ORGAN

TRANSPLANTATION
AND PROTESE

Dr.Mgs. Roni Saleh, SpB. SpBP
Background

The organ transplantation or human tissue
is a medical action which is very beneficial
for the patient having hindrance in the
function of the heavy organ of the body. It
is the best alternative therapy to assist the
patient with the broken organ because its
result is more satisfied than conservative
therapy.
The Problem

Eventhough nowadays medical action is after
done but it cannot be done as we want
because there are many non medical side must
be considered such as religion, law, culture,
ethics and moral.
The Problem (Cont)
The problem faced by the Indonesia
nowadays in determining transplantation
therapy is limited amount of living related
donor and donation of corpse organ,
therefore; it is needed supporting
cooperation among related experts (law,
medical, sociology, religion, leader, society
leader ) with private and government.
Kinds of Transplantation
There are many kinds of transplantation whether it is cell,
network and organs of the body as follows:
1. Autograft, that is the movement of body network from
one place to another from the patient him / herself.
2. Allograft, that is the movement from one body to
another who have the same species.
3. Isograft, that is the movement from one body to
another who are identical for instance: identical twins.
4. Xenograft, that is the movement from one body to
another who have different species.

Organ or body network that will be
moved can be taken from living donor
or corpse of the person who just died.
The organs or tissues that can be taken from
the living donor are skin, kidney, bone marrow
and blood. The organs or tissues that can be
taken from corpse are heart, liver, kidney,
cornea, pancreas, lungs and brain cell. Recently
can be done transplantation for the arteria
mamaria interna for surgery among coronaries
and cell transplantation substansia nigra from
baby who has died to the patient who has
Parkinson. All of the efforts in body
transplantation and human cell tissues certainly
need the view from law and medical ethics side.
Prothese or replacement material can be
descended from metal such as titan,
stainless steel, polimer likes silicon,
ceramic. The using of the replacement
material is matched by the need likes on
the broken bones or disablement.
The Law Aspects of Transplantation

From the law side, organs transplantation or
tissues are considered as a lofty effort to make
people healthy and welfare : eventhough this
case is am action which fight criminal law that is
mistreatment criminal action. But because of
there is reason for the punishment exception or
fighting law materially, so that action is not
threatened criminal and can be accepted. In PP
No. 18 1981 stated some articles about
transplantation as follows:
Article I:
a) Human parts of body is drove of body tissues which is
formed by kinds of cell and has deed form for the
body.
b) Body Tissue is drove of cells which has the same form
and deed.
c) Transplantation is series of medical action for the
movement of tool and or human body tissue that is
form another person in doing the treatment to change
the tool and or the organ network which is not
functioned well.
d) Donor is person who gives the tool or his/her organ
tissue to another for the healthy need.
e) Pass away is the condition of someone that is made
sure by the medical expert that when the function of his
/ her brain, respiration, and or heart beat have stopped.
The definition of pass away is clarified by
SK PB IDI No. 336/PB IDI/a.4 in March
15th 1988 that followed by SK PB IDI No.
231/PB.A.4/07/90 that is meant by death
is when automatically function of
respiration and heart has surely been
stopped or irreversible or has been proved
that the brain stem has been died.
The following in PP consist of the articles :
Article 10
by giving Transplantation of tool and or human tissue is done
attention to the stipulations meant in article 2a and b, that is must
with written agreement for the patient and or his / her closed family
after the patient has passed away.

Article 11
Transplantation for tool and or human tissue may only be done by
doctors asked by the minister of health
Transplantation for tool and or human tissue may not be done by
doctors who take care or cure the donor.

Article 12
In transplantation, the determining the death time is determined by
two doctors who have no medical relationship with doctors who do
transplantation.


Article 13
The written agreement meant in article 2a, Article 14 and 15 are made in
stamp paper with two witnesses.
Article 14
Removal tool or human tissue for the transplantation need or eyes bank
from an accident victim who pass away done by written closed agreement
family.
Article 15
Before the agreement about transplantation tool and or human tissue by
the living donor, candidate donor informed earlier by the doctor who takes
care of him / her, include of consultant doctor about surgery, the effect and
possibilities will be happened.
Doctor meant in verse I must really believe that candidate donor has
realized about the agreement well.
Article 16
Donor or donors family who pass away has no right for material
compensation as transplantation repayment
Article 17
It is forbidden to buy and sell tool or human tissue
Article 18
it is forbidden to send and receive tool or human tissue in any of form into
or out to country
The delivery tool or human tissue into or
out to country must be limited in science
research, cooperation and mutual help in
certain condition. In UU No. 23, 1992
about health :
- Article 33
In curing the disease and recovering health can
be done organ or body tissue transplantation,
blood transfusion, medicine implant and or
health tool, plastic surgery and reconstruction.
Organ and or body tissue transplantation also
blood transfusion meant in verse I done only for
humanity objective and forbidden for
commercial objective.
- Article 34
Organ and body tissue transplantation only can be done
by medical team who has skill and right and done in
certain health facility.
The removal of the organ and or body tissue from a
donor must concern the donors health and also there is
agreement from the heir or family
The stipulation about requirement and the way, how to
do transplantation as meant in verse 1 and 2 is firmed
up by the government regulation.
In health constitution is also clarified that the organ
transplantation or body tissue and blood transfusion only
can be done for the humanity aim, is for bidden to be
object to look for profit, buy and sell and another form
of commercialization.
In health coonstituantion is also clarified
that the organ transpalantation or body
tissue and blood tranfusion only can be
done for the humanity aim, is for-bidden
to be object to look for profit, buy and
sale and another form of comercialization
The Ethics Aspects of Transplantation

Transplantation is the last way to assist the patient who has the
failure of the function of one of his / her organ. From the medical
ethics side, this action must be done if the there is indication,
based on some articles in KODEKI that are:

- Article 2
A doctor must always do his / her profession according to the
highest measurement.

Article 10
Every doctor must always remember and his / her duty to protect
someones life.

- Article 11
Every doctor must be honest and straight forward and uses his / her
knowledge and skill for the patient need.
Based on the articles above, so a
doctor must master, develop and
exploit the transplantation science and
technology for the patients and his /
her family benefit.
The articles about transplantation in PP No. 18 1981 in
fact, has included the aspects of ethics, especially about
the for bidden of buying and selling tool or body tissue
for transplantation objective or ask for the material
compensation. But raise the question, if it may not be
sold and bought or be given compensation, how to
increase the amount of donor? May non-material
repayment for example ask for the prisoners to be donor
and they are given decreasing of remission time as
repayment it seems that this activity is not impossible to
do because there is no weaknesses and even give
mutual benefit.
Another thing needs to be cared is the determining
when someone passed away whose organs will be taken
away by two doctors who have no medical relationship
with the doctors who will do transplantation. This is
closed to the success of transplantation, because the
fresher the organs and tissues are the better the result
is. But it may
Not be happened deviation where the patient almost die
but has not died yet, his / her organs have been taken
away, the determining when the patient die in the
modern hospitals can be sure by electroensefalografi
check up and it is said die when the brain stem is not
functioned well anymore, there is no respiration as well
as the heart beat has stopped spontaneously. This check
up is done by another doctors who are not the doers of
transplantation so the decision is really objective.
Thank You