3.
04
RENAL DISEASE CONTROL PROGRAM
3A – Group 7
Department of Family and Community Medicine
THE BURDEN OF KIDNEY DISEASES IN THE
PHILIPPINES
 It is estimated that 10% of the global population is
suffering from CKD.
 (WHO, 2014) Philippines ranked 13th worldwide in terms
of death due to kidney diseases per 100,000 population
with a rate of 25.71%.
 (NKTI) One Filipino develops chronic renal failure every
hour.
 (DOH) Kidney diseases such as nephritis, nephrotic
syndrome and nephrosis, ranked 9th in the top leading
causes of mortality in the Philippines in the year 2013.
 In 2014, UTI ranked 4th in the leading causes of morbidity
in the country.
 In the past, chronic glomerulonephritis was the most
common cause of chronic renal failure.
 Today, diabetes mellitus and hypertension have taken
center stage in the causation of ESRD which together
account for almost 60% of dialysis patients.
 More than 250,000 renal transplants have been performed
since 1963.
 Nationally, there are still over 7,000 end stage renal disease
patients on renal transplant waiting lists.
THE RENAL DISEASE CONTROL PROGRAM (REDCOP)
 History: On January 1994 the DOH launched the Preventive
Nephrology Project (PNP) then on January 2000, PNP was
renamed to REDCOP.
 What is REDCOP?
o It is the office in-charge of implementing the NKTI's
public health projects on the prevention and control of
renal and other related diseases.
 It plans, implements and monitors projects for research,
advocacy, training, service and quality assurance.
 REDCOP's works with network of Regional Coordinators
throughout the country.
 It also administers and manages the Philippine Renal
Disease Registry (PRDR)
o PRDR is composed of:
 The End Stage Renal Disease (ESRD) Registry
composed of:
 Hemodialysis
 Peritoneal Dialysis
 Transplant Registries
 The Chronic Kidney Disease Registry composed
of Biopsy
VISION
 To be the lead office in the prevention and control of
kidney diseases and End-Stage Renal Disease (ESRD)
through a comprehensive public health program and an
integrated approach to renal disease management.
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January 5, 2018
MISSION
 To ably reduce the morbidity and mortality from kidney
diseases and end-stage renal disease through a strong
advocacy campaign, extensive information drive, training
and public education, research, service and quality
assurance.
GOALS
 To conduct research studies related to renal diseases;
 To assist the existing health facilities, both local and national.
 To formulate guidelines and protocols on the proper
implementation of different levels of prevention and care of
renal diseases, for use of medical practitioners and other
related professions.
 To give recommendations to law and policy-makers on renal
health.
 To assist in the development of dialysis and transplant
centers/units in strategic locations all over the Philippines.
 To establish an efficient and effective networking system
with other programs and agencies, both GOs and NGOs.
PROGRAM COMPONENTS
RESEARCH
 The Philippine Renal Disease Registry (PRDR) started in May
2000.
 It is a joint project of NKTI-REDCOP and the Philippine
Society of Nephrology (PSN).
 This serves as the main repository/source of data on end
stage renal disease (ESRD) and other related diseases in the
country.
 The MAIN OBJECTIVE of PRDR is to provide a national
perspective on kidney disease/s and its/their treatment.
OTHER RESEARCH STUDIES
 Prevalence Studies on Glomerulonephritis (GN) and Kidney
Stone (KS)
 Nationwide Urine Screening of Public School Children
 Nationwide Survey on People's Knowledge, Attitudes and
Practices on Preventive Nephrology
TRAINING
Purpose:
 To help local health workers develop the capability and
expertise in early recognition and treatment of Renal and
Urinary Tract diseases and
 Help them make proper judgment on when and where to
refer the patients for further management.
 Also aims to develop advocates on kidney and Urinary
Tract disease prevention & control nationwide
 To help local health workers develop the capability and
expertise in early recognition and treatment of Renal and
Urinary Tract diseases
 To help them make proper judgment on when and where to
refer the patients for further management

 To develop advocates on kidney and Urinary Tract disease
prevention & control nationwide
 The training module and training kits have been completed
with the technical assistance of the Philippine Society of
Nephrology (PSN), Department of Health (DOH), and the
Philippine Information Agency (PIA).
 Training module/manual
o Used as the standard to guide the trainers and
advocates in the whole country under a well-planned
and conceptualized national training program
spearheaded by the National Technical Working Group
(NTWG)
o Initiated in 2002
o Primary aim of this project is to educate doctors and
paramedical personnel,
o Ultimate beneficiary is the general public
o Finally used last March 29 to April 2, 2004 at the
Bayview Hotel in Roxas Boulevard, Manila, during the
national training of all regional and assistant regional
coordinators from the Center for Health Development
of the Department of Health.
o Most Outstanding Public Information Tool last
November 17, 2004 – the Gawad Oscar Florendo
Award was given to REDCOP
 The challenge posed by REDCOP and the PSN to the
participants: duplicate this training to the different
provincial and city coordinators, reaching eventually the
barangay health unit.
 Training starts from the national level and will be filtered
down to the barangay level.
