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WELCOME TO THE CLINICAL
CENTER GRAND ROUNDS,

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A WEEKLY SERIES OF EDUCATIONAL
LECTURES FOR PHYSICIANS AND

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HEALTH CARE PROFESSIONALS
BROADCAST FROM THE CLINICAL

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CENTER AT THE NATIONAL
INSTITUTES OF HEALTH IN

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BETHESDA, MD.

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THE NIH CLINICAL CENTER IS THE
WORLD'S LARGEST HOSPITAL TOTALLY

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DEDICATED TO INVESTIGATIONAL
RESEARCH AND LEADS THE GLOBAL

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EFFORT IN TRAINING TODAY'S
INVESTIGATORS AND DISCOVERING

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TOMORROW'S CURES.

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LEARN MORE BY VISITING US ONLINE
AT HTTP://CLINICALCENTER.NIH.GOV

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HI EVERYONE I'M DR. ANDREW

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REDD HEAD INTERNATIONAL VIROLOGY


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UNIT AT NIAID.

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I WILL LIKE TO WELCOME YOU TO

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GRAND ROUNDS, THE HOPKINS

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ACTIVITY CODE IS 50527.

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PLEASE TEXT THIS CODE TO THE

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JOHNS HOPKINS CME PHONE NUMBER

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ON THE SLIDE TO RECEIVE CME

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CREDIT FOR THIS LECTURE.

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WE KINDLY INVITE TO YOU PROVIDE

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FEEDBACK ON TODAY'S LECTURE BY

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SCANNING THE QR CODE SHOWN ON

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THE CME SLIDE AND FOR THOSE

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APPLYING FOR CME, YOU WILL

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RECEIVE THE FEEDBACK SURVEY LINK

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VIA E-MAIL, THE SURVEY WILL BE

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USED TO PROVIDE IMPORTANT

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FEEDBACK ABOUT THIS PRESENTATION

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AND ALLOWS TO YOU SUBMIT ANY

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SUGGESTIONS ARE IF FUTURE GRAND

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ROUNDS TOPICS.

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FOLLOWING THE PRESENTATION,

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QUESTIONS FOR THE SPEAKER WILL

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BE TAKEN FROM THE MICROPHONES IN

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THE AISLES, AND THEN, ARK

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DITIONALLY VIDEOCAST VIEWERS CAN

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SUBMIT SUBMIT LECTURES DURING

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THE LECTURE BY SCROLLING DOWN

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AND CLICKING ON THE 5 FEEDBACK

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BUTTON DURING THE VIDEOCAST

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WEBSITE.

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Q&A WILL HAPPEN AS TIME
PERMITSA

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THE END OF THE PRESENTATION.

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TODAY WE'RE EXCITED TO HAVE

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DR. ELMI MULLER PRACTICES

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UNIVERSITY OF STEWELL, LEN

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BOSCH SOWING AFRICA AND HIGHLY

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SOUGHT AFTER TRANSPLANT SURGEON.

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SHE EARNED HER MASTERS AND

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Ph.D. AND SURGERY AT THE

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UNIVERSITY OF CAPE TOWN AS WELL

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AS MBA AT THE UNIVERSITY OF

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STELLENBOSCH.

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DR. MULLER IS BEST KNOWN ARK

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ROUND THE WORLD FOR HER

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PIONEERING WORK FROM HIV

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POSITIVE TO HIV POSITIVE TRAN

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PLANT ORGAN TRANSPLANTATION

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EMPLOY SHE WAS THE FIRST DOCTOR

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TO TRANSPLANT A KIDNEY FROM AN

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HIV DONOR TO A REIENT.

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SHE ACCOMPLISHED THIS DESPITE

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EXTRAORDINARY PUSH BACK FROM HER

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INSTITUTE AND FROM HER CAREER: 

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MOST NOTABLY BY LEADING THE WAY

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FOR THE PASSAGE OF THE HIV

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POLICY OR EQUITY HOPE ACT THAT

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WAS PASSED BY THE U.S. CONGRESS

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IN 2013 WHICH ALLOWS FOR ORGAN

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TRANSPLANTATION FROM HIV

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POSITIVE DONORS TO RECIPIENTS

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LIVING WITH HIV.

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IN 2015, I BEGAN COLLABORATING

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WITH ELMI AND HER TEAM IN SOUTH

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AFRICA TO INVESTIGATE SOME OF

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THE VIROLOGY AND CLINICAL

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QUESTIONS, THAT THESE UNIQUE

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ORGAN RECIPIENTS POSE SUCH AS

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EXAMINING FOR THE PRESENCE OF

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HIV SUPERINFECTION AND WE

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CONTINUE TO WORK TODAY THROUGH A

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UR1 GRANT FUNDED THAT IS FUNDED

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THROW THE U.S. SOUTH AFRICA

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PROGRAM FOR COLLABORATIVE

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BIOMEDICAL RESEARCH.

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FROM 2012 TO 2021, PROFESSOR

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MULLER SERVED AS THE HEAD OF THE

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TRAN PLANT UNIT AT

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[INDISCERNIBLE] HOSPITAL IN CAPE

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TOWN AND FROM 2017-2021 SHE

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SERVED AS THE HEAD OF THE

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HOSPITALS DIVISION OF GENERAL

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SURGERY, IN 2022, SHE WAS

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APPOINTED DEAN OF THE FACULTY OF

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MEDICINE AND HEALTH SCIENCE AT

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STELLENBOSCH UNIVERSITY, 1 OF

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THE LARGEST TRAINING

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INSTITUTIONS FOR HEALTHCARE

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PROFESSIONALS ON THE CONTINENT.

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A SOUGHT AFTER EXPERT, SHE HAS

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WORK AS A VISITING PROFESSOR AT

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HARVARD AND AS A FELLOW AT

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NORTHWESTERN UNIVERSITY AND

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RECEIVED NUMEROUS AWARDS WARDS D

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HONORS FOR HER WORK.

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SHE PLAYED A CRITICAL ROLE FOR

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TRANSPLANTEURISM, SINCE 2018

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SHE'S SERVED AS A PART OF THE W.

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H. O. TRANSPLANTATION TASK FORCE

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AND IN 2021 SHE WAS NOMINATED TO

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THE DRUGS AND CRIME ECPETTER

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GROUPOT VERY LONG AND

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PROSECUTION OF TRAFFICKING

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PERSONS FOR ORGAN REMOVAL EMPLOY

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AFTER WORKING WITH ELMI FOR

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ALMOST A DECADE NOW I CAN SAY

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THAT WITHOUT A DOUBT SHE IS 1 OF

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THE MOST INNOVATIVE, DARING AND

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PASSIONATE CLINICIAN SCIENTISTS

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I'VE HAD THE PRIVILEGE OF

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WORKING WITH AND I THINK AS YOU

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WILL SEE TODAY, SHE IS 1 OF THE

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RARE GROUP OF PEOPLE WHO TRULY

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THINK OUTSIDE OF THE BOX TO

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SOLVE THE PROBLEMS THAT WE FACE

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AROUND THE WORLD TODAY. 

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FRAMING TODAY'S PRESENTATION, A

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PROGRESSIVE EFFORT TO IESHES

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DENTIFY GAPS IN INFRASTRUCTURE

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AND RESOURCES TO DRIVE

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TRANSPLANTATION IN APRICKA AND

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HER POLICY WORK RELATED TO

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TRANSPLANTATION AND ORGAN

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DONATION SERVES AND LOW AND

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MIDDLE INCOME COUNTRIES.

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PLEASE WELCOME PROFESSOR MULLER

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WHO WILL PRESENT THE TALK

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ENTITLED TRANSPLANTATION AND

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DIALYSIS AND LOW AND MIDDLE

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INCOME COUNTRIES TIME TO RETHINK

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THE LANDSCAPE. 

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ELMI.

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[ APPLAUSE ]

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>> THANK YOU FOR SUCH A

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WONDERFUL INTRODUCTION AND

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OPPORTUNITY.

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I DENTY HAVE ANY FINANCIAL

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DISCLOSURES AND I WILL NOT BE

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DISCUSSING ANY UNAPPROVED OR

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OFF-LABEL DRUGS TODAY.

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OUR LEARNING OBLIGATIONS

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YECTIVES FOR TODAY'S TALK,

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PERHAPS TO UNDERSTAND SOME OF

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THE ISSUES THAT WE SEE WHEN WE

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DRIVE TRANSPLANTATION PROGRAMS

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AND ALSO DRIVING THE PROGRAM,

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ESPECIALLY FOR THE HEALTHCARE

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SECTOR IN GENERAL BUT ALSO FOR

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THE COUNTRY THE WAY WE'RE

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DIDDING IT, UNDERSTAND THE ROLE

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OF TRANSPLANTATION IN EMERGING

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ITS OF SUSTAINABLE DEVELOPMENT

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GOALS AND THEN I WILL END UP

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WITH SOME BARRIERS SITTING UP

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TRANSPLANT PROGRAMS IN LOW AND

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MIDDLE INCOME COUNTRIES.

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THE FIELD OF TRANSPLANTATION HAS

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MADE MODERN STRIDES IN

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TRANSPLANTATION ENCLUEDING LARGE

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QUANT, AUTONOMY, OFFERING HOPE

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AND A SECOND CHANCE AT LIFE TO

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MILLIONS OF INDIVIDUALS WORLD

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WIDE EMPLOY ORGAN AND TISSUE

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TRANSPLANTATION HAS EVOLVED INTO

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A CRITICAL COMPONENT OF

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HEALTHCARE ESPECIALLY ADDRESSING

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NONCOMMUNICABLE DECEASES SUCH AS

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KIDNEY FAILURE AND TERMINAL

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STAGES OF HEART, LIVER AND LUNG

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DECS.

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THE CONTRIBUTION OF

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TRANSPLANTATION EXPANDS THROUGH

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HUMAN CELL AND PRANS PLANTATION

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AND MANIFESTATIONS OF

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NONCOMMUNICABLE DISEASES, MANY

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FOR CONGENITAL DISEASES ISSUES

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STROMA OR THE INCREASING NEEDS

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OF A FLOABALLY AGING POPULATION.

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MORE OVER TRANSPLANTATION PLAYS

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A PIVOTAL ROLE IN ADVANCING THE

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GLOBAL GOAL OF UNIVERSAL ACCESS

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TO HEALTH.

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ON THE SLIDE YOU CAN SEE AN

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ESTIMATE OF TRAN PLANTS THAT'S

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HAPPENING WORLD WIDE PER YEAR.

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AS YOU CAN SEE, SOME AREAS HAVE

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GOT MORE TRANSPLANTS AND SOME

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HAVE LESS, SO I'M JUST GOING

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SHOW YOU 2 REGIONS THAT ARE

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SITTING ON THE LOWER END OF THE

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SPECTRUM.

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IN THIS GRAPH, WE SEE THE TOW

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TOTAL TRANSPLANTATION NUMBERS IN

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SOUTHEAST ASIA OVER A 20 YEAR

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PERIOD.

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ALTHOUGH THE RATE OF

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TRANSPLANTATION HAS GROWN TO

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JUST OVER 6 PER MILLION

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POPULATION, THAT'S ALMOST 15,000

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SOLID ORGAN TRANSPLANTS PER

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YEAR, THIS IS STILL COMPLETELY

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INADEQUATE FOR THE REGION.

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WHILE TISSUE AND CELL

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TRANSPLANTATION THRIVES IN MORE

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DEVELOPED AREAS OF THE WORLD AND

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WITH ITS CONTRIBUTION FULLY

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RECOGNIZE, THERE ARE CLEAR GAPS

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FROM PROGRAM ANDS ACCESS IN THIS

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REGION.

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REDUCED OR ABSENT HUMAN TISSUE

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TRANSPLANTATION ACTIVITY IN ANY

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COUNTRY OR REGION SHOULD NOT BE

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INTERPRET AS A LACK OF NEED FOR

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HUMAN TRANSPLANTATION AND HUMAN

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ISSUE CELL, RATHER IT SIEWCIALLY

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SKTAS AND INDICATES THAT THE

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BENEFITS OF DONATION, TISSUE

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BANKING AND TRANSPLANTATION HAVE

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NOT BEEN FULLY RECOGNIZED.

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AND THAT THE TRAN PLANT

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AVAILABILITY HAS NOT COMPLETELY

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BEEN ADDRESSED.

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HOWEVER, IF WE LOOK AT AFREK ARK

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THE SITUATION IS MUCH MORE

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DISMAL.

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TRANSPLANTATION NUMBERS ARE LESS

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THAN 1 PER MILLION POPULATION

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AND THE TOTAL NUMBER OF

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TRANSPLANTS ON THE CONTINENT IS

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LESS THAN A THOUSAND PER YEAR.

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SO WHAT ARE THE RISKS WHEN HAVE

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YOU THESE VERY LOW TRANSPLANT

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NUMBERS IN ESPECIALLY THE

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DEVELOPING WORLD.

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I WANT TO LOOK AT THESE RISKS

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FROM 3 DIFFERENT VIEW POINTS.

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FESTERLY FROM A PATIENT

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HORRTALLITY POINT OF VIEW,

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SECONDLY FROM ORGAN TRAFFICKING

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POINT OF VIEW, AND THIRDLY, I

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WANT TO TALK ABOUT THE FINANCIAL

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RISK THAT WE HAVE WHEN WE SEE

254
00:09:25,564 --> 00:09:26,331
DIALYSIS PROGRAMS THRIVING.

255
00:09:26,331 --> 00:09:28,867
PATIENT DEATH IS THE EASIEST TO

256
00:09:28,867 --> 00:09:31,136
UNDERSTAND BECAUSE ORGAN

257
00:09:31,136 --> 00:09:32,871
TRANSPLANTATION IS SUCH A

258
00:09:32,871 --> 00:09:33,905
TREATMENT MODALITY FOR PEOPLE

259
00:09:33,905 --> 00:09:35,640
WITH END STAGE DISEASE.

260
00:09:35,640 --> 00:09:36,775
IT'S USUALLY A LIFE SAVING

261
00:09:36,775 --> 00:09:39,344
DISEASE BUT IT CAN BE A LIFE

262
00:09:39,344 --> 00:09:40,612
ENHANCING TREATMENT MODALITY AS

263
00:09:40,612 --> 00:09:41,913
WELL DEPENDING ON WHICH ORGAN IS

264
00:09:41,913 --> 00:09:43,882
AFFECTED AND WHETHER THERE IS

265
00:09:43,882 --> 00:09:46,184
REPLACEMENT THERAPY AVAILABLE

266
00:09:46,184 --> 00:09:47,319
FOR THE ORGAN.

267
00:09:47,319 --> 00:09:48,887
SO WITHOUT A TRANSPLANT, A

268
00:09:48,887 --> 00:09:50,822
PATIENT MIGHT EITHER DIE, OR

269
00:09:50,822 --> 00:09:55,794
MIGHT HAVE A VERY POOR QUALITY

270
00:09:55,794 --> 00:09:56,361
OF LIFE.

271
00:09:56,361 --> 00:09:59,498
THE INTERESTING 1 IS TO THINK

272
00:09:59,498 --> 00:10:01,366
ABOUT THIS LOW TRANSPLANTATION

273
00:10:01,366 --> 00:10:03,201
NUMBERS AS A RISK FOR ORGAN

274
00:10:03,201 --> 00:10:05,937
TRAFFICKING AND MEDICAL TOURISM.

275
00:10:05,937 --> 00:10:07,806
WE KNOW THAT ORGAN TRAFFICKING

276
00:10:07,806 --> 00:10:10,008
CAN LEAD TOCCATA STROPHIC

277
00:10:10,008 --> 00:10:11,209
FINANCIAL EXPENSES, FOR

278
00:10:11,209 --> 00:10:12,844
POTENTIAL RECIPIENTS WHO WANT TO

279
00:10:12,844 --> 00:10:15,347
BUY A KIDNEY AND SO NO OTHER

280
00:10:15,347 --> 00:10:15,680
OPTION.

281
00:10:15,680 --> 00:10:17,783
WE ALSO KNOW THAT ORGAN

282
00:10:17,783 --> 00:10:19,184
TRAFFICKING ALSO RESULTS IN A

283
00:10:19,184 --> 00:10:21,119
CRIMINAL RECORD FOR THE PERSON

284
00:10:21,119 --> 00:10:24,556
WHO HAVE BEEN PROVIDING A

285
00:10:24,556 --> 00:10:25,123
KIDNEY.

286
00:10:25,123 --> 00:10:26,558
LASTLY THERE ARE PUBLIC HEALTH

287
00:10:26,558 --> 00:10:29,060
RISKS WHEN WE THINK ABOUT

288
00:10:29,060 --> 00:10:29,728
COMMERCIAL TRANSPLANTATION

289
00:10:29,728 --> 00:10:30,996
ESPECIALLY IN TERMS OF SAFETY

290
00:10:30,996 --> 00:10:37,402
AND I WILL SAY A LITTLE BIT MORE

291
00:10:37,402 --> 00:10:37,969
ABOUT THIS NOW.

292
00:10:37,969 --> 00:10:39,738
WHEN WE LOOK AT ORGAN

293
00:10:39,738 --> 00:10:42,140
TRAFFICKING THERE ARE 3 THINGS

294
00:10:42,140 --> 00:10:46,077
THAT HAS TO BE IN PLACE TO MAKE

295
00:10:46,077 --> 00:10:47,846
ORGAN TRAFFICKING POSSIBLE, THE

296
00:10:47,846 --> 00:10:49,981
INFRASTRUCTURE NEEDS TO BE GOOD

297
00:10:49,981 --> 00:10:50,949
ENOUGH FOR TRANSPLANT TO HAVE

298
00:10:50,949 --> 00:10:53,652
UPON, SO YOU NEED A REASONABLY

299
00:10:53,652 --> 00:10:58,990
GOOD HOSPITAL, AND HEALTHCARE

300
00:10:58,990 --> 00:10:59,224
WORKERS.

