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The year 2006 has paved the way to a more challenging and competitive endeavor as the Institute continuously embark on innovations, upgrading the existing infrastructure, acquiring modern equipment and enhancing customer satisfaction. Inspired by its strong vision to be the leading tertiary specialty center for renal diseases and organ transplantation, the Institute has earlier participated in the global market and actively in the international health service competition under the auspices of the Department of Health through its Medical Tourism Program. Among this year’s significant developments is the New Laboratory Reception Hall which is considered the Institute’s newest showcase. The area was strategically designed to create an ambience of a world class international health care facility equipped with customer friendly facilities. A pioneering project was the establishment of the Center for Molecular and Cellular Therapeutics designed for both therapeutic care and research activities. Another major project was the renovation of wards 2D and 3D which were re-designed to improve patients’ comfort and convenience. Other capital projects included the establishment of a Business Center that provides services to business needs of the patients, relatives and guests such as Internet, fax, printing and photocopy services and the opening of the Gourmet Express (NKTI Café) to provide food services to employees, patients, visitors and guests. In line with its educational campaign, we released the Coffee Table Book entitled “NKTI @ 20, A Dynamic Pulse” and the Book “May Bukas Pa” that will serve as an information and educational reference for patients with renal failure.

A testament to the Institute’s continuous effort to improve quality health care is the investment in the hospital equipment and the implementation of an equipment replacement program to strengthen its capabilities and improve its efficiency. Major acquisitions in 2006 were the Sterilization System, Urological Instruments, Operating Room Instruments, new Anesthesia Machines, Surgical Table, Plasma Freezer, Refrigerated Table Top Centrifuge, and Real Time Polymerase Chain Reaction Analyzer and many more. The aggressive renovation projects and equipment acquisitions done by the Institute over the last few years influenced the recorded growth in major hospital services. Our core operations provided the major contributions-hemodialysis sessions went 12 Annual Report 2006 up by 17% and kidney transplantations increased by 6.7% with a laudable 26% increase in service cases. Laboratory tests increased by 11.8% while ancillary laboratories registered a 6.9% increase. The temporary closure of two ward units due to renovation reduced patient admissions but this was neutralized by the increased volume of out-patient visits.

Translating the operational performance into its financial equivalent, the hospital’s gross revenue increased by 22% with quantified free service and expenses increasing by 20% and 18% respectively. In spite of the annual government subsidy being maintained at P185 million over the last five years, the Institute continued to provide free hospital assistance to service patients so much so that this year, Quantified Free Services has exceeded government subsidy. For every P1.00 of quantified free services provided, the Institute gave P0.32 while the national government’s subsidy contributed P0.68. Operating costs and expenses were contained at 90% of gross income in 2006.

The Institute received recognition for its efforts in promoting quality health care services. As the lead agency in the National Voluntary Blood Donation Program, NKTI once again received the Sandugo Masigasig Award for conducting the highest number of mobile blood donation activities and Sandugo Mabuhay Award for having the highest voluntary walk-in donors.

Indeed, in 2006 we witnessed the Institute emerge as a globally competitive healthcare institution. We have had the most productive and challenging year and our doctors, officers and staff have all contributed immensely to these achievements. Clearly, the National Kidney and Transplant Institute remains steadfast in its commitment.

A long with the establishment of the National Kidney Institute in 1983 came the humble beginnings of the Section of Urology, under the Department of Surgery. Under the wings of three (3) pillars in Urology, Drs. Benjamin Magsino, Abelardo Prodigalidad and Genaro Yusi, it immediately created an impact in the local urologic community by establishing at the time of its inception a residency training program. Soon after, the patients came and the Urology service was born with an exponential growth in consultations and surgical procedures performed over the next two decades. An alliance was formed with the University of the Philippines-Philippine General Hospital Section of Urology adding greater academic interaction among the staff of two institutions.

It has since then produced over 40 urologists who are now among the leaders and leading academic and clinical practitioners in the country with some of them holding key positions in the Philippine Board of Urology, Philippine Urological Association and major medical centers in the country. Not being content with being a general urology service, it expanded to endourology and transplant urology which eventually became the trademark of the newly formed center. It has since evolved from a section to a department becoming the biggest surgical service in the hospital with an output of 1,067 major operations, 1,400 minor surgeries and 1,264 out-patient procedures in 2006. Out of an initial 50 bed facility, which is shared with the other specialists of the hospital, it has, in 2006, seen 8,840 out-patient service consults and an undetermined number of private consultations. The Department also had 382 service and 1,312 pay admissions plus 694 pay and 125 service referrals.

