Organ shortage for transplantation has led to commercialization and criminalization-Prof. Vugar Mammadov

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Plenary Session-II at SMDC conference
Organ shortage for transplantation has led to commercialization and criminalization
Prof. Vugar Mammadov

More oocytes ensures better number of live birth rate-Prof. Hakan
Young patients can be better treated with mastectomy and
breast
reconstruction - Mari-Claire Magnant

LAHORE: Prof. Paul Barach alongwith Prof. Bilal Bin Younis chaired the second plenary session during the Third International Conference or Shalamar Medical & Dental College on second day of the conference on February 2, 2019. Prof. Hakan Yarali was the first speaker whose presentation was on “Individualized approach for IVF to maximize efficacy and minimize risks and treatment burden.” He discussed in detail the ovarian stimulation, trigging final oocytes maturation and felt the laboratory tests were very important.

Every couple, Prof. Hakan opined is different hence ovarian response is also different. There is significant intra cycle inter variability hence IVF treatment has to be individualized which is associated with significant positive response. Since similar birth is ongoing, one need to take into account the obstetric outcome. About eight oocytes are considered enough. More oocytes ensures better number of live birth rate. With cumulative oocyte there is no increase in live birth rate. hCG is till gold standard in normal and poor responders. Patients Prof. Hakan said, love multiples if they are born healthy but singleton healthy live birth is good, he added.

This was followed by an excellent presentation by Prof. Vugar Mammadov from Azerbaijan who talked about Bioethics and legal issues related with living donor transplants. He emphasized the importance of improved communication and coordination in transplant programme. Medical law is promoted in medical and law colleges worldwide. He then described the success story of transplantation and pointed out that it was in 1954 that a successful kidney transplant was performed in Boston. He then gave details of various transplant programmes in different centers of the world. Though many people have availed the benefit of transplants and many of them are alive even today, the number of people on the waiting list for transplant is increasing. While waiting list is going up the availability of organs for transplant is static. There is an increasing shortage of organ material which has given birth to commercialization and criminalization. Illegal organ trade is going on and transplant tourism is also increasing. People travel from developed countries to developing countries like India and other under developed countries for transplantation.


Prof. Zahid Bashir Principal SMDC presenting memento to Dr. Hakan while Mr. Shahid Hussain
Chairman BHT is presenting mementoes to Prof. Vugar Mammadov, Dr. Mari-Clarie
Magnant and Prof. Bilal Bin Younis during the Third International Medical Conference
organized by
Shalamar Medical & Dental College from 1-3, Feb 2019.

Prof. Vugar Mammadov then referred to the criminalization of organ trade in Russia. Ukraine is supplying organs to developed world. Europe is the leading supplier. It was in these circumstances that transplantation law was enacted in 1999. Now postmortem donation is accepted in Azerbaijan. Brain death perinatal donation and cadaveric donations are allowed. There are people who wish to donate their organs after death but there are no places to apply. Brain death diagnosis is a dilemma. It is feared that rich and affluent people will find a way out and benefit from such donations while poor patients will die waiting for organs which remain in short supply. We need to create a balance between harm and helping the disabled. Brain death and cadaveric donations needs to be promoted through education. Increase in health expenditures results in added treatment burden on family and relatives. There is a need to improve brain death diagnostics. He then referred to the organ donation cards introduced in Brazil through Sports Clubs with the result that sports fans filled fifty one thousand donor cards in Brazil. This has resulted in reducing the waiting list for heart and cornea transplant. These sports club can motivate people to donate organs. This success story in Brazil can be repeated in other countries as well, he remarked.

Dr. Colette Mari-Claire Magnant from USA was the next invited speaker from USA who highlighted the multidisciplinary approach to Women’s Health at John Hopkins. It is mainly focused on reproductive health. She pointed out that better model for women care are needed. It is a team approach. Individual specialists examine the patients and then the whole team meets and discuss the case. Different options are offered to the patients and then the decision taken is implemented.


She then talked about multidisciplinary approach to management of breast cancer patients. Downsizing the tumour was advocated for breast conservation. Down size the axilla for fewer nodes to be taken. Mastectomy and reconstruction is seldom preferred due to cultural and economic reasons. I am told doctors in Pakistan see patients with breast cancer in their 30s and 40s. Chemotherapy is used to downsize the tumour. One should always look for a genetic cause in early breast cancer. The patients should be advised to accept mastectomy and reconstruction. It offers good cosmetic results and patient satisfaction is high with lower risk of just 5-10%. She then referred to cardiac side effects of chemotherapy, long term effects of radiation and recurrences. Young patients, she said, can be better treated with mastectomy and breast reconstruction. Herceptin reduces recurrence rate. It was approved by FDA in 1998. Genetic testing should be performed if possible. Women’s Health Centers, she further stated, were established in USA which aim at protection of women in health profession. This started twenty years ago and now there are numerous such centers which are functioning. Re-productive health she opined, needs to be separated.

During the discussion referring to the use of sports clubs to motivate donors it was pointed out that marketing tactics should be used to solve health problems. Organ charity needs to be promoted. Medical and legal thinking is different. There is a view that why one should promote organ donation which will help certain elements who will exploit it for their commercial interests. It was also suggested that healthcare professionals should have some legal education to prevent legal complications.