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Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Kim DS, Yoon YI, Kim BK, Choudhury A, Kulkarni A, Park JY, et al.

Hepatol Int, 2024 Apr;18(2):299-383.
PMID: 38416312 DOI: 10.1007/s12072-023-10629-3

Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines.

Matched MeSH terms: Tissue and Organ Procurement*
Social and cultural aspects of organ donation in Asia

Woo KT

Ann Acad Med Singap, 1992 May;21(3):421-7.
PMID: 1416796

In Asian countries, it is more difficult to obtain cadaver kidneys for renal transplantation because of certain socio-cultural beliefs and customs. The issues affecting living related kidney donation are more social than cultural. This is due to the web of family pressures and personal conflicts for both donor and recipient surrounding the donation. Important misconceptions and fears are: fear of death, the belief that removal of organ violates sanctity of decreased, concern about being cut up after death, desire to be buried whole, dislike of idea of kidneys inside another person, wrong concept of brain death, and the idea of donation being against religious conviction. In Singapore, with the introduction of the Human Organ Transplant Act (HOTA) in 1988, the number of cadaveric transplants have increased, including those from the Medical Therapy Act (MTA). HOTA and education have played pivotal roles in bringing about an increased yield of cadaveric kidneys. With the availability of living unrelated donor (LUD) transplants in India, our living related donor (LRD) transplant programme has suffered, because patients would rather buy a kidney from overseas than get a relative to donate one. Patients are also going to China for overseas cadaveric transplants where the kidneys come from executed convicts. People in countries like Hong Kong, Japan and the Philippines share the same Asian tradition of not parting with their organs after death. Muslim countries like Malaysia require the deceased to have earlier pledged his kidneys for donation prior to death before they can be harvested for transplantation at death.

Matched MeSH terms: Tissue and Organ Procurement*
Factors limiting deceased organ donation: focus groups' perspective from culturally diverse community

Wong LP

Transplant Proc, 2010 Jun;42(5):1439-44.
PMID: 20620450 DOI: 10.1016/j.transproceed.2009.11.053

BACKGROUND: In-depth understanding of cultural and religious factors limiting organ donation of three ethnic populations (Malay, Chinese, and Indian) in Southeast Asia is lacking. Identification of factors limiting organ donation among these three ethnic groups will provide insights into culturally appropriate strategies to promote acceptance of organ donation in a multiethnic Asian community.
METHODS: A total of 17 focus group discussions (105 participants) were conducted between September and December 2008. Participants were members of the general public aged 18 to 60 years, recruited through convenient sampling around the Klang Valley area of Malaysia.
RESULTS: Although the majority had favorable attitudes toward deceased organ donation and transplantation, a diversity of myths and misinformation were unearthed from the discussions across the ethnic groups. These include perceived religious prohibition, cultural myths and misperceptions, fear of disfigurement, fear of surgery, distrust of the medical system, and family disapproval. Culture and religious beliefs played important prohibitive roles among those opposed to organ donations. There were distinctive ethnic differences in cultural and religious concerns regarding organ donation. Less-educated and rural groups appeared to have more misconceptions than the well-educated and the urban groups.
CONCLUSION: Our findings may assist organ donation and transplantation organizations to reach diverse sociodemographic and ethnic communities with culture-specific information about organ donation. The involvement of community and religious leaders is critical in organ donation requests.

Matched MeSH terms: Tissue and Organ Procurement/methods; Tissue and Organ Procurement/statistics & numerical data*
Knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in Malaysia's multi-ethnic society: a baseline study

Wong LP

Clin Transplant, 2011 Jan-Feb;25(1):E22-31.
PMID: 20718827 DOI: 10.1111/j.1399-0012.2010.01312.x

Malaysia's organ and tissue donation rates are among the lowest in the world. The study aims to explore the knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in the diverse ethnic communities in the state of Selangor, Malaysia.

