Experts encourage organ donation from living donors, even those unrelated to patients, but stress that donors should be informed of potential consequences prior to giving consent

Before stuffing yourself with sweets, oil-rich food and alcohol this Christmas, you may want to take this as a warning.

Approximately one person with kidney failure in the Philippines dies every hour according to a well-known surgeon who specializes in kidney transplantation.

National Kidney and Transplant Institute (NKTI) Executive Director Dr. Enrique Ona said that every year, some 10,000 Filipinos develop kidney failure mainly from diabetes and high blood pressure. Worse, their numbers are increasing by about 10% annually since 5 years ago.

Ona presented the data at a health forum organized by the Novartis Healthcare Philippines, a pharmaceutical company whose products include drugs that prevent the rejection of kidney transplants in adult patients.

The data came from a study conducted by the Department of Health (DOH) with the NKTI under the Renal Disease Control Program. The program studied post-dialysis patients in the country for the past 10 years.

Lead a healthy life

To prevent kidney disease, people should lead healthier lives good diet and regular exercise, according to Ona.

He recalled the experience of former President Fidel Ramos who was diagnosed with kidney infection during his last year as senior cadet. Ten months after his graduation, Ramos was commanding a platoon in the Korean War, Ona said.

This was possible, according to Ona, because Ramos is very cautious about his physique and conscious of what he eats, Ona said.

Ona shared Ramos’ experience because the latter’s kidney problem did not hinder him from reaching his goals, and going beyond them. “At almost 80, he still plays golf and does not use a cart. He walks,” Ona exclaimed. Ramos is also a blood donor and donor to NKTI.

Need for donors

For a person with end-stage organ failure, the only chance for survival is an organ transplant, Ona said.

Unfortunately, he said, that the waiting list for organ recipients is long because transplantable organs and willing organ donors in the country are scarce.

Ona notes that of the 10,000 Filipinos who develop kidney failure every year, only 1 in every 20 (about 500) receive a kidney transplant every year.

Some 70% patients (7 out of every 10) are able to start lifelong dialysis or blood transfusion, Ona said. After a year, almost half of them die because they could no longer afford or find a suitable kidney donor, he said.

Dr. Angeles Tan-Alora, Executive Director of the Southeast Asian Center for Bioethics, said that “organ donation is good and should be encouraged.” Many Filipinos, she said, are still ignorant of the value of organ donation.

This, according to Tan-Alora, is why the DOH and NKTI implemented the Philippine Organ Donation Program (PDOP) last 2007.

Revise the rules

Medical practitioners present at the forum scored the implementing rules of the Anti-Trafficking in Persons Act of 2003 (RA 9208) for making it more difficult for patients to obtain new organs.

In particular, Dr. Antonio Paraiso, medical specialist and consultant in Nephrology of NKTI, cites Section 5 of the IRR which prohibits anybody from “any propaganda material that promotes trafficking in persons.”

Paraiso cited potential problems arising from the new rules.

Paraiso says this might make kidney patients vulnerable to lawsuits. “What if a person verbally announces the need for an organ? This person has committed a crime,” Paraiso said.

Paraiso also said that the law prohibits aliens to receive organs from Filipinos. He asked how it would be possible for a Filipino to donate his organ to a long-time foreign friend if the law considers his act a crime.

Another instance would be if the recipient would only agree to accept an organ if he or she would pay. He asked: “Is that a crime?” He said that in all 3 scenarios, not one person was trafficked nor trafficked another.

Controversial

The Philippine organ donation program had been severely criticized over the past years following reports of rampant sale of human organs that were allegedly condoned by surgeons and hospital administrators.

This was after the number of transplantations conducted in the country soared over the past years. The increase was fuelled both by the influx of foreign patients seeking new body parts and the availability of “donors” who, due to extreme poverty, are willing to sell their kidneys at the right price.

Ethical questions have been raised over whether health care providers have been taking the welfare of donors into consideration particularly given expected returns from each transplant operation.

In 2008, this prompted president Arroyo to order a ban on the transplantation of organs from living non-related Filipino donors to foreigners.

Prohibit organ sale

A staunch advocate of the donation program, Ona said that the program would ensure the safety of both organ donors and recipients.

Tan-Alora said that payment as precondition to kidney donation and sale or purchase of kidney, or any other organ, should be strictly prohibited

Although sale is not allowed, the donor should benefit from the donation, Tan-Alora said.

“But, you cannot commodify an organ,” she said. Tan-Alora mentioned this because of the long history of kidney trade in the Philippines. (Read: Timeline: Kidney Trading in the Philippines)

She said: “It is ‘walang-hiya’ to get an organ from somebody and just say ‘Thank you’.”

Tan-Alora said: “Most recipients (of organs) are rich … Measures have to be done in order for the poor to acquire benefits.”

Informed consent

Tan-Alora notes that while society is quick to condemn the poor for selling their organs, what they really need is protection.

The study entitled “Failure of Informed Consent in Compensated Non-Related Kidney Donation in the Philippines” published last June 2009 in the Asian Bioethics Review showed that of the 311 Filipinos they interviewed, the compensation received by the organ vendors is almost equivalent to average wages of vendors for 2 years. Although they do get money, there are no remarkable economic improvements in 36% of the respondents.

According to the study, only a few experience economic improvement briefly after receiving payment for their organs.

In the study, it was also said that 28% of the respondents claim they never went through any form of health counseling. Forty five percent of the respondents said that information given to them prior to donating their organ was not enough for them to fully understand the implications of selling their kidneys, 30% did not receive any advice for post-operative checkup.

Reacting to the study, social welfare secretary Esperanza Cabral, one of the vocal critics of the way the organ donation program is being managed by local health providers, also batted for informed consent in a recent press release.

Cabral said it is very important that donors are fully aware of the nature and consequences of their actions saying, “the awareness of the donor and the validity of his informed consent to the transplant will help curb exploitation and even save their lives.” (abs-cbnNEWS.com/Newsbreak)

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