301
00:10:59,224 --> 00:11:01,426
THE OVERSIGHT HAS TO BE POOR, SO

302
00:11:01,426 --> 00:11:02,961
USUALLY IT HAPPENS IN COUNTRIES

303
00:11:02,961 --> 00:11:04,596
WHERE THERE'S POOR LEGISLATION

304
00:11:04,596 --> 00:11:05,430
AND LIMITED LEGAL ACTION

305
00:11:05,430 --> 00:11:05,697
AVAILABLE.

306
00:11:05,697 --> 00:11:07,899
AND THIS HAS TO BE COMBINED WITH

307
00:11:07,899 --> 00:11:09,534
POVERTY, WHERE WE CAN HAVE

308
00:11:09,534 --> 00:11:14,806
POTENTIAL DONORS WHO COME  AND

309
00:11:14,806 --> 00:11:17,209
GIVE THEMSELVES UP AND PROVIDE A

310
00:11:17,209 --> 00:11:17,776
KIDNEY FOR PAYMENT.

311
00:11:17,776 --> 00:11:20,078
HERE I WILL SHOW YOU 2 EXAMPLES

312
00:11:20,078 --> 00:11:22,047
OF WHERE WE KNOW ORGAN

313
00:11:22,047 --> 00:11:23,815
TRAFFICKING IS STARTING TO BE A

314
00:11:23,815 --> 00:11:25,484
BIG PROBLEM.

315
00:11:25,484 --> 00:11:29,221
FOR MANY YEARS, SYRIAN REFUGEES

316
00:11:29,221 --> 00:11:31,223
HAVE FLED TO TURKEY DONATING AN

317
00:11:31,223 --> 00:11:34,125
ORGAN IN A SMECIAL SETTING CAN

318
00:11:34,125 --> 00:11:34,826
PROVIDE TEMPORARY FINANCIAL

319
00:11:34,826 --> 00:11:35,894
RELIEF TO A FAMILY EMPLOYOT

320
00:11:35,894 --> 00:11:38,430
SLIDE IS AN EXAMPLE OF AN

321
00:11:38,430 --> 00:11:40,232
ADVERTISEMENT THAT WAS PLACED IN

322
00:11:40,232 --> 00:11:44,102
TURKEY TO POTENTIAL ORGAN

323
00:11:44,102 --> 00:11:45,470
PROVIDERS.

324
00:11:45,470 --> 00:11:47,172
THIS CAN BE A DISMAL WAY TO

325
00:11:47,172 --> 00:11:48,807
RECEIVE QUITE A SMALL AMOUNT OF

326
00:11:48,807 --> 00:11:51,443
MONEY AT THE COST OF YOUR

327
00:11:51,443 --> 00:11:52,377
LONG-TERM HEALTH.

328
00:11:52,377 --> 00:11:55,747
THIS CASE REPORT FROM UKRAINE

329
00:11:55,747 --> 00:11:57,282
EXAMINES THE INITIAL EXPERIENCE

330
00:11:57,282 --> 00:12:00,485
OF POLAND IN RESPONDING TO THE

331
00:12:00,485 --> 00:12:02,487
CURRENT REFUGEE CRISIS TRIGGERED

332
00:12:02,487 --> 00:12:03,221
BY THE UKRAINIAN WAR.

333
00:12:03,221 --> 00:12:06,057
IN THE FIRST 2 MONTHS OF THE

334
00:12:06,057 --> 00:12:07,325
CRISIS MORE THAN 3 MILLION

335
00:12:07,325 --> 00:12:09,194
REFUGEES FLED TO POLAND.

336
00:12:09,194 --> 00:12:11,997
THE LARGE INFLUX OF REFUGEES

337
00:12:11,997 --> 00:12:16,735
RAPIDLY OVERWHELMED THE LOCAL

338
00:12:16,735 --> 00:12:20,605
SERVICES AND LED TO A COMPLEX

339
00:12:20,605 --> 00:12:21,373
HUMANITARIAN SITUATION.

340
00:12:21,373 --> 00:12:23,909
IT WAS TO ADDRESS BASIC HUMAN

341
00:12:23,909 --> 00:12:26,211
NEEDS SUCH AS SHELTER,

342
00:12:26,211 --> 00:12:27,078
INFECTIOUS DISEASE, HELT CARE

343
00:12:27,078 --> 00:12:30,949
ACCESS BUT IT HAS EVOLVED INTO

344
00:12:30,949 --> 00:12:32,083
KIAL SIS, TRANSPLANTATION,

345
00:12:32,083 --> 00:12:35,153
NONCOMMUNICABLE DEC AND

346
00:12:35,153 --> 00:12:35,453
PROTECTION.

347
00:12:35,453 --> 00:12:36,688
THIS NECESSITATED A WHOLE OF

348
00:12:36,688 --> 00:12:38,390
SOCIETY RESPONSE IF INVOLVING

349
00:12:38,390 --> 00:12:42,894
MULTIPLE AGENCIES AND CIVIL

350
00:12:42,894 --> 00:12:43,461
SOCIETY.

351
00:12:43,461 --> 00:12:44,629
EMERGING LESSONS LEARNED INCLUDE

352
00:12:44,629 --> 00:12:46,965
THE NEEDS FOR ONANYTHING NEEDS

353
00:12:46,965 --> 00:12:48,133
ASSESSMENTS, ROBUST DISEASE

354
00:12:48,133 --> 00:12:51,336
MONITORING AND SURVEILLANCE AS

355
00:12:51,336 --> 00:12:53,004
WELL AS FLEXIBLE MULTISECTORRAL

356
00:12:53,004 --> 00:12:55,407
RESPONSES THAT ARE CULTURALLY

357
00:12:55,407 --> 00:12:55,941
SENSITIVE.

358
00:12:55,941 --> 00:12:57,542
POLAND'S EFFORTS TO INTEGRATE

359
00:12:57,542 --> 00:12:58,910
REFUGEES MAY HELP MITIGATE SOME

360
00:12:58,910 --> 00:13:03,381
OF THE ADVERSE CONSEQUENCES OF

361
00:13:03,381 --> 00:13:04,516
THIS RELATED MIGRATION.

362
00:13:04,516 --> 00:13:06,351
HOWEVER, IT REMAINS A BIG

363
00:13:06,351 --> 00:13:07,986
PROBLEM NOT ONLY IN THESE PARTS

364
00:13:07,986 --> 00:13:10,021
OF THE WORLD BUT IN MANY OTHER

365
00:13:10,021 --> 00:13:12,557
PLACES IN EUROPE WHERE THEY ARE

366
00:13:12,557 --> 00:13:15,427
NOT ENOUGH ORGAN TRANSPLANTATION

367
00:13:15,427 --> 00:13:18,063
AND DIALYSIS FACILITIES

368
00:13:18,063 --> 00:13:18,330
AVAILABLE.

369
00:13:18,330 --> 00:13:21,266
IN INDIA WE KNOW THAT THERE IS A

370
00:13:21,266 --> 00:13:24,002
LARGE MEDICAL TOURISM INDUSTRY

371
00:13:24,002 --> 00:13:24,502
HAPPENING.

372
00:13:24,502 --> 00:13:26,204
MANY PEOPLE FROM AFRICA AND LOW

373
00:13:26,204 --> 00:13:27,505
AND MITSD INCOME COUNTRIES

374
00:13:27,505 --> 00:13:29,140
TRAVEL TO INDIA FOR THE

375
00:13:29,140 --> 00:13:29,441
TRANSPLANTS.

376
00:13:29,441 --> 00:13:31,543
AND THAT IS A PROBLEM FOR

377
00:13:31,543 --> 00:13:32,711
DRIVING LOCAL PROGRAMS IN THESE

378
00:13:32,711 --> 00:13:34,446
COUNTRIES AND I WILL SAY A

379
00:13:34,446 --> 00:13:37,515
LITTLE BIT MORE ABOUT THIS

380
00:13:37,515 --> 00:13:37,749
SHORTLY.

381
00:13:37,749 --> 00:13:42,787
WHEN YOU LOOK AT COMMERCIAL

382
00:13:42,787 --> 00:13:43,622
TRANSPLANTATION THERE ARE

383
00:13:43,622 --> 00:13:44,422
SERIOUS PUB LIAISON HEALTH

384
00:13:44,422 --> 00:13:46,825
ISSUES THAT NEED TO BE TAKEN

385
00:13:46,825 --> 00:13:49,561
UNDER CONSIDERATION, 1 OF THIS

386
00:13:49,561 --> 00:13:50,362
IS INFECTION, THE TRANSPLANTS

387
00:13:50,362 --> 00:13:52,697
THAT COME FROM THESE DONORS WHO

388
00:13:52,697 --> 00:13:53,765
ARE ORGAN TRAFFICS OFTEN COME

389
00:13:53,765 --> 00:13:57,502
ALSO WITH A CHRONIC INFECTION

390
00:13:57,502 --> 00:14:00,405
FOR INSTANCE TUBERCULOSIS, VIRAL

391
00:14:00,405 --> 00:14:02,674
HEPATITIS, HIV, MALARIA, AND

392
00:14:02,674 --> 00:14:06,878
OTHER BLOOD BOARN INFECTIONS. 

393
00:14:06,878 --> 00:14:08,380
SO AFTER TOURISM ACTIVITY A

394
00:14:08,380 --> 00:14:10,782
DONOR DERIVED EARLY OR LIGHTING

395
00:14:10,782 --> 00:14:12,017
INFECTION IS SOMETHING WE NEED

396
00:14:12,017 --> 00:14:13,485
TO CONSIDER AND OBVIOUSLY IF

397
00:14:13,485 --> 00:14:15,987
THESE PATIENTS TRAVEL, THEY WILL

398
00:14:15,987 --> 00:14:17,555
SPREAD THE INFECTION TO THE

399
00:14:17,555 --> 00:14:19,024
ENVIRONMENT WITH WITHOUT COMING

400
00:14:19,024 --> 00:14:19,524
BACK TO.

401
00:14:19,524 --> 00:14:21,192
THERE ARE OTHER INFECTIONS AS

402
00:14:21,192 --> 00:14:24,963
WELL, SO IT'S NOT ONLY DONOR

403
00:14:24,963 --> 00:14:25,463
DERIVED.

404
00:14:25,463 --> 00:14:26,131
REMEMBER, OFTEN THESE

405
00:14:26,131 --> 00:14:28,233
TRANSPLANTS TAKE PLACE IN TOOR

406
00:14:28,233 --> 00:14:29,868
OPERATING ROOM CONDITIONS, LACK

407
00:14:29,868 --> 00:14:34,239
OF SURGICAL SKILLS, THEY ARE NO

408
00:14:34,239 --> 00:14:36,174
PREOP KREENING AND ABSENCE OF

409
00:14:36,174 --> 00:14:36,908
PROPHYLAXIS GIVEN.

410
00:14:36,908 --> 00:14:40,111
SO PEASHTS CAN COME BACK WITH

411
00:14:40,111 --> 00:14:41,346
NEWEL ACQUIRED INFECS WHICH CAN

412
00:14:41,346 --> 00:14:43,548
BE COMMUNITY OOH QUIREDDER

413
00:14:43,548 --> 00:14:45,517
HOSPITAL ACQUIRED OR

414
00:14:45,517 --> 00:14:46,384
OPPORTUNISTIC AND ONCE AGAIN I

415
00:14:46,384 --> 00:14:47,652
WANT TO MAKE THE POINT THAT

416
00:14:47,652 --> 00:14:48,820
BECAUSE WE DON'T HAVE ENOUGH

417
00:14:48,820 --> 00:14:50,889
LEGAL AND GOOD PROGRAMS ACROSS

418
00:14:50,889 --> 00:14:52,490
THE WORLD, THESE PRACTICES ARE

419
00:14:52,490 --> 00:14:54,893
TAKING PLACE AND PUTS US ALL

420
00:14:54,893 --> 00:14:59,064
INTO A HIGH RISK SITUATION.

421
00:14:59,064 --> 00:15:00,865
IT'S ALSO VERY CHALLENGING

422
00:15:00,865 --> 00:15:02,500
BECAUSE OFTEN THESE PAGES COME

423
00:15:02,500 --> 00:15:04,235
BACK WITH SURGICAL WOUND

424
00:15:04,235 --> 00:15:04,602
INFECTION.

425
00:15:04,602 --> 00:15:05,637
THEY ARE IMMUNE SUPPRESSED SO

426
00:15:05,637 --> 00:15:08,373
IT'S VERY DIFFICULT TO MAKE

427
00:15:08,373 --> 00:15:08,640
DIAGNOSIS.

428
00:15:08,640 --> 00:15:12,377
WE SEE A LOT OF MULTIRESISTANT

429
00:15:12,377 --> 00:15:13,912
ORGANISMS IN THESE PATIENT

430
00:15:13,912 --> 00:15:14,245
GROUPS.

431
00:15:14,245 --> 00:15:16,448
WHICH IS BECOMING A PUBLIC

432
00:15:16,448 --> 00:15:16,881
HEALTH RISK.

433
00:15:16,881 --> 00:15:20,185
IN THE GRAY BOX, I WANT TO

434
00:15:20,185 --> 00:15:22,620
EMPHASIZE THAT IF YOU LOOK AT

435
00:15:22,620 --> 00:15:24,656
TOURISTS, THIS IS NONTOURIVE

436
00:15:24,656 --> 00:15:25,957
TRANSPLANTS, THE RATE OF

437
00:15:25,957 --> 00:15:28,860
INFECTION IS AS HIGH AS 54%

438
00:15:28,860 --> 00:15:29,627
AFTER ORGAN TRAFFICKED

439
00:15:29,627 --> 00:15:32,397
TRANSPLANTS SO THAT IS AN 85

440
00:15:32,397 --> 00:15:37,235
FOLD INCREASE IN INFECTIOUS

441
00:15:37,235 --> 00:15:37,435
RISK.

442
00:15:37,435 --> 00:15:39,938
THE THIRD RISK OF HAVING THESE

443
00:15:39,938 --> 00:15:43,174
LOW TRANSPLANT NUMBERS IS AROUND

444
00:15:43,174 --> 00:15:45,610
FINANCIAL IMPLICATIONS. 

445
00:15:45,610 --> 00:15:48,213
AND IT IS AROUND HOW WE DEAL

446
00:15:48,213 --> 00:15:51,049
WITH THE MONEY THAT WE ARE

447
00:15:51,049 --> 00:15:52,684
SPENDING FOR END STAGE RENAL

448
00:15:52,684 --> 00:15:53,017
FAILURE.

449
00:15:53,017 --> 00:15:56,254
AND IF WE ARE SPENDING SO MUCH

450
00:15:56,254 --> 00:16:00,592
MONEY ON DIALYSIS, IT TAKES AWAY

451
00:16:00,592 --> 00:16:02,727
FROM THIS POTENTIAL MONEY POOL

452
00:16:02,727 --> 00:16:03,895
FROM MORE COST EFFECTIVE

453
00:16:03,895 --> 00:16:05,063
TREATMENT WHICH WILL BE

454
00:16:05,063 --> 00:16:06,564
TRANSPLANTATION AND I THINK THIS

455
00:16:06,564 --> 00:16:08,800
IS A SERIOUS RISK AS WELL.

456
00:16:08,800 --> 00:16:12,070
BECAUSE IF YOU LOOK AT DIALYSIS

457
00:16:12,070 --> 00:16:13,138
ACTIVITY AND REMEMBER THIS SLIDE

458
00:16:13,138 --> 00:16:14,205
I SHOWED YOU RIGHT IN THE

459
00:16:14,205 --> 00:16:15,907
BEGINNING IN EMERGING ITS OF

460
00:16:15,907 --> 00:16:17,709
TRANSPLANTATION ACTIVITY, YOU

461
00:16:17,709 --> 00:16:20,345
CAN SEE HERE THAT THE BEST

462
00:16:20,345 --> 00:16:21,279
COUNTRIES PROVIDE DIALYSIS AT

463
00:16:21,279 --> 00:16:24,149
THE RATE OF OVER 600 PERMILLION

464
00:16:24,149 --> 00:16:26,284
POPULATION, BUT IN THE LOW%

465
00:16:26,284 --> 00:16:28,186
INCOME COUNTRIES WHICH HAD

466
00:16:28,186 --> 00:16:29,487
ALMOST NO TRANSPLANTATION,

467
00:16:29,487 --> 00:16:33,458
DIALYSIS IS PROVIDED AT 108 PER

468
00:16:33,458 --> 00:16:34,325
MILLION POPULATION.

469
00:16:34,325 --> 00:16:36,294
SO THE DIALYSIS IS IN A

470
00:16:36,294 --> 00:16:39,731
COMPLETELY DIFFERENT PLACE IN

471
00:16:39,731 --> 00:16:42,734
TERLS OF NUMBERS THAN

472
00:16:42,734 --> 00:16:43,368
TRANSPLANTATION.

473
00:16:43,368 --> 00:16:43,668
WHY IS THIS?

474
00:16:43,668 --> 00:16:45,970
I THINK THERE A SIGNIFICANT

475
00:16:45,970 --> 00:16:49,774
IMBALANCE IN THE UTILIZATION OF

476
00:16:49,774 --> 00:16:51,810
DIALYSIS AS THE PRIMARY RENAL

477
00:16:51,810 --> 00:16:53,978
REPLACEMENT THERAPY COMPARED TO

478
00:16:53,978 --> 00:16:55,814
KIDNEY TRANSPLANTATION.