Matched MeSH terms: Tissue and Organ Procurement/statistics & numerical data*
Fulltext Information needs, preferred educational messages and channel of delivery, and opinion on strategies to promote organ donation: a multicultural perspective

Wong LP

Singapore Med J, 2010 Oct;51(10):790-5.
PMID: 21103814

INTRODUCTION:
This study assessed the information needs, preferred educational messages and channels of delivery, as well as opinions on strategies to promote organ donation. It aimed to provide insight into a culturally sensitive public education campaign to encourage organ donation in diverse ethnic communities in Asia, namely the Malays, Chinese and Indians.

METHODS:
A total of 17 focus group discussions with 105 participants were conducted between September and December 2008. The participants were members of the general public aged 18 to 60 years, who were recruited through convenient sampling in the Klang Valley area of Malaysia.

RESULTS:
Across ethnic groups, there was a general concern about the mistreatment of the deceased's body in the organ procurement process. The Chinese and Indian participants wanted assurance that the body would be treated with respect and care. The Muslims wanted assurance that the handling of a Muslim's body would follow the rules and regulations of the Islamic faith. The most important information requested by the Muslim participants was whether cadaveric donation is permissible in Islam. A lack of national public education and promotion of organ donation was noted. All the three ethnic groups, especially the Malays, required community and religious leaders for support, encouragement and involvement, as sociocultural influences play a significant role in the willingness to donate organs.

CONCLUSION:
The pronounced ethnic differences in information needs suggest that culturally sensitive public educational messages are required. Organ donation and transplantation organisations should work closely with community and religious organisations to address the sociocultural barriers identified.

Matched MeSH terms: Tissue and Organ Procurement
Fulltext Malaysian Organ Sharing System (MOSS)

Wong HS

Med J Malaysia, 1999 Dec;54(4):537-8.
PMID: 11072480
Matched MeSH terms: Tissue and Organ Procurement*
Fulltext Attendance and institutional facilities of long-term kidney donors follow-up

Makmor, T, Raja Noriza, RA, NurulHuda, MS, Sook-Lu, Y, Soo-Kun, L, Kok-Peng, N, et al.

JUMMEC, 2016;19(1):1-6.
MyJurnal

Introduction:
Living donation is an important source for organs transplantation in Malaysia. This study aims to investigate
the Malaysian living donors’ follow-up attendance, their preferences on medical-institutional facilities, and
the financial circumstances pertaining to the follow-up costs
Materials and Methods:
Primary data were collected through a survey of 80 living donors who made their donation at the University
of Malaya Medical Center (UMMC) between 1991 and 2012.
Results:
Out total of 178 donors, only 111 were reachable and 80 of them participated in the survey (72%). The findings
revealed that most of the donors (71.2%) attend the follow-up regularly. Nevertheless, donors seem to neglect
the importance of follow-up as they consider themselves healthy (28.9%) or consider the follow-up as being
troublesome (28.9%). Most donors (67.5%) are not in favour of being treated as patients, but prefer to be
monitored under donor registry (88.8%) and getting their health service in special clinics for donors (80%).
The majority of the donors fund the follow-up costs themselves (32.4%), while 25% of the donors’ follow-up
costs were funded by family members. Among those donors without income and those of low-income (84.8%
of respondents), 60.3% believe that the follow-up costs should be borne by the government.
Conclusions:
Based on the findings, it is therefore suggested that the government provides all living donors with proper
free health service through donor registry and donor clinics. Adequate care has to be given to the donors to
pre-empt any unforeseen health complications due to the organ donation surgical procedures.

Matched MeSH terms: Tissue and Organ Procurement
Demographics of healthcare professionals' knowledge and attitude toward deceased organ donation: Survey of critical care areas in a tertiary hospital

Foong JW, Ong JS, Oo WL, Hossain MM, Baskaran ND, Haron H, et al.

