J Korean Soc Transplant.  2018 Sep;32(3):38-48. 10.4285/jkstn.2018.32.3.38.

Status of Organ Donation and Solution of Organ Shortage in Korea

• Cho WH

• KMID: 2421279
• DOI: http://doi.org/10.4285/jkstn.2018.32.3.38

Abstract

Deceased organ donation in Korea has increased steadily after legislation of transplantation law. Since last year, however, several obstacles resulting in a decrease in organ donation have been experienced. Among them, the reduced reporting of potential brain death from large size hospitals and reduced consent rate of medically available deceased donors are two main hurdles. The consent rate of organ donation was 41.9% in 2017 but has dropped to approximately 10% than 2016. Other strong family members overrode approximately 10% of donations initially consented by their next of kin. In addition to the medical points, difficulties in labor shortage are being experienced during donor management, testing and organ recovery in the hospital. Some end stage patients who are candidates as organ donor give up further management and decide to withdrawing life sustaining treatment, which deprive the chance of donation. Moreover, the national mortality rate of cerebrovascular and traffic accidents, which occupy a major part of brain death, have decreased over the recent 10 years. All of these events can cause a decrease in brain death development so it is important to find solutions to overcome all of them. Revising transplant law and donation system should be led by government. Efforts to increase the consent rate, procurement rate, and transplant rate and decrease the organ discard rate are all the responsibility of the medical team. Public awareness and a positive attitude towards organ donation are the most important basic requirements for increasing organ donation. A comprehensive task force team to overcome all of these problems is requested.

Keyword

Organ and tissue procurement; Waiting lists; Organ transplantation; Informed consent; Organ donor

MeSH Terms

Accidents, Traffic
Advisory Committees
Brain Death
Humans
Informed Consent
Jurisprudence
Korea*
Mortality
Organ Transplantation
Tissue and Organ Procurement*
Tissue Donors
Waiting Lists

Figure

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  Fig. 1 Organ donation & waiting list of Korea. Data from 2017 annual report of KONOS and KODA.

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  Fig. 2 Consent rate in medically available donor. Data from 2017 annual report of KODA.

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  Fig. 3 Deceased donor in USA. Abbreviations: DBD, donation after brain death; DCD, donation after cardiac death; DD, deceased donor Adapted from Table 3 of reference [31].

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  Fig. 4 Rate of recoverd organs not transplanted. Reprinted from Table 27 of reference [31].

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  Fig. 5 Influence of mass media on actual organ donation.

Reference

1. The declaration of Istanbul on organ trafficking and transplant tourism. Editorial. Nephrol Dial Transplant. 2008; 23:3375–3380.

2. Shafer TJ, Wagner D, Chessare J, Schall MW, McBride V, Zampiello FA, et al. US organ donation breakthrough collaborative increases organ donation. Crit Care Nurs Q. 2008; 31:190–210.

3. Davis BD, Norton HJ, Jacobs DG. The organ donation breakthrough collaborative: has it made a difference. Am J Surg. 2013; 205:381–386.

4. European Commission. Action plan on organ donation and transplantation (2009-2015): Strengthened Cooperation between member states : Communication from the Commission. Brussels: European Commission;2008.

5. Sue Hughes. Brain death rates falling [Internet]. New York, NY: Medscape, Inc.;2013. Available from: https://www.medscape.com/viewarticle/815005.

6. Kramer AH, Zygun DA, Doig CJ, Zuege DJ. Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region. CMAJ. 2013; 185:E838–E845.

7. Korea Organ Donation Agency (KODA). Bridge for life: KODA annual report. Seoul: KODA;2017.

8. Statistics Korea. 2016 Cause of death statistics [Internet]. Daejeon: Statistics Korea;2016. Available from: http://kostat.go.kr.

9. Hypothermia after. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; 346:549–556.

10. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346:557–563.

11. Mateen FJ, Josephs KA, Trenerry MR, Felmlee-Devine MD, Weaver AL, Carone M, et al. Long-term cognitive outcomes following out-of-hospital cardiac arrest: a population-based study. Neurology. 2011; 77:1438–1445.

12. Sandroni C, D'Arrigo S, Callaway CW, Cariou A, Dragancea I, Taccone FS, et al. The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis. Intensive Care Med. 2016; 42:1661–1671.