With its mission-vision of becoming the premier urologic center in training, service and research not only in the Philippines but in Southeast Asia, it has continued to grow and expand to reach this goal. The Department staff has blossomed to more than triple its original number. It has under its wings young and dedicated urologists, board certified and fully armed with training received in prestigious centers in the world. With the rapid pace of evolution of the diagnosis and treatment of urologic National Kidney and Transplant Institute 5 disorders came the need for sub-specialization. We have responded by creating the sections of Pediatric Urology, Urologic Oncology, Minimally Invasive Urology which includes Endourology and our newest “baby”, Laparoscopic Urology. The last decade has seen the development of new medical and surgical modalities such that the need for sub-specialty training, dedication and concentration to a particular field became essential for growth.

Endourology became a byword and began to revolutionize the management of stones. With heavy investment in state of the art equipment, ureteroscopy and percutaneous renal techniques were developed to provide highest standards of care at par with leading
urologic institutions of the world. Although some patients are still undergoing open stone surgery, a great number are subjected to minimally invasive techniques and extracorporeal shock wave lithotripsy (ESWL). Gone are the days when the probability of an attactk of renal/ ureteral colic would end up in an operating room because of the availability of the above procedures at the NKTI. The Department prides itself in having two ESWL machines which has doubled the output and provided faster service to our patients, with 968 procedures performed for 2006.

New equipments are in the pipeline such as a laser lithotripter and a new C-arm. In the field of Neuro-urology, the Department has been one of the first to acquire a Urodynamics machine which has provided the needed diagnostic armamentarium in the diagnosis and treatment of functional disorders of the lower urinary tract. There was once a time when we were the referral center for Urodynamics in this section of the metropolis. Other institutions have since acquired their own and we have upgraded to a newer generation machine plus a separate Uroflowmeter dedicated solely to the prostrate health clinic.

The field of Pediatric Urology has emerged as one of the true subspecialties of Urology being an entirely different set of discipline with a big array of urologic disorders, mainly congenital anomalies, far different from adult urology. Conditions which are seldom seen in adults such as vesicoureteral reflux, congenital hydronephrosis, duplicated collecting systems, hypospadias, undescended testis, etc., became a common discussion in the Department. As such, diagnostics, instrumentation and
treatment are different, thus the need for specialization.

The Department has responded to this need and has in its fold, 4 fully trained pediatric urologists. It also prides itself in having the most complete set of surgical equipment for the care of these children. A Pediatric Urology clinic has also been established in collaboration with Pediatric Nephrology. A fellowship program in Pediatric Urology will soon be started to answer the needs of the nation to provide specialists in the care of children outside of Metro Manila.

The prostrate has been the “bread and butter” of every urologist. Majority of male consultations in the 50 and above age bracket would be due to a prostrate disorder. To provide better patient care and focused treatment and follow-up, the Prostrate Health Clinic was established in
2005 and since then, it has seen an increasing number of patients particularly in those undergoing screening for prostrate cancer. A total of 331 prostrate biopsies were performed in 2006. One hundred sixty seven (167) prostatectomies for benign disease were performed 6 National Kidney and Transplant Institute 03 majority of them (154) via the transurethral route (TURP).

Thirteen (13) radical prostatectomies were performed and just recently, laparoscopic approach is now being employed. In addition to this, the Department has at its disposal High Intensity Focused Ultrasound (HIFU) which is an alternative minimally invasive option in the ablation of localized prostrate cancer. Twelve (12) patients were given this treatment in 2006, the only machine of its kind in Southeast Asia, and the favored minimally invasive option in Western Europe.

