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Asian Transplant Registry (1999)
Asian Transplant Registry (1999) K. Ota
T
HE ASIAN TRANSPLANT REGISTRY was started in 1989, with the kind cooperation of many members of our Society and pharmaceutical companies. Each year we have compiled data through surveys obtained from countries in this geographic region. In this study, the number of transplants performed in each country, and the legal, social, and ethical problems encountered during 1995 to 1999 are reported along with the present status of dialysis patients in Asia.
Countries Involved in the Survey
METHOD OF SURVEY Outline of the Questionnaire
All 16 countries responded to the questionnaire, although there were some omissions in their answers, particularly the questionnaire from Indonesia. The number of transplants performed between 1995 and 1999 is illustrated in Table 1, and the detailed data, including the numbers and varieties
The questionnaire includes: (a) number of centers that performed organ transplants; (b) type and number of organ transplants performed in 1998 and 1999; (c) present status of dialysis, number of dialysis patients, and number of the candidates on the list for transplantation; (d) number of patients going abroad for transplantation; and (e) recent transplant highlights, news, and issues affecting each country during 1998 to 1999.
Questionnaires were sent to the key persons in each country where transplantation currently takes place. The deadline for the completion of questionnaires was set for March 31, 2000. Sixteen countries were involved in the survey including: Bangladesh, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Oman, Pakistan, PR China, The Philippines, Saudi Arabia, Singapore, Taiwan, Thailand, and United Arab Emirates (UAE).
RESULTS Response
From the Ota Medical Research Institute, Ota, Japan. Address reprint requests to Dr Kazuo Ota, Ota Medical Research Institute, 3-4-16 Nihon Bashi, Chuo-ku, Tokyo, Japan.
Table 1. Number of Organ Transplantations in Asia (1995 to 1999) Kidney
Bangladesh Hong Kong India Indonesia Japan Korea Malaysia Oman PR China Pakistan Philippines Saudi Arabia† Singapore Taiwan Thailand UAE Total
Liver
Cadaveric Donor
Living Donor
Cadaveric Donor
Living Donor
Pancreas
Pancreas–Kidney*
Heart
Lung
Heart–Lung
0 229 491 0 810 955 124 4 14,717 13 60 331 218 522 443 0 18,917
85 264 10,977 450 2352 3953 221 85 38 2319 1057 669 116 158 153 15 22,912
0 72 22 0 2 225 0 0 179 0 0 97 36 79 62 0 774
0 56 2 0 836 209 14 0 1 0 1 8 17 37 0 0 1181
0 0 0 0 0 9 0 0 3 0 0 0 0 6 0 0 18
0 0 0 0 0 14 0 0 31 0 0 0 0 0 0 0 45
0 22 49 0 3 128 6 0 36 0 0 20 8 226 42 0 540
0 5 1 0 0 5 0 0 11 0 0 4 0 32 13 0 71
0 1 0 0 0 3 0 0 3 0 0 0 0 1 18 0 26
*Data of 1996 to 1999. † No data available for 1995.
© 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
0041-1345/01/$–see front matter PII S0041-1345(00)02763-9 1989
Transplantation Proceedings, 33, 1989–1992 (2001)
1990
OTA Table 2. Number of Organ Transplantations in Asia (1998 to 1999) Kidney
Liver
1998
Bangladesh Hong Kong India Indonesia Japan Korea Malaysia Oman Pakistan Philippines PR China Saudi Arabia Singapore Taiwan Thailand UAE Total
1999
1998
Pancreas– Kidney
Pancreas
Heart
Lung
Heart–Lung
1999
CD
LD
CD
LD
CD
LD
CD
LD
1998
1999
1998
1999
1998
1999
1998
1999
1998
1999
0 33 185 0 149 233 16 0 9 12 3369 84 42 133 90 0 4355
20 37 3300 18 509 779 29 8 615 218 10 160 26 11 0 2 5742
0 47 174 0 158 298 10 0 0 6 3626 76 54 84 129 0 4662
17 24 3450 13 550 791 49 14 725 493 24 188 22 12 0 3 6375
0 15 12 0 0 59 0 0 0 0 27 20 7 23 12 0 175
0 12 2 0 207 41 0 0 0 0 0 1 4 8 0 0 275
0 19 6 0 2 84 0 0 0 0 116 23 11 18 13 0 292
0 17 0 0 241 113 0 0 0 0 0 7 6 11 0 0 395
0 0 0 0 0 4 0 0 0 0 1 0 0 0 0 0 5
0 0 0 0 0 2 0 0 0 0 2 0 0 0 0 0 4
0 0 0 0 0 5 0 0 0 0 7 0 0 0 0 0 12
0 0 0 0 0 7 0 0 0 0 22 0 0 0 0 0 29
0 2 22 0 0 30 3 0 0 0 12 4 1 54 5 0 133
0 6 14 0 3 28 2 0 0 0 15 6 5 41 3 0 123
0 1 1 0 0 0 0 0 0 0 1 2 0 4 2 0 11
0 2 0 0 0 3 0 0 0 0 8 1 0 4 3 0 21
0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 3
0 0 0 0 0 0 0 0 0 0 2 0 0 1 2 0 5
CD, cadaveric donor; LD, living donor.
