Status and Change Pattern of Kidney Transplantation:One Center Research

Ji-rui Niu,Zhi-gang Ji＊,Hai Wang,Jing-min Zhou,and Zhen-yu Zhang

Departments of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College,Beijing 100730,China

THERE is an increasing prevalence of chronic kidney disease worldwide,which has become one of the main public health problems to mankind and causes the rapidly increased number of end-stage renal disease and dialysis patients.The prevalence rate of chronic kidney disease is 14.82% in our country and the prevalence rate of end-stage renal disease is 0.86%.1Therefore,millions of patients with renal dysfunction need kidney transplantation each year in China.In 2006,with 11 000 organ transplants,China ranked second in terms of number of transplants in the world.2An alarming shortage of transplantable organs in China urges ethicists and policymakers to make vital strategies to meet the requirement,especially some strategies for boosting donations.Regulations of kidney transplantation have lagged behind advances in medical science in China.The interim Provisions on Clinical Application and Management of Human Organ Transplantation was issued by the Ministry of Health in our country.2Yet we are confronting organ-shortage crisis.In this study,we analyzed the number of patients receiving kidney transplantation each year in our hospital during 1995 and 2010,to investigate the status and change pattern of kidney transplantation.

PATIENTS AND METHODS

We conducted a descriptive research to summarize the number of patients undergoing renal transplantation each year from January 1st,1995 to December 31st,2010 in Peking Union Medical College Hospital.The abscissa axis represented the time in year and on ordinate axis we calculated the number of patients having receiving kidney transplantation.Then we made a histogram.

RESULTS

The first kidney transplantation was performed in our hospital in the 1960s.The number of kidney transplantation increased until reaching a maximum of 47 grafts in 2001;since then the number fell (Fig.1).

DISCUSSION

This descriptive study revealed the number of renal transplants increased until 2001,since then organ donation was decreasing in our hospital.Huanget al2reported the number of procedures for kidney transplants increased until 2004;since then,the number of kidney transplants was decreasing.The decreasing numbers of kidney transplants performed each year in our hospital can reflect the situation of kidney transplantation in our country.Our hospital is subjected to looming organ-shortage crisis.

The continuing shortage of kidneys for transplantation requires major efforts to expand the donor pool.Currently,kidney transplants come from cadaveric donors and living related donors.We analyzed the current status of renal transplants by four Chinese classifications,3which have been suggested to the official trial for guiding the practice of cadaveric donors at the current stage,and investigated the solution to the organ shortage.

Type C-I∶donation after brain death (DBD).Because the concept of brain death has not yet been nationally adopted in China,DBD can not expand the donor pool now.

Type C-II∶donation after cardiac death (DCD),including Maastricht I-V.Before the introduction of brain death into law,most organ transplants came from nonheat beating donors (NHBDs).NHBDs are grouped into five types by the Maastricht classification.4Type I∶brought in death,Type II∶unsuccessful resuscitation,Type III∶awaiting cardiac arrest,Type IV∶cardiac rest after brain-stem death,and Type V∶cardiac arrest in a hospital inpatient.Kidneys from Type II donors can be used for transplantation,and all the organs except the heart from Type III,IV,and V donors can be potentially used for transplantation.4Since the first DCD case which is classified by Type C-II was reported in 2005 in China,more than 100 successful organ donation cases have been documented.3Type C-II is an effective way to expand the donor pool.

Type C-IV,death sentenced donation,is common.In China,more than 90% of transplanted organs are obtained from type C-IV donors.In this process,additional safeguards are established to ensure the rights of these individuals,including written consent for organ removal from the donor,review of all death sentences by the Supreme People’s Court,transplant professionals involved in donation after death of crime,and participation by the Red Cross to publicize the need for organ donation.However,there are debates concerning the use of organs taken from executed prisoners for transplantation proceeds.With changes in death penalty laws,the number of the capital crimes reduced in our country.So the available supply of organs is decreased.

There is now a widespread use of kidneys from living donors in China.Living donation provides superior results including a better success rate of graft surgery and fewer immunologic complications when compared with deceased donation.Living donation had expanded the donation pool.Because living donation violates the“do no harm”medical ethical principle,5the practice is strictly limited by our government now.So the number of living donation is reduced rapidly.

Figure 1.Number of patients for kidney transplantation each year during 1995 and 2010 in Peking Union Medical College Hospital.

The following efforts are likely to increase the cadaveric and living donations.To enforce legislation for organ transplantation is a very important way to solve the organ shortage crisis.Our country is launching provisions on transplantation,which is in accordance with international standards.5Spain has established the international transplant community having the highest organ donation rate in the world with 34 donors per million people.Success factors of the Spanish Model include its legal approach and a comprehensive program of education,communication,public relations,hospital reimbursement,and quality improvement.Brain-dead donors provide more than 90% of transplants in Spain.6In our country,medical professionals have called for legislation on transplantation and organ donation,while legislation on brain death is in process.7

In addition,it is vital for China to establish an ethical system of organ procurement and to promote organ donor awareness in physicians and the public.Chenet al8conducted a cross-sectional survey about transplantation using questionnaires among 922 Chinese undergraduates from mainland China and overseas regions of the world.They found that blood donors showed significantly better awareness of heart,liver,lung,skin,and tendon donation among commonly transplanted organ.Blood donors among university students have a greater knowledge of transplantation and a more positive attitude toward organ donation.Since university students are an important source of blood donors in China,they will be a potential pool of organ donors in the future.8It is very important to encourage people to donate their organ after their death in our country.

In a word,the increased organ donation is the strategy to solve the shortage of organ.DCD can expand the potential donor pool,but we need to strictly control the criteria for potential donors.

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