The ever-rising popularity of laparoscopy or keyhole surgery did not spare the field of urology. With the emphasis now on improving patient care in terms of shortened hospital stay, faster recovery, better cosmesis and reduced need for post-op analgesics, the Department was driven to embark on a learning expedition in laparoscopy guided by recently graduated fellows with training abroad. Live animal workshops were conducted and post-graduate courses were given. After countless hours of work in the operating room, the Department is proud to say that the section of Laparoscopic Urology is here to stay. With investments in new equipment, more and more urologic procedures are now being handled laparoscopically. Most notable of which is laparoscopic live donor nephrectomy, which is slowly becoming the “method” of choice for kidney donation especially in the developed countries. To date, almost 100 such procedures were already successfully performed. Aside from these, various other urologic operations can be performed including radical prostatectomy, adrenalectomy and even pediatric procedures for undescended testis and vesicoureteral reflux.

With such growth and the need to excel and provide service to more and more of our countrymen, the Department in its vision to look beyond its boarders, has plan for the future. The emergence of subspecialties plus the need to establish and develop new ones such as urologic oncology, female urology and infertility only means one thing, the need for expansion. With key urologic personnel already in place (e.g. staff with training or undergoing training), the plan to build a Women’s Medical Center is very timely to support this project. First, a comprehensive multi-modality cancer center that would be part of this, being also a gynecologic facility complete with radiation oncology services and state of the art diagnostic equipment would virtually create a “one-stop shop” for patients with cancer of the genitourinary tract as it would complement the existing set-up with the added bonus of having a molecular and cellular laboratory providing immunotherapy support.

Second, with the anticipated increased number of female patients will come the need for a gynecologic urologic tieup and lastly, a reproductive clinic with male and female “arms” would be a natural offshoof of this new medical facility. This would therefore mean that the need for more beds, highly specialized and organized urologic care and a bigger facility y is now a reality. With such a prospect, a Department can only grow and the next “size” for it to grow is to become an Institute-one that would complement and support the Women’s Medical Center and the National Kidney and Transplant Institute. It would become the most comprehensive urologic facility in the country providing full-time academic and clinical practitioners with focus on quality health care, training of the future urologists and engage in clinically relevant research. The Institute of Urology and Men’s Health, it was once a dream can now become a reality.

Malignant tumors are characterized by uncontrolled proliferation of abnormal cells with lethal potential. Cancer cells can arise from any body tissue and can invade adjacent tissues by infiltration or direct extension or they can spread to distant organs or tissues through vascular or lymphatic channels. Cancer is more common in the older age groups, but it can occur at any age. Seventy five percent of all cancers occur after the age of 50. About 4.0% occur in children (0-14 years). The incidence of cancer in a given population is rising. In the Philippines, cancer ranks as the third leading cause of death, following cardiovascular and infectious diseases. Around 71,526 new cases of cancers were recorded in 1998 (33,898 in males and 37,628 in females). About 189.1 per 100,000 Filipinos in 1998 developed cancer and 1 out of 5 Filipinos age 74 and above would have cancer. Survival was generally better for the younger age group with the exception of breast cancer, where the lowest survival was noted in the under 35 years age group. Survival rates were higher for cases with early clinical stage compared with those with advanced lesions.

Several cases of cancer are seen and treated at the National Kidney and Transplant Institute, both as ambulatory and in-patient. For those who are busy and do not want to stay in the hospital, they can avail of out-patient treatment; while those who need monitoring and longer period of intensive treatment are usually admitted in the hospital. The Chemotherapy, Blood Transfusion and Pain Management Unit of NKTI, which is the busiest section of the Center for Special Services in terms of patient load, offers outpatient care and adjuvant as well as palliative treatment of solid organ tumors and hematologic malignancies. It is manned by highly experienced and specially trained nurses and doctors. Other services offered include blood component transfusion and intravenous antibiotic therapy for a selected group of patients and some diagnostic medical procedures like bone marrow aspiration. This special service unit operates with the expertise of the Institute’s Medical Oncology and Hematology consultants, with assistance from the Oncology fellows and first year medical resident rotating in Oncology. Subspecialty support referrals are also facilitated through the unit, hence more convenience for the patient and his family.

