Manauis M N, Pilar K A, Lesaca R, de Belen Uriarte R, Danguilan R, Ona E
National Kidney and Transplant Institute, Quezon City, Philippines.
Transplant Proc. 2008 Sep;40(7):2100-3. doi: 10.1016/j.transproceed.2008.06.033.
The objectives of this study are to describe the mechanism of the program and to present initial donor outcome.
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.
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.
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.
本研究的目的是描述该项目的机制并展示最初的供体结果。
这是一项描述性研究，评估菲律宾一项针对非定向活体亲属外供体（LURD）肾脏捐赠的国家项目在其3年实施过程中的表现。它解释了该项目的机制以及供体的社会经济和临床概况。频率和百分比用于衡量供体人口统计学数据、医疗随访依从率以及捐赠前后的就业情况。需要诊断实验室标准来展示供体临床概况。
2002年，当地卫生部发布行政命令成立国家移植伦理委员会（NTEC），以解决猖獗的器官买卖和供体剥削问题。它还制定了指导方针并打算监督来自LURD的移植。该项目的要点如下：（1）禁止买卖；（2）移植中心的认证；（3）将等待名单上的患者纳入 deceased 供体和非定向 LURD 项目；（4）伦理委员会对 LURD 的评估；（5）创建国家肾脏移植等待名单和活体供体登记处，允许集中、非定向的肾脏分配；（6）分配给外国人的比例上限为10%；（7）创建肾脏供体监测单位，为供体结果的反馈评估提供免费的10年年度医疗随访；（8）允许由一个基金会为LURD提供诸如健康和人寿保险、收入损失补偿、教育计划和工作安置等感恩礼物。从2004年到2006年，695名潜在供体登记；97名被接受并被认为医学上适合捐赠。其余598名因直接要求买卖（103名）、医学上不适合（77名）、伦理委员会不批准（12名）和撤回同意（406名）而被拒绝。在97名合格供体中，79名已捐赠，9名正在接受评估，9名在2006年底等待分配。供体人口统计学显示如下：54%（381名）单身，77%（538名）男性，70%（488名）年龄在21至40岁之间。79名中的68名在捐赠后成为小规模企业家。此外，53%（79名中的42名）符合医疗随访要求。6个月、1年和2年时的平均血清肌酐水平分别为1.3、1.33和1.05mg/dL。两名供体有微量蛋白尿，一名有（+1）蛋白尿。
大多数供体是年龄在21至40岁、从事蓝领工作的单身男性。退出的主要原因是撤回同意和医学上不适合。供体的社会经济地位有所改善。在本研究中，53%符合预期的医疗随访，显示平均血清肌酐在正常范围内。79名供体中有2名出现蛋白尿。这种规范的方法提供了一个合理、可及且公平的供体分配项目。它保障了供体的权利，避免了供体剥削和无监管器官买卖的泛滥。关于他们术后肾功能的数据收集将显示活体供体肾脏捐赠的长期结果。