 REDCOP conducts training activities to build and enhance
the capability of health workers in the whole country to
empower them and to handle and manage potential renal
patients especially at the local health facilities.
 According to the REDCOP, an AVP was uploaded on
November 2013, about 500 key medical and paramedical
who have benefited from the training and more are
currently being trained.
ADVOCACY CAMPAIGNS
 Purpose:
o To increase the level of awareness of the people on
health promotion and the different levels of kidney
disease prevention, including prevention of death due
to end-stage renal disease (ESRD)
 Done nationwide utilizing different media of information,
education and communication (IEC) dissemination such as:
o Broadcast media
o Print, interpersonal, etc.
 REDCOP has produced and distributed thousands of leaflets
and brochures, flyer fans, VHS & cassette tapes of REDCOP
Plugs, documentary films and other IEC materials
nationwide
 The REDCOP advocacy team has visited all regions around
the Philippines for its interpersonal information
dissemination for two rounds already, since 1998.
 Massive advocacy campaign: People have become aware of
the importance of early detection and prevention of kidney
disease through increased consultation and access rate to
medical consultation.
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RENAL DISEASE CONTROL PROGRAM
 Memorandum Circular No. 2012-124:
o Issued by DILG in March 16, 2012 in support of the
national government’s advocacy to increase awareness
and empower local health workers on renal health
promotion and renal disease prevention
o Enjoining all Provincial Governors, City and Municipal
Mayors of the ARMM to extend their support to the
Renal Disease Control Program of the National Kidney
Research Institute.
o In furtherance of promoting public health, all local
chief executives are encouraged to:
 Designate a Provincial, a City or a Municipal
REDCOP Coordinator who shall take the lead in
the:
a. Coordination and implementation of
REDCOP's national projects and activities
e.g., nationwide training in Maximizing the
Utilization of Routine Urinalysis for the
Detection of Renal Diseases and Nephrology
for the Generalist, and advocacy campaign
for organ and transplantation.
b. Recommendation of renal health projects or
activities which are critical in his or her
area of responsibility, and implementation
of the same.
c. Submission of accomplishment or progress
reports to the concerned REDCOP Regional
Coordinator, and
d. Participation in the regional consultative
meetings.
 Include, in their respective local Annual Investment
Program, a project or activity which promotes
renal health (e.g., development of a community-
based advocacy strategy and training of health
workers on the early detection of renal diseases).
 They have been utilizing social networking sites
such as Facebook since 2010 and regularly posting
updates about the program’s activities and
accomplishments.
SERVICE
 Medical services delivered to the public by conducting
community laboratory examinations and medical check-up
in areas being visited by the REDCOP team.
 Made possible with the help and cooperation of the NKTI
Nephrology and Urology specialists and fellows.

 Other services are delivered through the research and
advocacy projects which provide laboratory examinations to
its subjects.
 All regions have been covered with laboratory and medical
services.
QUALITY ASSURANCE
 Aims to insure the efficiency and reliability of the component
projects of the Program.
 Includes activities such as monitoring and assessment of all
component activities/projects of the Program, supervisory
visits, etc, to ensure the effective implementation of project
protocols.
PHILIPPINE ORGAN DONATION PROGRAM (PDOP)
 Created under the Health Operation Cluster of the DOH
through AO no. 124, series of 2002:
o Order to prescribe the guidelines on how the PODP will
operate in coordination with the various offices and
agencies including the organized bodies and
committees as specified in the Department Order no.
191-F series of 2002 with the end view of developing a
comprehensive renal care program.
 PODP is established under the Degenerative Disease Office
of the National Center for Disease Prevention and
Control.
 PODP shall mobilize various offices and units of the
Department of Health and convene representatives from
these offices into Technical Working Groups as necessary.
 PODP taps into the technical expertise of National Kidney
and Transplant Institute (NKTI): the only government
Specialty Center on renal diseases.
 May specifically build on the systems and other activities as
initiated by the Renal Disease Control Program (REDCOP)
under NKTI.
 PODP is also assisted by the National Transplantation Ethics
Committee (NTEC) which is responsible in formulating the
ethical standards for organ transplantation and which, in
turn is the basis of the ethical standards for all hospitals and
other facilities.
 The National Transplant Advisory Board primarily provides
policy recommendations and advice in the following tasks:
o Setting of guidelines or criteria for the prioritization of
recipients of kidney organs from donors.
o Development of systems and procedures that will allow
for transparency, exchange, networking, and
collaboration with different health facilities,
organization, associations, and professionals.
o Facilitation and promotion of technical assistance
among professionals and health and health-related
facilities involved in kidney and other organ
transplantation.
POLICY STATEMENTS
 Living non-related donations are permitted only under
certain conditions. Sale and purchase of kidney organs by
kidney vendors is prohibited.
 Kidney organ donation programs shall be guided by these
principles: Equity, Justice, Benevolence, Non-maleficence,
Solidarity, Altruism, and Volunteerism
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RENAL DISEASE CONTROL PROGRAM
 All health and health related facilities shall implement and
adopt quality standards and practices in the medical and
organizational management of kidney transplantation.
 The Department of Health (DOH) 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.