For the past six years, the unit has served an average of a thousand out-patient chemotherapy sessions per year including blood transfusion, bone marrow aspiration procedure, porta-catheter flushing and pulse therapy of both pediatric and adult nephrology patients. Aside from providing out-patient chemotherapy services, a cancer support group was also created to help both patients and their care-givers feel more in control at a time when they feel most isolated and vulnerable. Every last Wednesday of the month, a meeting with a group is held at the Unit wherein a series of practical advise are given to patients regarding follow-ups and other treatment options. It is very important to keep in touch with and offer support to patients especially those with poor prognosis. The Unit is also actively involved in other activities promoting cancer awareness in public. Last December, the Oncology Service invited Taguig Representative Alan Peter Cayetano as special guest in their annual christmas party held at NKTI Atrium. It was Rep. Cayetano’s brother Lino who donated a part of his liver to his father, the late senator Renato Cayetano, when the latter suffered from liver cancer to which he eventually succumbed. The appearance of Rep. Cayetano has inspired patients and their relatives to continue with their fight against cancer. The audience was also made more aware of the devastating effects of the disease and the importance of reassurance and continued support of the community.

The Chemotherapy, Blood Transfusion and Pain Management Unit of the Institute with the help and support of its medical personnel, nurses, residents, fellows and consultants not only provides basic out-patient chemotherapy services but also promotes the emotional well-being of their patients. It is consistent with the Institute’s goal of providing quality care to meet patient’s satisfaction measured through continuous clinical performance activities and excellent medical outcomes.

A transplant symposium entitled "Maximizing Clinical Outcomes in Kidney Transplantation" will be held on April 16, 2008 (Wednesday) from 8 AM to 4 PM at EDSA Shangrila Hotel during the 28th Annual PSN Convention. This is a joint effort of the Departments of Adult Nephrology and Organ Transplantion. Registration fee is Php 1,000.00 if settled on or before March 31, 2008. On-site registration is Php 1,200.00.


For inquiries, please call the Secretariat at 926-89-18 and look for Rhea Decena or Abby Padua.

Program is as follows:

First Transplant Symposium
Theme: "Maximizing Clinical Outcomes in Kidney Transplantation"
Mactan Ballroom Edsa Shangrila Hotel
April 16, 2008 8:00 am to 4:00 pm

 
 

 

8:00 - 8:45 am Registration  
8:45 - 8:50 am Invocation Lito Rioveros, MD
    Chief Fellow, NKTI
8:50 - 8:55 am National Anthem  
8:55 - 9:00 am Welcome Remarks Romina Danguilan, MD
    Chief, Dept. of Adult Nephrology
    NKTI
     
Session 1: Factors Compromising Allograft Function
Chair: Ma. Cecilia Manalo, MD  
     
9:00 - 9:30 am Acute and Chronic Rejection:  Antonio Paraiso, MD
  Early Detection and Intervention NKTI
9:30 - 9:40 am Open Forum  
9:40 - 10:10 am Differential Diagnoses in Renal  Sonia Chicano, MD
  Allograft Biopsies NKTI
10:10 - 10:20 am Open Forum  
10:20 - 10:50 am Non-immunologic Risk Factors Affecting  Robert Tanchanco, MD
  Recipient's Survival: CVD, Infection, Malignancy,  TMC
  Disease Recurrence  
10:50 - 11:00 am Open Forum  
11:00 - 11:30 am Donor Contribution to Transplant Injury Servando Simangan, MD
    NKTI
11:30 - 11:40 am Open Forum  
11:40 - 1:00 pm ROCHE Lunch Symposium  
  SYMPHONY study  
     
Session 2: Immunosuppresive Strategies
Chair: Arlene Lamban, MD    
1:00 - 1:30 pm Tailoring Immunosuppresive Protocols: Standard Yvette Tomacruz, MD
   Risk, High Risk and Special Population NKTI
1:30 - 1:40 pm Open Forum  
1:40 - 2:10 pm Antibody Induction: Impact on Graft Survival Joseph Bernard Africa, MD
    NKTI
2:10 - 2:20 pm Open Forum  
2:20 - 2:50 pm WYETH Symposium Romina Danguilan, MD
  Understanding Chronic Allograft Nephropathy:  NKTI
  Options for Therapy  
2:50 - 3:00 am Open Forum  
3:00 - 3:30 am NOVARTIS Symposium Enrique Ona, MD
  Immunosuppression Minimization: How to Do It? NKTI
  Steroid Withdrawal/Avoidance  
  CNI minimization/Elimination  
  Proliferation Signal Inhibitors  
3:30 - 3:40 am Open Forum  
3:40 - 3:45 pm Closing Remarks Benito Purugganan, MD
    Chair, Dept. of Organ Transplantation
    NKTI

“A passion for service and excellence everyday...” This is the theme the National Kidney and Transplant Institute (NKTI) is celebrating as it approaches its 25th Year Founding Anniversary on February 23, 2008. Armed with the purpose of bringing quality service to all its patients, the NKTI today is perceived to be a highly competitive hospital with world-class standards that remains to be true to its mission: “To work hand-in-hand with government in the achievement of good health for the Filipino people by providing specialized medical services.” Honor goes to its employees for their commitment to excellence, innovation, dedication, and loyalty to the Institute.

