Rizvi S A H, Naqvi S A A, Hashmi A, Akhtar F, Hussain M, Ahmed E, Zafar M N, Abbas Z, Jawad F, Sultan S, Hasan S M
Sindh Institute of Urology and Transplantation, Dow Medical College, Karachi, Pakistan.
Transplant Proc. 2004 Sep;36(7):1894-5. doi: 10.1016/j.transproceed.2004.08.135.
Organ transplantation started with organs donated by living subjects. Increasing demands brought cadaveric organ donation. The brain-death law, mandatory for this procedure, is prevalent in all countries involved in organ transplantation except Pakistan. Spain is the leading country in cadaveric organ donation (32.5 pmp). Despite the sources of living and cadaveric organs, both heart-beating and non-heart-beating, the gap between the demand and supply has widened. An example is the United States, where the numbers of patients on the waiting list for kidney transplantation have risen from 30,000 in 1988 to more than 116,000 in 2001. This has caused a resurgence in living donors all over the world. These can be related, unrelated, spousal, marginal, or ABO-incompatible donors. Family apprehensions, medical care costs, and nonexistent social security can be barriers to this form of organ donation. Unrelated organ donation can open the doors to commercialism. To make this process more successful, transplantation should be made reachable by all sectors of the population. This is possible when transplantation is taken to the public sector institutions and financed jointly by the government and community. To increase living organ donation especially in Asian countries, which face barriers of low literacy rates, ignorance, and cultural and religious beliefs, more efforts are needed. Public awareness and education play an important role. Appreciation and supporting the donors is necessary and justified. It is a noble act and should be recognized by offering job security, health insurance, and free education for the donor's children.
器官移植始于活体捐赠者捐献的器官。需求的增加促使了尸体器官捐赠的出现。脑死亡法是这一程序的强制性规定，在除巴基斯坦之外的所有参与器官移植的国家都很普遍。西班牙是尸体器官捐赠的领先国家（每百万人口中有32.5例）。尽管有活体和尸体器官的来源，包括心跳骤停和非心跳骤停的情况，但供需差距仍在扩大。美国就是一个例子，肾移植等待名单上的患者人数从1988年的3万增加到了2001年的超过11.6万。这导致了全球活体捐赠者的再度兴起。这些捐赠者可以是亲属、非亲属、配偶、边缘人群或ABO血型不相容的捐赠者。家庭担忧、医疗费用以及不存在的社会保障可能成为这种器官捐赠形式的障碍。非亲属器官捐赠可能会为商业化打开大门。为了使这一过程更加成功，移植手术应该让所有人群都能够接受。当移植手术进入公共部门机构并由政府和社区共同资助时，这是可行的。为了增加活体器官捐赠，尤其是在面临识字率低、无知以及文化和宗教信仰等障碍的亚洲国家，需要做出更多努力。公众意识和教育起着重要作用。赞赏和支持捐赠者是必要且合理的。这是一项高尚的行为，应该通过为捐赠者提供工作保障、医疗保险以及为其子女提供免费教育来得到认可。