479
00:16:55,814 --> 00:17:00,118
BECAUSE DIALYSIS REQUIRE FEWER

480
00:17:00,118 --> 00:17:01,653
HUMAN RESOURCES, FEWER STAFF,

481
00:17:01,653 --> 00:17:03,922
IT'S EASIER TO IMPLEMENT, MUCH

482
00:17:03,922 --> 00:17:06,124
EASIER THAN A TRANSPLANT PROGRAM

483
00:17:06,124 --> 00:17:08,593
AND IT'S FAIRLY EASY TO KALE IT

484
00:17:08,593 --> 00:17:09,093
ACCORDING TO NEED.

485
00:17:09,093 --> 00:17:10,762
BUT APPROXIMATE WE THINK ABOUT

486
00:17:10,762 --> 00:17:14,899
IT, THERE IS SO MANY GOOD

487
00:17:14,899 --> 00:17:16,534
ADVANTAGES TO KIDNEY

488
00:17:16,534 --> 00:17:17,669
TRANSPLANTATION TREMAINS FOR ME

489
00:17:17,669 --> 00:17:19,103
A QUESTION WHY THIS IS

490
00:17:19,103 --> 00:17:19,404
HAPPENING.

491
00:17:19,404 --> 00:17:21,172
WE KNOW THAT ANNUALLY, ACROSS

492
00:17:21,172 --> 00:17:23,641
THE WORLD, THERE ARE MORE THAN

493
00:17:23,641 --> 00:17:26,344
5 MILLION PATIENTS PER YEAR ON

494
00:17:26,344 --> 00:17:29,380
DIALYSIS, BUT ONLY ABOUT 5-10%

495
00:17:29,380 --> 00:17:32,016
OF THESE PATIENTS RECEIVE A

496
00:17:32,016 --> 00:17:32,317
TRANSPLANT.

497
00:17:32,317 --> 00:17:35,787
NOW, I WANT TO MAKE AN IMPORTANT

498
00:17:35,787 --> 00:17:38,957
STATEMENT HERE AND THAT IS THAT

499
00:17:38,957 --> 00:17:40,024
I THINK KIDNEY TRANSPLANTATION

500
00:17:40,024 --> 00:17:44,462
NEEDS TO BE PUT BACK ON TO THE

501
00:17:44,462 --> 00:17:46,264
HEALTHCARE AGENDAS OF OUR

502
00:17:46,264 --> 00:17:48,032
MINISTRIES OF HEALTH AND OUR

503
00:17:48,032 --> 00:17:50,602
DECISION MAKERS FOR THE

504
00:17:50,602 --> 00:17:51,669
FOLLOWING REASONS:  FIRSTLY, IT

505
00:17:51,669 --> 00:17:53,771
IS THE MOST COST EFFECTIVE

506
00:17:53,771 --> 00:17:55,673
TREATMENT.

507
00:17:55,673 --> 00:17:57,542
AND THIS HAS BEEN SHOWED IN MANY

508
00:17:57,542 --> 00:17:59,477
PARTS OF THE WORLD WHERE, IN

509
00:17:59,477 --> 00:18:01,346
EUROPE AND AMERICA BUT IT'S ALSO

510
00:18:01,346 --> 00:18:03,448
BEEN SHOWED IN LOW AND MIDDLE

511
00:18:03,448 --> 00:18:04,515
INCOME COUNTRIES LIKE THE STUDY

512
00:18:04,515 --> 00:18:05,583
I'M SHOWING YOU HERE FROM CHINA

513
00:18:05,583 --> 00:18:08,052
WHERE YOU CAN SEE THE COST OF

514
00:18:08,052 --> 00:18:10,455
HEMODIALYSIS, AND THE COST OF

515
00:18:10,455 --> 00:18:12,957
PERO TON EEL KIAL SIS IN THE TOP

516
00:18:12,957 --> 00:18:15,426
2 ROWS AND THEN THE COST OF

517
00:18:15,426 --> 00:18:16,261
KIDNEY TRAN TRANSPLANTATION IN

518
00:18:16,261 --> 00:18:17,028
THE FIRST YEAR VERSUS

519
00:18:17,028 --> 00:18:18,496
SECURITIZATION. YEAR AND YOU CAN

520
00:18:18,496 --> 00:18:19,430
IMMEDIATELY SEE IT'S DROPPING

521
00:18:19,430 --> 00:18:21,666
DOWN IN THE SECOND YEAR TO BE

522
00:18:21,666 --> 00:18:23,468
EQUAL TO HEMODIALYSIS AND IN THE

523
00:18:23,468 --> 00:18:27,906
LONG RUN BECOMES CHEAPER AND

524
00:18:27,906 --> 00:18:28,606
CHEAPER.

525
00:18:28,606 --> 00:18:29,774
HOWEVER, PROBABLY THIS IS AN

526
00:18:29,774 --> 00:18:30,408
IMPORTANT RESEARCH AREA THAT

527
00:18:30,408 --> 00:18:32,677
NEEDS TO BE FULLY EXPLORED

528
00:18:32,677 --> 00:18:34,646
BECAUSE WE DON'T HAVE SO MANY

529
00:18:34,646 --> 00:18:37,181
MODELS IN LOW AND MITTED INCOME

530
00:18:37,181 --> 00:18:39,150
COUNTRIES SHOWING THAT IT'S MORE

531
00:18:39,150 --> 00:18:39,817
COST EFFECTIVE.

532
00:18:39,817 --> 00:18:44,489
BUT WE DO HAVE MANY STUDIES

533
00:18:44,489 --> 00:18:47,558
SHOWING THAT PATIENTS ON

534
00:18:47,558 --> 00:18:48,860
DIALYSIS ARE A WORST OUTCOME IN

535
00:18:48,860 --> 00:18:50,728
EMERGING ITS OF SURVIVAL

536
00:18:50,728 --> 00:18:51,930
COMPARED TO KIDNEY TRANSPLANT

537
00:18:51,930 --> 00:18:53,331
PROGRAMS, SO FOR THAT REASON, WE

538
00:18:53,331 --> 00:18:56,401
CAN ALSO THINK ABOUT KIDNEY

539
00:18:56,401 --> 00:18:57,835
TRANSPLANTATION AS THE PRIORITY

540
00:18:57,835 --> 00:18:59,137
TREATMENT OPTION.

541
00:18:59,137 --> 00:19:00,638
AND THIRDLY, FOR QUALITY OF

542
00:19:00,638 --> 00:19:04,208
LIFE, YOU CAN IMAGINE THE

543
00:19:04,208 --> 00:19:06,611
DIALYSIS THAT TAKES PEOPLE OUT

544
00:19:06,611 --> 00:19:07,812
OF THE WORK SITUATION, WASTES A

545
00:19:07,812 --> 00:19:11,049
LOT OF TIME IN THE SOCIOECONOMIC

546
00:19:11,049 --> 00:19:13,551
PERSON GIVES A MUCH POORER

547
00:19:13,551 --> 00:19:15,954
QUALITY OF LIFE THAN A KIDNEY

548
00:19:15,954 --> 00:19:16,988
TRANSPLANT.

549
00:19:16,988 --> 00:19:19,958
SO TO SUMMARIZE SYDNEY

550
00:19:19,958 --> 00:19:21,459
TRANSPLANTS SHOULD BE

551
00:19:21,459 --> 00:19:23,361
PRIORITIZED BECAUSE OF COST

552
00:19:23,361 --> 00:19:24,062
EFFECTIVENESS, SURVIVAL RATES,

553
00:19:24,062 --> 00:19:27,098
ENHANCED QUALITY OF LIFE,

554
00:19:27,098 --> 00:19:28,132
ACCEPTABILITY, FAIRNESS,

555
00:19:28,132 --> 00:19:29,500
FEASIBILITY, AND SUPERIOR

556
00:19:29,500 --> 00:19:31,569
CLINICAL OUTCOMES AT A LOWER

557
00:19:31,569 --> 00:19:31,803
COST.

558
00:19:31,803 --> 00:19:37,108
WHY IS IT NOT HAPPENING?

559
00:19:37,108 --> 00:19:38,376
IT IS IMPORTANT TO THINK ABOUT

560
00:19:38,376 --> 00:19:39,777
WHAT IS DRIVING DIALYSIS.

561
00:19:39,777 --> 00:19:47,685
WELL IS A BILLION DOLLAR

562
00:19:47,685 --> 00:19:48,319
INDUSTRY DRIVING DIALYSIS.

563
00:19:48,319 --> 00:19:52,190
THE MARKET SIZE IS ESTIMATED TO

564
00:19:52,190 --> 00:19:56,160
BE 99.3 BILLION DOLLARS IN 2019

565
00:19:56,160 --> 00:20:00,331
AND ESTIMATED TO REACH 177

566
00:20:00,331 --> 00:20:02,734
BILLION DOLLARS BY 2027, THIS IS

567
00:20:02,734 --> 00:20:05,503
A GROWTH RATE OF 7.7% ISSUES

568
00:20:05,503 --> 00:20:06,537
WHICH IS HUGE.

569
00:20:06,537 --> 00:20:08,840
THIS COMES FROM THE FORTUNE

570
00:20:08,840 --> 00:20:09,240
BUSINESS INSIDES.

571
00:20:09,240 --> 00:20:12,643
AND WHAT ARE THE BIG CUTCHES

572
00:20:12,643 --> 00:20:15,446
PROVIDING DIALYSIS FOR INSTANCE

573
00:20:15,446 --> 00:20:18,883
LIKE FORZENIA, THEY HAVE OVER

574
00:20:18,883 --> 00:20:22,720
2800 PEOPLE ON DIALYSIS, DAVITA,

575
00:20:22,720 --> 00:20:24,022
2400 PEOPLE ON DIALYSIS, SO IT'S

576
00:20:24,022 --> 00:20:26,858
VERY DIFFICULT WHEN YOU HAVE

577
00:20:26,858 --> 00:20:28,226
THIS INDUSTRY DRIVING THE

578
00:20:28,226 --> 00:20:29,160
TREATMENT OPTION AS THE

579
00:20:29,160 --> 00:20:30,261
PREFERRED OPTION AND PUTTING A

580
00:20:30,261 --> 00:20:33,564
LOT OF MONEY INTO THIS TO MAKE

581
00:20:33,564 --> 00:20:34,599
THE CASE FOR TRANSPLANTATION AND

582
00:20:34,599 --> 00:20:37,268
TO MAKE SURE THAT PEOPLE PUT

583
00:20:37,268 --> 00:20:38,536
TRANSPLANTATION AS A FIRST

584
00:20:38,536 --> 00:20:40,571
OPTION FOR KIDNEY TRANSPLANT.

585
00:20:40,571 --> 00:20:43,074
BUT I ALL THINK WE HAVE TO

586
00:20:43,074 --> 00:20:46,577
UNDERSTAND WHAT ARE THE OTHER

587
00:20:46,577 --> 00:20:47,678
THINGS THAT MAY BE PLAYING A

588
00:20:47,678 --> 00:20:48,980
ROLE AND I THINK IT IS TRUE THAT

589
00:20:48,980 --> 00:20:52,050
THERE IS A LACK OF LEADERSHIP,

590
00:20:52,050 --> 00:20:53,818
ESPECIALLY OUTSIDE OF THE

591
00:20:53,818 --> 00:20:55,219
CLINICAL REALITY, WHEN WE HAVE

592
00:20:55,219 --> 00:20:56,954
MEETINGS WITH THE MINISTERS OF

593
00:20:56,954 --> 00:20:58,389
HEALTH FOR INSTANCE IN AFRICA,

594
00:20:58,389 --> 00:21:00,792
THEY DO FOCUS ON THE EVEN THINK

595
00:21:00,792 --> 00:21:02,260
ABOUT KIDNEY TRANSPLANTATION,

596
00:21:02,260 --> 00:21:03,528
THEY ONLY THINK ABOUT DIALYSIS.

597
00:21:03,528 --> 00:21:06,397
THERE IS A LACK OF STRATEGIC

598
00:21:06,397 --> 00:21:10,668
DECISION MAKING AROUND THE

599
00:21:10,668 --> 00:21:11,903
PREFERRED TREATMENT FOR KIDNEY

600
00:21:11,903 --> 00:21:12,804
TRANSPLANT AND THEN PATIENTS

601
00:21:12,804 --> 00:21:15,440
NEED TO BE EDUCATED BECAUSE SOME

602
00:21:15,440 --> 00:21:17,475
OF THEM THINK DIALYSIS IS AN

603
00:21:17,475 --> 00:21:18,943
EASIER OPTION, IT IS LESS

604
00:21:18,943 --> 00:21:20,578
INVASIVE AND THEY MAKE A CHOICE

605
00:21:20,578 --> 00:21:24,415
FOR DIALYSIS, SO THIS IS HUGE

606
00:21:24,415 --> 00:21:25,917
REASONS AND HUGE THOUGHTS THAT

607
00:21:25,917 --> 00:21:28,986
WE AS CLINICIANS NEED TO THINK

608
00:21:28,986 --> 00:21:29,187
ABOUT.

609
00:21:29,187 --> 00:21:30,988
THEN THERE'S ALSO THE WAY WE

610
00:21:30,988 --> 00:21:33,491
ORGANIZE OUR CLINICAL PRACTICE.

611
00:21:33,491 --> 00:21:40,131
SO, USUALLY IN MOST PLACES

612
00:21:40,131 --> 00:21:41,566
PATIENTS PRESENT WITH RENAL

613
00:21:41,566 --> 00:21:43,067
FAILURE, THE DOCTORS WORK THE

614
00:21:43,067 --> 00:21:44,802
PEASHT UP, THEY RECEIVE

615
00:21:44,802 --> 00:21:46,204
DIALYSIS, THEY GET ON A TRAN

616
00:21:46,204 --> 00:21:47,872
PLANT LIST AND IF THEY'RE LUCKY

617
00:21:47,872 --> 00:21:49,140
THEY WILL RECEIVE A TRAN PLANT.

618
00:21:49,140 --> 00:21:50,908
I THINK IT'S TIME FOR US

619
00:21:50,908 --> 00:21:52,877
ESPECIALLY IN LOW AND MIDDLE

620
00:21:52,877 --> 00:21:53,945
INCOME COUNTRIES TO RETHINK THE

621
00:21:53,945 --> 00:21:55,313
ORDER IN WHICH WE OFFER TREME.

622
00:21:55,313 --> 00:21:58,783
SHOULD WE SAY TO A PATIENT WHO

623
00:21:58,783 --> 00:22:00,184
PRESENTS WITH RENAL FAILURE THAT

624
00:22:00,184 --> 00:22:02,386
A KIDNEY TRAP PLANT IS YOUR BEST

625
00:22:02,386 --> 00:22:04,288
OPTION, THAT YOU SHOULD BRING

626
00:22:04,288 --> 00:22:05,490
FORWARD SOME OF YOUR FAMILY AND

627
00:22:05,490 --> 00:22:07,391
FRIENDS TO BE A POTENTIAL LIVING

628
00:22:07,391 --> 00:22:09,560
DONOR THAT WE IMMEDIATELY

629
00:22:09,560 --> 00:22:13,498
PRIORITIZE PEASHTS ON THE

630
00:22:13,498 --> 00:22:14,465
DECEASED DONOR'S WAITING LIST

631
00:22:14,465 --> 00:22:16,767
AND OHM USE DIALYSIS AS A

632
00:22:16,767 --> 00:22:18,503
BRIDGING METHOD FOR THESE PATES

633
00:22:18,503 --> 00:22:19,937
I BELIEVE WE WILL SAVE A LOT OF

634
00:22:19,937 --> 00:22:20,872
MONEY AND PROROADWAY A MUCH

635
00:22:20,872 --> 00:22:21,806
BETTER QUALITY OF LIFE.

636
00:22:21,806 --> 00:22:24,275
BUT THE SECOND PART OF MY TALK I

637
00:22:24,275 --> 00:22:26,177
WANT TO ALSO PLACE

638
00:22:26,177 --> 00:22:28,246
TRANSPLANTATION INTO YOUR MIND

639
00:22:28,246 --> 00:22:30,047
IN TERMS OF THE SUSTAINABLE

640
00:22:30,047 --> 00:22:31,048
DEVELOPMENT GOALS AND I HAVE

641
00:22:31,048 --> 00:22:32,350
QUITE A LOT OF THINGS THAT I

642
00:22:32,350 --> 00:22:35,186
WANT TO EMPHASIZE ON THIS SLIDE.

643
00:22:35,186 --> 00:22:36,521
SO FORGIVE ME FOR TAKING A BIT

644
00:22:36,521 --> 00:22:40,024
OF TIME ON THIS EMPLOY

645
00:22:40,024 --> 00:22:40,791
SUSTAINABLE DEVELOPMENT GOAL 3

646
00:22:40,791 --> 00:22:41,926
FOR GOOD HEALTH AND WELL BEING,

647
00:22:41,926 --> 00:22:44,228
I WILL TALK ABOUT THIS IN MORE

648
00:22:44,228 --> 00:22:47,231
DETAIL NOW, BUT WE ALL KNOW THAT

649
00:22:47,231 --> 00:22:47,932
TRANSPLANTATION PROMOTES WELL

650
00:22:47,932 --> 00:22:50,301
BEING WITH A FOCUS ON REDUCED

651
00:22:50,301 --> 00:22:51,836
MORTALITY, IMPROVING QUALITY OF

652
00:22:51,836 --> 00:22:55,106
LIFE, SO IT IS--IT IS A VERY

653
00:22:55,106 --> 00:22:55,940
LOGICAL THING THAT

654
00:22:55,940 --> 00:22:58,609
TRANSPLANTATION SITS IN THAT

655
00:22:58,609 --> 00:22:58,809
GOAL.