Year 2007 was truly a remarkable year for the National Kidney and Transplant Institute. Over its twenty five years of operation, it has proven that despite adverse circumstances, it possesses the dynamism and the ingenuity required to weather internal and external challenges. The NKTI continues to lead the way in defining quality healthcare. With the massive organizational and infrastructural changes in the last twenty five years, everyone marvels at how the Institute has metamorphosed into one of the best hospitals in the Philippines.

Born in 1983 as the National Kidney Foundation of the Philippines (NKFP), it was meant to serve as a modern medical center accessible to the Filipino patient. Starting with just 50 beds for the patients, who would have thought that the foundation would now be a premier center of excellence - the forerunner of the country’s transplant centers.

The NKTI story is a never-ending journey. As it celebrates its 25 years of existence, including an interregnum of a disastrous fire, the NKTI continues to grow.

The year 1998 was a period of marked difficulty for the NKTI. Fire gutted the Lung Center of the Philippines affecting the nearby NKTI Annex building housing the Emergency Room, Wards, Operating Room and Radiology Complex. Newly appointed Executive Director then, Dr. Enrique T. Ona was undeterred by these seemingly insurmountable difficulties. He pursued an aggressive rehabilitation program on the infrastructure and at the same time, uplifted the morale of dispirited medical and hospital staff. He chose to rehabilitate the patients’ rooms and construct more rooms to accommodate the growing number of its patient population. With his energized leadership, the Institute has since then undergone a series of changes. The Center for Special Services composed of the Urology, Endoscopy, and Chemotherapy/Transfusion/ Pain Management Unit, Physical Medicine and Rehabilitation, Prostate Health Clinic, Vascular Laboratory, Ostomy and Wound Care Clinic and Molecular and Cellular Therapeutics Center were among those established to cater to patients with specialized needs. Doctors’ Clinics, Hemodialysis Center, Out-Patient Services at the Annex II building were built to accommodate the ever increasing number of Filipinos suffering from kidney diseases and other ailments.

The Emergency room complex was specially redesigned to suit its purpose with its 7-bed observation and 9-bed treatment rooms. The Pharmacy and Housekeeping sections were also constructed to pave the way for better and faster services. The Laboratory has evolved into the country’s most modern and leading referral clinical laboratory, boasting of a large ultra-modern Laboratory Reception Hall.

A new Chapel for Christians and a Masjid Prayer room for Muslims were made available to become a source of spiritual strength for patients and their relatives. Other facilities such as the Doctors’ Lounge, Residents Quarters, Medical Department Offices (Surgery, Urology, Pediatric and Adult Nephrology, Anesthesiology, Organ Transplantation, and Internal Medicine), Nutrition and Dietetics Division, and Cafeteria were constructed. The Administrative Offices were relocated and renovated. A newly renovated well-lighted atrium lobby exuding a luxurious hotel like atmosphere welcomes the visitor, with escalators connecting the lobby to the second floor. Keeping its medical facilities and equipment up-to-date, Spiral CT-Scan, Mammography, Millenium VG Gamma Camera, Open Magnetic Resonance Imaging (MRI), Ablatherm Machine, Extra Corporeal Shockwave Lithotripsy (ESWL), Flow Cytometry, Fluorescence In Situ Hybridization (FISH), Energy Filtering Transmission Electron Microscope and other state-of-the-art equipment were also acquired.