PROGRAM COMPONENTS
POLICY AND PROGRAM STANDARDS
 The PODP is 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.
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, advocacy campaigns through multi-media.
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 LNRD’s and registry of all patients seeking
kidney transplantation using LNRD’s.
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.
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.
MONITORING AND EVALUATION
 A built-in monitoring and evaluation system shall be part of
the 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.
IMPLEMENTING MECHANISMS
 The PODP shall ensure coherent and sound implementation
of activities both at the national and hospital / other health-
related facility level based on program standards
 The PODP shall ensure the institutionalization of the
following systems:
 A Donor/Recipient Screening and Matching System which
shall be operationalized by a Screening and Matching
Committee. This Committee is composed of a Transplant
Immunologist, a Transplant Nephrologist and/or a
Transplant Surgeon/Physician. This Committee is tasked to
formulate:
o Formulate guidelines and criteria on the evaluation of
donor/recipients prior to enrollment/ listing in the
National Registry in close coordination with NTEC.
o Ensure implementation on matching of donor and
recipient to the individual transplant facility.
o Provide regular feedback and report updates to the
PODP.
 The PODP shall remain a National Donor/Recipient Registry.
Data shall emanate from the different accredited
hospital/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. This, in turn, will have the registry containing 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. The 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.
 The PODP furnishes lists of approved donor-recipient
matches to the NKTI and other accredited hospitals and
health facilities.
 The DOH-Bureau of Health Facilities and Services- Philippine
Health Insurance Corporation shall issue in separate orders
licensing and accreditation standards for hospitals and
health-related facilities.
 Each hospital/health facility shall submit a quarterly report
on transplantation operations conducted to PODP.
 NTEC and the Ethics Committee of the hospitals and health
facilities shall issue their own guidelines and criteria in
accordance with national policies and program standards.
REVISED NATIONAL POLICY ON LIVING NON-RELATED
DONATIONS AND TRANSPLANTATION
RATIONALE
 In order to commit the Department of Health (DOH) to abide
the rules of Republic Act 9208 (Anti- Human Trafficking
Act), the Declaration of Istanbul on Organ Trafficking and
Transplant Tourism, and WHO Guiding Principles on Organ
Transplantation – Administrative Order 2008-00004-A
(Revised National Policy on Living Non-Related Donation
and Transplantation) was amended last June 23, 2010
through non-permission of non-directed living non-related
donation (LNRD).
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 One of the amendments is to change the nomenclature from
National Human Organ Preservation Effort (NHOPE) to
Philippine Network for Organ Sharing (PHILNOS) with a
corresponding clarification on its scope of function.
Furthermore, the function of PhilNETDAT was then
transferred to the existing Philippine Organ Donation and
Transplantation Program (PODTP) as a result of the
abolition of non-directed LNRD and hence, the creation of
PHILNOS.
COVERAGE
 The Revised National Policy on Living Non-Related
Donations and Transplantation covers the following:
o Kidney and other organ donors and recipients.
o All health and health-related professionals and
individuals engaged or have any participation in the
conduct of transplantation and donation.
o All offices/bureaus, including attached agencies and
filed offices of the DOH.
o All health and health-related facilities such as but not
limited to hospitals, laboratories.
o Other government and non-government agencies and
organizations, such as but not limited to foundations
organized to promote and support transplantation and
donation programs and associations such as medical
and specialty societies.
DEFINITION OF TERMS
 Living Related Donors (LRDs): related to the recipient by
blood within the fourth-degree of consanguinity (e.g.
parents, children, siblings, nephews/nieces, first cousins).
 Living Non Related Donors (LNRDs): not related to the
recipient by blood but have the willingness and intention to
donate a kidney based on certain reasons.
o Voluntary Donors: not related by blood to the
recipient but bear close emotional ties with him/her
(e.g. spouses, relatives by affinity, friends,
employers/employees of long standing, colleagues,
fiance/fiancee, and adoptive parents or children).
o Commercial Donors: kidney/organ vendors who offer
their kidneys and other organs for sale, usually engage
the services of a broker or an agent with a payment as
a precondition and pre-requisite to the organ donation.
o Directed Kidney/Organ Donor: someone who has a
specific recipient in mind whom he wound want to
donate to (donor’s wishes are given due
consideration).
o Non-directed Kidney/Organ Donor: donor who would
donate to whoever s/he matches on a list of waiting
patients for organ transplant.
 Board: refers to Philippine Board for Organ Donation and
Transplantation (PBODT).
GUIDING PRINCIPLES
 Equity
o Non-directed donated organs belong to the community
o Organs must be allocated fairly among transplant
centers and among recipients
o Determination of priority shall be based on medical
need and probability of success

 Justice
o Determining of allocation of organs must be objective
and independent of gender, race, creed, culture, and
socio-economic status
 Benevolence
o Only organs that are voluntarily donated with full
informed consent by a competent adult shall be subject
for transplantation
o All health and health related facilities shall not allow
the trade or commerce of organs
 Non-maleficence
o No harm should occur to donor or recipient in the
process of transplantation whether immediate or post
transplantation
 Solidarity
o All stakeholders shall have a common and shared
objective of safeguarding the health of both the
recipient and the donor
 Altruism
o Organ donation must be done first and foremost out of
selflessness and philanthropy to save and ensure the
quality of the beneficiary
 Volunteerism
o Organ donation must be done out of the donor’s
competence (decision-making capacity), willingness to
donate, freedom from coercion, medical and
psychosocial suitability, full information of the risks
and benefits as a donor, and full information of the
risks, benefits and other alternative treatment
available to the recipient.
