paton lacture 2013 (final)...

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Paton Lecture 2013

Naoshi Shinozaki

Executive Director; Japan Organ Transplant Network (JOT)

Executive Director; Cornea Center & Eye Bank

Executive Director; Keio Eye Bank, Fukui Eye Bank

Expert Advisory Board; World Health Organization (WHO)

�� Eye Bank Association of America

November, 15, 2013

New Orleans, LA

Financial Disclosures

• No disclosures related to this presentation

• The Ministry of Health, Labour and Welfare research

grant for “Promotion of Organ Transplant and Social

Infrastructure for Organ Donation” has been granted to

Cornea Center and Japan Organ Transplant Network

EBAA

1961; The first transplant association

Dec. 15, 1944

First eye bank at Manhattan

Eye, Ear and Throat Hospital

by Dr. R. Townley Paton

�Role of stem cell in transplantation�Models for Successful Donation�CTO transplantation in the world

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PKP-Penetrating Keratoplasty-

Macular Corneal Dystrophy

46 Y.O. Female

2009/3/26, OD, PKP

VA

Before Operation �0.03

5 Months After Operation �0.7

Before

Operation

After

Operation

ALK-Anterior Lamellar Keratoplasty-

Corneal Opacity

42 Y.O. Male

2008/2/21, OS, ALK

Before

Operation

After

Operation

DALK-Deep Anterior Lamellar Keratoplasty-

KEP-Keratoepithelioplasty-

Mooren Ulcer

66 Y.O. Female

2009/7/30, OD, KEP

VA

Before Operation �No Record

1 Month After Operation �0.6

Before

Operation

After

Operation

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Corneal Stem CellCorneal Stem Cell

New England Journal of Medicine,

Tsubota, et. al 1999

In 1996

The first “body stem

cell transplantation”

Limbal Transplantation (LT)Amniotic Membrane Transplantation (AMT)

COMET

-Cultivated Oral Mucosal Epithelial Transplantation-

Chemical Burn

68 Y.O. Female

2008/9/17, OS, COMET

VA


10 Months After Operation �0.6

Before

Operation

After

Operation

COMET

-Cultivated Oral Mucosal Epithelial Transplantation-

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DSAEK-Descemet's Stripping Automated

Endothelial Keratoplasty-

Bullous Keratopathy

67 Y.O. Female

2008/4/10, OD, DSAEK

VA


16Months After Operation �1.2

Before

Operation

After

Operation

Tissue Engineering Cornea (not Clinical)

From: Griffith et al. Science 286: 2169, 1999 Griffith et al. FASEB: 2001

• Cornea Stroma : man made collagen with cross-linking

• Corneal Epithelium : human stem cell

• Nerve : rat nerve stem cell

Tissue Engineering Cornea (not Clinical)Novel Prize in Medicine 2012

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Mouse iPS derived epithelial cells K14 Multi-layer markerK18 Mono- layer epidermal marker

Trends in Corneal Transplant

• PKP (Whole Corneal Transplant)

• LKP, DLKP

• Stem Cell Transplant (LT, COMET)

• Endothelial Transplant

• Tissue Engineering Cornea

Providing cells & tissue

• Functions of eye bank

– Procure the cornea from deceased donor

– Provide safe tissue

• Future trends of eye bank

– Provide “parts” of cornea

– Provide order made tissue & cells

Eye banking in Asia

• Often blamed on culture for law donation rate

• Is it religion or culture? Why? How?

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What is Culture?

• Set of learned beliefs, values & behaviors common to the members of a given society

• Culture’s essential feature is that it is learned.

• Culture exists in a constant state of change

What is Religious Barriers?

��

Regulations and Laws

Numbers of Donations PMP �� !"#$%!"& '()*+, -./0-/*1 *22.