of transplants performed between 1998 and 1999, is shown in Table 2. Variety and Number of Transplants
Kidney transplants. All countries surveyed performed kidney transplantation. The total number of kidney transplants performed between 1995 and 1999 in this region was 41,829, including 18,917 (45.2%) cadaveric and 22,912 (54.8%)
living donor. Further analysis of living donors was made using data obtained in 1998 and 1999 (Table 3). Among 5742 patients transplanted with grafts from living donors in 1998, 3759 received organs from related donors, 1983 from unrelated donors, and 737 from a spousal donor. No specifics on donor types were available for the 329 transplants in Korea. For the 6375 patients transplanted with grafts from living donors in 1999, 3533 had living related donors, and spousal donation comprised 1081 of the
Table 3. Sources of Donors in Living Donor Kidney Transplantation (1998 to 1999) 1998
1999 Unrelated
Unrelated
Country
Living Related
Spouse
Living Unrelated
Others
Total
Living Related
Bangladesh Hong Kong India Indonesia Japan Korea Malaysia Oman Pakistan Philippines PR China Saudi Arabia Singapore Taiwan Thailand UAE Total
19 32 2000 18 509 450 27 6 355 141 10 160 19 11 —* 2 —
1 5 700 0 0
0 0 600 0 0 329* 1 2 237 77 0 0 0 0 — 0 —
0 0 0 0 0 0 0 0 0 0 0 0 0 0 — 0 —
20 37 3300 18 509 779 29 8 615 218 10 160 26 11 0 2 5742
15 24* 2100 13 510
*Details not reported. † No data available.
1 0 23 0 0 0 7 0 — 0 —
45 14 401 187 24 188 22 12 — 2 —
Spouse
2 750 0
4 0 43 281 0 0 0 0 — 1 —
Living Unrelated
Others
Total
0 0 600 0 35* 791* 0 0 281 25 0 0 0 0 — 0 —
0 0 0 0 5
17 24 3450 13 550 791 49 14 725 493 24 188 22 12 0 3 6375
0 0 0 0 0 0 0 0 — 0 —
ASIAN TRANSPLANT REGISTRY
renal transplants. No specific data related to the donor types were available regarding 791 cases from Korea, 24 cases from Hong Kong, and 35 cases from Japan (Table 3). Liver transplants. Liver transplantation was conducted in all the countries, except Bangladesh, Indonesia, Malaysia, Oman, and Pakistan. The number of transplants increased each year between 1995 and 1999. In 1999, the total number of liver transplants reached 1955, including 1181 living related and 774 cadaveric transplants. Of the latter, 179 livers donated in PR China were said to be from non– heartbeating cadaver donors. Five countries, Hong Kong, Japan, Korea, Singapore, and Taiwan, conducted both living and cadaveric liver transplants; however, for Korea details were incomplete. PR China, Thailand, and India used mainly cadaveric liver donations (Table 2), and their data for liver transplants in 1998 and 1999 are shown in Table 3. They have increased their numbers yearly, reaching 687 in 1999. Heart transplants. Heart transplantation was conducted in ten countries, including Hong Kong, India, Japan, Korea, Malaysia, PR China, Saudi Arabia, Singapore, Taiwan, and Thailand. The annual number increased from 67 in 1995 to 133 in 1997, followed by 132 in 1998, thus the total number of heart transplants in these 5 years was 533. Among these countries, Taiwan showed the largest number at 226 (41.9%) followed by Korea at 128 (23.7%), and Thailand at 42 (7.8%). These three countries made up 73.3% of the total number of heart transplants in Asia. Lung, and heart–lung transplants. Between 1995 and 1999, 71 lung transplants and 26 heart–lung transplants were conducted. Of the 71 lung transplants 32 cases (45.0%) were performed in Taiwan, and 13 cases (18.3%) were done in Thailand. Among 26 heart–lung transplants performed, 18 cases (69.2%) were done in Thailand. The annual number of lung transplants increased from 8 in 1995 to 17 in 1996, 14 in 1997, 11 in 1998, and 21 in 1999. However, heart–lung transplants have decreased since 1995. Pancreas, and pancreas– kidney transplants. The total number of pancreas transplants during the 5 years was only 18, while that of pancreas– kidney transplants was 45 between 1996 and 1999. Of those countries conducting pancreas transplants, 9 cases (50.0%) were performed in Korea, 6 (33.3%) in Taiwan, and 3 (16.7%) in PR China. Countries conducting pancreas– kidney transplants included PR China in 31 instances (68.9%) and Korea in 14 (31.1%). Status of Dialysis Patients