GENERAL POLICY STATEMENTS
 DOH is committed to abide by the WHO Guiding Principles
on Organ Transplantation, the Declaration of Istanbul on
Organ Trafficking and Transplant Tourism and RA 9208.
 The safety of both donor and recipient shall be given highest
consideration and transparency regarding the risks to both
shall be pursued rigorously.
 Payment as precondition for kidney donation and sale and
purchase of kidneys by kidney vendors/commercial donors
are strictly prohibited.
 Kidney transplantation is not part of medical tourism.
 Foreigners are not eligible to receive organs from Filipino
living non-related donors.
 All health and health-related facilities and professionals
h\shall not allow the trade of kidneys.
 Directed LNRDs are permitted only when it is voluntary and
truly altruistic, without any kind of compensation of gratuity
package attached to it. They must be screened and approved
by the Hospital Ethics Committee. Non-directed LNRD are
not allowed to donate organs for transplantation. No
hospital, foundation or agency are allowed to keep a list of
potential non-directed LNRDs and to utilize non-directed
LNRDs for transplantation.
 All health and health-related facilities shall implement and
adopt quality standards and practices in the medical and
organizational management of kidney transplantation. These
facilities will be monitored by DOH and the Philippine Health
Insurance Corporation (PHIC) in terms of licensing and
accreditation rules and regulations.
 All professional societies related to organ donation and
transplantation shall ensure that all their members comply
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RENAL DISEASE CONTROL PROGRAM
with PODTP guidelines relative to the practice of organ
transplantation.
 In no instance shall any kidney/organ be transported or
exported for transplantation abroad.
 POBDT is created for the purpose of overseeing the
implementation of policies related to organ transplantation.
PODTP shall serve as the overall implementing body for
organ donation and transplantation in the country. PHILNOS
serves as the coordinating body in charge of allocating
organs from deceased donors.
OPERATIONAL STRUCTURES
 Philippine Board for Organ Donation and
Transplantation (PBODT) is assigned to review and
approve policies in support of a rational, ethical, accessible
and equitable organ transplantation program in the country.
It also approves the issuance of the Certificate of
Accreditation of transplant facilities.
 Philippine Organ Donation and Transplantation
Program (PODTP) is the overall implementing body of the
organ donation and transplantation system in the country.
Its role is to monitor compliance of transplant facilities to
policies set forth.
 National Transplant Ethics Committee (NTEC) formulates
national ethical standards/ guidelines on organ donation
and transplantation for approval of the PBODT. This
committee also assist the PBODT in the resolution of ethical
issues. They also assist in monitoring of transplant facilities
to ensure compliance with ethical standards/ guidelines.
 Philippine Network for Organ Sharing (PHILNOS) act as
the central coordinating body to ensure that all donor
kidney/organs from deceased donors are allocated
according to established criteria. They also implement the
policies on deceased donor allocation.
 Bureau of Health Facilities and Services (BHFS) inspect
and monitor transplant facilities. They also issue certificate
of accreditation. They implement sanctions to non-compliant
transplant facilities.
 Philippine Health Insurance Corporation (PHIC) issue
accreditation of health facilities and professional. They
implement sanctions to non-compliant transplant facilities.
They also serve as a member of inspection and monitoring
team.
 Hospital Ethics Committee (HEC) monitor and resolve
ethical issues that may arise in the process of organ donation
and transplantation in the hospital. They also recommend
sanctions for violation of the guidelines to the hospital
administration. The hospital shall determine the proper
sanction to be given to whoever is deemed culpable for the
violation.
 Hospital Transplant Coordinating Office (HTCO) is in
charge of maintaining the 3 registries at the transplant
hospital level. They also report to the PHILNOS.
 Kidney Donor Monitoring Unit (KDMU) is in charge of
follow-up donor protection and long-term monitoring of
donors after donation based on specific guidelines. They also
report activities of the transplant facility to the PODTP.
 Transplant Facility comply with the rules and regulations
governing the accreditation and operation of kidney
transplant facilities.

FUNDING AND SUPPORT
 The national government will allocate P20 million pesos per
year in support of the operations of the organ donation and
transplantation starting 2010.
 Funds may be augmented from government and private
sources to support the program.
MONITORING AND EVALUATION
 The Philippine Organ Donation and Transplantation
Program (PODTP) shall take the lead in monitoring relative
to compliance to rules and regulations, and shall report
regularly to the PBODT and provide recommendations
related to the practice of organ donation and
transplantation.
 The PODTP shall call on support of independent bodies and
organizations involved in kidney transplantation to
constitute a monitoring and evaluation team involving
medical and special societies, non-government
organizations, the private sector, other professionals and
civil society.