21.5

33.7

0

5

10

15

20

25

30

35

Do

no

r p

er

mil

lio

n

0.5

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3456785 9:; <=:96>=:5?@ABCDAE FGHBAHI JKLMNONI FGHBAHIPQRSTUVRSW XYZ[\] ^_`a^̀ [b[cc_defdfegd

gehdheijkjlmnlopqqpjk Professional Education

Respondent’s Profile

Medical staff: 14%

Nursing staff: 67%

Others: 19%

Japan

(5,527 answers)Medical staff: 19%

Others: 14%

Nursing staff: 67%

Europe

(6,064 answers)

Attitudes towards donation: all CCU staff

92%

84%

92%

52%

70%69%

35%

45%

14% 11%

0

20

40

60

80

100

'supportdonation, in

general'

'would donateown organs'

'would donateadult relative's

organs'

'would donatechild's organs'

'donation helpsfamilies coping

with grief'

%

Europe Japan

P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001 P<.0001P<.0001

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69.3

8

22.7

11.6

30.6

57.8

0

10

20

30

40

50

60

70

% yes % no % don't know, noanswer

%

Europe Japan

“Donation helps families coping with grief”

Presented at 3rd International DA meeting (5th Sep. 2004/ Vienna)

30% of people don’t believedonation helps families coping with grief

Medical Staff

General Public

Attitudes towards donation in Japan

Public vs. Medical professionals

Medical Staff

yes67.2%

no8.8%

don't know24.0%

Q. Do you accept organ donation?

National poll in 2006

– Culture

• Public acceptance

• Religions

• Education level

• Other factors affecting consent rate

– Are these all for donor side issue?

Donation rate Donation at Cornea Center Eye Bank, Japan

0

50

100

150

200

250

300

350

400

'96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12

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The first Routine referral system in AsiaCornea Center Eye Bank (2004-2012)

0 500 1000 1500 2000 2500 3000 3500 4000

Donation

I.C.

Refferd

Deaths

267

1963

3329

3764

13.6%

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013rstuvwxyz{|}~Transplant Coordinator

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013rstuvwxyz{|}~Transplant Coordinator

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

1

2

3

4

5

Transplant Coordinator

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Consent rate on Routine Referral System (RRS)

Co # IC # Cons. # Cons. Rate

1 762 114 15.0 %

2 28 7 25.0 %

3 806 113 14.7 %

4 485 36 7.4 %

5 110 7 6.4 %


Consent rate on Routine Referral System (RRS)

Co # IC # Cons. # Cons. Rate

1 762 114 15.0 %

2 28 7 25.0 %

3 806 113 14.7 %

4 485 36 7.4 %

5 110 7 6.4 %

ABCDE�gddgd�d�d�dfddfgdf�df�d 140-160

120-140

100-120

80-100

60-80

40-60

20-40

0-20

-20-0

Human skills48 pattern of Recognition factors

Scores for high consent rate staff

A

0

20

40

60

80

100

120

140

160

A

B

C

Ave.1

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Scores and average for low consent rate staff

0

20

40

60

80

100

120

140

160 D

E

Ave.2

Human Skills

• There exists high & low consent rate groups within coordinators

• Evaluation of recognition pattern of

each groups with ES and/or CS may lead to overcome cultural issue

CTO transplantation in the world

WHO “Transplant”

Expert Advisory Panel

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Guiding Principles

• 1987 TTS Ethics guidelines

• 1991 WHO “Guiding Principles on Transplant”

• 2008 Declaration of Istanbul

• 2010 Revised Guiding Principles on CTO, WHO

• WHO;

– EUSTITE, BIG, SOHO, NOTIFY, ISBT128, etc.

� �� ¡¡¢ Global Coding

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Cornea Center & Eye BankSince 1993 Acknowledgements

• Keio University, School of Medicine

– Tsubota Kazuo, M.D., Ph.D.

• Tokyo Dental College, Dept. Ophthalmology

– Shimazaki Jun, M.D., Ph.D.

• Cornea Center• Aoki Dai,

• Fukuda Tomoko,

• Matsumoto Yuka,

– International Advisory BoardEdward Holland, M.D., Ph.D.

Paul Dubord, M.D., Ph.D.

Monty Montoya, CEBT, MBA

Acknowledgements

• Kyoto Prefectural Medical University

– Shigeru Kinoshita, M.D. Ph.D.

• Kyorin University, School of Medicine

– Akito Hirakata, M.D. Ph.D.

• Japan Race Horse Owners Association

– Komurasaki Yoshio

– Yokose Kan-ichi

• Japan Organ Transplant Network

– Nomoto Kikuo, M.D., Ph.D.

– Ohkubo Michihiko

• Current-R, Inc. Ritsuko Miyachi, Shinichi Suzuki, Sayuri Hara

Thank you

&

��

paton lacture 2013 (final)...

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