6. Living Organ Donation Program in Saudi Arabia 1986 – 2010 4395 358 KIDNEYS LIVER
- 7. Dialysis Population: Current and Projected 1995 - 2015 16000 14000 14855 13738 12000 12633 12040 11168 10000 10280 9533 8000 8482 7833 7526 7809 7383 7029 6000 6008 5206 4000 4861 4322 3869 2000 0 Average Net Annual Increase = 584 Patients Average Percentage of Annual Increase = 8.3%
- 8. Counts of Kidney Transplants and Waiting List in USA Transplants or Awaiting /Year (1000's) 90 80 Living Donor 77.987 Deceased Donor 70 Total Donors 60 Waiting List 50 40 30 20 17.091 10 10.659 6.432 0 88 89 90 91 92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006 UNOS DATA 2006
- 9. Process of Consenting for Organ Donation from the next of Kin of the Deceased donors Convincing Families to Study family donate organs status from their beloved socially deceased donor Coordinators do Pay incentive not mention In need by government incentives unless asked by the family Approval Pay to Not in charity on Interview need behalf of the family No Abort approval donation
- 10. Organ Donation Is Mandatory for Organ Transplantation Live Recipients Deceased
- 11. Education for Organ Donation Government Medical Community Public at Large
- 12. Education Has Many Methods Which May Have a Positive Long-Term Effect on Society at Large Community Schools Media Centers • Under • Public not in • All levels of graduates the education society • Post system graduates
- 13. Is a Financial Incentive a Good Method for Education? We apply it in schools • Scholarships We apply it in business • Overtime
- 14. Should Financial Incentives Be Applied for Organ Donation? Yes, they help the process of educating the society to donate organs • Disseminating the idea that good acts and volunteering are appreciated Yes, due to variability of cultures in the education levels and values that should be respected • Some may appreciate a certificate or a medal, others appreciate a financial incentives ( When stopped , some programs went into a standstill such as Qatar, Bahrain) Yes, governments can be the source of the financial incentives not the recipients, which may antidote commercialism Government s control natural resources and compensate in disasters ( floods and earthquakes) and society trust them for future planning
- 15. Principals for Compensation for Organ donation Should preserve the concept of organ as a gift Should convey gratitude for the gift Should not be an excessive inducement that would undermine the personal values and alter decision making solely to receive money Should preserves voluntariness Should not lead to a slippery slope that fosters the sale of live human organs Ref.=Gruessner and Benedetti, Living donor Organ Transplantation ; Mc growhill -Page 96-2010???
- 16. Principals for Compensation for Organ Donation Should honor the deceased by not assigning a monetary value for individual’s organs Should respect the sacred nature of the human body by not tampering or intruding without a specific permission Should serve the public good by maintaining the current public perception of organ donation as good Should maintain the public trust by not altering patient care by premature life- support withdrawal from a person who might donate and also not placing the transplant recipients at increased health risk by jeopardizing the integrity of the organ pool Gruessner and Benedetti, Living donor Organ Transplantation ; Mc growhill -Page 96
- 17. Slippery Slope for Compensations • Though no risk of death Family may withhold information that may affect recipients ( cancer in donors) to get the payment Deceased Donation • Family may consent to prematurely withdraw life- support from patient who do not fulfill brain criteria for death
- 18. Guarantees to avoid slippery slope Establishing National Organ donation Centers • Supervises organ donation activities nationwide National protocols for organ donation process including diagnosis of death and allocation of organs • The diagnosis of death should follow a strict protocol for the purpose of organ donation and executed by personnel different from those in charge of transplantation
- 19. Types of Compensation for Deceased Organ Donation Direct Payment Income Tax Credit Reimbursement for Funeral Expenses A Contribution to a Charitable Organization determined by the Family
- 20. Arguments for Compensation for Deceased Organ donation Other than the families everybody receives incentives • Doctors, OPO Coordinators, charges of transplant centers for hospitalization Different cultures need different approaches for education. One size does not fit all • America is different from Saudi Arabia
- 21. Arguments against Monetary Compensation for Deceased Organ Donation Charges for services rendered to recipients are ethically different from payments for consents for organs recovered from donors Payments to OPOs and Physicians are exercises of their responsibilities Payments introduce an unacceptable commerce to the value for human life ( variable value from place to place)
- 22. ASTS meeting in 2001 to Address Ethically Acceptable Methods to Increase Organ Donations Conclusion of the committee = • There is a risk that financial incentives can undermine the public trust of the transplant system . Of the Types of compensation = • Payment for funeral expenses was the most ethical The ASTS issued a statement opposing payments to deceased and living donors
- 23. We May Need Financial Compensation for the Deceased Organ Donation Program Education of the public • Incentives helped education about importance of dialysis for replacement of end-stage renal disease in Saudi Arabia 1980-1995 Pay for expenses such as funeral and hospital bills rendered by families as an approach may have a similar effect on our culture • We prefer the direct payment as a government in Saudi Arabia, since the administrative system is not mature enough to have accurate follow-up of the real expenses. Hopefully, with time this incentive can be cancelled
- 24. Conclusions • May be a good tool for Education for Organ Donation. Incentives • Will remain controversial. • Has several different ways and should respect culture. • Living donation is different from the deceased in several aspects and direct comparisons do not apply properly. Deceased • Can be controlled by governmental supervision through a Donation • National Center, which insures appropriate • implementation of the protocol for diagnosis of death, consenting and allocating of organs. • Differences do exist and affected by education. Culture • One size solutions may not fit all.