 It shall continually to develop and support programs and
projects toward achieving a world-class status for the
country in renal/organ care and transplantation.
VIOLATIONS AND SANCTIONS
 Non-compliance with the standards and policies of the
PODTP shall be a ground for suspension or revocation of the
license to operate the hospital or its transplant facility.
 Furthermore, any violations by erring professionals (doctors
and members of the transplantation team) shall be
forwarded to the DOH and to the PRC, PSN, and PSTS and
other appropriate professional organizations for
appropriate sanctions without prejudice to the filing of
appropriate civil or criminal charges whenever warranted.
NATIONAL PROGRAM FOR SHARING OF ORGANS FROM
DECEASED DONORS
RATIONALE
 Prolongation and improvement of lives of patients in need of
organ replacement has been permitted by transplantation.
 The traditional source of organ grafts has been deceased
donors, that is, those who suffer severe irreversible brain
injury with the rest of the body remaining practically intact
and “healthy”.
 However, the perennial lack of deceased organ donors has
continually hampered the widespread application of
transplantation.
 The inequity of supply and demand has created the need to
resort to other sources of grafts, such as living donors.
 Organ donation from living donors, although a noble act of
charity, has been surrounded by numerous ethical issues
and has unfortunately lent itself to abuse and has been
tainted with commercialism in many areas of the world,
including the Philippines.
 While the Department of Health (DOH) finally addressed the
situation and established mechanisms to curtail organ sale
and protect the living kidney donor through AO no. 2002-
0124 and AO no. 2008-0004-A, deceased donor organ
transplantation had not been given enough attention.
 While the National Kidney Transplant Institute (NKTI) based
Human Organ Preservation Effort (HOPE) has been
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functioning since 1983, the deceased donation rate in the
Philippines has remained at way below 1 per million
population per year.
 In accordance to 2008 declaration of Istanbul on Organ
Trafficking and Transplant Tourism strongly encouraged
governments, in collaboration with health care institutions,
professional and nongovernmental organizations to take
appropriate action to increase deceased organ donation,
remove obstacles and disincentives to deceased organ
donation, enact legislation and create transplantation
infrastructure so as to fulfill each country’s deceased donor
potential (Istanbul Declaration 2008).
 Undertaking the issue of human organ and tissue
transplantation in the 63rd World Health Assembly, it was
reported that “experience in countries with the most
successful deceased donor programs has shown the
advantage of having strong national organizations that can
stimulate, coordinate and regulate donation and
transplantation.
 Such organizations can inform the public about the
importance of sustaining a community resource that is built
on voluntary, unpaid donation of organs, tissues and cells
rather than on the exploitation inherent in organ purchases
and that provides equitable access to all. (63rd World Health
Assembly provisional agenda item 11, 21).
 Promotion of organ donation from deceased donors and
sharing of grafts through the Philippine Network for Organ
Sharing (PHILNOS) is being led by the Department of Health
(DOH).
 The potential of deceased donor organs is yet to be
maximized in our country where the estimated number of
deaths due to accidents is about 8000 per year (ADB-ASEAN
Regional Road to Safety Program, Accident Costing Report
AC7: Philippines.
 This Network will implement a system of timely referral and
processing of potential multiple organ donors, equitable
allocation and efficient procurement and transplantation of
organs from them.
 Furthermore, the DOH has developed an online database, the
Philippine Organ Donor and Recipient Registry System
(PODRRS) that will support the implementation of the
PHILNOS guidelines.
OBJECTIVES
 To establish the Philippine Network for Organ Sharing
(PHILNOS)
 To initiate and maintain the Philippine Organ Donor and
Recipient Registry System (PODDRS)
 To promote organ donation from the deceased
COVERAGE
 The policies and guidelines contained herein shall apply to
all government and private hospitals and health facilities,
Organ Procurement Organizations, medical and allied
medical practitioners involved in organ and tissue
transplantation in the Philippines.
DEFINITION OF TERMS
 Brain Death (BD)
o irreversible cessation of all functions of the entire
brain, including the brain stem

 Death (as per RA 7170 definition)
o irreversible cessation of circulatory and respiratory
functions or the irreversible cessation of all functions
of the entire brain, including the brain stem, which is
determined in accordance with the acceptable medical
practice and diagnosed separately by the attending
physician and another consulting physician, both of
whom must be appropriately qualified and suitably
experienced in the care of such patients.
 Decedent
o a deceased individual and includes the still-born infant
or fetus
 Donor Allocation Scoring System (DASS)
o the national scoring system by which allocation of
kidney grafts from deceased donors shall be based
 Graft
o an organ that has been removed from the body of an
organ donor for transplantation into recipient.
 Hospital Transplant Candidate Waiting List
o the database of all potential organ recipients of a
particular Transplant Center. This shall be
administered by the Clinical Transplant Coordination
of the Hospital’s transplant Center
 National Transplant Candidate Waiting List
o the Philippine database of all potential organ
recipients. The candidates who will be registered in
this list shall come from the waiting lists of the
different accredited Transplant Centers of the
Philippines.
