Law Summary
Objectives of the Order
- Establish PHILNOS as the national organ sharing network.
- Initiate and maintain the national organ donor and recipient registry (PODRRS).
- Promote deceased organ donation in the Philippines.
Coverage
- Applies to all government and private hospitals, health facilities, Organ Procurement Organizations (OPOs), and medical practitioners involved in organ and tissue transplantation nationwide.
Key Definitions
- Brain Death: irreversible cessation of all brain functions.
- Death: irreversible cessation of circulatory/respiratory or entire brain functions, diagnosed by qualified physicians.
- Decedent: deceased person, including still-born infant/fetus.
- Donor Allocation Scoring System (DASS): national scoring system for kidney graft allocation.
- Graft: organ removed for transplantation.
- Hospital and National Transplant Candidate Waiting Lists: lists of potential recipients managed respectively by transplant coordinators and PHILNOS.
- Organ Procurement Organization (OPO): DOH-accredited organizations coordinating donor identification, evaluation, and organ retrieval.
- Potential Multiple Organ Donor (PMOD): patient imminently or currently brain dead.
- Transplant Coordinator (TC): trained professional coordinating donor and recipient processes.
- Philippine Organ Donor and Recipient Registry System (PODRRS): national computerized registry for donors and recipients.
General Guidelines for PHILNOS
- PHILNOS supersedes previous organ preservation initiatives as central coordinating body.
- Mandated to manage deceased donor programs ensuring efficiency, equity, transparency.
- Responsible for awareness programs, ethical policies, national registries, and policy recommendations.
- Organ Procurement Organizations (OPOs) must be DOH accredited, with regional designations.
- Existing memoranda between OPOs and hospitals terminated; accreditation renewable every three years after evaluation.
- Tertiary and trauma hospitals must have a Procurement Transplant Coordinator (PTC) trained and certified by PHILNOS.
- All brain-dead or imminent brain death cases must be referred to PTC.
- Organ and recipient data registered in PODRRS.
- Donor evaluation, management protocols, and organ acquisition fees standardized nationally.
Organizational Structure
- PHILNOS led by Program Manager appointed by DOH Secretary.
- Executive Committee includes assistant manager, committee heads, and medical advisers.
- Various working committees established: Accreditation and Training, Ethics & Legal Affairs, Finance, Information and Advocacy, OPO, and Registry.
- External Audit Committee conducts audits to ensure fair organ allocation.
- Membership open to accredited organizations including OPOs, transplant centers, scientific and patient groups.
Operational Procedures
Enlistment of Kidney Transplant Candidates (KTC)
- Registration done in person at chosen Transplant Center (TxC) by Filipino patients nearing or at end-stage renal disease.
- Only one waiting list enlistment allowed; transfers must be reported.
- Candidates initially placed as INACTIVE until approved as ACTIVE.
- Monthly serum samples stored for cross-matching.
- Communication requirements for inaccessible areas ensured through a contact person.
Waiting List Status
- Only ACTIVE patients eligible to receive organ offers.
- Temporary INACTIVE status applied if medically/financially unfit.
- Patients going abroad must inform coordinators; failure to do so leads to delisting.
Identification and Referral of Potential Donors
- Any brain dead or imminent brain death patient referred to hospital PTC or designated OPO PTC.
- PTC conducts comprehensive evaluation including consulting medical staff and reviewing records.
- Special considerations include obstetrical consultation for pregnant patients and ethics or medico-legal referrals as needed.
Request and Consent for Organ Donation
- Attending physician informs family of prognosis.
- PTC requests donation consent from legal next-of-kin in order prescribed by law.
- Even if donor had organ donation card, family consent still necessary.
Brain Death Certification
- Independent physicians diagnose brain death based on established guidelines.
- Two evaluations at least two hours apart mandatory.
- Death certificate issued by attending physician noting time of brain death.
- Transplant team excluded from brain death certification process.
Donor Management
- Commences after consent, focusing on maintaining organ viability.
- Managed by ICU or emergency room physician or designated OPO physician.
Donor Evaluation and Organ Allocation
- Completion of medical evaluations and necessary tests before allocation.
- Allocation based on geographical location, blood type compatibility, and the Donor Allocation Scoring System (for kidney).
- PODRRS used to generate top candidate lists.
- Zero antigen mismatches prioritized.
- Non-renal organ availability announced to other tissue banks.
Donor Allocation Scoring System (DASS) for Kidney Transplants
- Factors: HLA mismatches, panel reactive antibodies, enrollment duration, recipient age, history as previous kidney donor.
- Highest scores receive priority; zero mismatch recipients prioritized regardless of score.
- Ties resolved first by enrollment duration, then by age.
- "Old donors for old recipients" policy for donors and recipients over age 55.
Organ Acceptance
- Uniform donor acceptance criteria required for all OPOs and transplant programs.
- Transplant centers submit acceptance criteria annually for renal and optionally for non-renal organs.
- Time limits set for reviewing offers and communicating acceptance or refusal.
- Documentation of decisions mandatory.
- Final acceptance decision reserved to transplant physician.
Organ Procurement
- Avoid conflicts of interest by excluding involved physicians from procurement.
- Organ retrieval coordinated by Host OPO or transplant center surgical teams.
- Non-renal organ retrieval performed by specialized teams.
- Grafts remain in custody of OPO until placement and transport.
Organ Transplantation
- Conducted at transplant center chosen by recipient.
- Transplant team selected by recipient performs procedure.
Financial Responsibility
- Pre-consent hospital expenses borne by donor’s estate/family.
- All organ acquisition related expenses covered by Host OPO.
- Host OPO reimbursed by recipients or third-party payers upon successful organ placement.
- No reimbursement for unplaced organs.
**Postmortem Care
- Hospital and Host OPO jointly provide postmortem care.
- Funeral assistance optionally provided by Host OPO.
Reporting Requirements
- Monthly performance reports submitted by PHILNOS Program Manager.
- Monthly submissions from OPOs and transplant centers on referrals and transplants.
- Quarterly reports from each PTC on referred PMODs.
Repealing and Effectivity Clauses
- Existing conflicting issuances are amended or repealed.
- Order effective fifteen days after publication in a newspaper of general circulation.