KARACHI, Dec 2: The speakers at the concluding day of the 9th Congress of Asian Society of Transplantation here discussed the issues hindering the cadaver transplant noting that Asia has the lowest transplant rate in the world.

Speaking at the congress, organized by the Sindh Institute of Urology and Transplantation (SIUT), Karachi, Dr Ajay Kumar of India said that the western theory about transplantation was based on individual’s right of choice and dignity while the eastern philosophy was driven by social values and family needs.

“One of the major issues about cadaver organ donation is accepting brain death in our societies,” he added.

Dr Kumar said that the need for organs had grown faster than the number of available organs.

He further said that donation in even families may not be truly altruistic, as most of the donors were females ie mother and wife, he added calling upon the policy makers to re-examine the value of using legal financial incentives to increase the supply of organs for transplantation.

Dr Oswald F. Fernando from Royal Free Hospital, UK stated that the outcomes of the solid organ transplantation in the paediatric population had improved due to the advances in immunosuppression and surgical techniques.

In the paediatric population, he said, adolescents enjoyed the best one-year transplant survival.

Dr Verma from AIIMS, New Delhi, spoke on the significance of protocol biopsies in live-related renal transplant recipients.

“Low grade rejection can occur and remain undetected in some patients, which can have an impact on long term graft survival. The biopsy should be done routinely within six months of transplant to detect a minor rejection and treat it likewise for better results,” he suggested.

Dr U. B. Berg from Sweden said that the long-term graft function and survival in paediatric renal transplant was better in the cases of living donation compared to the cadaver organ grafts.

Hypertension in a one-year-old child and more than one episode of rejection during the first year post-transplant has a poor prognosis, he added.

Dr Joseph Llovera from Barcelona, Spain said that the elderly cadaveric donors did not give favourable results, but if it was unavoidable and if the waiting list of transplants needed to be decreased, this source could be considered.

“In Spain, about 35 per cent cadaveric donors are older than 60 years of age and most common cause of death in them is brain haemorrhage. Family refusal for cadaveric donation of organ in Spain is about 20 to 25 per cent,” he told.

Dr G. Koostra from Maastricht talked about non-heart beating donation of organs for transplantation. This has increased from 30 per cent in 2002 to 42 per cent in 2005 in Netherlands, he added.

Dr Koostra said that in Japan only heart beating donors were used. The long term result of heart beating donors versus non-heart beating donors is the same. In Asia and the Middle East non-heart beating donation would readily be accepted to reduce the shortage of kidneys, he observed.

Prof A. Vathsala from Singapore said that scholars in the Muslim countries had passed a Fatwa permitting transplantation based on the Quranic verse that “If any one saves a human life, it would be as if he saved the life of the entire mankind”. He told that first cadaveric transplantation in Singapore was done in 1970.

“There are economic barriers in doing a cadaveric transplant that calls for a community-government relationship to overcome the subsequent high cost of immunosuppression,” Dr Vathsala said. —PPI