The NKTI is a leader in providing continuing education for young doctors. It has extensive training programs which include internship and residency training in medicine, urology, radiology, pathology, anesthesiology and internship and fellowship training in adult and pediatric nephrology, oncology, vascular surgery and organ transplantation. Moreover, to continually develop and upgrade the level of skills of the nurses and other allied health care providers, the Institute developed and established the Institute of Advanced Nursing and Allied Health Professions (IANAHP). It is envisioned to provide and equip its nursing and paramedical staff the necessary training, exposure, and skills based on globally accepted standards. With excellent service combined with excellent facilities, the NKTI moves with eagerness in creating a world-class hospital environment for its patients.

Today, with its three-storey edifice and two Annex Buildings with a full range of state-of-the-art equipment, services, and professional expertise to provide quality tertiary medical services, the NKTI continues to hold its reputation of being the Philippine’s Premier Institution for Kidney Diseases and Organ Transplantation. As the first and only government hospital to be ISO 9001:2000 certified, NKTI has become the model and benchmark of good governance for other government hospitals. Aside from its equipment, manpower, and services which are all of the highest standard, it boasts of the most modern diagnostic techniques for kidney and other related diseases, all modes of dialysis, and surgical procedures, most notably, laparoscopic urologic surgery and organ transplantation. Kidney transplantation is a regular activity of the hospital and to this date, the NKTI holds the record of the most number of kidney transplants performed in the country since 1983.

Marking its 25th anniversary this year, more priority projects are underway – the Women’s Medical Center, the Diagnostic Radiotherapy Center, and the Institute of Urology and Men’s Health.

Truly, behind the physical attributes of the hospital and the services it provides, is an inspiring story of how leadership and commitment to excellence enabled NKTI to overcome hardships and to break barriers to deliver medicine beyond ordinary care. The NKTI is the same hospital that was there for your family in the past 25 years. Today, we commit ourselves as we start our road to a new and higher level of quality care, a JCI accreditation, a virtual “ gold standard” for health care performance, so that we can better serve you in the next 25 years and beyond – with the same passion for service and excellence. Indeed, we have cause for celebration!

The issue of kidney transplantation and the use of living non-related donors especially to foreign recipients has been so muddled with misinformation, innuendos and aspersions to the country’s entire transplant program by some members of the local transplant community. They have been targeting, among others, the NKTI Transplant Program as an institution and me as the executive director and supposed "father of the derided organ donor program."

One must look back to the past to understand the unfolding events in kidney transplantation in our country today. Unlike in the US and other developed countries, through the years, kidney donors in the Philippines were mostly from living related donors (95%) and a mere 5% from deceased/cadaver donors despite all our efforts to work on the latter. The passage of the Organ Donor Act of 1990 legally recognized brain death and the legality of the organ donor card. This fact (difficulty of brain dead donation) is true in all developing countries including Japan and the reasons are manifold.

The shortage of donors in the US and all developed countries (except Spain) has resulted in a 5-8 years waiting time for patients who wished to be transplanted and the burgeoning costs of end-state renal disease or ESRD care ($2.5 billion annually in the US).

In Japan, the waiting time is indefinite because despite a legal recognition of brain death since 1997, only eight deceased donors have been retrieved.

At the same time, rapid advances in immunosuppression, the maturation of the surgical technique and overall improvement of care have markedly improved survival rate so that transplantation is now the preferred treatment for patients with ESRD compared to prolonged or life-long dialysis.

This has been shown by several comparative studies with regards to overall survival rate, long term costs and quality of life. This became clear globally as early as the late 1980’s and became more obvious in the 1990’s and more so today.


Evidence


Two important facts on living donors have become established. One, it is safe to be a living kidney donor – one lives a normal life in terms of life expectancy, sexual activity, with no or little danger of a higher incidence of hypertension and albuminuria.

Two, recipients with live donors have a significantly longer survival rate, compared to the best matched deceased donors
The above evidence-based medical facts have added to the tremendous demand of patients with ESRD to seek kidney transplantation as early as possible (pre-emptive), to look for a living donor beyond their family circle, and regardless of racial source.

In addition, the mounting demand for kidney transplantation has been exacerbated by the almost epidemic increase of patients with ESRD globally as a consequence of an "epidemic" of patients with Diabetes Mellitus and hypertension, the latter two being the most common cause of ESRD today.


Medical tourism

The past 5-10 years have also witnessed the development of "medical tourism" as exemplified by countries like India, Thailand and Singapore (but now world-wide) as improved hospital facilities in the less developed countries have attracted patients from developed countries where health care costs were expensive and unaffordable especially to those with no health insurance.

