A national program for nondirected kidney donation from living unrelated donors: the Philippine experience

M N Manauis, K A Pilar, R Lesaca, R de Belen Uriarte, R Danguilan, E Ona
Transplantation Proceedings 2008, 40 (7): 2100-3

OBJECTIVES: The objectives of this study are to describe the mechanism of the program and to present initial donor outcome.

METHODS: This is a descriptive study evaluating the performance of a national program for nondirected kidney donation from living unrelated donors (LURDs) in the Philippines in its 3-year implementation. It explains the mechanism of the program and socioeconomic and clinical profiling of donors. Frequencies and percentages were used to measure donor demographic data, medical follow-up compliance rate, and employment predonation and postdonation. Diagnostic laboratory criteria were required to show donor clinical profiles.

RESULTS: In 2002, the local Health Department issued an administrative order to create a National Transplant Ethics Committee (NTEC) to address issues of rampant organ sale and donor exploitation. It also set guidelines and intended to oversee transplantation from LURDs. Salient points to the program are as follows: (1) prohibition of sale; (2) accreditation of transplantation centers; (3) enrollment of waitlisted patients in both deceased donor and nondirected LURD program; (4) ethics committee evaluation of LURDs; (5) creation of a national kidney transplant wait list and live donor registry allowing centralized, nondirected kidney allocation; (6) 10% cap on allocation to foreigners; (7) creation of a kidney donor monitoring unit with free 10-year annual medical follow-up for feedback evaluation on donor outcome; and (8) allowance of gratitudinal gifts such as health and life insurance, reimbursement for lost income, educational plan, and job placement to LURDs run by a foundation. From 2004 to 2006, 695 potential donors enrolled; 97 were accepted and deemed medically fit to donate. The remaining 598 were rejected due to demand for outright sale (103), medical unsuitability (77), disapproval by the Ethics Committee (12), and retracted consent (406). Of the 97 qualified donors, 79 had donated, 9 were being evaluated, and 9 await allocation at the end of 2006. Donor demographics show the following: 54% (381) single, 77% (538) males, and 70% (488) aged 21-40 years old. Sixty-eight of 79 became small-scale entrepreneurs postdonation. Also, 53% (42 of 79) complied with medical follow-up requirements. Mean serum creatinine level at 6 months, 1 years, and 2 years were 1.3, 1.33, and 1.05 mg/dL, respectively. Two donors had trace protein and 1 had (+1) protein.

DISCUSSION AND CONCLUSIONS: The majority of the donors are single males, aged 21-40 years with blue collar jobs. Major reasons for dropouts are retracted consent and medical unsuitability. Donors have improved socioeconomic status. In this study, 53% complied with expected medical follow-up, showing mean serum creatinine within normal range. Proteinuria appeared in 2 of 79 donors. This regulated approach provides a rational, accessible, and equitable donor allocation program. It safeguards the rights of donors and avoids donor exploitation and proliferation of unregulated organ sale. Data collection on their postoperative renal function will show long-term outcome of kidney donation from live donors.

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