656
00:22:58,809 --> 00:23:00,511
BUT IT ALSO SITS IN SOME OF THE

657
00:23:00,511 --> 00:23:03,381
OTHER GOALS FOR INSTANCE, GOAL

658
00:23:03,381 --> 00:23:07,351
NUMBER 8, THIS PROMOTES

659
00:23:07,351 --> 00:23:07,952
SUSTAINED INCLUSIVE ECONOMIC

660
00:23:07,952 --> 00:23:12,356
GROWTH ISSUE FULL AND PRODUCTIVE

661
00:23:12,356 --> 00:23:13,157
EMPLOYMENT, DESCENT WORK

662
00:23:13,157 --> 00:23:14,625
EXPERIENCE FOR ALL, IT IS VERY

663
00:23:14,625 --> 00:23:16,627
DIFFICULT TO HAVE THIS IF YOU

664
00:23:16,627 --> 00:23:20,097
ARE ON DIALYSIS BUT

665
00:23:20,097 --> 00:23:21,365
TRANSPLANTATION PROVIDES YOU

666
00:23:21,365 --> 00:23:23,668
WITH THE OPPORTUNITY TO REMAIN

667
00:23:23,668 --> 00:23:24,402
ECONOMICALLY PRODUCTIVE THROUGH

668
00:23:24,402 --> 00:23:25,903
THE RETURN OF YOUR AUTONOMY.

669
00:23:25,903 --> 00:23:28,973
IT IS VERY EASY TO WORK AFTER A

670
00:23:28,973 --> 00:23:30,474
TRANSPLANT BUT IT'S VERY

671
00:23:30,474 --> 00:23:32,443
DIFFICULT TO WORK IF YOU ARE ON

672
00:23:32,443 --> 00:23:34,512
A RESOURCE AND TIME CONSUMING

673
00:23:34,512 --> 00:23:36,447
TREATMENT AND TO HOLD A

674
00:23:36,447 --> 00:23:38,749
FULL-TIME JOB WITH DIALYSIS.

675
00:23:38,749 --> 00:23:41,686
IF WE LOOK AT SUSTAINABLE

676
00:23:41,686 --> 00:23:43,754
DEVELOPMENT GOAL NUMBER 9, WE

677
00:23:43,754 --> 00:23:45,556
KNOW THAT TRANSPLANTATION HAS

678
00:23:45,556 --> 00:23:46,691
THE OPPORTUNITY TO STIMULATE

679
00:23:46,691 --> 00:23:50,027
GROWTH IN THE SECTOR INDUSTRY,

680
00:23:50,027 --> 00:23:51,662
SO, TRANSPLANTATION DEMANDS A

681
00:23:51,662 --> 00:23:54,065
SKILLED WORKFORCE AND A

682
00:23:54,065 --> 00:23:55,066
DEVELOPMENT INFRASTRUCTURE INTO

683
00:23:55,066 --> 00:23:55,666
THE HEALTHCARE SETTING.

684
00:23:55,666 --> 00:24:00,805
IF WE WANT TO HAVE SUCCESSFUL

685
00:24:00,805 --> 00:24:03,407
OUTCOMES IN ORGAN AND TISSUE

686
00:24:03,407 --> 00:24:04,842
TRANSPLANT WE NEED BIOENGINEERS.

687
00:24:04,842 --> 00:24:06,544
WE NEED ORGAN SUBSTITUTES, WE

688
00:24:06,544 --> 00:24:08,946
NEED BETTER MEANS FOR ORGAN

689
00:24:08,946 --> 00:24:10,081
PROFUSION AND TRAN SPORT

690
00:24:10,081 --> 00:24:12,850
SYSTEMS, WE NEED TO DEVELOP OUR

691
00:24:12,850 --> 00:24:16,254
CELL THERAPIES, SO ONCE AGAIN

692
00:24:16,254 --> 00:24:19,223
THIS FITS IN VERY WELL WITH

693
00:24:19,223 --> 00:24:20,591
SUSTAINABLE DEVELOPMENT GOAL 9

694
00:24:20,591 --> 00:24:21,659
WHICH DIALYSIS SIMPLY DID NOT DO

695
00:24:21,659 --> 00:24:22,593
AND THEN IF WEB CONNECTED LOOK

696
00:24:22,593 --> 00:24:27,531
AT THE 2 GOALS AROUND

697
00:24:27,531 --> 00:24:28,933
INEQUALITY, 5 AND 10, 1 IS

698
00:24:28,933 --> 00:24:30,067
EQUALITY IN GENERAL AND THE

699
00:24:30,067 --> 00:24:32,203
OTHER 1 SPECIFIC LOW AROUND

700
00:24:32,203 --> 00:24:35,206
GENDER INEQUALITY, WE KNOW THAT

701
00:24:35,206 --> 00:24:36,307
THE EQUALITY IN TRANSPLANTATION

702
00:24:36,307 --> 00:24:38,909
IS A VERY IMPORTANT PART OF HOW

703
00:24:38,909 --> 00:24:45,583
WE THINK AND HOW WE PRIORITIZE

704
00:24:45,583 --> 00:24:47,118
TO PATIENTS THE TREATMENT

705
00:24:47,118 --> 00:24:47,618
OPTIONS.

706
00:24:47,618 --> 00:24:49,220
WE ALSO THROUGH TRANSPLANTATION

707
00:24:49,220 --> 00:24:51,422
ADDRESS THE CULTURAL DISPARITIES

708
00:24:51,422 --> 00:24:53,958
RELATED TO GENDER AND

709
00:24:53,958 --> 00:24:54,425
MINORITIES.

710
00:24:54,425 --> 00:24:58,062
WE MAKE ONGOING MODIFICATIONS IN

711
00:24:58,062 --> 00:24:59,797
SECURING 4 LOCATION POLICIES FOR

712
00:24:59,797 --> 00:25:01,766
ORGANS AND THEN CAN THEN SERVE

713
00:25:01,766 --> 00:25:03,534
AS AN EXAMPLE IN SOME OF THE

714
00:25:03,534 --> 00:25:04,468
OTHER FIELDS ESPECIALLY WITH

715
00:25:04,468 --> 00:25:13,944
WHEN WE ARK --APPLY TO

716
00:25:13,944 --> 00:25:16,080
MINORITIES. 

717
00:25:16,080 --> 00:25:20,851
WHEN WE LOOK AT THE NEXT 1,

718
00:25:20,851 --> 00:25:22,086
TRANSPORTATION PROVIDES USE OF

719
00:25:22,086 --> 00:25:23,854
WATER AND LESS WASTE WATER WHICH

720
00:25:23,854 --> 00:25:24,889
IS DRICH QUITE DRAMATIC

721
00:25:24,889 --> 00:25:26,257
REDUCTIONAT BEINGLY BY DIALYSIS.

722
00:25:26,257 --> 00:25:30,061
THERE'S ALSO THIS PLASTIC WASTE

723
00:25:30,061 --> 00:25:32,730
CONSERVING RESOURCES AND

724
00:25:32,730 --> 00:25:34,265
PROMOTING SUSTAINABLE PRACTICES.

725
00:25:34,265 --> 00:25:39,003
IN TERMS OF GOAL 18,

726
00:25:39,003 --> 00:25:39,603
TRANSPLANTATION HAS GOT

727
00:25:39,603 --> 00:25:41,706
ADVANTAGE THAT IT HAS NO IMPACT

728
00:25:41,706 --> 00:25:43,541
ON GREENHOUSE GAS EMISSIONS FROM

729
00:25:43,541 --> 00:25:46,177
WASTE MANAGEMENT AND IT ALSO IS

730
00:25:46,177 --> 00:25:46,944
BUILDING RESILIENCE IN

731
00:25:46,944 --> 00:25:48,245
HEALTHCARE WHICH I WILL TALK

732
00:25:48,245 --> 00:25:58,756
ABOUT A LITTLE BIT AT THE END.

733
00:25:59,190 --> 00:26:04,962
IN TERMS OF PEACE ISSUES JUSTICE

734
00:26:04,962 --> 00:26:06,197
AND STRONG INSTITUTIONS, WE HAVE

735
00:26:06,197 --> 00:26:07,965
SOMETHING THAT IS BUILT FOR ALL,

736
00:26:07,965 --> 00:26:09,166
OOSKTIVE AND,A COUNTABLE ASK

737
00:26:09,166 --> 00:26:12,236
INCLUSIVE TO ALL INSTITUTIONS.

738
00:26:12,236 --> 00:26:14,105
THE YESTERDAY AND EQUITY

739
00:26:14,105 --> 00:26:15,806
PRINCIPLES UNDERPIN ORGAN TISSUE

740
00:26:15,806 --> 00:26:18,909
AND CELL DONATION PRACTICES,

741
00:26:18,909 --> 00:26:20,511
ADVANCING SOCIAL AND FINANCIAL

742
00:26:20,511 --> 00:26:21,645
CREDIBILITY BY DELIVERING HIGH

743
00:26:21,645 --> 00:26:24,281
QUALITY HEALTHCARE IN A

744
00:26:24,281 --> 00:26:25,883
TRANSPARENT AND ACCOUNTABLE

745
00:26:25,883 --> 00:26:27,585
MANNER BY COUNTERING TRANSPLANT

746
00:26:27,585 --> 00:26:30,354
TOURISM ALIGNS WITH THIS

747
00:26:30,354 --> 00:26:32,590
SUSTAINABLE DEVELOPMENT GOAL.

748
00:26:32,590 --> 00:26:36,961
FOLLOWING THE DECLARATION OF

749
00:26:36,961 --> 00:26:39,163
ISTANBUL, THIS IS JUSTICE,

750
00:26:39,163 --> 00:26:40,865
ALLOCATION AND STRENGTHENING OF

751
00:26:40,865 --> 00:26:42,133
LENL SLAIGZ ADDRESSING ORGAN

752
00:26:42,133 --> 00:26:44,068
TRAFFIC IN THIS SEVERAL

753
00:26:44,068 --> 00:26:44,702
COUNTRIES SUGGIESTING PROGRESS

754
00:26:44,702 --> 00:26:47,571
HAD BEEN MADE TOWARDS THIS GOAL.

755
00:26:47,571 --> 00:26:51,075
THE PRINCIPLES OF

756
00:26:51,075 --> 00:26:52,410
SELF-SUFFICIENCY AND FINANCIAL

757
00:26:52,410 --> 00:26:53,844
NEUTRALITY ARE SUCH IMPORTANT

758
00:26:53,844 --> 00:26:54,578
PRINCIPLES IN TRANSPLANTATION

759
00:26:54,578 --> 00:26:56,847
AND ONCE AGAIN FITS WELL INTO

760
00:26:56,847 --> 00:26:57,782
THIS GOAL.

761
00:26:57,782 --> 00:27:00,551
AND THEN LASTLY, PARTNERSHIP FOR

762
00:27:00,551 --> 00:27:03,421
THE GOALS, THERE IS NO BETTER

763
00:27:03,421 --> 00:27:04,588
PARTNERSHIP EXAMPLE THAN

764
00:27:04,588 --> 00:27:06,957
TRANSPLANTATION, WE SHARE

765
00:27:06,957 --> 00:27:10,094
TECHNOLOGY, WE SHARE NOVEL

766
00:27:10,094 --> 00:27:11,128
THERAPY, IMPROVED STANDARDS IN

767
00:27:11,128 --> 00:27:13,431
OUR TISSUE TYPING AND OTHER

768
00:27:13,431 --> 00:27:15,900
LABS, IT FOSTERS COOPERATION

769
00:27:15,900 --> 00:27:18,869
AMONG GOVERNMENTS, AMONG

770
00:27:18,869 --> 00:27:21,305
BUSINESSES, AMONG INDIVIDUALS,

771
00:27:21,305 --> 00:27:23,774
SCIENTISTS, CIVIL SOCIETY, AND

772
00:27:23,774 --> 00:27:28,412
PROVIDE A SUSTAINABLE NATIONAL

773
00:27:28,412 --> 00:27:29,146
AND REGIONAL PROGRAM.

774
00:27:29,146 --> 00:27:31,949
BUT IT IS TRUE, THAT THE MOST

775
00:27:31,949 --> 00:27:33,984
IMPORTANT PLACE FOR

776
00:27:33,984 --> 00:27:34,685
TRANSPLANTATION IS AROUND GOOD

777
00:27:34,685 --> 00:27:44,161
HEALTH AND WELL BEING. 

778
00:27:44,161 --> 00:27:47,131
AND THERE ARE SEVERAL TARGET 4

779
00:27:47,131 --> 00:27:49,767
TO PREVENT PREMATURE MORTALITY

780
00:27:49,767 --> 00:27:53,604
FOR NONCOMMUNICABLE DECS, TARGET

781
00:27:53,604 --> 00:27:55,372
8 TO HAVE FINANCIAL RISK

782
00:27:55,372 --> 00:27:56,207
PROTECTION TO PATIENTS, ACCESS

783
00:27:56,207 --> 00:28:01,178
TO QUALITY AND ESSENTIAL

784
00:28:01,178 --> 00:28:02,446
HEALTHCARE SERVICES

785
00:28:02,446 --> 00:28:03,047
RECOMMENDATION C SUBSTANTIALLY

786
00:28:03,047 --> 00:28:05,649
INCREASE HELT CARE FINANCING,

787
00:28:05,649 --> 00:28:06,317
RECRUITMENT, DEVELOPMENT,

788
00:28:06,317 --> 00:28:10,454
TRAINING AND RETENTION OF THE

789
00:28:10,454 --> 00:28:11,722
HEALTH WORKFORCE, AND

790
00:28:11,722 --> 00:28:12,990
RECOMMENDATION D, STRENGTHENING

791
00:28:12,990 --> 00:28:15,893
THE CAPACITY OF ALL COUNTRIES IN

792
00:28:15,893 --> 00:28:17,361
PARTICULAR DEVELOPING COUNTRIES

793
00:28:17,361 --> 00:28:19,196
FOR EARLY WARNING, RISK

794
00:28:19,196 --> 00:28:21,465
REDUCTION, AND MANAGEMENT OF

795
00:28:21,465 --> 00:28:26,437
NAGGAL AND  GLOBAL HEALTH RISKS.

796
00:28:26,437 --> 00:28:27,838
THE BURDEN OF NONCOMMUNICABLE

797
00:28:27,838 --> 00:28:29,006
DEC HAS BECOME A CRITICAL

798
00:28:29,006 --> 00:28:30,741
CONCERN IN THESE DEVELOPING

799
00:28:30,741 --> 00:28:32,543
COUNTRIES AS THEY TRANSITION

800
00:28:32,543 --> 00:28:35,045
FROM LOW, LOW INCOME COUNTRIES

801
00:28:35,045 --> 00:28:37,481
TO MIDDLE INCOME STATUS, THIS

802
00:28:37,481 --> 00:28:41,585
TRANSITION IS A ACCOMP PANIED BY

803
00:28:41,585 --> 00:28:42,520
BY GLOBALIZATION WHICH RESULTS

804
00:28:42,520 --> 00:28:46,891
IN AN AGING POPULATION.

805
00:28:46,891 --> 00:28:48,125
SIGNIFICANTLY NONCOMMUNICABLE

806
00:28:48,125 --> 00:28:49,393
DISEASES OFTEN AFFLICT WORKING

807
00:28:49,393 --> 00:28:51,095
AGE INDIVIDUALS CAUSING A

808
00:28:51,095 --> 00:28:55,799
PROFOUND SOCIAL AND ECONOMIC

809
00:28:55,799 --> 00:28:56,267
IMPACT.

810
00:28:56,267 --> 00:28:58,669
THIS INCLUDES SUBSTANTIAL

811
00:28:58,669 --> 00:28:59,370
PROCESSES IN PRODUCTIVITY,

812
00:28:59,370 --> 00:29:01,071
PEOPLE EXITING THE WORKFORCE,

813
00:29:01,071 --> 00:29:02,406
SPOUSES LEAVING THEIR YOBS TO

814
00:29:02,406 --> 00:29:05,376
CARE FOR ILL FAMILY MEMBERS, ET

815
00:29:05,376 --> 00:29:05,676
CETERA.

816
00:29:05,676 --> 00:29:08,245
THE COMMISSION HAS GOT A VERY

817
00:29:08,245 --> 00:29:10,381
INTERESTING REPORT WHICH I'M

818
00:29:10,381 --> 00:29:12,650
GOING TO SHOW YOU SOME OF IN MY

819
00:29:12,650 --> 00:29:14,752
NEXT SLIDE ALSO IN WHICH THEY

820
00:29:14,752 --> 00:29:16,387
ARE STATING THAT TRANSPLANTATION

821
00:29:16,387 --> 00:29:17,788
THERAPY IS THE MOST COST

822
00:29:17,788 --> 00:29:19,823
EFFECTIVE AND SOMETIMES THE ONLY

823
00:29:19,823 --> 00:29:20,891
AVAILABLE TREATMENT OPTION FOR

824
00:29:20,891 --> 00:29:23,527
THOUSANDS OF PATIENTS FACING

825
00:29:23,527 --> 00:29:27,031
ORGAN FAILURE, CANCER, AND OTHER

826
00:29:27,031 --> 00:29:28,299
CONDITIONS STEMMING FROM NCDs.

827
00:29:28,299 --> 00:29:31,468
AND THEY HAVE MADE A VERY

828
00:29:31,468 --> 00:29:35,005
IMPORTANT POINT ALSO AROUND THE

829
00:29:35,005 --> 00:29:36,140
INTERSECTORRAL POLICIES THAT

830
00:29:36,140 --> 00:29:38,008
HAVE TO BE DRIVEN AND THIS HAS

831
00:29:38,008 --> 00:29:39,276
TO DO WITH PREVENTION AND I

832
00:29:39,276 --> 00:29:40,344
THINK THAT IS ALWAYS IMPORTANT

833
00:29:40,344 --> 00:29:42,413
FOR US WHEN WE TALK ABOUT A HIGH

834
00:29:42,413 --> 00:29:44,148
LEVEL TREATMENT OPTION LIKE

835
00:29:44,148 --> 00:29:47,751
TRANSPLANTATION, TO ALSO TALK

836
00:29:47,751 --> 00:29:48,385
ABOUT PREVENTION.