In 1999, a TV documentary exposed more than a hundred kidney transplants done in a private hospital from living non-related donors coming from the very poor section of the city, called BASECO in Tondo. This created a public uproar similar to what we have today, resulting in a Senate investigation, of which I had the difficult task of explaining and "defending" the practice.

Senator Juan Flavier instructed then Secretary Alberto Romualdez to create a body to which I was a member to come up with recommendations to stop this nefarious practice and come up with corrective measures. After several public hearings and meetings, it eventually resulted, after three years, in the passage of Administrative Order 124 in 2002, under the term of Sec. Manuel Dayrit.

Administrative Order No. 124 created the Philippine Organ Donation Program (PODP). The most important features of AO 124 were the following: separate accreditation of the transplant program (Kidney) from the hospital accreditation (the first in the country) and a 10% cap for foreign recipients in any transplant center.



Ethical debate

The year 2002 – 2007 must be reviewed to better understand our problems today, among which are:

   1. The rapid world-wide demand for kidney transplants from all types of donors, deceased or living.

   2. The program of "medical tourism" propagated by private hospitals to include kidney transplantation despite official pronouncements by the DOH to the contrary.

   3. The ease of information dissemination through the Internet.

   4. The rapid advances in transplantation beyond the HLA tissue types and better immunosuppression.

   5. Poor governance, weakness and lack of clarity in certain parts of the previous AO 124.

   6. The continuing global debate on the unresolved issue of donor compensation, assistance, gratuity or gift as differentiated from payment, sale or commerce for organ donors.


In the Philippines, reciprocating a favor with some gift or token of appreciation is an accepted cultural practice, not in the context of payment or commerce, but in the spirit of gratitude. Admittedly, this is often abused. If one was dying or in grave threat and a stranger offers help (on this instance, his kidney), are there guidelines on how one may reciprocate on this kindly act?

Responding to abuses happening in the US in the early years of kidney transplantation in 1987, the National Organ Transplant Act of the US was passed which forbids the receiving of any "valuable consideration" by the donor, deceased or living. This has been the hallmark of organ donation with varying modifications in other countries and the one supported by the WHO.

This has been the contentious issue of debate in the international transplant community of which no global consensus is forthcoming. In the late 1980’s, the US modified their position in accepting "emotionally related donors" such as husband and wife, fiancées and other persons that maybe emotionally affected if the recipient dies. In the last few years, the US has also accepted "exchange of donors" between unmatched pairs (living donors) and also accepted "removing disincentives" from donors by reimbursing expenses up to $8,000 dollars to volunteer living donors.


Help the suffering

It is true that the NKTI and the entire country’s kidney transplant program is predominantly a living donor program. This has been true despite long-term efforts to develop a deceased donor program.

The transplant program of the NKTI, with its excellent results comparable to that of the first world countries, has attracted patients internationally especially as the hospital achieved ISO-2002 certification six years ago. To say that our country attracts foreign recipients "only because they can easily buy cheap kidneys" is most unkind and undeserving of a reply.

Out of the 690 kidney transplants done in the Philippines in 2006, 158 (23%)of these were done for foreign recipients and in year 2007 a total of 1046 were done and 536 (51%) of these were done in the 13 private hospitals that strongly objected and ignored the 10% limit mandated by AO 124.

These number of transplants to foreigners including the flagrant abuses attracted world-wide attention and were reported by the Philippine Society of Nephrology (PSN) internationally putting us in the category of the abuses on organ trade with Pakistan, India, Turkey, Colombia, China and other eastern European countries.

Organ transplantation is a rapidly developing scientific endeavour which unfortunately is beset with various issues of moral, ethical and legal ramifications. This will even become more complex as we tackle issues on stem cell research and its medical applications, in-vitro fertilizations, implications of nanotechnology and other medical advances in the horizon.

We must try to keep an open mind and face these challenging fields with no malice, other than try to remember why we physicians are here for. Yes, donors must be protected from any abuse, respected and even honoured. Just as important is to help these suffering and dying patients take access to the advances of medical science today.

These are excerpts from Dr. Ona's speech read before the Board of Philippine Organ Donation and Transplantation, Office of the Secretary of Health, Manila on June 18.