The total number of dialysis patients in Asia was 278,566 at the end of 1998 and 298,457 at the end of 1999. This increase of 19,891 patients on dialysis in 1999 is mainly due to the lack of data from India in 1998. Accordingly, Japanese patients, which comprised 66.3% of the total patients on dialysis in 1998, decreased to 66.0% in 1999, followed by India (11.0%), Taiwan (9.0%), and Korea (6.0%), respectively. The numbers of dialysis patients per million population in 1999 was 1568.2 in Japan, 1230.9 in
1991
Taiwan, 832.5 in Singapore, 477.8 in Hong Kong, 391.4 in Korea, 292.8 in Saudi Arabia, 189.1 in UAE, 188.7 in Oman, 33.5 in India, 18.6 in Indonesia, 14.4 in The Philippines, 11.1 in Pakistan, and 5.4 in Bangladesh. No data were available for Thailand. The number of patients on the waiting list in each country at the end of 1999 was 13,356 in Japan, 5640 in Taiwan, 3225 in Saudi Arabia, 1032 in Hong Kong, and 607 in Singapore. No data were available for India, Korea, Malaysia, PR China, and Thailand. Organ Transplants Abroad
Data were obtained from 15 countries, but data from Thailand were not available. By the end of 1999, 3057 patients went abroad for transplantation. These included 2722 cases for kidney transplant, 262 cases for liver, 61 cases for heart, and 11 cases for lung. Among the 2722 that went abroad for transplants, 89.0% received kidneys. The number was the highest in Hong Kong (741 cases, 27.2%) followed by Taiwan (482 cases, 17.7%), Oman (362 cases, 13.3%), Singapore (249 cases, 9.2%), and Bangladesh (229 cases, 8.4%). Data from Japan show that there were 325 cases of transplantation abroad, including 66 kidney transplants, 207 liver transplants, 44 heart transplants, and 8 lung transplants. Liver transplant was 79.0%, heart transplant 73.8%, and lung transplant 72.7% of the total cases of each organ transplant, respectively. DISCUSSION
Development of transplantation is an ongoing process in each of the Asian countries surveyed. There continues to be obstacles related to brain death as well as social, economic, and ethical issues. Based on this report special attention should be given to the significant increase in the number of liver transplantations using living donors. Particularly in Japan, the number of living donor liver transplants in 1999 was 239 and the number of living donor kidney transplants was 550; therefore, the number of living donor liver transplants reached 43.5% of the total number of living donor kidney transplants. If this progression continues, the number of living donor liver transplants may exceed the number of living donor kidney transplants. The number of heart transplants in Asia has decreased between 1998 and 1999. This is primarily due to the decreased number of heart transplants in Taiwan. The number of heart transplants in Taiwan included 66 cases in 1997, 54 cases in 1998 and 41 cases in 1999. It has been suggested that the decrease in donation is the result of the compulsory use of helmets for motorcycle drivers. With regard to lung transplantation, the number of transplants is very small, because of the necessity of heart– lung transplantation. As a result of single lung transplantation, the total number of lung transplants in 1999 increased to 21. This may be the result of the technical improvements in single lung transplantation.
