QuestionsQuestions (DOH ADMINISTRATIVE ORDER NO. 2010-0019)
PHILNOS is the national organization that facilitates and oversees deceased donor organ/tissue donation and transplantation in the country. It serves as the central coordinating body to manage the national deceased donor program, increase awareness and deceased organ donation, formulate ethical policies, maintain the national waiting list and national registry, recommend legislation to DOH, and perform other functions ordered by the Secretary of Health.
PODRRS is the national computerized database of all organ transplant candidates, transplant recipients, and organ donors. It supports the implementation of PHILNOS guidelines by serving as the system for registration of candidates, recording donor referrals, and running matching/allocation processes.
All government and private hospitals and health facilities, Organ Procurement Organizations (OPOs), and medical and allied medical practitioners involved in organ and tissue transplantation in the Philippines.
A Potential Multiple Organ Donor (PMOD) is any patient who will imminently become brain dead or who currently meets criteria for brain death. Any PMOD found in the ER or pediatric/adult ICU of a referring hospital must be referred to the referring hospital’s PTC.
Brain Death is the irreversible cessation of all functions of the entire brain, including the brain stem. Death (RA 7170 definition) is the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain (including brain stem), determined by acceptable medical practice and diagnosed separately by the attending and another consulting physician.
The PTC coordinates the donor’s evaluation, management, and recovery of organs/tissues for transplantation. The CTC coordinates the transplant candidate’s evaluation, management, and follow-up care.
All tertiary hospitals and trauma centers are required to have a PTC, working full-time or part-time, to optimize identification and referral of potential deceased donors; all accredited Transplant Centers (TxCs) are mandated to have a PTC. All PTCs must be trained and duly certified by PHILNOS.
KTCs are enlisted in person at their chosen TxC. Only Filipino KTCs may be enlisted. The TxC registers the patient in the National Transplant Candidate Waiting List through PHILNOS. KTCs are initially INACTIVE until approved by PHILNOS, then changed to ACTIVE. Only ACTIVE candidates in the National list are eligible to receive offers of deceased organs.
The KTC is temporarily considered INACTIVE. The status can be reactivated once the medical or financial problem is resolved, while the original date of enrollment is retained.
Consent from the legal next-of-kin must still be obtained regardless of the decedent’s living legacy (e.g., donation card or will). The PTC is solely responsible for securing family consent after the Brain Death certificate is issued.
The consent must come from the legal next-of-kin in this priority: (1) legal spouse, (2) son or daughter of legal age, (3) either parent, (4) brother or sister of legal age, and (5) guardian over the deceased person at the time of death.
The attending physician (AP) refers the PMOD to another physician with skills in neurological assessment or calls two other qualified physicians to assess brain death. A second evaluation by those same physicians must be performed after at least two hours. No member of the transplant team or host OPO shall participate in determination of brain death.
The CTC (or designee) must access donor information in PODRRS within one hour of initial offer notification; otherwise, the offer is considered refused. After accessing, the TxC has one hour to communicate acceptance/refusal. If no response within one hour, the offer is considered refused and PHILNOS may offer the organ to the next candidate.
Allocation involves geographical considerations, ABO compatibility, and for kidney grafts, the Donor Allocation Scoring System (DASS) when needed. Zero antigen mismatch/complete match takes priority regardless of geographic location. If no zero mismatch recipient exists, DASS is used to rank candidates for kidney graft allocation, with PHILNOS drawing shortlists from regional/areas of responsibility lists and national lists.
DASS includes: (1) number of HLA mismatches, (2) panel reactive antibodies (PRA >50% assigned higher points), (3) date of enrollment at PHILNOS (ACTIVE status time), (4) recipient age bracket (priority for <18, then 19–65, then >65), and (5) previous kidney donor (with advantage if it resulted in ESRD). The maximum points is 29.
First, tie is broken by waiting time: priority to the oldest date of enrollment (in months and days). If still equally ranked, priority is then given by age: the youngest recipient age (in days).
Neither the attending physician at the time of death (of the decedent) nor the physician who determines and certifies the decedent’s death may participate in the operative procedure for removing or transplanting an organ.