April 30, 2003
ADMINISTRATIVE ORDER
No. 41 series 2003
PHILIPPINE
ORGAN DONATION PROGRAM UNDER DEPARTMENT OF HEALTH
I. INTRODUCTION
The
National Policy on Kidney Transplantation from Living Non–related organ donors
(LNRDs) per Administrative Order No. 124 series 2002 sets
the general guidelines and ethical principles whereby the act of organ donation
and conduct of transplantation from the LNRDs shall be managed and regulated.
The order also prescribes for the adoption of a rational, equitable, ethical
and accessible renal care program in the country which among others includes
the use of LNRDs for kidney transplantation.
Under
A.O. No. 124 series 2002, a Philippine Organ Donation Program (PODP) has been
created under the Health Operation Cluster of the DOH. This Order is issued to
prescribe the guidelines on how the PODP will operate in coordination with
various offices and agencies including the newly organized bodies and
committees as specified in Department Order 191–F series 2002 with the end–view
of developing a comprehensive renal care program.
II. COVERAGE
This
A.O. covers all health and health–related professionals, facilities, offices,
bureaus and all other organizations and individuals involved in the practice of
transplantation and organ donation.
III. POLICY
STATEMENTS
The
operation of the Philippine Organ Donation Program shall be anchored on the
policies set forth under A.O. 124 series 2002:
A. Living non–related donations are permitted only under
certain conditions detailed out in A.O. 124 series 2002. Sale and purchase of
kidney organs by kidney vendors is prohibited.
B. Kidney organ donation programs shall be guided by
these principles: Equity, Justice, Benevolence, Nonmaleficence, Solidarity,
Altruism and Volunteerism.
C. All health and health related facilities shall
implement and adopt quality standards and practices in the medical and
organization management of kidney transplantation.
D. The Department of Health through its Bureau of Health
Facilities and Services and the Philippine Health Insurance Corporation shall
enforce and monitor these health facilities through their licensing and
accreditation rules and regulations.
IV. THE
PHILIPPINE ORGAN DONATION PROGRAM (PODP)
The
PODP is established under the Degenerative Disease Office of the National
Center for Disease Prevention and Control. In the performance of its role, the
PODP shall mobilize various offices and units of the Department of Health and
convene representatives from these offices into Technical Working Groups as
necessary. Further, for a sound implementation of the program, PODP shall tap
the technical expertise of the National Kidney and Transplant Institute (NKTI),
the only government Specialty Center on renal diseases. It may specifically
build on the systems (e.g. registry, screening/matching of donors–recipients)
and other activities as initiated by the Renal Disease Control Program (REDCOP)
under NKTI.
As
specified in A.O. 124 series 2002, the PODP shall have a National Transplant
Advisory Board which shall primarily policy recommendation and advice in the
following tasks:
1. Setting of guidelines or criteria for the
prioritization of recipients of kidney organs from donors.
2. Development of systems and procedures that will allow
for transparency, exchange networking and collaboration with different health
facilities, organizations, associations and professionals.
3. Facilitation and promotion of technical assistance
among professionals and health and health–related facilities involved in kidney
and other organ transplantation.
The
PODP shall also be assisted by a National Transplantation Ethics Committee
(NTEC) which shall be responsible in formulating the ethical standards for
organ transplantation and which, in turn, shall be the basis of the ethical
standards for all hospitals and other facilities.
V. PROGRAM
COMPONENTS
A.
Policy and
Program Standards
The
PODP shall be responsible for formulating policies and program standards
towards the development of a rational, ethical accessible and equitable renal
health care program in the country through coordination with other
organizations, associations and professionals engaged in transplantation and
donation programs and activities.
B.
Advocacy /
Information Education Campaign
The
PODP shall undertake activities which shall increase public awareness on organ
transplantation and renal diseases. This may include patient information and
education, public education and advocacy campaign through multi–media.
C.
Systems
Development
The
PODP shall put in place a system for the screening and matching of donors and
recipients prior to their inclusion in the registry. The system shall involve
the creation of a Selection and Matching Committee both at the National and
hospital/or facility level. It shall also maintain a national registry which shall
include a registry of all kidney transplants performed in the country, registry
of all LNRDs and registry of all patients seeking kidney transplantation using
LNRDs.
D.
Research
The
program shall support researches/studies concerning organ donation and
transplantation. It shall particularly support baseline studies and other
related studies, results of which shall provide inputs to policy formulation
and program development.
E.
Networking
The
program shall actively promote, enjoin the participation of other stakeholders,
government organizations, academe, private institutions and civil society to
form a well–coordinated network supporting efforts for the transfer of
technology among these partners in order to improve renal health care in
general.
F.
Monitoring
and Evaluation
A
built–in monitoring and evaluation system shall be part of program. It shall
require regular reports and feedback from the hospitals / health facilities.
The program may also exercise oversight functions if necessary. Results of
monitoring and evaluation shall always inform policy discussions and
deliberations by program and DOH top management to improve and to introduce
innovations in the program.
VI. IMPLEMENTING
MECHANISM
1. The PODP shall ensure coherent and sound
implementation of activities both at the national and hospital/other health–related
facility based on program standards.
2. The PODP shall ensure the institutionalization of
these systems
a. A Donor/Recipient Screening and Matching System shall
be operationalized by a Screening and Matching Committee. This Committee shall
be composed of a Transplant Immunologist, a Transplant Nephrologist and or a
Transplant Surgeon/Physician. This Committee is tasked to formulate the
following:
(1) Formulate guidelines and criteria on the evaluation of
donor/recipients prior to enrollment/listing in the National Registry in close
coordination NTEC.
(2) Ensure implementation of set of guidelines and
policies to donor/recipient applicants.
(3) Issue clearance on matching of donor and recipient to
the individual transplant facility.
(4) Provide regular feedback and report updates to the PODP.
b. The PODP shall maintain a National Donor/Recipient
Registry. Data shall emanate from the different accredited hospitals/ medical
centers nationwide and/or through walk in donors and recipient – enrollees who
qualified based on the NTEC and Donor/Recipient Screening and Matching System
criteria.
In
effect, this registry shall contain a pool of data/information of donors and
recipients who have been subjected to an initial screening and matching process
by the Screening and Matching Committee.
As
above–mentioned, PODP may build on the existing registry of REDCOP and the
Human Organ Preservation Effort (HOPE). This shall require close coordination
by the PODP with all hospital– / facility–based registries.
In
view of the above, the PODP shall furnish list of approved donor – recipient
matches to the NKTI and other accredited hospitals and health facilities.
3. The PODP shall provide sufficient information so that
patients seeking transplantation can go directly to the PODP or to the
accredited hospital/health facilities for inquiries registration and/or
consultation.
4. The DOH – Bureau of Health Facilities and Services –
Philippine Health Insurance Corporation shall issue in separate orders
licensing and accreditation standards or hospitals and health–related facilities.
5. Each hospital/health facility shall submit quarterly
report on transplant operations conducted to PODP.
6. NTEC and Ethics Committee of hospitals and health
facilities shall issue their own guidelines and criteria in accordance with
national policies and program standards.
VII.
EFFECTIVITY
This
order shall take effect immediately
MANUEL M. DAYRIT, MD,
MPH
Secretary of Health
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