1992
The first pancreas transplant in Asia took place in 1984 by Iwasaki. Since 1990 we have performed 11 pancreas transplants at Tokyo Women’s Medical University. Pancreas transplantation was stopped due to legal impasses 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 PR China and Korea. Because there has been an increase in the number of dialysis patients as well as improved graft survival, demand for kidney transplantation has increased in many countries, except in India, PR China, Korea Malaysia, and Thailand. These countries have waiting lists for kidney transplantation. Numbers of patients on waiting lists are as follows: 13.356 in Japan; 5640 in Taiwan; 3225 in Saudi Arabia; 1032 in Hong Kong; 5640 in Taiwan; 3225 in Saudi Arabia; 1032 in Hong Kong; and 607 in Singapore. Average waiting time is 5.6 years in Japan, 4.9 years in Hong Kong, and 4.8 years in Singapore. The chief complaint from most patients is the long waiting period, particularly in Japan. 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, two other cases of heart transplantation were conducted in 1999, and three cases were performed by August 20, 2000. Donation from brain-dead cadavers has been limited despite the active distribution of 50 million donor cards. Very rigid donation criteria, includ-
OTA
ing the requirement of a written living will of the donor and the family’s approval to realize donation, are considered to be the biggest obstacles to increasing the number of cadaveric donors. CONCLUSION
Since 1989, the Asian Transplant Registry has conducted surveys throughout Asia and it is through these surveys that we are able to learn more about specific transplant issues facing other Asian countries. Based on the medical, legal, social, economic, and cultural infrastructure within each country, the development of transplant programs varies. It is important to continue to share ideas and exchange information so that Asia will be able to deliver the highest quality of patient care in transplantation. ACKNOWLEDGMENT The author thanks all cooperative members in each country: Dr Harun-Ur-Rashid (Bangladesh), Dr Sui-Shen Xia (PR China), Dr T.M. Chan (Hong Kong), Dr Anant Kumar (India), Dr Wiguno Prodjosudjad (Indonesia), 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 A. Vathsala (Singapore), Dr Long-Bin Jeng (Taiwan), Dr Visist Dhitavat (Thailand), and Dr Shahe Nawaz (UAE). I am grateful for the cooperation I have received from Mr K. Asakawa, Ms A. Nasr, and Ms T. Tanaka of Novartis Pharma KK, Japan.
T
HE ASIAN TRANSPLANT REGISTRY was started in 1989, with the kind cooperation of many members of our Society and pharmaceutical companies. Each year we have compiled data through surveys obtained from countries in this geographic region. In this study, the number of transplants performed in each country, and the legal, social, and ethical problems encountered during 1995 to 1999 are reported along with the present status of dialysis patients in Asia.
Countries Involved in the Survey
METHOD OF SURVEY Outline of the Questionnaire
All 16 countries responded to the questionnaire, although there were some omissions in their answers, particularly the questionnaire from Indonesia. The number of transplants performed between 1995 and 1999 is illustrated in Table 1, and the detailed data, including the numbers and varieties
The questionnaire includes: (a) number of centers that performed organ transplants; (b) type and number of organ transplants performed in 1998 and 1999; (c) present status of dialysis, number of dialysis patients, and number of the candidates on the list for transplantation; (d) number of patients going abroad for transplantation; and (e) recent transplant highlights, news, and issues affecting each country during 1998 to 1999.
Questionnaires were sent to the key persons in each country where transplantation currently takes place. The deadline for the completion of questionnaires was set for March 31, 2000. Sixteen countries were involved in the survey including: Bangladesh, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Oman, Pakistan, PR China, The Philippines, Saudi Arabia, Singapore, Taiwan, Thailand, and United Arab Emirates (UAE).
RESULTS Response
From the Ota Medical Research Institute, Ota, Japan. Address reprint requests to Dr Kazuo Ota, Ota Medical Research Institute, 3-4-16 Nihon Bashi, Chuo-ku, Tokyo, Japan.