Med J Malaysia, 2019 04;74(2):109-115.
PMID: 31079120

INTRODUCTION: Organ donation rate in Malaysia is amongst the lowest in the World. Healthcare professionals (HCPs) working in critical care areas play an important role in the deceased organ donation (DOD) process. This study seeks to identify the demographics of HCPs working in the critical care areas and their knowledge and attitudes toward the DOD process.
METHOD: A cross-sectional survey on the demographics, knowledge and attitudes of the doctors and nurses working in critical care areas was undertaken by the random sampling method, using a validated, structured questionnaire. HCP's knowledge and attitudes towards brain death (BD), DOD, organ transplantation (OT), and possession of organ donor card were compared against their demographics.
RESULTS: Four hundred and twelve (72.9%) out of the total 565 HCPs in critical care areas responded of whom 163 (39.6%) were doctors and 249 (60.4%) were nurses. After adjusting for other factors, department of work and profession were highly correlated with the overall knowledge score (p<0.001 and p=0.003 respectively) and knowledge about BD (p<0.001 and p=0.013 respectively). HCPs from the neurosurgical intensive care unit (p<0.001) and doctors (p<0.001) had higher mean knowledge scores compared to their counterparts. Profession was most significantly correlated with having a positive attitude towards BD (p<0.001) and OT (p<0.001).
CONCLUSION: Department, profession and ethnicity were the demographic characteristics that correlated with knowledge and attitudes of HCPs on organ donation. Efforts to improve DOD rates in Malaysia should include targeted interventions to address the knowledge and attitudes of HCPs working in critical care areas.

Matched MeSH terms: Tissue and Organ Procurement/statistics & numerical data*
Fulltext Knowledge and attitudes of healthcare professionals and the impact on willingness to donate organs: a tertiary hospital survey

Oo WL, Ong JS, Fong JW, Hossain MM, Baskaran ND, Haron H, et al.

Singapore Med J, 2019 Jul 22.
PMID: 31328238 DOI: 10.11622/smedj.2019080

INTRODUCTION: Healthcare professionals (HCPs) working in critical care areas play an important role in the organ donation (OD) process. We studied HCPs' own willingness to be organ donors and its association with sociodemographic factors as well as their knowledge and attitudes about OD and transplantation.

METHODS: A cross-sectional survey of HCPs working in four critical care units in a major transplant centre in Malaysia was undertaken using a validated structured questionnaire. Responses were analysed using multivariable analysis with willingness to donate as the dependent variable.

RESULTS: Of the 412 respondents (response rate 98.1%), the majority were nurses (60.4%), Malay (71.1%) and female (77.2%). Overall, 68.0% were willing to donate. The independent predictors of willingness to donate were profession (p < 0.001) and the Hindu religion (p = 0.001). Ethnicity (p = 0.003), religious belief (p < 0.001), knowledge (p = 0.016), belief in brain death (p = 0.018) and confidence in transplantation (p < 0.001) also independently correlated with willingness to donate, while attitudes to OD did not. Of those willing to donate, only 37.3% were carrying a donor card and only 63.1% had informed their family of their intention to donate.

CONCLUSION: Although willingness to donate was higher in critical care HCPs than HCPs in general, significant knowledge gaps as well as certain beliefs and perceptions that could pose a barrier to OD were identified in this group. Measures to improve OD rates in Malaysia should include targeted educational programmes for HCPs working in critical care areas.

Matched MeSH terms: Tissue and Organ Procurement
Cadaveric organ donation at University Hospital Kuala Lumpur

Chen TP, Teo SM, Tan JC, Koh SN, Ambalavanar N, Tan SY

Transplant Proc, 2000 Nov;32(7):1809-10.
PMID: 11119946
Matched MeSH terms: Tissue and Organ Procurement/organization & administration*
Fulltext The complexities of modern medicine

Tan SY

JUMMEC, 2010;13(2):70-71.
MyJurnal

The current issue of JUMMEC touches on many diverse topics and in many ways reflects the evolution of modern medicine from the practice of acupuncture to epidemics facilitated by modern travel to the subject of ethics including controversies surrounding financial incentives given in promoting organ donation.(Copied from article).

Matched MeSH terms: Tissue and Organ Procurement
Determinants of Willingness to Become Organ Donors among Dialysis Patients' Family Members

Tumin M, Mohd Satar NH, Zakaria RH, Raja Ariffin RN, Soo-Kun L, Kok-Peng N, et al.

