Transcript HDI

RELATION BETWEEN DONATION AND TRANSPLANTATION
PRACTICES AND SOME DEVELOPMENT INDICATORS:
DATA FROM THE GLOBAL OBSERVATORY ON DONATION AND
TRANSPLANTATION (2009)
Mahillo B, Carmona M, Alvarez M, Calvo R, SánchezBercedo S, Noel L, Matesanz R
Introduction & Objective
Introduction
The Global Observatory on Donation and Transplantation (GODT):
The most comprehensive source of worldwide data
Principle of transparency
Data available through the website
Objective
To study the relation between selected development indicators and donation
and transplantation activities, legislation and organizational structures.
Materials & Methods
Field: 193 Member States in the six WHO Regions.
Data Collection:
Ad hoc questionnaire: questions on
legislation, organization and aggregated
transplantation data.
 Source of data: health authorities or
officially designated by them
United Nations Population Fund 2009
report:
 Population size
 Human Development Index (HDI)
 Total expenditure on Health as % of Gross
Domestic Product (GDP)
Statistical analysis:
Spss 15.0
Descriptive statistics
Inferential statistics
 Chi squared test
 Mann-Whitney test
 Spearman Coefficient
Materials & Methods
Selected variables
Organizational systems:
Number of countries with:
 Official body responsible for overseeing donation and transplantation at national level or
Specific organization or institution responsible for national coordination
 Systems for the collection and analysis of data
 Surveillance system of adverse events in organ transplants recipients
 Surveillance system of donation complications in live organ donors
 Mechanisms to ensure donor safety and follow up
Legislative aspects:
Number of countries with:
 Specific legislation for donation and transplantation
 Explicit prohibition of organ trafficking in the legal framework
Activity data:
 Kidney transplant from deceased and living donors
 Liver transplants from deceased and living donors
Development:
 Human Development Index (HDI). *HDI low to medium (<0.8) or HDI high (≥ 0.8)
 Total expenditure on Health as % of Gross Domestic Product (GDP)
Results (I). Organizational systems vs HDI and Health Expenditure
Of the 98 countries providing information, 84.7% reported a structure
supervising or coordinating donation and transplantation.
HDI
Differences (Chi squared test p < 0.000) were
found depending on HDI (low to medium and
high) for the variables:
Donation and transplantation organizational
structure:
Organiz. structure
No
yes
HDI low to medium
13 (34.2%)
25 (65.8%)
HDI high
2 (3.3%)
58 (96.7%)
Systems for the collection and analysis of
data:
Data collection system
No
yes
HDI low to medium
18 (48.6%)
19 (51.4%)
HDI high
3 (5.0%)
57 (95.0%)
Total Health Expenditure
Also differences depending on the
Total Health Expenditure for the
variable:
Systems for the collection and
analysis of data:
Mann Whitney test p=0.044
Results (II). Legislative system
91% of 99 countries with information on legislation have specific law for
organ donation and transplantation.
Differences were found (Chi squared test p = 0.025) depending on HDI for
the variable specific law for organ donation and transplantation.
Specific law
HDI low to medium
HDI high
No
yes
7 (18.4%)
31 (81.6%)
2 (3.3%)
59 (96.7%)
We did not find differences between countries with explicit prohibition for
organ trafficking depending on HDI or Total Health Expenditure.
Results (IV). Activity Data vs HDI
Statistical differences were found in rates of kidney and liver
transplantation, especially from deceased donor, in countries with
a high HDI or with a low to medium HDI (Mann Whitney test p <
0.000).
Kidney transplants from deceased donors were more common
than from living donors in highly developed countries.
However, in countries with low to medium HDI, kidney
transplants from living donors were more frequent.
A similar trend was observed for liver transplants (Mann Whitney
test p ≤ 0.002).
Results (IV). Activity Data vs Total Health Expenditure
Spearman Coefficient: 0.668 (p< 0.000)
Spearman Coefficient: 0.609 (p< 0.000)
Total health expenditure as % of GDP vs:
 Living Kidney transplants: Spearman Coef. 0.232 (p= 0.021)
 Living Liver transplants: Spearman Coef. 0.325 (p=0.004)
Conclusions
 Development level and health resources availability may contribute
to:
- country variability in organizational systems
- legislation
- transplants from living donors versus deceased donors
 Organizational structures can also contribute to country variability in
living versus deceased donors transplantation.
Thank you!
www.transplant-observatory.org
Beatriz Mahillo
[email protected]