Don't give your kidneys to heaven, we need them here

MANILA, Philippines - It might seem to border on the macabre — this subject of harvesting the organs of the dead so that these may be transplanted and prolong the lives of needy patients. But with a growing population requiring transplants, deceased organ donation is the most feasible alternative to address the problem of lack of organs for transplantation.

Consider these figures: The Philippine Renal Disease Registry said that in 2007, 10,000 to 12,000 individuals developed end-stage renal disease. Of these, half or 5,000 required kidney transplants. However, less than 10 percent (or less than 500) were able to undergo transplant surgery because of insufficient organ supply. With 95.5 percent of the kidneys transplanted coming from living donors in the Philippines, only 15 deceased donor organs are transplanted each year. This means that otherwise usable kidneys are buried and in effect, wasted.

“It is always easier to convince a living donor than the bereaved of the deceased to donate a kidney,” says Dr. Vicente Tanseco, chairman of the Integrated Program on Organ Donation (IPOD).

In Filipino culture, the removal of body parts is perceived to be tantamount to the desecration of the body and shows disrespect for the deceased. And because living donors are generally perceived as more acceptable, we witnessed the thriving phenomenon of kidneys as commerce — where individuals from certain communities were recruited and convinced to part with their kidneys for a price.

To prevent exploitation of would-be donors, the National Policy on Kidney Transplantation from Living Non-Related Donors was passed. This sets guidelines and ethical principles whereby acts of donation and conduct of transplantation from living non-related donors are managed. It appears that the policy has been effective in curtailing the sale of kidneys, thus far. At a recent forum, Dr Ernie Vera of the National Center for Disease Prevention and Control said that from 312 Filipino and 531 foreign kidney transplant recipients in 2007, the figures were 274 Filipino versus 167 foreign kidney transplant recipients in 2008. The clause ruling that foreigners are not eligible to receive organs from non-related Filipino donors seems to have been effective in curbing the objectionable kidney-for-sale-to-foreigners trade. Still, the problem of lack of kidneys for transplantation is not addressed.

 The situation is different in the United States where 58 organ procurement associations are designated by the federal government. These effectively operate in geographically distinct areas, so that between 15,000 and16,000 individuals receive kidney transplants from deceased donors per year. Harvesting usable organs from the deceased has become the norm.

“Don’t take your kidneys to heaven; we need them here,” was the appeal of Howard Nathan who spoke at the recently held First Organ Donation and Transplantation Summit. “This is an opportunity to make good out of the death of a family member. Because of the organs they receive, many people’s lives are changed.”

As president and CEO of Gift of Life, one of the largest and oldest organ procurement organizations in the US, Howard Nathan visited the Philippines recently to help build awareness for the importance of deceased organ donation.

“The most important thing is for families to be assured that everything was done for the patient,” says Nathan. He relates that 44 percent of drivers in the United States have consented to donate their organs should the worst happen to them. The procurement organizations are able to keep track of donors because organ-donation consent is stored in computers with data from driver’s licenses. But while kidney transplantation has been funded in the United States by the federal government since 1973, transplant costs average from P250,000 to P300,000 in the Philippines. That spells a big difference.

The Integrated Program on Organ Donation (IPOD) does not have the resources available to organ procurement organizations in the United States, but the organization seeks to advocate the continuous supply of organs from deceased donors by increasing awareness. IPOD president Dr. Angel Luis Amante says, “Our group was formed to address the problem regarding organ — particularly kidney — transplant. We communicated with 10 private and five government hospitals in the National Capital Region, and the responses appear to be favorable.” Dr. Tanseco adds, “This task cannot be done by only one organ procurement organization. We are hoping that all stakeholders will be with us in deceased organ donation program. We are banking for legislative support.”

But inevitably, the success of the program starts with the family of the bereaved. Deceased organ donation means giving part of a loved one so someone else may live. It is the ultimate in generosity because the act entails giving even if it hurts.