Current status of organ transplantations in Asian countries☆

Article Outline

• Method of survey
  • Outline of the questionnaire
  • Countries involved in the survey
• Results
  • Response
  • Variety and number of transplantations
    • Kidney transplantations
    • Liver transplantations
    • Heart transplantations
    • Lung and heart-lung transplantations
    • Pancreas and pancreas-kidney transplantations
  • Status of dialysis patients
  • Organ transplantations abroad
• Discussion
• Conclusion
• Acknowledgements
• Copyright

The Asian Society of Transplantation was founded in 1989, and the transplantation registry also was started in the same year with the kind cooperation of many members of our Society and pharmaceutical companies. On an annual basis we have compiled data through survey results obtained from countries in this area.

In this article, the number of transplants performed in each country, the legal, social, and ethical problems encountered during 1996 and 2000 are reported along with the present status of dialysis patients in Asia.

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Method of survey 

Outline of the questionnaire 

The questionnaire includes the following: (1) number of centers that performed organ transplantation, (2) varieties and numbers of organ transplantations performed in 1999 and 2000, (3) present status of dialysis, number of dialysis patients, and number of candidates on the list for transplantation, (4) number of patients going abroad for transplantation, and (5) recent transplantation highlights, news, and issues affecting each country during 1999 to 2000.

Countries involved in the survey 

Questionnaires were sent to key persons of each country where transplantation currently takes place. The deadline for the completion for the questionnaires was set for August 20, 2001. Because of the war against terrorism in Afghanistan, however, the 7th Congress of the Asian Society of Transplantation was postponed, and the deadline of the questionnaire also was postponed.

There were 16 countries involved in this survey: Bangladesh, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Oman, Pakistan, China, The Philippines, Saudi Arabia, Singapore, Taiwan, Thailand, and United Arab Emirates (UAE).

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Results 

Response 

Thirteen of 16 countries responded to the questionnaire, although there were some omissions in their answers. We had no answers from Indonesia, Singapore, and UAE. The number of transplantations performed between 1996 and 2000 is illustrated in Table 1, and the detailed data including the numbers and varieties of transplantations performed between 1999 and 2000 is shown in Table 2.

Table 1. The Number of Organ Transplantations in Asia (1996–2000)

Table 2. The Number of Organ Transplantations in Asia (1999–2000)

Variety and number of transplantations 

In 13 countries surveyed, kidney transplantation was performed. The total number of kidney transplantations performed between 1996 and 2000 in this region was 48,420 including 22,531 cadaveric transplantations (46.5%) and 25,889 living donor transplantations (53.5%). Further analysis of living donors was made using data obtained in 1999 and 2000 (Table 3).

Table 3. Sources of Donors in Liver Transplantation in Asia (1999–2000)

—, No data available.

Among 6231 patients who underwent transplantation with grafts from living donors in 1999, 3894 received organs from related donors and 2337 from unrelated donors. Of the total transplantations, 938 were from spouse donors. No specifics on donor types were available for the 352 transplantations in Korea and the 35 transplantations in Japan.

For the 6222 patients who underwent transplantation with grafts from living donors in 2000, 3846 had living related donors, and spouse donation contributed to 676 of the renal transplantations. No specific data regarding donor types were available regarding 23 cases from Japan.

Liver transplantation was conducted in all the countries except Oman and Pakistan. The number of transplantations increased each year between 1996 and 2000. The total number of liver transplantations reached 2702, including 1675 living related transplants and 1027 cadaveric transplants. Of the latter, 406 livers donated in China were from non–heart beating cadaver donors. Nine countries, Hong Kong, India, Japan, Korea, Malaysia, China, Philippines, Taiwan, and Thailand, conducted both living and cadaveric liver transplantations, however, both Oman and Pakistan conducted no liver transplantations. China and Saudi Arabia used mainly cadaveric liver grafts (Table 2). Their total numbers of liver transplantations in 1999 and 2000 are shown in Table 4. In Japan the number of living donor transplantations increased rapidly, reaching 1036 at the end of the year 2000.

Table 4. Sources of Donors in Living Donor Kidney Transplantation (1999–2000)

—, No data available.

Heart transplantation was conducted in 9 countries: Hong Kong, India, Japan, Korea, Malaysia, China, Saudi Arabia, Taiwan, and Thailand. From 1996 through 2000, 571 heart transplantations were performed. Among them, Taiwan had the largest number at 245 (42.9%), followed by Korea with 121 (21.1%) and China with 61 (10.7%). These 3 countries make up 74.7% of the total number of heart transplantations in Asia.

Between 1996 and 2000, 77 lung transplantations and 25 heart-lung transplantations were conducted. Of the 77 lung transplantations, 32 cases (41.6%) were performed in Taiwan, and 11 cases each (18.3%) were done in China and Thailand.

Among the 25 heart-lung transplantations performed, 16 cases (64.0%) were done in Thailand. The annual number of lung transplantations decreased from 17 in 1996 to 14 in 1997, 11 in 1998, and increased to 21 in 1999 and decreased again to 14 in 2000. The heart and lung transplantations have decreased from 1996 to 1998 (from 6 to 3), however, increased to 5 in 1999 and 6 in 2000.

The total number of pancreas transplantations between 1996 and 2000 was only 18, whereas that of pancreas-kidney transplantations was 83. Of those countries conducting pancreas transplantations, 17 cases (94.4%) were performed in Korea, and only 1 case (5.5%) was performed in Taiwan. Countries conducting pancreas-kidney transplantations were China with 64 cases (77.1%), Korea with 16 cases (19.3%), India with 2 cases (2.4%), and Japan with 1 case (1.2%).

