Liver - Hospital Authority

Kidney Cadaveric 1969

Living 1980

Cornea 1961

Liver Cadaveric 1991

Living 1993

Bone 1991

Heart 1992 Skin 1992

Lung 1995 Pancreas NYD

Heart / Lung 1995 Gut NYD

Neuro NYD

n deceased

n living

Renal Transplantation Performed in HK

1 2 0 2 0 5 2 0 3 312

6 7 6 413 12

18 1724

33 32 34 31

44 44

5847

33

4741

48

73

44 4451 53 57

66

87

74

57

0 0 0 0 0 0 0 0 0 0

11 0

01 1

2 15

19

31

2423 35

44 42

42 63 65

92

151

201 184

169159

127

204

97

130

98

60

61

0

50

100

150

200

250

300

70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 '00 '02 '04 '06 '08 '10

n HK living n HK deceased

n Outside HK

Renal Transplantation Followed-up in HK

0200400600800

1000120014001600180020002200240026002800300032003400

87 88 89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11

HK deceased HK living China Others

0

1000

2000

3000

4000

5000

6000

84

86

88

90

92

94

96

98

'00

'02

'04

'06

'08

'10

Number on dialysis

Number transplanted

0

5

10

15

20

25

30

最長輪候期 16 17 18 19 20 21 21 22 22 23 24 25 26 27 28 28 28 28 28

93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11

Number of Organs Available

Graft & Patient Survival

Extended Criteria Living Donation

Deceased Donation Rate

Recipient Matching Cold Ischemic Time

Immunosuppressants Manage Co-morbidities

ExtendedCriteriaDonor

StandardCriteriaDonor

UNOS- Age>60 or Age >50 + 2 out of 3 (stroke / HT / creatinine >130umol/L)

Include all unfavorable medical conditions

152 (41.2%)

217 (58.8%)

79 (24.9%)

277 (75.1%)

Total: 369

Act of donation should be regarded as heroic and honored

Shorten time for living donor evaluation

Hospitalization and renal transplantation operation fee waived for living donor

Life Long follow-up

Living donor with renal failure support with dialysis

& priority for access to renal transplantation

Promote pre-emptive renal transplant

Expand source of donors e.g. elderly donors, donors with mild BP, unrelated donors & paired exchange donors

0

10

20

30

40

50

60

70

A 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Contribute ~40% of all donors

No. of deceased organ donor amongst 15 H.A. acute hospitals (2003 - 2007)

21

2527

31

44

2628 29 30 29

7

108

16 16

12 1113

1513

0

5

10

15

20

25

30

35

40

45

50

98 99 '00 '01 '02 '03 '04 '05 '06 '07

H.K. A

Successful donors

Directly proportional to number of referrals

Stroke (70%)

50% from Neurosurgery or Medical ward

77% of potential donors missed

Majority of potential donors not admitted into ICU but cared in general wards (50% failed to reach brain death due to poor donor maintenance)

Nurses and transplant co-ordinators (and early rapport) important

Awareness of the general ward nurses are vital for more referrals

Overlook organ procurement and transplant

Set policies and guidelines and unify practice

Four major directions of work

Alignment of donor assessment and acceptance

Alignment of donor maintenance

Assuring support to transplant co-ordinators

Boosting referral rate and organ donation rate through improving coordination

Alignment of donor assessment and acceptance

Standardize donor acceptance criteria Standardize donor assessment and

investigation protocols Standardize referral initiation to initiate

donor maintenance early

Assuring support to transplant co-ordinators

Formation of Cluster Transplant Committee to establish the local donor

maintenance policy Smooth out logistics and support in referring, assessing and maintaining

potential donors

Alignment of donor maintenance Standardize the donor maintenance

protocol Endorse the role of transplant co-

ordinator to assist the parent team doctors in donor maintenance and

monitoring

Boosting referral rate and organ donation rate through improving coordination

Increase number of transplant co-ordinatiors from 4 to 5 (2008) to 7 (2009)