 Organ Procurement Organization (OPO)
o a DOH accredited non-profit organization, independent
or hospital-based, composed primarily of transplant
coordinators and transplant specialists (internists and
surgeons), who can identify, evaluate and maintain
potential organ donors and retrieve organs from them.
 Host OPO
o the particular OPO responding to an organ donor call
from a referring hospital.
 Organ Transplant Candidate (OTC)
o a patient with end-stage-organ disease (ESOD) who is
qualified to receive an organ graft
 Kidney Transplant Candidate (KTC)
o a patient with end-stage-renal-disease (ESRD) who is
qualified to receive
 Liver Transplant Candidate (LTC)
o a patient with end-stage-liver-disease (ESLD), acute
liver failure, or specific metabolic disorder who is
qualified to receive a liver graft.
 Philippine Organ Donor and Recipient Registry System
(PODRRS)
o The system that shall contain the national
computerized database of all organ transplant
candidates, transplant recipients and organ donors
 Potential Multiple Organ Donor (PMOD)
o Any patient who will imminently become brain dead,
or who currently meets the criteria for brain death
 Referring Hospital (RH)
o Any hospital that identifies and refers potential
deceased organ donors to PHILNOS
 Transplant Center (TxC)
o Hospitals with transplant facilities duly accredited by
the Department of Health
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RENAL DISEASE CONTROL PROGRAM
 Transplant Coordinator (TC)
o The designated trained health care professional who
takes the central role and acts as liaison among the
donor hospital, retrieval, and transplant team
members in the processing a potential organ donor
 Procurement Transplant Coordinator (PTC)
o The TC who shall have the responsibility of
coordinating the donor’s evaluation, management, and
recovery of organs and/or tissues for transplantation
 Clinical Transplant Coordinator
o The TC who shall have the responsibility of
coordinating the transplant candidate’s evaluation,
management, and follow-up care
 Transplant Recipient (TR)
o A patient who has received an organ graft
PHILIPPINE NETWORK FOR ORGAN SHARING
GENERAL GUIDELINES
 The Philippine Network for Organ Sharing (PHILNOS)
shall be the organization that will facilitate and oversee the
organ donation and organ transplantation involving
deceased donors in the country.
 It shall serve as the central coordinating body of all
deceased organ/tissue donation and transplantation
activities
 It shall replace the National Human Organ Preservation
Effort (NHOPE) which was established by virtue of A.O. no.
2008-004
 Task of the PHILNOS shall be carried out through special
organ procurement services units called Organ
Procurement Organizations (OPO) that need to be DOH
accredited
 Organ Procurement Organization (OPO) shall be
designated in each region. The National Capital Region
(NCR), shall be further divided into several areas of
responsibility and each area of responsibility shall be
serviced by a designated OPO. All OPOs shall be directed to
serve their designated areas of responsibility and other
regions to be assigned by the program manager on an annual
basis.
o Upon issuance of this AO, all existing memoranda of
agreement between an OPO and a referring hospital or
transplant center shall be terminated.
o All existing OPOs shall be given privileged
accreditation for a period of one yea , provided that
they fulfill the minimum requirements of such
organizations
o After the initial year of accreditation, the existing OPOs
shall be subjected to a review of performance and
renewal of accreditation which shall be every 3 years
o Accreditation of new OPOs shall also be initially be for
a period of one year. Thereafter, they may apply for
reaccreditation
 All tertiary hospitals and trauma centers are required to
have a Procurement Transplant Coordinator (PTC) ,
working full-time or part-time, in order to heighten the
identification and referral of potential deceased organ
donors throughout the country. All TxCs are mandated to
have a PTC.
o All PTCs shall be trained and duly certified by
PHILNOS to perform their duties and responsibilities

o In the absence of a hospital PTC in the referring
hospital, the PTC of the designated OPO shall be
called
 All patients deemed to be brain dead or in a state of
imminent brain death must be referred to the PTC for
evaluation as a PMOD in all hospitals
 All transplant candidates shall be enlisted according to
established criteria per organ. They shall be registered
through their respective TxCs
 All donor referrals shall be registered in PODRRS. Required
donor data shall be provided by the Host OPO
 Protocols for donor evaluation, management, and
procurement including organ acquisition fees shall be
standardized by PHILNOS
o The organ acquisition fee shall include the following:
 Brain death assessment and certification costs
 Donor evaluation costs
 Donor management costs
 Organ recovery and delivery costs
 Professional fees of specialists involved
 OPO administrative costs
o Funeral assistance to the family of the deceased shall
be optional
SPECIFIC OBJECTIVES
 To manage the national deceased donor program, ensuring
effectiveness, efficiency, equity, and transparency in the
national system of allocation of deceased organs
 To initiate and implement programs that will increase
awareness and acceptance of deceased organ donation and
transplantation and increase the number of deceased donors
who will donate organs for transplantation
 To formulate, recommend, and implement policies that will
promote the ethical practice of deceased organ donation and
transplantation
 To maintain a national waiting list of transplant candidates
and a national registry of transplant recipients
 To make policy recommendations to the DOH for legislation