13. Ministry of Government Legislation. Labor Standard Act (Article 51. Flexible Working Hour System). Sejong: Ministry of Government Legislation;1997.

14. Ministry of Government Legislation. Act on Decisions on Life-sustaining Treatment for Patients in Hospice and Palliative Care or at the end of Life (Article 2, 16). Sejong: Ministry of Government Legislation;2018.

15. Klein AS, Messersmith EE, Ratner LE, Kochik R, Baliga PK, Ojo AO. Organ donation and utilization in the United States, 1999–2008. Am J Transplant. 2010; 10(4 Pt 2):973–986.

16. Kootstra G, Daemen JH, Oomen AP. Categories of non-heart-beating donors. Transplant Proc. 1995; 27:2893–2894.

17. Bernat JL, D'Alessandro AM, Port FK, Bleck TP, Heard SO, Medina J, et al. Report of a National Conference on Donation after cardiac death. Am J Transplant. 2006; 6:281–291.

18. Shemie SD, Baker AJ, Knoll G, Wall W, Rocker G, Howes D, et al. National recommendations for donation after cardiocirculatory death in Canada: donation after cardiocirculatory death in Canada. CMAJ. 2006; 175:S1.

19. Donation after circulatory death steering group. BTS/ICS: Consensus guidelines on organ donation after circulatory death [Internet]. Macclesfield: The British Transplantation Society;2010. cited 2011 Apr 2. Available from: http://www.bts.org.uk/transplantation/standards-and-guidelines.

20. Australian Organ and Tissue donation and Transplantation Authority. National protocol for donation after cardiac death 2010 [Internet]. Canberra: The Organ and Tissue Authority;2010. cited 2011 Apr 2. Available from: https://donatelife.gov.au/resources/clinical-guidelinesand-protocols/national-protocol-donation-after-cardiacdeath-2010.

21. Mahillo B, Carmona M, Álvarez M, Noel L, Matesanz R. Global database on donation and transplantation: goals, methods and critical issues. Transplant Reviews. 2013; 27:57–60.

22. Wahlster S, Wijdicks EF, Patel PV, Greer DM, Hemphill JC 3rd, Carone M, et al. Brain death declaration: Practices and perceptions worldwide. Neurology. 2015; 84:1870–1879.

23. Sade RM. Brain death, cardiac death, and the dead donor rule. J S C Med Assoc. 2011; 107:146–149.

24. Domínguez-Gil B, Haase-Kromwijk B, Van Leiden H, Neuberger J, Coene L, Morel P, et al. Current situation of donation after circulatory death in European countries. Transpl Int. 2011; 24:676–686.

25. Levin A. The impact of first person consent legislation on the supply of deceased organ donors. Honors Senior Thesis. Grand Valley State Univ.;2014. English.

26. Mesich-Brant JL, Grossback LJ. Assisting altruism: evaluating legally binding consent in organ donation policy. J Health Polit Policy Law. 2005; 30:667–717.

27. Traino HM, Siminoff LA. Attitudes and acceptance of first person authorization: A national comparison of donor and nondonor families. J Trauma Acute Care Surg. 2013; 74:294–300.

28. Callison K, Levin A. Donor registries, first person consent legislation, and the supply of deceased organ donors. J Health Econ. 2016; 49:70–75.

29. Organdonor.gov. People registered as donors in the US [Internet]. Washington, DC: US Department of Health & Human Services;2017. Available from: http://www.organdonor.gov/statistics-stories/statistics.html#registration.

30. The University of Chicago Medical Center. When the living and the deceased don't agree on organ donation [Internet]. Chicago: The University of Chicago Medical Center;c2018. Available from: http://www.uchospitals.edu/news/2013/20131126-organ-donation.html.

31. Israni AK, Zaun D, Rosendale JD, Schaffhausen C, Snyder JJ, Kasiske BL. OPTN/SRTR 2016 Annual Data Report: Deceased Organ Donation. Am J Transplant. 2018; 18:Suppl 1. 434–463.

32. Statute book of Organ and Tissue donation, Korea center for disease control and prevention (KCDC). 2013. p. 159.

33. Vitallink workshop for developing teaching plan of 'Gift of life' for youth. Seoul: Vitallink;2018.

34. Green Reg. The Nicholas effect: A boy's gift to the world. Beijing; Sebastopol, CA: O'Reilly;1999. p. 248.