Pool call system of the transplant co-ordinators to increase efficiency

Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7

*Queen Mary

Hospital

Pamela

Youde

Nethersole

Eastern

Hospital

*Queen

Elizabeth

Hospital

United

Christian

Hospital

*Prince of

Wales

Hospital

*Princess

Margaret

Hospital

Tuen Mun

Hospital

Ruttonjee &

Tang Shiu

Kin Hospital

Tseung

Kwan O

Hospital

Alice Ho Miu

Ling

Nethersole

Hospital

Caritas

Medical

Centre

Pok Oi

Hospital

North

District

Hospital

Kwong Wah

Hospital

Yan Chai

Hospital

Seminar to all Hospital Authority staff on organ procurement and donation

Seminars to hospital nurses

CENTRALIZED ORGAN DONATION REGISTER

C.O.D.R.

「捐器官, 我願意」器官捐贈推廣

活動

April 2006

Appeal thro’ Radio Television HK

Press Conference

全球同步支持器官捐贈日暨向捐贈者

致敬晚會

October 2008

Thanks Giving Ceremony

January 2010

Best Organ Donation Rate

in 2009

Cerebrating 100 heart transplants in HK

December 2009

Chinese Transplant Games World Transplant Games

2007

Bangkok

21 pt

17medals

2009

Australia

43 pt

45medals

2011

Sweden

37 pt

43medals

2006

Wuhan

10 pt

1 medal

2008

Shanghai

31 pt

24medals

2010

Tianjin

45 pt

46medals

Cable TV

RTHK

Press Conference

WTGF

3347

4149

74

42 4451 53 58

65

87

12

14

15

1918

23

30

18 19

23 2326

26

43

4758

0

10

20

30

40

50

60

70

80

90

100

110

120

130

140

150

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Kidney Liver Heart Lung

Data from Organ Procurement System, Hong Kong Hospital Authority

0

1

2

3

4

5

6

7

8

69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99 '01 '03 '05 '07 '09

Medical & Health Department Hospital Authority

2 TC

Renal

Liver

Heart Lung

4 TC

CTC

7 TC

5 TC

2009

Spain 34.4 USA 26.1 UK 15.5 Australia 13.8 (2010) Canada 13.7 (2010)

Taiwan 8.5 (2008)

Hong Kong 7.5

Singapore 4.6 Malaysia 1.4 Source: www.tpm.org

Number of Organs Available

Graft & Patient Survival

Extended Criteria Living Donation

Deceased Donation Rate

Recipient Matching Cold Ischemic Time

Immunosuppressants Manage Co-morbidities

QMH PMH QEH

12 10.3 9.6

17

13.4 13.4

0

2

4

6

8

10

12

14

16

18

QMH PMH QEH

1st Kidney 2nd Kidney

9.9 9.3 9.3

0

2

4

6

8

10

12

14

16

18

QMH PMH QEH

Overall

2010 2011

0.5

0.6

0.8

0.9

1.0

0 1 2 3 4 6 7 8 9 10

Graft Survival, First RTx, - HLA Matching - Death Not Censored

Time in Years

Sur

viva

l Pro

babi

lity

6 mm

5 mm

4 mm

3 mm

2 mm

1 mm

0 mm

Hong Kong Result

Guarding

Recipient

Against

Failed

Transplant

Graft Survival Rate vs HLA Antibody Testing

95%

79%

75% 74%

99%93%

89%

50%

60%

70%

80%

90%

100%

0 1 2 3 4 5 6

Years after Transplant

% G

raft

Su

rviv

al

90%

HLA Antibody Absent

HLA Antibody Present

•Improve graft survival •Meet international Standards •Meet increasing transplant demand •Utilize contemporary antibody detection technology •Improve 5-year graft survival from 83% to 88%

Pre-transplant HLA antibody screening: From 6 monthly to 3 monthly

Post-transplant HLA antibody

monitoring (new): Weekly in 1st month

Monthly for first 3 months Quarterly for 1st year

Yearly

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

5500

6000

6500

7000

2005 2006 2007 2008 2009 2010 2011

Pre-Tx

Post-Tx

AMR

Deceased Donor 4

Living Related Donor 1

Donor in China 5

No. of Patient sample referred for antibody screening

No.