837
00:29:48,385 --> 00:29:52,623
PREVENTION THEN CAN HELP US TO

838
00:29:52,623 --> 00:29:53,624
BE MORE SELF-SUFFICIENT BECAUSE

839
00:29:53,624 --> 00:29:57,528
LESS PEOPLE WILL GET END STAGE

840
00:29:57,528 --> 00:29:59,530
ORGAN FAILURE.

841
00:29:59,530 --> 00:30:02,032
THIS IS AN INTERESTING EXAMPLE

842
00:30:02,032 --> 00:30:03,767
OF A LOW MITTED INCOME COUNTRY

843
00:30:03,767 --> 00:30:06,170
WHO HAVE DONE QUITE WELL IN

844
00:30:06,170 --> 00:30:10,574
TERMS OF DRIVING TRABZ PLANT

845
00:30:10,574 --> 00:30:14,712
PRACTICE, DR. RISVE RUNS A

846
00:30:14,712 --> 00:30:16,213
TRANSPLANT NOT FOR PROFIT CENTER

847
00:30:16,213 --> 00:30:17,448
IN PAKISTAN.

848
00:30:17,448 --> 00:30:19,283
THEY'RE DOING ABOUT 6-8

849
00:30:19,283 --> 00:30:21,752
TRANSPLANTS PER WEEK WHICH COMES

850
00:30:21,752 --> 00:30:23,120
TO QUITE A LOT OVER A WREER AND

851
00:30:23,120 --> 00:30:25,389
1 OF THE MOST ACTIVE TRANSPLANT

852
00:30:25,389 --> 00:30:26,323
DRUG PROGRAMS IN PAKISTAN AND

853
00:30:26,323 --> 00:30:32,496
WHAT IS INTERESTING ABOUT THIS

854
00:30:32,496 --> 00:30:35,399
PROGRAM IS THAT IT HAS A GOOD

855
00:30:35,399 --> 00:30:35,933
FINANCIAL MODEL, COMBINING

856
00:30:35,933 --> 00:30:36,700
FINANCIAL SUPPORT FOR THE

857
00:30:36,700 --> 00:30:39,603
GOVERNMENT WITH CONSTRUCTIONS

858
00:30:39,603 --> 00:30:41,672
FROM THE COMMUNITY, SO THESE

859
00:30:41,672 --> 00:30:42,806
GRANT FINDINGS FROM COMMUNITY

860
00:30:42,806 --> 00:30:48,078
AND FROM THE PUBLIC IN

861
00:30:48,078 --> 00:30:49,947
COMBINATION WITH THE PROVENTIAL

862
00:30:49,947 --> 00:30:51,248
BUDGET MAKES THIS AREA

863
00:30:51,248 --> 00:30:53,083
COMPLETELY ACCESSIBLE AND FREE

864
00:30:53,083 --> 00:30:56,820
FOR PATIENTS IN THIS REGION

865
00:30:56,820 --> 00:30:58,188
EMPLOY SO IT'S NOT ACROSS

866
00:30:58,188 --> 00:30:59,556
PAKISTAN BUT IT IS AN

867
00:30:59,556 --> 00:31:00,290
INTERESTING EXAMPLE OF HOW

868
00:31:00,290 --> 00:31:01,425
PEOPLE COME TOGETHER TO CREATE

869
00:31:01,425 --> 00:31:04,128
SOMETHING THAT IS SUSTAINABLE

870
00:31:04,128 --> 00:31:05,329
EMPLOY AND THEN I JUDGE UOF THE

871
00:31:05,329 --> 00:31:09,533
WANT TO SAY SOMETHING ABOUT THE

872
00:31:09,533 --> 00:31:10,200
SUSTAINABLE DEVELOPMENT GOAL

873
00:31:10,200 --> 00:31:11,268
NUMBER 13 WHICH IS A LITTLE BIT

874
00:31:11,268 --> 00:31:14,805
MORE THAN WHAT I SAID BEFORE AND

875
00:31:14,805 --> 00:31:16,774
REMEMBER THAT HEALTHCARE IN THE

876
00:31:16,774 --> 00:31:18,242
GENERAL CONTRIBUTES TO FOSSIL

877
00:31:18,242 --> 00:31:20,844
FUEL EMATIONS AND THE CLIMATE

878
00:31:20,844 --> 00:31:21,078
CRISIS.

879
00:31:21,078 --> 00:31:23,681
IF HEALTHCARE WAS A COUNTRY IT

880
00:31:23,681 --> 00:31:26,684
WOULD BE THE FIFTH HIGHEST

881
00:31:26,684 --> 00:31:30,988
EMITTER WORLD WIDE EXCEEDING

882
00:31:30,988 --> 00:31:32,156
AIRPLANE TRAVEL, THIS SUGGESTS

883
00:31:32,156 --> 00:31:34,458
THAT THE HEALTHCARE SECTOR IS

884
00:31:34,458 --> 00:31:39,596
NOW RESPONSIBILITY FOR 5.2% OF

885
00:31:39,596 --> 00:31:41,098
THE TBLOABAL FOSSIL FUEL

886
00:31:41,098 --> 00:31:42,599
EMISSION AND THE DIALYSIS IS

887
00:31:42,599 --> 00:31:46,236
PROBABLY 1 OF THE BIGGEST

888
00:31:46,236 --> 00:31:47,638
DRIVERS WITHIN HEALTHCARE FOR

889
00:31:47,638 --> 00:31:54,378
THIS PROCESS, IT HAS A VERY

890
00:31:54,378 --> 00:31:55,212
LARGE CARBON FOOTPRINT AND

891
00:31:55,212 --> 00:31:56,947
FIRSTLY IN TERMS OF WATER, CAN

892
00:31:56,947 --> 00:32:02,753
YOU SAY THAT ABOUT 120 LITERS OF

893
00:32:02,753 --> 00:32:05,856
PURIFIED WATER S&P USED
DURING A

894
00:32:05,856 --> 00:32:06,690
4-HOUR DIALYSIS SESSION.

895
00:32:06,690 --> 00:32:12,029
IN TERMS OF ENERGY, 1 4-HOUR

896
00:32:12,029 --> 00:32:13,864
SESSION REACHES THE TOTAL ENERGY

897
00:32:13,864 --> 00:32:15,733
OF A TOTAL HOUSEHOLD PER DAY

898
00:32:15,733 --> 00:32:17,234
EMPLOY A HUGE AMOUNT OF MEDICAL

899
00:32:17,234 --> 00:32:20,204
WASTE, SO WE'RE THINKING

900
00:32:20,204 --> 00:32:24,208
DIALYSIS, AV TUBING SETTING,

901
00:32:24,208 --> 00:32:27,211
NEEDLES, SODIUM CARTRIDGES,

902
00:32:27,211 --> 00:32:31,148
BAGS, BI CARBONATE, ACID

903
00:32:31,148 --> 00:32:32,616
SOLUTIONS, ENDOTOXINS CULTURES,

904
00:32:32,616 --> 00:32:34,017
TRANSPORTATION AND MATERIAL, SO

905
00:32:34,017 --> 00:32:38,355
THE USUAL TRANSPORTATION WASTES

906
00:32:38,355 --> 00:32:42,893
AND PATIENTS TRAVELING WITH

907
00:32:42,893 --> 00:32:44,795
LOCAL FACILITY AND SO CURRENTLY

908
00:32:44,795 --> 00:32:47,164
IT'S ESTIMATE THAD WE HAVE MORE

909
00:32:47,164 --> 00:32:49,566
THAN 600 MILLION HEMODIALYSIS

910
00:32:49,566 --> 00:32:50,834
SESSIONS EVERY YEAR WORLD WIDE.

911
00:32:50,834 --> 00:32:55,272
AND THE NUMBER OF PATIENTS HAD

912
00:32:55,272 --> 00:32:55,672
ARE STILL GROWING.

913
00:32:55,672 --> 00:32:58,041
SO JUST FROM THAT POINT OF VIEW,

914
00:32:58,041 --> 00:32:58,742
TRANSPLANTATION IS SUCH AN

915
00:32:58,742 --> 00:33:03,814
IMPORTANT PART OF WHAT WE HAVE

916
00:33:03,814 --> 00:33:06,583
TO DRIVE FOR OUR PATIENTS AND

917
00:33:06,583 --> 00:33:07,151
FOR OUR PLANET.

918
00:33:07,151 --> 00:33:08,418
BUT IF WE DID THIS RIGHT WHAT

919
00:33:08,418 --> 00:33:12,256
WOULD BE THE FURTHER ADVANTAGES

920
00:33:12,256 --> 00:33:14,224
FOR OUR HEALTHCARE CASES.

921
00:33:14,224 --> 00:33:15,359
TRANSPLANTATION REALLY HAS GOT

922
00:33:15,359 --> 00:33:19,930
AN IMPORTANT IMPACT ON A

923
00:33:19,930 --> 00:33:20,864
HEALTHCARE SYSTEMS RESILIENCE.

924
00:33:20,864 --> 00:33:21,932
THE TRANSPLANTATION OF VITAL

925
00:33:21,932 --> 00:33:24,268
ORGANS LIKE THE HARE, KIDNEYS,

926
00:33:24,268 --> 00:33:26,370
LIVERS AND LUNGS HAS A PROFOUND

927
00:33:26,370 --> 00:33:27,604
IMPACT NOT ONLY ON THE

928
00:33:27,604 --> 00:33:29,439
INDIVIDUAL'S HEALTH BUT ALSO ON

929
00:33:29,439 --> 00:33:32,843
THE BROADER HEALTHCARE SYSTEM.

930
00:33:32,843 --> 00:33:35,579
THE IMPACT IS MULTIFACETED AS

931
00:33:35,579 --> 00:33:37,414
TRANSPLANTATION NOT ONLY ADDRESS

932
00:33:37,414 --> 00:33:38,448
NONCOMMUNICABLE DISEASE AND

933
00:33:38,448 --> 00:33:40,884
UNIVERSAL ACCESS TO HEALTH BUT

934
00:33:40,884 --> 00:33:41,585
ALSO POSITIVELY INFLUENCE

935
00:33:41,585 --> 00:33:44,988
HEALTHCARE IN A MORE GENERAL

936
00:33:44,988 --> 00:33:45,622
SENSE.

937
00:33:45,622 --> 00:33:47,591
IT INVOLVES INTRICATE MEDICAL

938
00:33:47,591 --> 00:33:49,293
PROCEDURES, IMMUNE SUPPRESSIVE

939
00:33:49,293 --> 00:33:51,261
TREATMENTS, LIFE LONG MONITORING

940
00:33:51,261 --> 00:33:52,296
WHICH INTRODUCE A COMPLEXITY

941
00:33:52,296 --> 00:33:55,265
INTO THE HEALTHCARE SYSTEM, IN

942
00:33:55,265 --> 00:33:58,202
PLACE OF DRUGS FOR INSTANCE

943
00:33:58,202 --> 00:34:00,137
RAISES CONCERNS ABOUT SIDE

944
00:34:00,137 --> 00:34:01,672
EFFECTS AND INCREASE OF

945
00:34:01,672 --> 00:34:03,173
INFECTION, THIS LAYER OF

946
00:34:03,173 --> 00:34:05,175
COMPLEXITY HELPS TO IMPROVE

947
00:34:05,175 --> 00:34:06,543
SURGICAL PROCEDURES, COUNTRIES

948
00:34:06,543 --> 00:34:09,179
WITH ESTABLISHED TRANSPLANT

949
00:34:09,179 --> 00:34:10,848
PROGRAMS HAVE AN ENHANCED

950
00:34:10,848 --> 00:34:12,082
HEALTHCARE SYSTEM COMPARED TO

951
00:34:12,082 --> 00:34:14,284
COUNTRY WHO IS DON'T HAVE IT.

952
00:34:14,284 --> 00:34:19,289
EXPERTISE AND KNOWLEDGE AROUND

953
00:34:19,289 --> 00:34:21,658
INFECTION MANAGEMENT IMPROVE

954
00:34:21,658 --> 00:34:22,593
LABORATORIES UNDERSTAND BETTER

955
00:34:22,593 --> 00:34:32,469
HOW TO DO POST OPERATIVE AND

956
00:34:32,469 --> 00:34:33,136
SCREENING, PHARMAICOLOGICAL DRUG

957
00:34:33,136 --> 00:34:34,438
SCREENING AND THIS DOESN'T

958
00:34:34,438 --> 00:34:35,572
HAPPEN IN THE PROGRAM.

959
00:34:35,572 --> 00:34:38,108
WHILE IT IS IN MANY PLACES IT IS

960
00:34:38,108 --> 00:34:39,877
OFTEN NOT STREAMLINED TO WORK

961
00:34:39,877 --> 00:34:40,911
TOGETHER EFFICIENTLY.

962
00:34:40,911 --> 00:34:41,845
TRANSPLANTATION REQUIRES THESE

963
00:34:41,845 --> 00:34:44,114
THINGS TO WORK TOGETHERENTIOUS

964
00:34:44,114 --> 00:34:46,083
FICIENTLY AND THEREFORE BENEFIT

965
00:34:46,083 --> 00:34:50,354
ALL PATIENTS, NOT ONLY THOSE

966
00:34:50,354 --> 00:34:52,122
WHORY CEIVE A TRANSPLANT.

967
00:34:52,122 --> 00:34:53,290
ACHIEVING RESILIENCE IN A

968
00:34:53,290 --> 00:34:54,992
HEALTHCARE SYSTEM COULD REFER TO

969
00:34:54,992 --> 00:34:57,094
CREATING SOME FORM OF

970
00:34:57,094 --> 00:34:58,128
COMPREHENSIVE HEALTHCARE SYSTEM

971
00:34:58,128 --> 00:35:01,565
THAT COVERS THE COST OF YOUR

972
00:35:01,565 --> 00:35:03,233
TRANSPLANT, REDUCE FINANCIAL

973
00:35:03,233 --> 00:35:04,268
BARRIERS FOR PATIENTS.

974
00:35:04,268 --> 00:35:05,569
THAT'S INSURING THAT IT IS

975
00:35:05,569 --> 00:35:06,403
ACCESSIBLE TO EVERYONE

976
00:35:06,403 --> 00:35:09,473
REGARDLESS OF THE ABILITY TO PAY

977
00:35:09,473 --> 00:35:12,943
AND INSURING EQUITABLE ACCESS TO

978
00:35:12,943 --> 00:35:14,211
TRANSPLANTATION REGARDING YOUR

979
00:35:14,211 --> 00:35:16,146
SOCIOECONOMIC STATUS.

980
00:35:16,146 --> 00:35:17,547
RISWRELIENCY BEING MEAN BUILDING

981
00:35:17,547 --> 00:35:20,517
A ROBUST SYSTEM THAT CAN

982
00:35:20,517 --> 00:35:21,685
WITHSTAND CHALLENGES AS WE

983
00:35:21,685 --> 00:35:23,086
RECENTLY EXPERIENCED DURING THE

984
00:35:23,086 --> 00:35:24,388
COVID PANDEMIC AND AS WELL AS

985
00:35:24,388 --> 00:35:27,824
HAVING THE ABILITY TO ADAPT AND

986
00:35:27,824 --> 00:35:28,692
CHANGE VERY EFFECTIVELY.

987
00:35:28,692 --> 00:35:31,929
IT MAY INCLUE DEVELOPING BETTER,

988
00:35:31,929 --> 00:35:33,130
FAIRER AND MORE TRANSPARENT

989
00:35:33,130 --> 00:35:35,165
ORGAN LOCATION SYSTEMS TO

990
00:35:35,165 --> 00:35:36,900
ENHANCE RESILIENCY IN GENERAL,

991
00:35:36,900 --> 00:35:39,069
BUT ESTABLISHING CLEAR CRITERIA

992
00:35:39,069 --> 00:35:41,505
FOR ORGAN DISTRIBUTION AND

993
00:35:41,505 --> 00:35:42,639
PRIORITIZING PATIENTS, PATIENTS

994
00:35:42,639 --> 00:35:46,944
ON MEDICAL NEED RATHER THAN

995
00:35:46,944 --> 00:35:49,012
FINANCIAL RESOURCES FOR EXAMPLE

996
00:35:49,012 --> 00:35:51,281
THAT WAY WE PROMOTE EQUITY AND

997
00:35:51,281 --> 00:35:52,616
REDUCE DISPARITY.

998
00:35:52,616 --> 00:35:54,451
AS MENTIONED ENCOURAGING

999
00:35:54,451 --> 00:35:56,219
COLLABORATION AND NETWORKING

1000
00:35:56,219 --> 00:35:57,220
BETWEEN TRANSPLANT CENTERS,

1001
00:35:57,220 --> 00:35:58,956
HEALTHCARE PROVIDERS AND

1002
00:35:58,956 --> 00:35:59,756
RESEARCHERS ALLOWS FOSTERING OF

1003
00:35:59,756 --> 00:36:01,158
KNOWLEDGE SHARING AND

1004
00:36:01,158 --> 00:36:04,161
DEVELOPMENT OF BASED PRACTICES.

1005
00:36:04,161 --> 00:36:07,597
THIS CAN HELP HOLD A RESILIENT

1006
00:36:07,597 --> 00:36:08,298
TRANSPLANT ECOSYSTEM THAT CAN

1007
00:36:08,298 --> 00:36:09,299
ASHES DATA PROTECTION TO

1008
00:36:09,299 --> 00:36:10,367
CHALLENGES AND PROVIEDMAN A BEST

1009
00:36:10,367 --> 00:36:12,269
POSSIBLE CARE FOR PATIENTS.