Table 1. Number of Organ Transplantations in Asia (1995 to 1999) Kidney
Bangladesh Hong Kong India Indonesia Japan Korea Malaysia Oman PR China Pakistan Philippines Saudi Arabia† Singapore Taiwan Thailand UAE Total
Liver
Cadaveric Donor
Living Donor
Cadaveric Donor
Living Donor
Pancreas
Pancreas–Kidney*
Heart
Lung
Heart–Lung
0 229 491 0 810 955 124 4 14,717 13 60 331 218 522 443 0 18,917
85 264 10,977 450 2352 3953 221 85 38 2319 1057 669 116 158 153 15 22,912
0 72 22 0 2 225 0 0 179 0 0 97 36 79 62 0 774
0 56 2 0 836 209 14 0 1 0 1 8 17 37 0 0 1181
0 0 0 0 0 9 0 0 3 0 0 0 0 6 0 0 18
0 0 0 0 0 14 0 0 31 0 0 0 0 0 0 0 45
0 22 49 0 3 128 6 0 36 0 0 20 8 226 42 0 540
0 5 1 0 0 5 0 0 11 0 0 4 0 32 13 0 71
0 1 0 0 0 3 0 0 3 0 0 0 0 1 18 0 26
*Data of 1996 to 1999. † No data available for 1995.
© 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
0041-1345/01/$–see front matter PII S0041-1345(00)02763-9 1989
Transplantation Proceedings, 33, 1989–1992 (2001)
1990
OTA Table 2. Number of Organ Transplantations in Asia (1998 to 1999) Kidney
Liver
1998
Bangladesh Hong Kong India Indonesia Japan Korea Malaysia Oman Pakistan Philippines PR China Saudi Arabia Singapore Taiwan Thailand UAE Total
1999
1998
Pancreas– Kidney
Pancreas
Heart
Lung
Heart–Lung
1999
CD
LD
CD
LD
CD
LD
CD
LD
1998
1999
1998
1999
1998
1999
1998
1999
1998
1999
0 33 185 0 149 233 16 0 9 12 3369 84 42 133 90 0 4355
20 37 3300 18 509 779 29 8 615 218 10 160 26 11 0 2 5742
0 47 174 0 158 298 10 0 0 6 3626 76 54 84 129 0 4662
17 24 3450 13 550 791 49 14 725 493 24 188 22 12 0 3 6375
0 15 12 0 0 59 0 0 0 0 27 20 7 23 12 0 175
0 12 2 0 207 41 0 0 0 0 0 1 4 8 0 0 275
0 19 6 0 2 84 0 0 0 0 116 23 11 18 13 0 292
0 17 0 0 241 113 0 0 0 0 0 7 6 11 0 0 395
0 0 0 0 0 4 0 0 0 0 1 0 0 0 0 0 5
0 0 0 0 0 2 0 0 0 0 2 0 0 0 0 0 4
0 0 0 0 0 5 0 0 0 0 7 0 0 0 0 0 12
0 0 0 0 0 7 0 0 0 0 22 0 0 0 0 0 29
0 2 22 0 0 30 3 0 0 0 12 4 1 54 5 0 133
0 6 14 0 3 28 2 0 0 0 15 6 5 41 3 0 123
0 1 1 0 0 0 0 0 0 0 1 2 0 4 2 0 11
0 2 0 0 0 3 0 0 0 0 8 1 0 4 3 0 21
0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 3
0 0 0 0 0 0 0 0 0 0 2 0 0 1 2 0 5
CD, cadaveric donor; LD, living donor.
of transplants performed between 1998 and 1999, is shown in Table 2. Variety and Number of Transplants
Kidney transplants. All countries surveyed performed kidney transplantation. The total number of kidney transplants performed between 1995 and 1999 in this region was 41,829, including 18,917 (45.2%) cadaveric and 22,912 (54.8%)
living donor. Further analysis of living donors was made using data obtained in 1998 and 1999 (Table 3). Among 5742 patients transplanted with grafts from living donors in 1998, 3759 received organs from related donors, 1983 from unrelated donors, and 737 from a spousal donor. No specifics on donor types were available for the 329 transplants in Korea. For the 6375 patients transplanted with grafts from living donors in 1999, 3533 had living related donors, and spousal donation comprised 1081 of the
Table 3. Sources of Donors in Living Donor Kidney Transplantation (1998 to 1999) 1998
1999 Unrelated
Unrelated
Country
Living Related
Spouse
Living Unrelated
Others
Total
Living Related
Bangladesh Hong Kong India Indonesia Japan Korea Malaysia Oman Pakistan Philippines PR China Saudi Arabia Singapore Taiwan Thailand UAE Total
19 32 2000 18 509 450 27 6 355 141 10 160 19 11 —* 2 —
1 5 700 0 0
0 0 600 0 0 329* 1 2 237 77 0 0 0 0 — 0 —
0 0 0 0 0 0 0 0 0 0 0 0 0 0 — 0 —
20 37 3300 18 509 779 29 8 615 218 10 160 26 11 0 2 5742
15 24* 2100 13 510
*Details not reported. † No data available.