Year

After GRAFT

After GRAFT

Before GRAFT

Allocation according to formula = (HLA matching score) + (60-age) + (duration of dialysis x 3)

HBV +ve HBV +ve

HCV +ve HCV +ve

0 MM 0 MM (share out all clusters)

Silver hair (>60 yr donor) Silver hair recipient

Two donated paediatric kidneys to an adult

Priority given to organ donor and age <13

0.0

0.1

0.2

0.3

0.4

0.6

0.7

0.8

0.9

1.0

0 1 2 3 4 6 7 8 9 10

Graft Survival, DDRT, Donor age >60; Death Not Censored

Time in Years

Sur

viva

l Pro

babi

lity

Donor Age < 60, n=428

Donor Age >60, n=69

P = 0.3835

Donor age 1 Year 5 Year 10 Year

<60 89.21% 79.07% 60.56%

>60 84.80% 70.82% -

0.0

0.1

0.2

0.3

0.4

0.6

0.7

0.8

0.9

1.0

0 1 2 3 4 6 7 8 9 10

Patient Survival, DDRT, Donor age >60

Time in Years

Sur

viva

l Pro

babi

lity

Donor Age < 60, n=428

Donor Age >60, n=69

P = 0.043

Donor age 1 Year 5 Year

<60 95.21% 90.79%

>60 89.54% 82.45%

CTS result

For 1st deceased kidney tx: 10 year patient survival:~70%

CTS result

For 1st deceased kidney tx: 10 yr graft survival: ~50%

0.0

0.1

0.2

0.3

0.4

0.6

0.7

0.8

0.9

1.0

0 1 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 18 19 20

Patient Survival - First transplants, DDRT Vs LDRT

Time in Years

Sur

viva

l Pro

babi

lity

P=0.0000

1 Year 5 Year 10 Year 20 Year

DDRT 96.08% 90.35% 84.08% 70.36%

LDRT 98.22% 97.12% 94.76% 87.83%

DDRT, n = 3494

LDRT, n = 567

CTS 70%

Hong Kong Result

0.0

0.1

0.2

0.3

0.4

0.6

0.7

0.8

0.9

1.0

0 1 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 18 19 20

Graft Survival - First transplants, DDRT Vs LDRT, Death NOT Censored

Time in Years

Surv

ival

Pro

babi

lity

P=0.0000 1 Year 5 Year 10 Year 20 Year

DDRT 92.42% 82.40% 69.22% 42.91%

LDRT 95.00% 89.69% 80.79% 56.68%

DDRT, n = 3494

LDRT, n = 567

CTS: 50%

(Death Not Censored)

First Line

Steroid

Azathioprine

Cyclosporin A

Second Line

Tacrolimus

Mycophenolate

Everolimus

Sirolimus

~30% renal transplant patients died with a functioning graft

Main causes of death:

cardiovascular disease

Malignancy

Infection

Management of cardiovascular risks factors and surveillance of malignancy

5%

6%

6%

10%

10%

7%

4%

9%

4%

5%

9%

5%2%

7%

5%

5%

5%

5%

5%

7%2% 7%

14%

29%

7%1%

7%

18%

8%

7%

3%

1%

5%

8%

6%3%1%1%

1%1%

5%

7%

1%1%

1%

2% 2%

2%

3%

16%

2%

1%

4%

2%

1%

PTLDLiverKaposi's SarcomaOral cavityOesophagusStomachColonCervixOvaryUterusAcute leukaemiaLungSkin (non melanoma)ThyroidKidney

Bladder and ureterBreastProstatePancreas

NPCMelanomaOthers

2000

2011

2%

Number of Organs Available

Graft & Patient Survival

Extended Criteria Living Donation

Deceased Donation Rate

Recipient Matching Cold Ischemic Time

Immunosuppressants Manage Co-morbidities

3rd Chinese Transplant

Games

Badminton champion

4 years back in ICU in

hepatic coma

24-Sept-2005 Died on 5-Dec-2005

2012.4.25

Thank You

Don’t take your organs to heaven…

Heaven knows we need them here

Give a call to the Transplant Co-ordinator!