1010
00:36:12,269 --> 00:36:13,403
INVESTING IN RESEARCH AND

1011
00:36:13,403 --> 00:36:16,139
INMODEL CITIZENIVATION IS

1012
00:36:16,139 --> 00:36:17,774
ESSENTIAL FOR ENHANCING

1013
00:36:17,774 --> 00:36:19,843
RESILIENCY IN ORGAN

1014
00:36:19,843 --> 00:36:21,211
TRANSPLANTATION WITH ENGEAJING

1015
00:36:21,211 --> 00:36:24,514
ADVANCEMENT IN REGENERATIVE

1016
00:36:24,514 --> 00:36:26,383
MEDICINE, IMMUNE SUPPRESSIVE

1017
00:36:26,383 --> 00:36:28,952
THERAPY, ORGAN PRESERVATION

1018
00:36:28,952 --> 00:36:29,586
TECHNIQUES, IMPROVED OUTCOME,

1019
00:36:29,586 --> 00:36:31,755
EXPAND THE POOL OF VIABLE ORGANS

1020
00:36:31,755 --> 00:36:33,290
SO WE WILL ALSO THROUGH THIS

1021
00:36:33,290 --> 00:36:37,794
RACE, PUBLIC AWARENESS AND

1022
00:36:37,794 --> 00:36:38,328
INCREASE DONATION RATES.

1023
00:36:38,328 --> 00:36:41,365
EDUCATION TO THE PUBLIC ABOUT

1024
00:36:41,365 --> 00:36:43,233
THE BENEFITS, RISKS AND

1025
00:36:43,233 --> 00:36:44,501
PROCEDURES INVOLVED IN

1026
00:36:44,501 --> 00:36:45,902
TRANSPLANTATION CAN ADDRESS

1027
00:36:45,902 --> 00:36:48,071
MISCONCEPTIONS AND PROMOTE MORE

1028
00:36:48,071 --> 00:36:50,941
INFORMED DECISION MAKING IN

1029
00:36:50,941 --> 00:36:51,174
GENERAL.

1030
00:36:51,174 --> 00:36:52,809
SO I WANT TO END MY TALK BY

1031
00:36:52,809 --> 00:36:57,547
SHOWING YOU SOME OF THE BARRIERS

1032
00:36:57,547 --> 00:36:59,516
WHY LOW AND MIDDLE INCOME

1033
00:36:59,516 --> 00:37:01,952
COUNTRIES ARE NOT MANAGING TO DO

1034
00:37:01,952 --> 00:37:03,320
THIS DESPITE ALL THE GOOD

1035
00:37:03,320 --> 00:37:04,254
REASONS I'VE GIVEN YOU.

1036
00:37:04,254 --> 00:37:06,656
WHEN WE TALK ABOUT THE DISEASE

1037
00:37:06,656 --> 00:37:13,764
DONATION, THERE ARE SPECIFIC

1038
00:37:13,764 --> 00:37:16,166
BARRIERS, OF COURSE DISEASE

1039
00:37:16,166 --> 00:37:17,868
DONATION, WE NEED INFRASTRUCTURE

1040
00:37:17,868 --> 00:37:22,672
AND TISSUE TYPING AND LABORATORY

1041
00:37:22,672 --> 00:37:24,241
FACILITIES.

1042
00:37:24,241 --> 00:37:25,709
FURTHER MORE DECEASED DONATION

1043
00:37:25,709 --> 00:37:27,978
ALLOWS THE PUBLIC TO BUY INTO

1044
00:37:27,978 --> 00:37:29,279
THE INFORMATION AND FOR THEIR

1045
00:37:29,279 --> 00:37:30,714
FAMILY TO BE DONORS SO THAT IS A

1046
00:37:30,714 --> 00:37:31,815
FURTHER IS IT EPI-BLAST THAT IS

1047
00:37:31,815 --> 00:37:33,183
REQUIRED AND OFTEN IF THESE

1048
00:37:33,183 --> 00:37:34,885
THINGS ARE NOT AVAILABLE,

1049
00:37:34,885 --> 00:37:37,554
COUNTRIES ARE NOT ABLE TO DRIVE

1050
00:37:37,554 --> 00:37:39,456
FOR THE DECEASE DONATION

1051
00:37:39,456 --> 00:37:39,689
PROGRAM.

1052
00:37:39,689 --> 00:37:40,991
I'VE TALKED ABOUT COST AND I'VE

1053
00:37:40,991 --> 00:37:43,860
SHOWN YOU A STUDY IN CHINA BUT I

1054
00:37:43,860 --> 00:37:48,265
THINK THAT WE ARE OFTEN QUOTING

1055
00:37:48,265 --> 00:37:50,233
HIGH INCOME COUNTRIES WHEN WE

1056
00:37:50,233 --> 00:37:52,135
DISCUSS COST OF TRANSPLANTATION.

1057
00:37:52,135 --> 00:37:54,971
IN AFRICA AND SOME OF THE LOWER

1058
00:37:54,971 --> 00:37:55,672
MIDDLE INCOME COUNTRIES ISSUES

1059
00:37:55,672 --> 00:37:57,641
THE COST OF FOLLOW UP CARE AND

1060
00:37:57,641 --> 00:37:59,276
THE PARTICULARLY THE COST OF

1061
00:37:59,276 --> 00:38:00,343
IMMUNE SUPPRESS IS VERY HIGH AND

1062
00:38:00,343 --> 00:38:01,645
WE HAVE TO REALLY DO SOME WORK

1063
00:38:01,645 --> 00:38:06,383
TO LOOK AT THE COST OF MINE

1064
00:38:06,383 --> 00:38:07,784
TAINING A FUNCTIONING GRAFT

1065
00:38:07,784 --> 00:38:08,151
VERSUS DIALYSIS.

1066
00:38:08,151 --> 00:38:10,053
AND IF THERE IS A BIG

1067
00:38:10,053 --> 00:38:11,088
DISCREMANCY WE FEED TO WORK ON

1068
00:38:11,088 --> 00:38:13,657
THAT COST BECAUSE IT SHOULD NOT

1069
00:38:13,657 --> 00:38:14,791
BE SO EXPENSIVE.

1070
00:38:14,791 --> 00:38:17,160
GOVERNMENT SUPPORT FOR

1071
00:38:17,160 --> 00:38:18,095
TRANSPLANT PROGRAMS IS VERY

1072
00:38:18,095 --> 00:38:19,362
IMPORTANT, IT IS VERY DIFFICULT

1073
00:38:19,362 --> 00:38:20,831
FOR AN INDIVIDUAL PROFESSIONAL

1074
00:38:20,831 --> 00:38:23,567
TO DRIVE A TRANSPLANT PROGRAM IF

1075
00:38:23,567 --> 00:38:24,201
THERE ISN'T GOVERNMENT SUPPORT

1076
00:38:24,201 --> 00:38:29,673
AND I WILL GIVE AN EXAMPLE OF A

1077
00:38:29,673 --> 00:38:30,841
PLACE WHERE GOVERNMENT SUPPORT

1078
00:38:30,841 --> 00:38:34,578
IS A PROBLEM, FOR INSTANCE IN

1079
00:38:34,578 --> 00:38:36,780
TANZANIA RECENTLY THEY ARE BUSY

1080
00:38:36,780 --> 00:38:37,581
CHANGING THAT, THEY WOULD

1081
00:38:37,581 --> 00:38:39,549
SUPPORT A PATIENT ON DIALYSIS,

1082
00:38:39,549 --> 00:38:40,951
THEY WILL SUPPORT A PATIENT WHO

1083
00:38:40,951 --> 00:38:42,352
RECEIVE A TRAN PLANT USUALLY IN

1084
00:38:42,352 --> 00:38:43,687
INDIA TO GO AND GET THE

1085
00:38:43,687 --> 00:38:45,088
PROCEDURE BUT WHEN THE PATIENT

1086
00:38:45,088 --> 00:38:47,190
COMES BACK, THEY WOULD NOT PAY

1087
00:38:47,190 --> 00:38:49,259
FOR THE IMMUNE SUPPRESSION.

1088
00:38:49,259 --> 00:38:53,163
THAT MEANS THAT PATIENT PAYS

1089
00:38:53,163 --> 00:38:55,499
THIS OUT OF POCKET AND FOR THAT

1090
00:38:55,499 --> 00:38:57,134
PATIENT DIALYSIS IS FREE BUT THE

1091
00:38:57,134 --> 00:38:59,970
TRANSPLANT WILL COST ME A

1092
00:38:59,970 --> 00:39:00,704
MONTHLY MEDICATION BILL AND

1093
00:39:00,704 --> 00:39:02,539
THEREFORE I CAN'T HAVE A

1094
00:39:02,539 --> 00:39:02,973
TRANSPLANT.

1095
00:39:02,973 --> 00:39:04,474
SO THOSE ARE ILLOGICAL THINGS

1096
00:39:04,474 --> 00:39:05,942
WHICH I SAID IN THE BEGINNING

1097
00:39:05,942 --> 00:39:07,744
THERE'S A LAGE OF STRATEGIC

1098
00:39:07,744 --> 00:39:14,751
LEADERSHIP SOMETIMES TO MAKE

1099
00:39:14,751 --> 00:39:15,485
THESE DECISIONS.

1100
00:39:15,485 --> 00:39:16,653
WE NEED PROFESSIONALS TO DRIVE

1101
00:39:16,653 --> 00:39:18,388
PROGRAMS AND THERE'S A LOT OF

1102
00:39:18,388 --> 00:39:19,990
DRIVING BETWEEN TRAINING AND

1103
00:39:19,990 --> 00:39:21,625
EXPERTISE WHICH IS DONE AND THEN

1104
00:39:21,625 --> 00:39:23,326
WE HAVE A HUGE PROBLEM WITH

1105
00:39:23,326 --> 00:39:24,060
BRAIN DRAIN.

1106
00:39:24,060 --> 00:39:24,895
SO PROFESSIONALS ARE FREE PEOPLE

1107
00:39:24,895 --> 00:39:26,363
AND THEY DON'T HAVE TO COME BACK

1108
00:39:26,363 --> 00:39:28,365
WHERE THEY COME FROM, AND I

1109
00:39:28,365 --> 00:39:29,299
RESPECT THAT BUT 1 OF THE THING

1110
00:39:29,299 --> 00:39:33,937
WE NEED TO DO IS MAKE IT

1111
00:39:33,937 --> 00:39:35,405
ATTRACTIVE FOR PEOPLE TO RETURN

1112
00:39:35,405 --> 00:39:37,741
TO THEIR HOME COUNTRIES SO THEY

1113
00:39:37,741 --> 00:39:40,677
CAN GO BACK AND START THEIR OWN

1114
00:39:40,677 --> 00:39:41,478
PROGRAMS,ENTIOUS SPECIALLY

1115
00:39:41,478 --> 00:39:42,646
NERMALS OF SURGICAL EXPERTISE

1116
00:39:42,646 --> 00:39:44,181
AND WHEN WE TALK ABOUT SOMETHING

1117
00:39:44,181 --> 00:39:45,715
LIKE LIVING DONORS WHO WE REALLY

1118
00:39:45,715 --> 00:39:48,685
CANNOT ARK FORD FOR ANYTHING TO

1119
00:39:48,685 --> 00:39:50,020
GO--OFORD FOR ANYTHING TO GO

1120
00:39:50,020 --> 00:39:50,887
WRONG THERE.

1121
00:39:50,887 --> 00:39:52,422
I SPOKEN ABOUT INDIA'S MEDICAL

1122
00:39:52,422 --> 00:39:53,823
INDUSTRY AND I WAS IN INDRALAST

1123
00:39:53,823 --> 00:39:56,226
WEEK FOR A MEETING AND IT WAS

1124
00:39:56,226 --> 00:39:59,029
VERY CLEAR TO ME THAT THE

1125
00:39:59,029 --> 00:40:00,764
FEELING THERE IS THAT WE CANNOT

1126
00:40:00,764 --> 00:40:02,499
DISCUSS THIS BECAUSE THEY ARE

1127
00:40:02,499 --> 00:40:04,434
PROVOIDING A SERVICE AT A VERY

1128
00:40:04,434 --> 00:40:06,069
GOOD STANDARD AND THEY ARE DOING

1129
00:40:06,069 --> 00:40:08,405
IT AT A GOOD COST AND THEREFORE

1130
00:40:08,405 --> 00:40:12,242
THEY CANNOT SEE WHY THIS IS A

1131
00:40:12,242 --> 00:40:13,877
PROBLEM BUT THEY'RE SAYING

1132
00:40:13,877 --> 00:40:15,812
AFRICAN PATIENTS SHOULD NOT BE

1133
00:40:15,812 --> 00:40:17,581
TRAVELING TO INDIA FOR THEIR

1134
00:40:17,581 --> 00:40:18,281
TRANSPLANTS.

1135
00:40:18,281 --> 00:40:19,916
HOWEVER, WHAT IS HAPPENING IN

1136
00:40:19,916 --> 00:40:20,684
AFRICA IN SWRIM BAB WEB

1137
00:40:20,684 --> 00:40:21,851
CONNECTED WHERE THEY START A

1138
00:40:21,851 --> 00:40:25,021
TRANSPLANT PROGRAM AND THEY HAD

1139
00:40:25,021 --> 00:40:25,889
THE NECESSARY EXPERTISE AND

1140
00:40:25,889 --> 00:40:26,957
PATIENTS WERE SAYING WE WOULD

1141
00:40:26,957 --> 00:40:28,358
RATHER GO TO INDIA BECAUSE WE

1142
00:40:28,358 --> 00:40:29,893
KNOW WE'RE GOING TO GET BETTER

1143
00:40:29,893 --> 00:40:30,126
SERVICE.

1144
00:40:30,126 --> 00:40:32,896
THIS IS PART OF PUBLIC

1145
00:40:32,896 --> 00:40:33,196
PERCEPTION.

1146
00:40:33,196 --> 00:40:35,298
IT MAKES IT VERY DIFFICULT TO

1147
00:40:35,298 --> 00:40:38,568
LET THE LOCAL PROGRAMS THRIVE IF

1148
00:40:38,568 --> 00:40:39,636
THE PUBLIC STILL BELIEVES THIS

1149
00:40:39,636 --> 00:40:41,938
AND OF COURSE WITH MARKETING IN

1150
00:40:41,938 --> 00:40:42,772
THE INDIAN ENVIRONMENT WHERE

1151
00:40:42,772 --> 00:40:46,209
THERE'S QUITE A LOT OF MONEY, A

1152
00:40:46,209 --> 00:40:47,410
VERY GOOD MARKETING GOES TO THE

1153
00:40:47,410 --> 00:40:50,180
PUBLIC AND THE CLINICIANS, IT

1154
00:40:50,180 --> 00:40:51,448
BECOMES VERY DIFFICULT TO SHOW

1155
00:40:51,448 --> 00:40:54,484
PEOPLE THAT THEY SHOULD DRAW THE

1156
00:40:54,484 --> 00:40:55,852
SUPPORT OF THEIR LOCAL

1157
00:40:55,852 --> 00:40:57,254
TRANSPLANT PROGRAM.

1158
00:40:57,254 --> 00:40:58,855
SO TRAVEL FOR TRANSPLANTATION IS

1159
00:40:58,855 --> 00:41:01,191
NOT ONLY AROUND THE ISSUES

1160
00:41:01,191 --> 00:41:02,692
AROUND MEDICAL TOURISM AND ORGAN

1161
00:41:02,692 --> 00:41:03,760
TRAFFICKING BUT IT ALSO BECOMES

1162
00:41:03,760 --> 00:41:08,398
A PROBLEM IN TERMS OF DRIVING

1163
00:41:08,398 --> 00:41:10,433
THE LOCAL PROGRAM.

1164
00:41:10,433 --> 00:41:14,704
SO WE CREATED THIS SHEET AND I

1165
00:41:14,704 --> 00:41:16,673
DON'T WANT TO GO INTO IT IN MUCH

1166
00:41:16,673 --> 00:41:17,974
DETAIL BUT THINK ABOUT IT FOR

1167
00:41:17,974 --> 00:41:19,743
WHAT DO WE NEED FOR A TRANSPLANT

1168
00:41:19,743 --> 00:41:21,278
PROGRAM, SO FOR INSTANCE DO YOU

1169
00:41:21,278 --> 00:41:23,113
HAVE A CRITICAL CARE OR HIGH

1170
00:41:23,113 --> 00:41:24,281
CARE FACILITY.

1171
00:41:24,281 --> 00:41:25,882
DO YOU PERFORM VASCULAR SURGERY

1172
00:41:25,882 --> 00:41:27,284
AND GENERAL SURGERY IN YOUR

1173
00:41:27,284 --> 00:41:29,819
INSTITUTION, DO YOU HAVE

1174
00:41:29,819 --> 00:41:30,754
INTERVENTIONAL RADIOLOGY LIKE CT

1175
00:41:30,754 --> 00:41:32,522
SCANS, DO YOU HAVE THE LABS FOR

1176
00:41:32,522 --> 00:41:34,557
SCREENING AND DRUG LEVELS, AND

1177
00:41:34,557 --> 00:41:36,159
THEN 1 CAN SORT OF SAY, OKAY, IF

1178
00:41:36,159 --> 00:41:37,560
YOU HAVE THESE THINGS, CAN YOU

1179
00:41:37,560 --> 00:41:39,929
START WITH EITHER A DECEASED OR

1180
00:41:39,929 --> 00:41:42,198
LIVING DONOR PROGRAM BUT OF

1181
00:41:42,198 --> 00:41:44,634
COURSE A LIVING DONOR PROGRAM IS

1182
00:41:44,634 --> 00:41:47,904
LOGISTICALLY SO MUCH EASIER.