1 0 23 0 0 0 7 0 — 0 —
45 14 401 187 24 188 22 12 — 2 —
Spouse
2 750 0
4 0 43 281 0 0 0 0 — 1 —
Living Unrelated
Others
Total
0 0 600 0 35* 791* 0 0 281 25 0 0 0 0 — 0 —
0 0 0 0 5
17 24 3450 13 550 791 49 14 725 493 24 188 22 12 0 3 6375
0 0 0 0 0 0 0 0 — 0 —
ASIAN TRANSPLANT REGISTRY
renal transplants. No specific data related to the donor types were available regarding 791 cases from Korea, 24 cases from Hong Kong, and 35 cases from Japan (Table 3). Liver transplants. Liver transplantation was conducted in all the countries, except Bangladesh, Indonesia, Malaysia, Oman, and Pakistan. The number of transplants increased each year between 1995 and 1999. In 1999, the total number of liver transplants reached 1955, including 1181 living related and 774 cadaveric transplants. Of the latter, 179 livers donated in PR China were said to be from non– heartbeating cadaver donors. Five countries, Hong Kong, Japan, Korea, Singapore, and Taiwan, conducted both living and cadaveric liver transplants; however, for Korea details were incomplete. PR China, Thailand, and India used mainly cadaveric liver donations (Table 2), and their data for liver transplants in 1998 and 1999 are shown in Table 3. They have increased their numbers yearly, reaching 687 in 1999. Heart transplants. Heart transplantation was conducted in ten countries, including Hong Kong, India, Japan, Korea, Malaysia, PR China, Saudi Arabia, Singapore, Taiwan, and Thailand. The annual number increased from 67 in 1995 to 133 in 1997, followed by 132 in 1998, thus the total number of heart transplants in these 5 years was 533. Among these countries, Taiwan showed the largest number at 226 (41.9%) followed by Korea at 128 (23.7%), and Thailand at 42 (7.8%). These three countries made up 73.3% of the total number of heart transplants in Asia. Lung, and heart–lung transplants. Between 1995 and 1999, 71 lung transplants and 26 heart–lung transplants were conducted. Of the 71 lung transplants 32 cases (45.0%) were performed in Taiwan, and 13 cases (18.3%) were done in Thailand. Among 26 heart–lung transplants performed, 18 cases (69.2%) were done in Thailand. The annual number of lung transplants increased from 8 in 1995 to 17 in 1996, 14 in 1997, 11 in 1998, and 21 in 1999. However, heart–lung transplants have decreased since 1995. Pancreas, and pancreas– kidney transplants. The total number of pancreas transplants during the 5 years was only 18, while that of pancreas– kidney transplants was 45 between 1996 and 1999. Of those countries conducting pancreas transplants, 9 cases (50.0%) were performed in Korea, 6 (33.3%) in Taiwan, and 3 (16.7%) in PR China. Countries conducting pancreas– kidney transplants included PR China in 31 instances (68.9%) and Korea in 14 (31.1%). Status of Dialysis Patients
The total number of dialysis patients in Asia was 278,566 at the end of 1998 and 298,457 at the end of 1999. This increase of 19,891 patients on dialysis in 1999 is mainly due to the lack of data from India in 1998. Accordingly, Japanese patients, which comprised 66.3% of the total patients on dialysis in 1998, decreased to 66.0% in 1999, followed by India (11.0%), Taiwan (9.0%), and Korea (6.0%), respectively. The numbers of dialysis patients per million population in 1999 was 1568.2 in Japan, 1230.9 in
1991
Taiwan, 832.5 in Singapore, 477.8 in Hong Kong, 391.4 in Korea, 292.8 in Saudi Arabia, 189.1 in UAE, 188.7 in Oman, 33.5 in India, 18.6 in Indonesia, 14.4 in The Philippines, 11.1 in Pakistan, and 5.4 in Bangladesh. No data were available for Thailand. The number of patients on the waiting list in each country at the end of 1999 was 13,356 in Japan, 5640 in Taiwan, 3225 in Saudi Arabia, 1032 in Hong Kong, and 607 in Singapore. No data were available for India, Korea, Malaysia, PR China, and Thailand. Organ Transplants Abroad
Data were obtained from 15 countries, but data from Thailand were not available. By the end of 1999, 3057 patients went abroad for transplantation. These included 2722 cases for kidney transplant, 262 cases for liver, 61 cases for heart, and 11 cases for lung. Among the 2722 that went abroad for transplants, 89.0% received kidneys. The number was the highest in Hong Kong (741 cases, 27.2%) followed by Taiwan (482 cases, 17.7%), Oman (362 cases, 13.3%), Singapore (249 cases, 9.2%), and Bangladesh (229 cases, 8.4%). Data from Japan show that there were 325 cases of transplantation abroad, including 66 kidney transplants, 207 liver transplants, 44 heart transplants, and 8 lung transplants. Liver transplant was 79.0%, heart transplant 73.8%, and lung transplant 72.7% of the total cases of each organ transplant, respectively. DISCUSSION