Urol J, 2015 Sep 04;12(4):2245-50.
PMID: 26341766

PURPOSE: This study explores the factors affecting the willingness of dialysis patients' family members to become involved in living and deceased organ donation.
MATERIALS AND METHODS: We utilize cross sectional data on 350 family members of dialysis patients collected through self-administered survey from June to October 2013. The factors affecting willingness to become deceased and living organ donors among respondents were identified by running logistic regressions.
RESULTS: The findings reveal that ethnicity, education and role in family are significant factors explaining willingness for living donation, while ethnicity, knowledge of organ donation and donor age drive willingness for deceased donation. We also find that the reasons of respondents being unwilling to donate center on the lack of information and family objections for deceased donation, while being medically unfit, scared of surgery and family objections are the reasons for unwillingness to donate living organs.
CONCLUSION: In light of our findings, educational efforts are suggested to decrease the reluctance to become involved in living and deceased donation.

Matched MeSH terms: Tissue and Organ Procurement*
Religious barriers to head transplantation: An Islamic viewpoint

Tafran K

Int J Surg, 2017 07;43:92-93.
PMID: 28549995 DOI: 10.1016/j.ijsu.2017.05.043
Matched MeSH terms: Tissue and Organ Procurement*
In search of the best organ donation legislative system for Hong Kong: further research is needed

Tafran K

Hong Kong Med J, 2018 06;24(3):318-319.
PMID: 29926801 DOI: 10.12809/hkmj187371
Matched MeSH terms: Tissue and Organ Procurement*
Criticizing the critique on the presumed consent system

Tafran K

Kidney Int, 2018 11;94(5):1023.
PMID: 30348288 DOI: 10.1016/j.kint.2018.08.017
Matched MeSH terms: Tissue and Organ Procurement*
Fulltext A call for knowledge and awareness with reference to organ donation among nursing students

ABM Tofazzal Hossain, Shaila Kabir, Constance Liew Sat Lin, Fairrul Kadir, M Tanvir Hossain Parash, Sadia Choudhury Shimmi, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):48-0.
MyJurnal

Introduction: Role of nurses is very important in raising awareness, motivation level and increasing rate of organ donation subsequently. There are many studies on critical care nurses’ roles and education affect organ donation. Methods: A narrative literature review article of published research. Twelve published articles from ten different countries were found using different renowned online search engines. Results: Knowledge about organ donation among nursing students almost all over the world is inadequate than expectation and requirement in respective country. Marlene R et al showed that scores on the knowledge, attitudes, and beliefs subscales were positively cor- related with the number of requests for tissue and organs and consents obtained (0.76); and consents obtained for tissues and consents obtained for organs (0.72). Professional education was indicated in 43% of nurses surpassing family beliefs, religion and mass media. The cognitive part (knowledge) is directly depends on non-cognitive (Aware- ness and Attitude). Findings from almost all articles suggest the need of adding organ donation topic in the nursing and medical curriculum to prepare competent nurses and health care providers for future. Conclusion: This study suggests that there is a need to integrate organ donation aspects into the educational program to prepare nurses for their roles in organ and tissue procurement as well as awareness among policy makers in this regard for the well-be- ing of our patients.

Matched MeSH terms: Tissue and Organ Procurement
Requirements for the development of a hand transplantation program

Gordon CR, Siemionow M

Ann Plast Surg, 2009 Sep;63(3):262-73.
PMID: 19692900 DOI: 10.1097/SAP.0b013e31818d45e9

Since 1998, 42 hand transplants in 30 patients have been performed in countries such as France, United States, China, Austria, Malaysia, Italy, Belgium, Poland, Spain, and Germany. Now, with recent improvements in immunosuppression, the clinical applicability may expand and the ethical obstacles may soon be overcome, allowing multiple US institutions to perform hand allotransplantation. The main purpose of this article is to facilitate access to pertinent details in regards to hand transplantation, such as donor/recipient selection criteria, immunosuppressive therapies, and associated complications. It is a comprehensive literature review compiled from published reports from multiple hand transplant programs throughout the world. Due to its inherent complexity, hand transplantation should only be attempted at institutions within the US capable of orchestrating a specialized multidisciplinary team, and each institution's protocol should be extremely detailed and individualized.

Matched MeSH terms: Tissue and Organ Procurement/organization & administration
Fulltext Prioritizing Factors Affecting Deceased Organ Donation in Malaysia: Is a New Organ Donation System Required?