1183
00:41:47,904 --> 00:41:50,707
BUT FOR US IN TERMS OF DRIVING

1184
00:41:50,707 --> 00:41:51,741
TRANSPLANTATION IN AFRICA AND

1185
00:41:51,741 --> 00:41:53,343
LOW AND MIDDLE INCOME COUNTRIES,

1186
00:41:53,343 --> 00:41:54,344
IT IS AROUND AND THAT'S KREBS

1187
00:41:54,344 --> 00:41:55,879
CYCLE I'M SHOWING THIS, IT'S

1188
00:41:55,879 --> 00:41:57,047
AROUND EVERY BLOCK IN THIS THING

1189
00:41:57,047 --> 00:41:59,049
TO TRY AND THINK, WHAT IS THE

1190
00:41:59,049 --> 00:42:00,250
BARRIER, CAN WE ADDRESS IT, WHAT

1191
00:42:00,250 --> 00:42:01,785
IS THE BARRIER CAN WE ADDRESS

1192
00:42:01,785 --> 00:42:03,420
IT, CAN WE HELP, CAN WE

1193
00:42:03,420 --> 00:42:04,788
COLLABORATE AND THERE ARE MANY

1194
00:42:04,788 --> 00:42:09,893
EXAMPLES WHERE PEOPLE ARE DOING

1195
00:42:09,893 --> 00:42:10,593
THAT SUCCESSFULLY.

1196
00:42:10,593 --> 00:42:13,029
BUT DESPITE THAT THIS IS JUST A

1197
00:42:13,029 --> 00:42:15,932
SURVEY I DID VERY RECENTLY.

1198
00:42:15,932 --> 00:42:17,334
QUITE AN INFORMAL SURVEY WHICH I

1199
00:42:17,334 --> 00:42:18,735
SENT TO MY PERSONAL CONBEING

1200
00:42:18,735 --> 00:42:20,136
TAKEN--THEYS TOW ASK THEM HOW

1201
00:42:20,136 --> 00:42:21,938
MANY PATIENTS ARE STILL

1202
00:42:21,938 --> 00:42:27,711
TRAVELING OUT OF THE COUNTRY FOR

1203
00:42:27,711 --> 00:42:31,481
A TRANSPLANT, YOU CAN SEE IT'S A

1204
00:42:31,481 --> 00:42:33,350
LOT, TANSIA, MORE THAN 50, IN

1205
00:42:33,350 --> 00:42:36,119
INDIA TRAVELING MORE THAN 50,

1206
00:42:36,119 --> 00:42:44,094
KENYA IT'S HIGH, NIGERIA,

1207
00:42:44,094 --> 00:42:45,595
RWANDA, SENEGAL, SUDAN, THEY ARE

1208
00:42:45,595 --> 00:42:46,663
TRAVELING OUT OF THEIR COUNTRY

1209
00:42:46,663 --> 00:42:47,964
BECAUSE THEY DON'T HAVE ACCESS

1210
00:42:47,964 --> 00:42:48,798
IN THEIR OWN COUNTRY.

1211
00:42:48,798 --> 00:42:51,101
SO WHAT DO WE NEED IN THE LONG

1212
00:42:51,101 --> 00:42:51,301
RUN?

1213
00:42:51,301 --> 00:42:52,535
WE NEED TO UNDERSTAND WHAT IS

1214
00:42:52,535 --> 00:42:52,802
HAPPENING.

1215
00:42:52,802 --> 00:42:54,838
WE NEED TO UNDERSTAND WHERE

1216
00:42:54,838 --> 00:42:56,373
PATIENTS ARE GOING AND WHERE

1217
00:42:56,373 --> 00:42:58,742
PATIENTS ARE RECEIVING THE

1218
00:42:58,742 --> 00:42:59,175
TREATMENT.

1219
00:42:59,175 --> 00:43:01,511
WE NEED TO UNDERSTAND COSTING

1220
00:43:01,511 --> 00:43:03,012
BETTER, AND THE CURRENT COSTING

1221
00:43:03,012 --> 00:43:08,318
LOW AND MIDDLE INCOME COUNTRIES.

1222
00:43:08,318 --> 00:43:11,054
WE NEED TO ALWAYS FOCUS ON

1223
00:43:11,054 --> 00:43:12,322
STAINING PREVENTION PROGRAMS AND

1224
00:43:12,322 --> 00:43:13,390
THERE ARE MULTIPLE OPPORTUNITIES

1225
00:43:13,390 --> 00:43:14,324
TO DRIVE SOME OF THESE QUESTIONS

1226
00:43:14,324 --> 00:43:17,060
AND LOOK AT SOME OF THESE

1227
00:43:17,060 --> 00:43:18,194
QUESTIONS BECAUSE THAT IS WHY

1228
00:43:18,194 --> 00:43:20,764
IT'S BEEN SO HELPFUL FOR ME TO

1229
00:43:20,764 --> 00:43:24,734
WORK WITH ANDREW AND HIS TEAM,

1230
00:43:24,734 --> 00:43:27,504
IT REALLY BROUGHT TO US A LITTLE

1231
00:43:27,504 --> 00:43:28,972
OF RESEARCH EXPERTISE THAT WE

1232
00:43:28,972 --> 00:43:30,507
DID NOT HAVE AVAILABLE IN SOUTH

1233
00:43:30,507 --> 00:43:32,509
AFRICA AND THAT IS THE TYPE OF

1234
00:43:32,509 --> 00:43:35,879
PARTNERSHIPS THAT WE NEED TO

1235
00:43:35,879 --> 00:43:37,414
CONTINUE TO BOLT AND COLLABORATE

1236
00:43:37,414 --> 00:43:37,680
TOGETHER.

1237
00:43:37,680 --> 00:43:40,316
SO THANK YOU VERY MUCH FOR THE

1238
00:43:40,316 --> 00:43:43,386
OPPORTUNITY TO TALK TO YOU AND

1239
00:43:43,386 --> 00:43:46,222
I'M HAPPY TO ANSWER ANY

1240
00:43:46,222 --> 00:43:46,489
QUESTIONS.

1241
00:43:46,489 --> 00:43:50,727
[ APPLAUSE ]

1242
00:43:50,727 --> 00:43:53,363
>> SO THANKS A LOT.

1243
00:43:53,363 --> 00:43:53,930
THAT WAS FASCINATING.

1244
00:43:53,930 --> 00:43:55,665
OBVIOUS 3 IF THERE'S QUESTIONS

1245
00:43:55,665 --> 00:43:57,100
COME TO THE MIC HERE EMPLOY 1 OF

1246
00:43:57,100 --> 00:44:02,205
THE QUESTIONS WE HAD ONLINE WAS

1247
00:44:02,205 --> 00:44:04,674
GIVEN THE ECONOMIC DISPARITY,

1248
00:44:04,674 --> 00:44:05,608
AND THEY WERE ASKING IN THE

1249
00:44:05,608 --> 00:44:07,143
UNITED STATES BUT ALSO MAYBE IN

1250
00:44:07,143 --> 00:44:10,914
SOUTH AFFRIC AWHY DO YOU THINK

1251
00:44:10,914 --> 00:44:12,315
THE NATIONAL HEALTHCARE

1252
00:44:12,315 --> 00:44:13,116
PROVIDERS HEALTH INSURANCE,

1253
00:44:13,116 --> 00:44:15,318
THINGS LIKE THAT AREN'T DOING

1254
00:44:15,318 --> 00:44:17,587
MORE TO PUSH FOR TRANSPLANTATION

1255
00:44:17,587 --> 00:44:19,189
GIVEN THE COST OF DIALYSIS AND

1256
00:44:19,189 --> 00:44:20,457
THINGS LIKE THAT?

1257
00:44:20,457 --> 00:44:22,292
>> I THINK WE'RE NOT
TARGETING

1258
00:44:22,292 --> 00:44:28,364
THEM ENOUGH TO MAKE THIS CASE.

1259
00:44:28,364 --> 00:44:31,067
CERTAINLY IN SOUTH AFRICA OUR

1260
00:44:31,067 --> 00:44:32,135
HEALTHCARE PROVIDERS ARE NOT

1261
00:44:32,135 --> 00:44:33,970
CONITANTLY THINK BEING THIS AND

1262
00:44:33,970 --> 00:44:35,138
DIALYSIS HAS COME JUST RUN O%

1263
00:44:35,138 --> 00:44:36,473
THE MILL THING THAT EVERYBODY

1264
00:44:36,473 --> 00:44:40,310
GOES TO, SO I THINK IT IS A LACK

1265
00:44:40,310 --> 00:44:42,779
OF CONVERSATION AND EDUCATION

1266
00:44:42,779 --> 00:44:45,048
THAT'S HAPPENING IN THIS

1267
00:44:45,048 --> 00:44:48,251
REALITY, WHICH OF COURSE PUTS

1268
00:44:48,251 --> 00:44:50,086
THE OWENESS BACK ON TO OFFICIALS

1269
00:44:50,086 --> 00:44:52,388
TO ADDRESS THIS BECAUSE FOR MOST

1270
00:44:52,388 --> 00:44:54,591
ECONOMIC POINT OF VIEW, IT

1271
00:44:54,591 --> 00:44:55,658
DOESN'T MAKE SENSE THAT THEY

1272
00:44:55,658 --> 00:44:58,394
SHOULD PAY FOR DIALYSIS.

1273
00:44:58,394 --> 00:45:02,732
>> HI, I REALLY ENJOYED
YOUR

1274
00:45:02,732 --> 00:45:03,533
PRESENTATION.

1275
00:45:03,533 --> 00:45:05,869
I WAS JUST WONDERING HOW WILL

1276
00:45:05,869 --> 00:45:08,638
WE--CAN I MAKE THIS HIGHER, HOW

1277
00:45:08,638 --> 00:45:10,340
WOULD WE BETTER COMBAT THE

1278
00:45:10,340 --> 00:45:17,413
AMOUNT OF BRAIN DRAIN THAT

1279
00:45:17,413 --> 00:45:19,482
HAPPENING FOR PROFESSIONALS IN

1280
00:45:19,482 --> 00:45:21,017
LOW AND MIDDLE INCOME COUNTRIES.

1281
00:45:21,017 --> 00:45:22,051
BECAUSE I KNOW SOME

1282
00:45:22,051 --> 00:45:23,186
PROFESSIONALS WOULD GO AND STUDY

1283
00:45:23,186 --> 00:45:25,188
IN A MORE WEALTHIER COUNTRY AND

1284
00:45:25,188 --> 00:45:26,890
SPLIT THEIR TIME FROM THAT

1285
00:45:26,890 --> 00:45:28,725
COUNTRY WITH THEIR COUNTRY OF

1286
00:45:28,725 --> 00:45:31,194
ORIGIN OR ANOTHER REGION O I WAS

1287
00:45:31,194 --> 00:45:35,698
JUST WONDERING HOW WE BEING MAKE

1288
00:45:35,698 --> 00:45:38,268
OR PUT IN TO MAKE IT MORE

1289
00:45:38,268 --> 00:45:41,371
ATTRACTIVE TO HELP LOWER INCOME

1290
00:45:41,371 --> 00:45:41,738
COUNTRIES.

1291
00:45:41,738 --> 00:45:43,373
>> IT'S A VERY DIFFICULT
THING,

1292
00:45:43,373 --> 00:45:45,909
IN THE SOUTH AFRICAN CONTEXT,

1293
00:45:45,909 --> 00:45:46,976
THE GOVERNMENT MADE IT

1294
00:45:46,976 --> 00:45:49,212
COMPULSORY FOR PEOPLE TO REMAIN

1295
00:45:49,212 --> 00:45:50,280
IN THE COUNTRY 2 YEARS AFTER

1296
00:45:50,280 --> 00:45:51,915
THEY QUALIFIED AND WORK IN A

1297
00:45:51,915 --> 00:45:53,683
STATE HOSPITAL, SO EVERYBODY IN

1298
00:45:53,683 --> 00:45:54,851
QUALIFIES IN SOUTH APRICKA HAS

1299
00:45:54,851 --> 00:45:56,286
TO DO THAT AND THEN IT BECOMES

1300
00:45:56,286 --> 00:45:57,987
VERY DIFFICULT BECAUSE YOU CAN'T

1301
00:45:57,987 --> 00:45:59,856
MAKE RULES ABOUT THE WAY PEOPLE

1302
00:45:59,856 --> 00:46:01,357
CAN GO BECAUSE THAT WOULD BE

1303
00:46:01,357 --> 00:46:03,593
UNFAIR TO THE INDIVIDUAL AND

1304
00:46:03,593 --> 00:46:04,994
PEOPLE HAVE VERY SPECIFIC

1305
00:46:04,994 --> 00:46:05,728
PERSONAL CIRCUMSTANCES WHY THEY

1306
00:46:05,728 --> 00:46:07,463
LEAVE COUNTRIES AND WHY THEY

1307
00:46:07,463 --> 00:46:09,799
MOVE, SO I DON'T THINK 1 CAN DO

1308
00:46:09,799 --> 00:46:11,968
IT WITH RULES OR WITH

1309
00:46:11,968 --> 00:46:17,307
LEGISLATION SO YOU HAVE TO DO IT

1310
00:46:17,307 --> 00:46:20,777
BY CHOICE OF COURSE IF YOU GET A

1311
00:46:20,777 --> 00:46:21,344
COMMONWEALTH SCHOLARSHIP IN

1312
00:46:21,344 --> 00:46:25,114
OXFORD, YOU SIGN A DECLARATION

1313
00:46:25,114 --> 00:46:27,650
THAT YOU WANT TO GO TO YOUR HOME

1314
00:46:27,650 --> 00:46:29,953
COUNTRY AND YOU WILL GO TO YOUR

1315
00:46:29,953 --> 00:46:32,055
HOME COUNTRY AND IT'S PART OF

1316
00:46:32,055 --> 00:46:33,456
YOUR [INDISCERNIBLE], SO IF YOU

1317
00:46:33,456 --> 00:46:35,458
DON'T DO IT, YOU PAY THE MONEY

1318
00:46:35,458 --> 00:46:36,426
BACK, BUT THAT'S 1 THING YOU CAN

1319
00:46:36,426 --> 00:46:37,927
DO BUT OF COURSE, CAN YOU GO

1320
00:46:37,927 --> 00:46:39,295
BACK FOR 2 YEARS OR SO AND YOU

1321
00:46:39,295 --> 00:46:41,664
CAN DO WHATEVER YOU WANT, SO I

1322
00:46:41,664 --> 00:46:44,334
THINK IT IS AROUND TRYING TO

1323
00:46:44,334 --> 00:46:45,702
CREATE THE INFRASTRUCTURE THAT

1324
00:46:45,702 --> 00:46:54,210
PEOPLE NEED TO HAVE OPTIMAL WORK

1325
00:46:54,210 --> 00:46:55,845
ENVIRONMENT IN THE PLACE YOU

1326
00:46:55,845 --> 00:46:57,146
WANT THEM TO TO BE EMPLOY THAT'S

1327
00:46:57,146 --> 00:46:58,114
WHAT WE WANT THEM TO DO EMPLOY

1328
00:46:58,114 --> 00:47:01,484
WE HAVE TO HAVE A OPTIMAL

1329
00:47:01,484 --> 00:47:03,086
INSTANCE IN KENYA OR NIGERIA

1330
00:47:03,086 --> 00:47:04,487
WHERE THE WORKFORCE WANTS TO

1331
00:47:04,487 --> 00:47:06,823
WORK, WHERE THEY'RE PAID WELL,

1332
00:47:06,823 --> 00:47:08,091
WHERE THE INFRASTRUCTURE EXISTS

1333
00:47:08,091 --> 00:47:09,826
BECAUSE IT'S NOT FEASIBLE FOR

1334
00:47:09,826 --> 00:47:11,260
SOMEBODY TO GO AND GET TRAINED

1335
00:47:11,260 --> 00:47:12,128
TO DO A PROCEDURE AND THEY WANT

1336
00:47:12,128 --> 00:47:16,332
TO GO BACK AND THEN THERE'S NO

1337
00:47:16,332 --> 00:47:17,133
INFRASTRUCTURE TO DO IT.

1338
00:47:17,133 --> 00:47:18,601
SO I THINK THERE'S A LOT OF WORK

1339
00:47:18,601 --> 00:47:21,037
THAT NEEDS TO GO INTO THAT AND A

1340
00:47:21,037 --> 00:47:23,106
POT OF THE PROBLEM IS THE LACK

1341
00:47:23,106 --> 00:47:24,941
OF COLLABORATION THAT SOMETIMES

1342
00:47:24,941 --> 00:47:29,212
HAPPEN BETWEEN THE PROFESSIONALS

1343
00:47:29,212 --> 00:47:30,179
AND THE GOVERNMENT, AND THEN WE

1344
00:47:30,179 --> 00:47:31,581
HAVE THESE MEETINGS AND WE ALL

1345
00:47:31,581 --> 00:47:33,883
TESTIMONY CATEGORY AND SAY LET'S

1346
00:47:33,883 --> 00:47:37,687
TRAIN A SURGEON FROM GANNAA AND

1347
00:47:37,687 --> 00:47:39,689
WE DO IT BUT GANA BUT THE

1348
00:47:39,689 --> 00:47:40,757
GOVERNMENT AND PEOPLE WHO FUND

1349
00:47:40,757 --> 00:47:43,459
THE HOSPITAL ISN'T IN THE ROOM

1350
00:47:43,459 --> 00:47:45,128
SO WHEN THE PERSON GOES BACK,

1351
00:47:45,128 --> 00:47:45,895
THERE ISN'T AN INFRANCIS COLLINS

1352
00:47:45,895 --> 00:47:50,667
STRUCKURE AND I THINK THAT WE

1353
00:47:50,667 --> 00:47:55,672
NEED TO BE BETTER ORGANIZED.

