Altruistic Living Non-Related Kidney Donation Program in Syria

Facts & Difficulties

Bassam SaeedKidney Hospital, Damascus , Syria

bassam.said@gmail.com

4th SSN Congress Riyadh, April 27, 2009

Introduction The kidney transplant program in Syria has been exclusively relying on

living related donors and remained sluggish for more than three decades

In 2003, There has been discussion in the country about the possibility of accepting unrelated living kidney donors

From an ethical point of view, there is no conclusive argument that could justify a general exclusion of unrelated donors(1-3)

1-Daar AS, Land W, Yahya TM, Schneewind K, Gutmann Th, Jakobsen A. Living donor renal transplantation: Evidence-based justification for an ethical option. Transpl Rev 1997;11:95-109

2- United Network for Organ Sharing 1991 Ethics Committee. Ethics of organ transplantation from living donors. Transplant Proc 1992; 24:2236-2237

3-Spital AL. Unrelated living donors: Should they be used? Transplant Proc 1992; 24:2215-2217

Sequential Legislations

In consideration of the widening gap between demand and supply of kidneys and other organs:

In January 2008, the government of Syria issued a pronouncement restricting kidney Tx to the public sector with a new national regulatory oversight of Tx practices

In November 2003, a new national Syrian legislation has been enacted and authorized the use of organs from both volunteer strangers and deceased donors providing the donation to be altruistic and between nationals to avoid transplant tourism

ESRD in Syria

The estimated incidence of ESRD in Syria:100 pmp/yr *

2000 new ESRD case /yr*

Prevalence of ESRD patients undergoing dialysis: 143 pmp*

Prevalence of ESRD ≈ 200 pmp**

*Saeed B, et al. Organ failure in Syria: initiating a national deceased donation program. SJKDT 2007;18(2):270-276

**Saeed B, et al. Volume of organ failure in Syria and obstacles to initiate a national cadaver donation program. IJKD 2007; 2 (2):65-71

Aim of The Study

To examine the donor characteristics of kidney transplants in Syria

To examine the impact of national Syrian legislation on the evolution of kidney transplantation activities in

the private and public sectors

Methods

Retrospective analysis of numbers of all kidney transplants performed in the private and public sector hospitals in Syria and abroad for Syrian nationals from 1990 to 2008 with a focus upon transplants since 2003

We reviewed the medical records of all donors from kidney transplant centers in Damascus over a period of 3 years (2005 to 2007) and recorded the donors and recipients' 1. Genetic relationship if any2. Ages3. Genders4. Difference in age5. Different barriers to donate kidney from potential related donors

Results

Increasing Rate of Kidney Tx

1990 2002 2007

0

2

4

6

8

10

12

14

16

18

2

7

17

Kidney Tx Rate pmp/per year

Substantial Decreasein Kidney Tx abroad

1988 1999 2007

0%

10%

20%

30%

40%

50%

60%

8%

60%

2%

Percent Kidney Tx Abroad

Results

A total of 856 kidney donors were enrolled

454 donors (53%) in public hospitals

402 donors (47%) in private hospitals

Related versus Non-related Donors 2005-2006-2007

71%29%

Non-RelatedRelated0

100

200

300

400

500

600

700

608

248

Gender Distribution in Related Compared to Non-Related Donors

All donors Non-Related Donors Related Donors

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

65%

87%

50%

35%

13%

50%

Male Female

Donor Age GroupsRelated versus Non-Related

All Donors Non-Related Related

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

41 3644

3755

25

15

8

21

71

10

< 30 years 30-40 years 40-50 years > 50 years

Kidney Selling

Despite the prohibition to buy a kidney in Syria, vendors had found ways to sell their kidneys through disreputable brokers especially in the private sector

Why Potential related donors were not inclined to donate kidneys to their relatives

1. kidneys could be bought from a non-related donor! 2. Fear of not being able to maintain family and raise children

3. Fear of developing kidney failure

4. The non-acceptance of their senior influent relatives

5. Fear of anesthesia, surgery, cosmetic complications

6. Fear of doing something against the religion

7. Fear of losing their job if any miss happening

8. Fear of losing the chance to get married

Live kidney donation : a balance

Donor Recipient

SelectionFollow-up

Care

DONATION

The hidden kidney donor

DonneurRecipient

SelectionSuivi

Prise en charge

DON

Kidney selling conceal the donor

A Step of Ethical Propriety

On January 17, 2008

The government of Syria issued a pronouncement restricting kidney

transplantation to the public hospitals

Evolution of Kidney Transplant Activities in Syria

2000 - 2009

Number of Public Transplant Centers

2000 2001 2002 2003 2004 2005 2006 2007 2008

0

1

2

3

4

5

6

7

23 3 3 3 3

4 4

7

2000 2001 2002 2003 2004 2005 2006 2007 20080

20

40

60

80

100

120

140

52

43

59

50

79

97

106

9095

0

21

66

124

53

64 6459

84

105

26

37 7 9

40

43

07

0

15

Mouassat University H Kidney H Tichreen Mil H Children H Assad University H Ibn Rochd H

Watani Homs H

Evolution of Kidney Tx Activities In Public Hospitals

-26%

Kidney Tx Number in Public Hospitals

2000 2001 2002 2003 2004 2005 2006 2007 2008

0

50

100

150

200

250

300

62 69

127

180144

168 181162

252

+55%

Evolution of Kidney Transplantation in Public vs Private Hospitals

2000 2001 2002 2003 2004 2005 2006 2007 20080

50

100

150

200

250

300

Kidney Tx Number in Public HospitalsKidney tx Number in Private Hospitals

Conclusion

The recommendations of the Istanbul Declaration and the Revised Guiding Principles of the WHO have yet to be implemented in Syria

The expansion of kidney transplants in the public sector is an important initial step to initiating a deceased organ donation program as an essential component of a comprehensive approach to the problem of the organ shortage

Thank you for your attention