Naghavi N, Mubarik MS, Rasiah R, Sharif Nia H

Int J Gen Med, 2020;13:641-651.
PMID: 32982381 DOI: 10.2147/IJGM.S253372

Purpose: The gap between the demand and the supply of human organs for transplantation is on the rise in Malaysia, despite the efforts of governments to promote donor registration. Factors affecting willingness to donate are contextual and vary from country to country. This research mainly focuses on the selection of most suitable organ donation system through factors affecting willingness to donate in Malaysia. The objectives of this study are to prioritize those factors acting as the pillars of the organ donation system and further to select the most suitable organ donation system for Malaysia.
Patients and Methods: The data were collected from 35 experts by using a bipolar questionnaire. The study applied an analytical hierarchal process (AHP) for prioritization factors contributing to willingness to donate and then selection of a suitable organ donation system based on prioritized factors.
Results: Based on the AHP results, it is evident that donation perception (0.36) has the highest priority in influencing organ donation rates, followed by socioeconomic status (0.32), demographic factors (0.23), and financial incentives (0.09). Further, our results challenge the existing opt-in donation system in Malaysia and present a presumptive approach as a suitable system for increasing deceased donation rate in Malaysia. Presumptive approach promotes the role of health-care professionals in securing the family consent.
Conclusion: This approach is a person-oriented rather than process-oriented strategy and it relies on designated requesters' skills to evoke altruism among bereaved families. Based on results, the authors recommended that relevant government agencies focus on training nurses to discuss donation with bereaved families and raising public awareness.

Matched MeSH terms: Tissue and Organ Procurement
Fulltext Muslims' views on the permissibility of organ donation: The case of Malaysia

Tumin M, Noh A, Mohd Satar N, Tafran K, Abdullah N, Wan Md Adnan WAH, et al.

International e-Journal of Science, Medicine & Education, 2016;10(1):41-46.
MyJurnal

Background: Some argue that Malaysia’s extremely low organ donation rate is attributed to religion, specifically Islam. Testing this argument, this study asked Malaysian Muslims their views regarding various issues on organ donation and examined whether their decisions to donate organs are framed by religious beliefs.
Materials and Methods: This study investigated the perspectives of Malaysian Muslims between October and December 2013 in Kuala Lumpur. Self-administered questionnaires were distributed to 900 people, with 829 responses collected (92% response rate). Respondents’ verbal consent was taken before proceeding with the survey.
Results: The survey found that more than half of respondents felt that organ donation is permitted in
Islam and that it is a communal responsibility. However, the same proportions were unsure on the issues of rewards for organs or on whether Islam permits the procuring of organs from brain dead patients.
Conclusions: Malaysian Muslims are not against organ donation; however, encouraging organ donation requires the state to address public concerns on Islam’s views on this sensitive issue through effective policy tools to help address these gaps in Malaysian Muslims’ understanding of organ donation. The organ donation rate could improve by using Islamic scholars as ambassadors for an organ donation drive to convey the message of Malaysia’s urgent need for organ donation.

Matched MeSH terms: Tissue and Organ Procurement*
Fulltext Family decision-making about organ donation: a systematic review

Makmor, T., Abdillah, N., NurulHuda, M.S., Raja Noriza, R.A., Roza Hazli, Z.

JUMMEC, 2015;18(1):1-4.
MyJurnal

The family is an important factor that influences an individual’s decision for organ donation. The number of studies addressing the family’s role in organ donation is limited. It is imperative to explore these studies and offer recommendations that may help in addressing organ shortage. 15 studies with more than 2100 participants were selected for a systematic review. The studies were accessed by searching three databases: MEDLINE, Elsevier, and PsycINFO. This systematic review indicates that knowledge about brain death and the circumstances surrounding organ donation and transplantation are the most important factors that affect a family’s decision regarding organ donation. Educational efforts targeting the family should be initiated, which can then guide the family’s decision on organ donation. We suggest that educational efforts be consistent with other factors such as religious beliefs that influence the family’s decision.

Matched MeSH terms: Tissue and Organ Procurement

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