Status of dialysis patients 

The total number of dialysis patients in Asia was 302,301 at the end of 1999 and 297,669 at the end of 2000. This decrease of 4,632 patients on dialysis in 2000 is mainly due to the lack of data from Korea. Accordingly, Japanese patients who occupied 65.2% of the total patients on dialysis in 1999 increased to 69.2% in 2000, followed by India at 11.3%, and Taiwan at 10.1%. The numbers of dialysis patients per million populations in 2000 was 1640.7 in Japan, 1,368.9 in Taiwan, 519.1 in Hong Kong, 343.4 in Saudi Arabia, 277.7 in Malaysia, 187.4 in Oman, 91.6 in Thailand, 35.3 in India, 25.2 in the Philippines, 22.6 in Pakistan, and 6.14 in Bangladesh. No data were available from Indonesia, Singapore, and UAE.

Because of the increase in the number of dialysis patients and improved graft survival, demand for kidney transplantation has increased in many countries. Numbers of patients on waiting lists are as follows: 13,362 in Japan, 5850 in Taiwan, 5010 in Saudi Arabia, 3120 in Korea, 3000 in Malaysia, 1293 in Pakistan, 1042 in Hong Kong, 1015 in Thailand, 315 in Oman, and 90 in Bangladesh. The average waiting time is 6.7 years in Japan, 4.8 years in Hong Kong, more than 10 years in Malaysia, 3.2 years in Thailand, and 2.7 years in Saudi Arabia. The chief complaint from most patients is the long waiting period, particularly in Japan.

Regarding the donor selection criteria for hepatitis B and C, transplantation from a B-positive donor to a B-positive recipient is accepted in 10 countries, whereas a B-positive donor to a B-negative recipient is accepted only in 3 countries (Hong Kong, Malaysia, and Oman).

Regarding transplantations from a C-positive donor to a C-positive recipient, it is accepted in 10 countries, however, for C-negative recipients, it is accepted in only India and Korea.

Organ transplantations abroad 

Data was obtained from 13 countries; however, not all countries could supply data for patients who went abroad to undergo transplantation. In Bangladesh 20 patients went abroad for kidney transplantations. In Hong Kong 97 patients went abroad for kidney transplantations. In India 15 patients went abroad for liver transplantations. In Oman 33 patients went abroad for kidney transplantations. In Pakistan 75 patients went abroad for kidney, 6 patients for liver transplantations, 1 patient for pancreas transplantations, and 10 patients for other procedures. In Saudi Arabia 241 patients went abroad for kidney transplantations. In Taiwan 160 patients went abroad for kidney transplantations and 2 patients went abroad for liver transplantations. No data were available for Korea, the Philippines, Thailand, and Japan. In China no patients went abroad to undergo transplantations.

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Discussion 

It is regrettable that in three countries (Indonesia, Singapore, and UAE) there are no data available. Based on this report, special attention should be given to the significant increase in the number of liver transplantations using living donors in this area. Particularly in Japan, the number of living donor liver transplantations in 2000 was 314 and the number of living donor kidney transplantations was 600, therefore, the number of living donor liver transplantations increased to 52.3% of the total number of living donor kidney transplantations. If this progression continues, the number of living donor liver transplantations may exceed the number of living donor kidney transplantations.

The number of heart transplantations in Asia decreased between 1999 and 2000. This is primarily due to the decreased number of heart transplantations in Korea and India. The number of heart transplantations in China and Taiwan increased in 2000 compared with 1999 (Table 2).

The number of lung transplantations is still very small, however, the number in Japan increased after introduction of brain death law and the technical improvement of single-lung transplantation.

The first pancreas transplantation in Asia was performed in 1984 in Japan by Iwasaki. Since 1990 we have done 11 cases at Tokyo Women’s Medical University. Pancreas transplantation stopped due to legal discussions regarding brain death, and during this time pancreas transplantation was done sporadically in Korea, Thailand, and Taiwan. Since 1998 simultaneous pancreas-kidney transplantation started to increase in China and Korea.

In Japan brain death law was implemented in October 1997. No brain dead donors were available in 1997 and 1998. The first brain dead donor was available on February 28, 1999. Since that time, 2 other cases of heart transplantation were conducted in 1999 and 3 cases were performed by the end of 2000. The number of donations from brain dead cadavers were limited despite the active distribution of 50 million donor cards. Very rigid donation criteria, including the necessity of a written living will of the donor and the family’s approval, are considered to be the biggest obstacles to increase the number of brain dead cadaveric donors.

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Conclusion 

Since 1989 the Asian Transplant Registry has conducted surveys throughout Asia and it is through these surveys we are able to learn more about specific transplantation issues facing other Asian countries. Thirteen years have passed, and many changes have happened in the medical, legal, social, economic, and cultural infrastructures within each country. The development of transplantation programs varied and also leaders in each field of transplantation changed. These conditions have made the collection of data in each country more difficult. It is strongly needed to reorganize the domestic registry system in each country and to designate the person in charge of these data.

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Acknowledgements 

I would like to thank the cooperative members in each country: Dr. Harun-Ur-Rashid (Bangladesh), Dr. Sui-Shen Xia (China), Dr. T.M. Chan (Hong Kong), Dr. Anant Kumar (India), Dr. Sang Joon Kim (Korea), Dr. Zaki Morad (Malaysia), Dr. A.S. Daar and Dr. Nabil Mohsin (Oman), Dr. S. Adibul Hasan Rizvi and Dr. S.A. Anwar Naqvi (Pakistan), Dr. Enrique T. Ona (the Philippines), Dr. Faisal A.M. Shaheen (Saudi Arabia), Dr. Long-Bin Jeng (Taiwan), and Dr. Visist Dhitavat (Thailand).