and other related matters pertaining to the deceased donor
program
 To perform such other functions as may be ordered by the
Secretary of Health in relation to its primary function
ORGANIZATIONAL STRUCTURE
 The PHILNOS shall have a head in the person of a Program
Manager who shall be appointed by the DOH secretary
 The PHILNOS shall be governed by an Executive Committee
composed of:
o 1 Program Manager
o 1 Assistant Program Manager
o Committee Heads
o 3 Medical Advisers (consultants)
 All members of the Executive Committee shall be appointed
by the DOH Secretary
 The Executive Committee will:
o oversee the day to day operations of PHILNOS;
o will handle the membership concerns;
o will formulate and recommend policies to the
Philippine Board of Organ Donation and
Transplantation (PBODT)
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RENAL DISEASE CONTROL PROGRAM
 It shall have an administrative staff that comprise of the
following personnel who will operate the PHILNOS office:
o 1 Administrative Officer
o 4 Nurses-PHILNOS Transplant Coordinators
o 3 IT Specialists
o 1 Utility Man
 It shall be composed of the following working committees
with specific functions:
o Accreditation and Training Committee
 will handle quality assurance and
standardization
 will handle accreditation of POPs
 will provide training and certification of
TCs
o Ethics and Legal Affairs Committee
 will handle ethical and legal concerns
o Finance Committee
 will handle costs and other financial
matters
o Information and Advocacy Committee
 will handle lay education, information
and dissemination, and media concern
o OPO Committee
 will handle OPO concerns in relation to
operations and implementation of
PHILNOS guidelines
o Registry Committee (PODRRS)
 will handle registry and research
 The heads and members of each committee shall be
appointed by the DOH secretary, upon the
recommendations of the PHILNOS Program Manager
 The External Audit Committee will be composed of
members with no conflict of interest, to be appointed by
the DOH secretary as recommended by the PBODT. This
committee shall
o conduct a periodic review and audit of the allocation
procedures of PHILNOS
o submit its reports to the PHILNOS executive
committee, the Philippine Organ Transplantation
Program (PODTO), the PBODT, and the DOH Secretary
 Organizations, or center with interest in organ donation and
transplantation may become members of the PHILNOS
o Organ Procurement Organizations (OPO) –DOH
accredited
o Transplant Centers (TxC) – DOH accredited
o Medical Scientific Organizations – PMA
o Patient Organizations/Support Groups – SEC
registered
o Histocompatibility Laboratories – DOH accredited
o Other groups that have relevance to the program
 Representatives from the above groups will be tapped as
members of the PHILNOS working committees except the
External Audit Committee

OPERATIONAL GUIDELINES
Naming the document
 Enlistment of the KTC for deceased donor graft should be
done in the transplant center (TxC) of choice of the patient
 At the time of enlistment, the KTC must at least be:
CONDITION CALCULATED CREATININE
CLEARANCE
Diabetic nephropathy/pre- <20 mL/min
emptive transplants (near-
ESRD)
Non-diabetic chronic kidney <15 mL/min
disease (ESRD)
 Enlistment must be done in person, and
o Only a bonafide Filipino KTC will be allowed to enlist in
a Hospital Transplant Candidate Waiting List of any
accredited TxC in the Philippines with the
requirements submitted and registration fee paid
o Following enlistment, names and required documents
of the patients will be forwarded by the TxC to
PHILNOS for enlistment in the National Transplant
Candidate Waiting List
 KTCs shall initially be listed as INACTIVE until approved by
PHILNOS. Once PHILNOS has reviewed and approved the
case, the status shall be changed to ACTIVE
 Once ACTIVE on the waiting list, fresh serum sample from
the KTC shall be stored every month and whenever
sensitizing events have occurred (i.e. blood transfusion,
pregnancy, failed allograft) at the PHILNOS reference
laboratories for use during cross-matching
 All KTC will be allowed to enlist in only 1 Hospital
Transplant Candidate Waiting List which should be in
their TxC of choice. In the event that the KTC decides to
transfer enlistment to another TxC, the TC shall immediately
report the change to PHILNOS
 If the KTC resides in an area that is inaccessible
(communication not possible), it shall be required that the
KTC provides a contact person with whom the CTC shall be
able to communicate with anytime on a 24/7 time frame.
This contact person must have the capability to
communicate or get in touch with the said KTC at all
times.
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RENAL DISEASE CONTROL PROGRAM
 The following guidelines shall be observed regarding the
waiting list:
o Only ACTIVE patients in the National Transplant
Candidate Waiting List are eligible to receive offers of
deceased organs
o If at a time a graft is offered, the KTC is found medically
unsuitable or financially incapable, he will be
temporarily considered INACTIVE. However:
 KTC status can be reactivated once the
medical or financial problem is resolved
 The original date of enrollment shall be
retained
o Enlisted KTCs who will be out of the country for a
certain period should inform their CTC who in turn will
transmit the information to PHILNOS so that the
patient status may be changed to INACTIVE during the
period of physical absence of the country
IDENTIFICATION AND REFERRAL OF POTENTIAL MULTIPLE
ORGAN DONORS
 Any patient found in the ER, or in the Pediatric or Adult
Intensive Care Unit (ICU) of a RH or TxC who is deemed to be
brain dead, or in a state of imminent brain death shall be
referred to as a PMOD to the PTC of the RH.