Development of transplantation is an ongoing process in each of the Asian countries surveyed. There continues to be obstacles related to brain death as well as social, economic, and ethical issues. Based on this report special attention should be given to the significant increase in the number of liver transplantations using living donors. Particularly in Japan, the number of living donor liver transplants in 1999 was 239 and the number of living donor kidney transplants was 550; therefore, the number of living donor liver transplants reached 43.5% of the total number of living donor kidney transplants. If this progression continues, the number of living donor liver transplants may exceed the number of living donor kidney transplants. The number of heart transplants in Asia has decreased between 1998 and 1999. This is primarily due to the decreased number of heart transplants in Taiwan. The number of heart transplants in Taiwan included 66 cases in 1997, 54 cases in 1998 and 41 cases in 1999. It has been suggested that the decrease in donation is the result of the compulsory use of helmets for motorcycle drivers. With regard to lung transplantation, the number of transplants is very small, because of the necessity of heart– lung transplantation. As a result of single lung transplantation, the total number of lung transplants in 1999 increased to 21. This may be the result of the technical improvements in single lung transplantation.
1992
The first pancreas transplant in Asia took place in 1984 by Iwasaki. Since 1990 we have performed 11 pancreas transplants at Tokyo Women’s Medical University. Pancreas transplantation was stopped due to legal impasses 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 PR China and Korea. Because there has been an increase in the number of dialysis patients as well as improved graft survival, demand for kidney transplantation has increased in many countries, except in India, PR China, Korea Malaysia, and Thailand. These countries have waiting lists for kidney transplantation. Numbers of patients on waiting lists are as follows: 13.356 in Japan; 5640 in Taiwan; 3225 in Saudi Arabia; 1032 in Hong Kong; 5640 in Taiwan; 3225 in Saudi Arabia; 1032 in Hong Kong; and 607 in Singapore. Average waiting time is 5.6 years in Japan, 4.9 years in Hong Kong, and 4.8 years in Singapore. The chief complaint from most patients is the long waiting period, particularly in Japan. 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, two other cases of heart transplantation were conducted in 1999, and three cases were performed by August 20, 2000. Donation from brain-dead cadavers has been limited despite the active distribution of 50 million donor cards. Very rigid donation criteria, includ-
OTA
ing the requirement of a written living will of the donor and the family’s approval to realize donation, are considered to be the biggest obstacles to increasing the number of cadaveric donors. CONCLUSION
Since 1989, the Asian Transplant Registry has conducted surveys throughout Asia and it is through these surveys that we are able to learn more about specific transplant issues facing other Asian countries. Based on the medical, legal, social, economic, and cultural infrastructure within each country, the development of transplant programs varies. It is important to continue to share ideas and exchange information so that Asia will be able to deliver the highest quality of patient care in transplantation. ACKNOWLEDGMENT The author thanks all cooperative members in each country: Dr Harun-Ur-Rashid (Bangladesh), Dr Sui-Shen Xia (PR China), Dr T.M. Chan (Hong Kong), Dr Anant Kumar (India), Dr Wiguno Prodjosudjad (Indonesia), 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 A. Vathsala (Singapore), Dr Long-Bin Jeng (Taiwan), Dr Visist Dhitavat (Thailand), and Dr Shahe Nawaz (UAE). I am grateful for the cooperation I have received from Mr K. Asakawa, Ms A. Nasr, and Ms T. Tanaka of Novartis Pharma KK, Japan.