1354
00:47:55,672 --> 00:47:57,340
>> THANK YOU FOR YOUR
TALK, I AM

1355
00:47:57,340 --> 00:47:58,875
FROM PAKISTAN AND I HAVE SEEN

1356
00:47:58,875 --> 00:47:59,942
PATIENTS FOR TRANSPLANT AND I

1357
00:47:59,942 --> 00:48:02,378
FEEL LIKE YOU COVERED ALL THE

1358
00:48:02,378 --> 00:48:04,380
POINTS AND LMIC, THE BARRIERS

1359
00:48:04,380 --> 00:48:05,381
WERE VERY WELL DESCRIBED AND

1360
00:48:05,381 --> 00:48:06,349
THANK YOU FOR THAT EMPLOY MY

1361
00:48:06,349 --> 00:48:08,518
QUESTION IS TO MY UNDERSTANDING

1362
00:48:08,518 --> 00:48:10,953
1 OF THE OTHER REASON FOR ORGAN

1363
00:48:10,953 --> 00:48:13,589
TRAFFICKING IS ORGAN CHART, SO

1364
00:48:13,589 --> 00:48:17,226
DO YOU SEE LIKE THE--TO DO

1365
00:48:17,226 --> 00:48:18,561
RESEARCH GOING ON, LIKE TAKING

1366
00:48:18,561 --> 00:48:23,700
ORGANS FROM PIG OR OTHER GENETIC

1367
00:48:23,700 --> 00:48:26,269
AS A SOLUTION FOR ORGAN SHORTAGE

1368
00:48:26,269 --> 00:48:27,070
IN THE LONG-TERM?

1369
00:48:27,070 --> 00:48:28,271
>> ABSOLUTELY, I THINK WE
HAVE

1370
00:48:28,271 --> 00:48:30,940
TO USE INNOVATION AS FAR AS WE

1371
00:48:30,940 --> 00:48:33,743
CAN, WHETHER IT'S XEEN O

1372
00:48:33,743 --> 00:48:34,310
TRANSPLANTS, BIOENGINEERING

1373
00:48:34,310 --> 00:48:36,045
MODELS, WE HAVE TO USE THOSE

1374
00:48:36,045 --> 00:48:37,447
THINGS AND WE HAVE TO DEVELOP

1375
00:48:37,447 --> 00:48:39,615
THEM AND THAT'S WHY THAT

1376
00:48:39,615 --> 00:48:41,117
RESEARCH IS SO IMPORTANT.

1377
00:48:41,117 --> 00:48:45,121
WE ALSO HAVE TO MAKE SURE WE USE

1378
00:48:45,121 --> 00:48:46,155
EVERY AVAILABLE ORGAN THAT COMES

1379
00:48:46,155 --> 00:48:49,559
OUR WAY AND WE ALSO HAVE TO MAKE

1380
00:48:49,559 --> 00:48:51,928
SURE THAT WE GET THE PUBLIC'S

1381
00:48:51,928 --> 00:48:53,429
BUY-IN BECAUSE IT'S NO USE, YOU

1382
00:48:53,429 --> 00:48:55,164
DIE WITH YOUR ORGANS AND WE HAVE

1383
00:48:55,164 --> 00:48:57,133
TO EDUCATE THE PUBLIC SO THAT WE

1384
00:48:57,133 --> 00:49:01,571
WORK ON ALL THE STREAMS BUT IT

1385
00:49:01,571 --> 00:49:02,705
IS ABSOLUTELY TRUE TAKEN--THEY

1386
00:49:02,705 --> 00:49:05,108
ORGAN SHORTAGE IS DRIVING ORGAN

1387
00:49:05,108 --> 00:49:05,908
COMMERCIALIZATION AND ORGAN

1388
00:49:05,908 --> 00:49:06,976
TRAFFICKING AND IF WE'RE NOT

1389
00:49:06,976 --> 00:49:08,177
GOING TO ADDRESS ORGAN SHORTAGE

1390
00:49:08,177 --> 00:49:09,245
WE WILL NOT GET TO THE ROOT

1391
00:49:09,245 --> 00:49:13,282
CAUSE OF THE PROBLEM.

1392
00:49:13,282 --> 00:49:14,083
>> THANK YOU.

1393
00:49:14,083 --> 00:49:15,952
>> THANK YOU FOR
PRESENTATION.

1394
00:49:15,952 --> 00:49:17,887
SO, ON THE CLINICAL FELLOW HERE

1395
00:49:17,887 --> 00:49:22,625
AND I ALSO INTERNED BACK IN

1396
00:49:22,625 --> 00:49:24,327
NIGERIA, SO WHEN YOU'RE TALKING

1397
00:49:24,327 --> 00:49:25,828
ABOUT THE INDIAN EXPERIENCE 1

1398
00:49:25,828 --> 00:49:27,797
THING THAT JUMPED AT ME WAS

1399
00:49:27,797 --> 00:49:29,999
ISSUES I COULD REMEMBER I

1400
00:49:29,999 --> 00:49:31,534
VISITED A CENTER [INDISCERNIBLE]

1401
00:49:31,534 --> 00:49:32,802
TRANSPLANTS BUT I THINK IT'S

1402
00:49:32,802 --> 00:49:33,970
ACTUALLY A PRIVATE ORGANIZATION

1403
00:49:33,970 --> 00:49:38,141
AND THE COST OF DOING THIS AT

1404
00:49:38,141 --> 00:49:40,143
THAT TIME IS ACTUALLY MORE

1405
00:49:40,143 --> 00:49:41,878
EXPENSIVE THAN IF YOU FLY BO

1406
00:49:41,878 --> 00:49:43,846
INDIA AND DO THE SAME PROCEDURE

1407
00:49:43,846 --> 00:49:46,816
SO IT BECOMES A QUESTION OF

1408
00:49:46,816 --> 00:49:49,218
[INDISCERNIBLE] I THINK IS INDIA

1409
00:49:49,218 --> 00:49:51,053
IT'S [INDISCERNIBLE] OR SO, BUT

1410
00:49:51,053 --> 00:49:52,488
I AM THINKING HOW DO YOU PITCH

1411
00:49:52,488 --> 00:49:56,459
THIS TO THE GOVERNMENT TO SORT

1412
00:49:56,459 --> 00:49:57,560
OF SUBSIDIZE THIS PROCEDURE TO

1413
00:49:57,560 --> 00:49:59,595
INSURE THAT PATIENTS GET TO STAY

1414
00:49:59,595 --> 00:50:04,133
TO DO IT AND THEN THEY DO NOT

1415
00:50:04,133 --> 00:50:05,401
DECIDE TO TRAVEL FOR THE RISK

1416
00:50:05,401 --> 00:50:05,768
IN.

1417
00:50:05,768 --> 00:50:07,203
>> THIS IS WHAT WE WANT TO
TALK

1418
00:50:07,203 --> 00:50:09,005
TO THE INDIAN PEOPLE ABOUT,

1419
00:50:09,005 --> 00:50:10,606
BECAUSE OBVIOUSLY THEY HAVE AN

1420
00:50:10,606 --> 00:50:11,908
ECONOMY OF SCALE EMPLOY SO

1421
00:50:11,908 --> 00:50:13,209
THEY'RE DOING THOUSANDS OF

1422
00:50:13,209 --> 00:50:16,179
TRANSPLANTS AND THEY'RE DOING IT

1423
00:50:16,179 --> 00:50:17,113
CHEAP AND EFFICIENTLY AND YOU

1424
00:50:17,113 --> 00:50:19,115
KNOW WE WERE THINKING PERHAPS WE

1425
00:50:19,115 --> 00:50:22,852
COULD GET THEM TO HELP US TO

1426
00:50:22,852 --> 00:50:25,388
DRIVE LOCAL PROGRAMS SO FOR

1427
00:50:25,388 --> 00:50:27,223
INSTANCE INSTEAD OF THEM GOING

1428
00:50:27,223 --> 00:50:28,791
TO INDIA, TRAIN PEOPLE, HELP THE

1429
00:50:28,791 --> 00:50:30,193
AFRICAN PEOPLE TO DO IT BUT FOR

1430
00:50:30,193 --> 00:50:33,229
THAT IT'S A DIFFERENT MIND SET

1431
00:50:33,229 --> 00:50:34,530
BECAUSE THAT CURRENT MODEL IN

1432
00:50:34,530 --> 00:50:36,365
INDIA IS A BUSINESS MODEL, AND

1433
00:50:36,365 --> 00:50:37,934
THE MIND SET WE'RE GOING TO GO

1434
00:50:37,934 --> 00:50:40,136
OUT AND TRAIN PEOPLE IN AFRICA

1435
00:50:40,136 --> 00:50:43,472
IS MORE ANN ACADEMIC MODEL, SO I

1436
00:50:43,472 --> 00:50:45,308
HAVE TO SAY, I DON'T KNOW WHAT

1437
00:50:45,308 --> 00:50:46,609
IS THE SOLUTION BECAUSE I KNOW

1438
00:50:46,609 --> 00:50:48,778
IT'S VERY, VERY DIFFICULT, AND

1439
00:50:48,778 --> 00:50:50,613
THE ONLY WAY WE WILL PROBABLY

1440
00:50:50,613 --> 00:50:53,916
ADDRESS IT IS IF WE LOOK AT ONCE

1441
00:50:53,916 --> 00:50:55,117
AGAIN BRINGS DOWN COSTS SO WE

1442
00:50:55,117 --> 00:50:57,453
HAVE TO GO AND LOOK WHAT ARE THE

1443
00:50:57,453 --> 00:50:58,955
REAL COST DRIVERS THAT'S MAKING

1444
00:50:58,955 --> 00:51:05,027
IT SO EXPENSIVE IN NIGERIA, IS

1445
00:51:05,027 --> 00:51:06,796
IT A LACK OF GORCHANCE IN TERMS

1446
00:51:06,796 --> 00:51:08,331
OF THE DRUGS AND THE SALARIES,

1447
00:51:08,331 --> 00:51:10,499
IS IT THE FACT THAT THERE'S SO

1448
00:51:10,499 --> 00:51:11,100
FEW TRANSPLANTS?

1449
00:51:11,100 --> 00:51:13,769
WE KNOW ANYTHING YOU DO AT A

1450
00:51:13,769 --> 00:51:17,306
SMALL VALIUM IS MORE EXPENSIVE?

1451
00:51:17,306 --> 00:51:22,778
SO IT WILL BE EXPENSIVE IF WE DO

1452
00:51:22,778 --> 00:51:23,012
MORE?

1453
00:51:23,012 --> 00:51:24,113
WE NEED TO LOOK AT THE ISSUE

1454
00:51:24,113 --> 00:51:25,548
BECAUSE WE DON'T HAVE THE

1455
00:51:25,548 --> 00:51:26,716
ANSWERS. 

1456
00:51:26,716 --> 00:51:27,516
>> THANK YOU.

1457
00:51:27,516 --> 00:51:28,718
>> THANK YOU FOR YOUR

1458
00:51:28,718 --> 00:51:29,051
PRESENTATION.

1459
00:51:29,051 --> 00:51:31,554
MY QUESTION IS AROUND THE FIRST

1460
00:51:31,554 --> 00:51:33,522
POINT, THE FIRST BARRIER THAT

1461
00:51:33,522 --> 00:51:35,324
YOU MENTIONED ABOUT DEVOAS

1462
00:51:35,324 --> 00:51:38,194
CEASED OWNERS, I WAS WONDERING

1463
00:51:38,194 --> 00:51:39,862
OBVIOUSLY THAT HAS A LOT OF

1464
00:51:39,862 --> 00:51:41,397
IMPLICATIONS ON CULTURAL

1465
00:51:41,397 --> 00:51:41,998
UNDERSTANDINGS AND SENSITIVITY

1466
00:51:41,998 --> 00:51:45,001
AND ALL OF THAT, AND LIKE,

1467
00:51:45,001 --> 00:51:46,269
MOTORUARYY PRACTICES AND

1468
00:51:46,269 --> 00:51:46,969
BELIEVES IN SAIRCHGHTITY OF THE

1469
00:51:46,969 --> 00:51:50,773
BODY AND THINGS LIKE THAT, HAVE

1470
00:51:50,773 --> 00:51:53,142
YOU ENCOUNTERED SITUATIONS WHERE

1471
00:51:53,142 --> 00:51:55,111
THAT BECAME YOU KNOW A BIG

1472
00:51:55,111 --> 00:51:58,180
BURDEN ON THE HEALTHCARE SYSTEM

1473
00:51:58,180 --> 00:52:00,549
AND HOW DID HEALTHCARE PROVIDERS

1474
00:52:00,549 --> 00:52:04,186
COME ABOUT KIND OF ADDRESSING

1475
00:52:04,186 --> 00:52:04,720
THAT SENSITIVELY.

1476
00:52:04,720 --> 00:52:06,122
>> DEFINITELY IT IS A BIG
BURDEN

1477
00:52:06,122 --> 00:52:08,791
AND A BIG PROBLEM, IN SOUTH

1478
00:52:08,791 --> 00:52:14,096
AFRICA FOR INSTANCE WE HAVE

1479
00:52:14,096 --> 00:52:15,698
CERTAIN GEOGRAPHICAL AREAS WHERE

1480
00:52:15,698 --> 00:52:17,233
THE TRANSPLANT COORDINATORS SAY

1481
00:52:17,233 --> 00:52:20,603
IN OUR AREA PEOPLE DON'T DONATE.

1482
00:52:20,603 --> 00:52:24,140
AND IT'S VERY MUCH PERCEPTION

1483
00:52:24,140 --> 00:52:25,241
THAT IS THERE, IF YOU GO TO THE

1484
00:52:25,241 --> 00:52:26,509
INDIVIDUALS AND YOU TALK TO THEM

1485
00:52:26,509 --> 00:52:28,811
AND YOU EXPLAIN IT TO THEM, SOME

1486
00:52:28,811 --> 00:52:33,683
OF THOSE PEOPLE THAT'S BEEN

1487
00:52:33,683 --> 00:52:35,051
LABELED NONDONORS WILL GIVE

1488
00:52:35,051 --> 00:52:35,351
PERMISSION.

1489
00:52:35,351 --> 00:52:36,953
IT IS TRUE FOR CERTAIN

1490
00:52:36,953 --> 00:52:40,690
RELIGIONS, IT IS TRUE FOR PEOPLE

1491
00:52:40,690 --> 00:52:42,224
WHO ARE VERY SPIRITUAL AFRICAN

1492
00:52:42,224 --> 00:52:43,626
PEOPLE WHO STILL BELIEVE IN A

1493
00:52:43,626 --> 00:52:46,829
LOT OF THE AFRICAN TRADITIONAL

1494
00:52:46,829 --> 00:52:47,563
THINGS, BUT USUALLY, CAN YOU

1495
00:52:47,563 --> 00:52:52,401
ADDRESS IT WITH THE GOOD

1496
00:52:52,401 --> 00:52:53,135
EDUCATIONAL APPROACH.

1497
00:52:53,135 --> 00:52:54,170
BUT WHAT YOU'RE SAYING IS

1498
00:52:54,170 --> 00:52:55,137
ABSOLUTELY TRUE AND I THINK THE

1499
00:52:55,137 --> 00:52:58,174
OTHER THING IS THAT YOU HAVE TO

1500
00:52:58,174 --> 00:52:59,241
BE CULTURALLY SENSITIVE, SO FOR

1501
00:52:59,241 --> 00:53:02,745
INSTANCE IN OUR SETTING, WE ARE

1502
00:53:02,745 --> 00:53:04,380
TRYING TO GET PEOPLE WHO HAVE

1503
00:53:04,380 --> 00:53:05,915
SIMILAR BACKGROUND AND A SIMILAR

1504
00:53:05,915 --> 00:53:07,984
RELIGION TO TALK TO THOSE PATES

1505
00:53:07,984 --> 00:53:10,786
AND THAT DOES MAKE A BIG IMPACT,

1506
00:53:10,786 --> 00:53:12,388
BUT OF COURSE THAT ALSO NEEDS

1507
00:53:12,388 --> 00:53:13,990
MONEY AND MORE PEOPLE AROUND AND

1508
00:53:13,990 --> 00:53:15,191
SO ON.

1509
00:53:15,191 --> 00:53:20,262
BUT IT IS--IT IS A BIG PROBLEM.

1510
00:53:20,262 --> 00:53:21,764
INTERESTINGLY FOR INSTANCE IN

1511
00:53:21,764 --> 00:53:24,500
THE MIDDLE EAST, TO HAVE QUITE A

1512
00:53:24,500 --> 00:53:25,234
HIGH DECEASED DONATION RATE BUT

1513
00:53:25,234 --> 00:53:26,902
WHEN YOU GO AND LOOK AT IT IN

1514
00:53:26,902 --> 00:53:28,337
MORE DETAIL, YOU WILL SEE THAT

1515
00:53:28,337 --> 00:53:30,373
IT'S ACTUALLY A LOT OF THE

1516
00:53:30,373 --> 00:53:34,076
PEOPLE WHO ARE IMMIGRANTS IN THE

1517
00:53:34,076 --> 00:53:35,277
MITSD EAST WHO BECOME THE DONOR

1518
00:53:35,277 --> 00:53:37,346
WHO SAY YOU HAVE TO INTERPRET

1519
00:53:37,346 --> 00:53:43,152
THAT DATA VERY CAREFULLY.

1520
00:53:43,152 --> 00:53:48,024
>> THANK YOU. 

1521
00:53:48,024 --> 00:53:49,225
>> THAT WAS FANTASTIC
ELMI,

1522
00:53:49,225 --> 00:53:50,926
THANK YOU SO MUCH FOR COMING AND

1523
00:53:50,926 --> 00:53:53,929
ALL THOSE VIEWING ONLINE AND

1524
00:53:53,929 --> 00:53:55,231
GIVE AROUND OF APPLAUSE AND

1525
00:53:55,231 --> 00:53:56,298
THANK YOU FOR A GREAT TALK

1526
00:53:56,298 --> 00:54:01,103
EMPLOY IT WAS GREAT.

1527
00:54:01,103 --> 00:54:11,147