 If the RH does not have an in-house PTC, its designated OPO
shall be contacted to send their PTC to assess and evaluate
the PMOD
 The PTC shall assess the eligibility of the PMOD. The PTC
shall then perform a complete clinical evaluation which
includes:
o Consultation with the primary Attending Physician
(AP) and nurse-in-charge
o Review of the patient’s medical records
o Review of all laboratory and diagnostic examination
results
o Performance of physical examination of the patient
o Exclusion of contraindication to organ donation
REQUEST FOR ORGAN DONATION
 When a patient is determined to be a PMOD, the AP and/or
Intensivist shall explain the current medical status and
prognosis of the patient. The PTC shall then offer to the legal
next of-kin or family of the patient the opportunity of the gift
of life, or the option of organ donation when:
 The family has expressed understanding and agreement to
proceed with the option of organ donation, the PTC shall
facilitate the process of BD certification.
 When the family opts out, this decision shall be recorded in
the patient’s chart. Further efforts for organ donation shall
be aborted.
 Once these criteria have been fulfilled, and if not yet done at
this point, the PTC shall then alert the Host OPO of the
identification of a PMOD.
CERTIFICATION OF BRAIN DEATH
 The attending physician shall refer the PMOD to another
physician with skills and experience in neurological
assessment, for the diagnosis of brain death.
 Alternatively, the AP may call on two (2) other qualified
physicians to assess brain death.

SECURING THE CONSENT FOR ORGAN DONATION FROM THE
DECEDENT’S NEXT-OF-KIN
 Securing the family consent shall be the sole responsibility
the PTC. After the BD certificate has been issued, the PTC
shall obtain the consent for organ donation. Consent for
organ donation must be obtained from the legal next-of-kin
of the PMOD in the following order of priority (RA 7170):
o Legal spouse
o Son or daughter of legal age
o Either parent
o Brother or sister of legal age
o Guardian over the deceased person at the time of death
 The Consent for Organ Donation form shall be signed by the
legal next-of-kin.
DONOR MANAGEMENT
 The donor management in the Intensive Care Unit (ICU) or
Emergency Room shall commence after consent for organ
donation is obtained
COMPLETION OF DECEASED DONOR EVALUATION AND
ALLOCATION
 After consent for organ donation is obtained, the PTC shall
facilitate the completion of medical evaluation or work-up of
the PMOD.
 Initial laboratory tests shall be requested. The PTC shall
analyze the test results and determine whether the PMOD
remains qualified as a multiple organ donor.
o If not qualified, further efforts for organ donation shall
be aborted
o If qualified, PHILNOS shall be alerted.
 Completion laboratory tests and examinations,
including HLA typing, shall then performed.
 Once the HLA typing is obtained, the PTC shall
inform PHILNOS and the donor allocation process
is started using PODRRS.
 The PHILNOS TC shall then run the match on PODRRS and
draw a shortlist of the top 10 KTCs as potential organ
recipients within the areas of responsibility/region of the
host OPO and the 10 KTCs in the national list, under the
following guidelines and priorities:
o A full house match or zero antigen mismatch takes
priority regardless of geographical location of the
potential organ recipient.
o When there is no zero mismatched KTC, the DASS shall
be used to determine kidney graft allocation.
 The Donor Allocating Scoring System (DASS) for kidney
grafts includes 5 criteria:
o Number of HLA Mismatches
o Panel Reactive Antibodies
o Date of Enrollment at PHILNOS
o Recipient Age
o Previous Kidney Donor
10 of
10
RENAL DISEASE CONTROL PROGRAM
 Categories assigned the highest point correspond to those
that are associated with the greatest graft survival
advantage.
 The maximum number of points that can be given is 29.
The KTC with the highest number of points using the
DASS will be offered the kidney graft first.
ORGAN PROCUREMENT
 Neither the AP nor the decedent at the time of death nor the
physician who determines and certifies the decedent’s death
may participate in the operative procedure for removing or
transplanting an organ from the decedent.
 If the PMOD is stable then the organ procurement may be
delayed until tissue cross-matching results of the potential
recipients are known. Otherwise, the organ retrieval team is
informed and the organ procurement is scheduled.
ORGAN TRANSPLANTATION
 The task of organ transplantation shall be carried out at the
TxC of choice of the KTC. The organ transplantation shall
also be performed by the transplant team of choice of the
KTC.
FINANCIAL CONSIDERATIONS
 All hospital expenses of the PMOD not related to organ
acquisition, i.e. prior to obtaining the consent for organ
donation, shall be for the account of the PMOD or his/her
next-of-kin.
 All charges related to organ acquisition, i.e. from time of BD
certification until transport of the organs to the TxC, shall be
for the account of the Host OPO.
o Regardless of graft placement, the Host OPO shall be
responsible in the immediate settlement of all bills
pertaining to organ acquisition in the referring
hospital.
POSTMORTEM CARE
 Postmortem care shall be provided for the decedent by the
hospital where the procurement was performed.
 The Host OPO and PTC will assist in providing this service.
 If necessary, assistance for funeral arrangements shall be
provided by the Host OPO.