Improvement in kidney transplantation in the Balkans after the Istanbul Declaration: where do we stand today?

Abstract

Due to the limited access to kidney transplantation (KTx) in developing countries, desperate patients have engaged in the purchase and sale of kidneys. In 2004, the World Health Assembly urged member states to protect the poor and vulnerable from being exploited through practices of illegal organ trafficking that had become widespread throughout the world. In 2008, the international transplant community convened a summit of transplant professionals, legal experts and ethicists to combat organ trafficking, transplant tourism and transplant commercialism that resulted in the Declaration of Istanbul (DOI). The South-Eastern Europe Health Network (SEEHN) represents a nine country multigovernmental collaboration on health systems. The Regional Health Development Centre on Organ Donation and Transplant Medicine (RHDC) was established in 2011 in Croatia to facilitate cooperation among south-eastern European countries to improve organ transplantation within the Balkan region. Since 2011, a collaboration between the RHDC, the Custodian Group of the DOI (DICG) and SEEHN professionals has enhanced strategic planning and definition of country-specific action plan priorities on organ donation and transplantation. Data of kidney transplantation provided in this report show a significant increase in transplantation activities in a 4-year period in Macedonia, Moldova, Bosnia and Hercegovina, Romania and Montenegro. The success of the donation and transplantation programmes was influenced by the engagement of key professionals and the establishment of organizational infrastructure with the implementation of an appropriate funding model. In conclusion, the DOI has provided an ethical framework for engagement of health professionals from south-eastern European countries. The newly established SEEHN RHDC as a technical coordinating body greatly contributed in building institutional capacity and strengthening regional collaboration between health authorities and professionals within these countries for improvement of transplant activities in the Balkans.

Nephrology in the Eastern and Central European region: challenges and opportunities

“…Croatia remains the role model for the region with the most successful deceased donation program worldwide, successfully providing support for development of deceased organ donation and transplant programs under the guidance of the Regional Health Development Centre on Organ Donation and Transplant Medicine. 7 Moldova and Macedonia also had big efforts on initiating their living and deceased donor programs following the South-Eastern Europe Health Network meeting. 7 Renal transplantation has procedure costs around 10,700 (range 7,500-23,000) V.…”

“…7 Moldova and Macedonia also had big efforts on initiating their living and deceased donor programs following the South-Eastern Europe Health Network meeting. 7 Renal transplantation has procedure costs around 10,700 (range 7,500-23,000) V.…”

Nephrology in Bosnia and Herzegovina: impact of the 1992–95 war

“…For example, Croatia is among the leading countries in transplantation, Slovenia has a successful transplant programme that dates from former Yugoslavia times, whereas Bosnia and Herzegovina, Macedonia and Montenegro do not have successful transplant programmes. The Regional Health Development Centre that covers all the Balkans with headquarters in Croatia is a technical body of the South-Eastern European Health Network established in 2011 with a goal to help Balkan countries to improve organ donation and transplantation, to ensure adequate numbers of transplantations for their citizens and to prevent transplant tourism [ 26 , 27 ]. Despite our attempts and help from professional societies in Europe and abroad, the number of transplantations in Bosnia and Herzegovina has not increased significantly.…”

Access of non‐residents to transplantation of deceased donor organs: practices and strategies in the European setting

“…Indeed, social injustice becomes even more evident when transplant services for non-residents are primarily provided by the private sector to those who have the financial resources [7]. From the latter, or countries of origin, access of their residents to transplantation in other destinations may deter their governments from making progress towards self-sufficiency by developing or improving their donation and transplantation programmes [8].…”