Organ transplant in Serbia – Waiting lists as a cause for serious concern

By Sara Nikolić

Only two organ transplants have been performed in the first five months of this year, while more than 2,000 people are waiting for a new organ, including about 40 children. By comparison, more than a decade ago, in 2013, Serbia recorded 41 organ transplants, with the highest number in 2017 when 92 transplants were performed. Since this programme has almost come to a halt in recent years, most patients in Serbia find their salvation by raising money to go for organ transplants in Belarus, Italy, or Turkey. Most of them never receive the call that could save their lives.

In terms of the number of organ donors, we are among the last in the world. Behind us are the Philippines, Nicaragua, and Vietnam, according to data from the International Registry of Organ Donation and Transplantation (IRODaT).

We have been waiting for three years for the final adoption of legal amendments that were announced as a great opportunity to increase the number of donors, as they propose that every citizen would automatically be a potential donor unless they explicitly state otherwise during their lifetime or if their immediate family opposes it.

This was also stipulated by the Organ Transplantation Act adopted in 2018. However, on the initiative of the Serbian Radical Party, the Constitutional Court declared three years later that the key article, which states that everyone is a potential donor until they say otherwise, was unconstitutional. After the Constitutional Court’s decision, it took the government two years to define the contentious provision and establish a new proposal for legal amendments in May 2023, but it has not yet reached the parliament’s agenda. In November, ahead of the December elections, the parliament was dissolved, meaning the law will have to go through the entire procedure again.

Thus, both the law and the saving of the lives of those for whom transplantation is the only hope are on hold.

“The current situation not only causes concern but instills fear. We no longer know the number of people who, unfortunately, have not lived to see a transplant. And for those waiting for a heart or liver, every day is on the edge. We have patients who need lung transplants, for which there isn’t even a waiting list, nor is there anyone in Serbia performing them. Over the past five years, there has been a drastic decline in transplants, affecting everyone on the list. And not just them, but also their families and friends,” Ivana Jović, president of the Donorstvo je Herojstvo (Donation is Heroism) Association, says.

She does hope that the legal amendments will be adopted as soon as possible and adds that political will, raising public awareness about organ transplantation and the importance of donation, as well as a coordinated approach, are necessary to improve the current situation. This includes not missing opportunities and the importance of a continuous campaign to inform citizens, which the state should undertake.

Left to fend for themselves

However, Jović adds, the most critical patients do not have time to wait for the “system to sort itself out.” Therefore, she says, it is necessary for the state to cover the costs of organ transplants abroad, for example, in Belarus. This was discussed at a recent meeting the Association had with the Minister of Health Zlatibor Lončar.

“The state authorities are the most important when it comes to resolving this issue. Twelve people, including myself, managed to raise money for a transplant in Belarus last year thanks to charitable donations while we are waiting for the situation in Serbia is being resolved. The Health Minister was supposed to have meetings with ambassadors and decision-makers in Belarus to come up with a new agreement. Until that is resolved, patients are left to fend for themselves,” Jović adds.

In addition to donating organs from immediate family members, the current law in Serbia allows for cadaveric transplantation, where the donor is a person who has experienced brain death. For this, the consent of the deceased person’s family is required.

Ivana Jović says that asking such a question to the family at the moment when their loved one has suddenly passed away in good health is a very stressful and difficult moment for the family, as well as for those who ask it.

“Although this system is in place, the efforts are extremely modest. For instance, if 50 consents were requested in Croatia since the beginning of the year, only 13 were requested in our country. This clearly shows that there is room for improvement within the system itself. Lončar told us that he has taken some measures within the donor hospitals. Simply, every missed opportunity to establish brain death and request consent from the family at that moment means removing people from the list and losing someone’s chance for life. This is extremely important, and that’s why this question must always be asked,” our interlocutor emphasizes.

“It is important for the church to join the campaign”

She adds that there must also be a parallel campaign to inform the public, which is the responsibility of the Ministry of Health, since it is a complex topic and citizens cannot be expected to understand everything quickly and easily.

“That is precisely why this campaign must be continuous, and only the state can do that. When we exchanged experiences with colleagues from Croatia, they told us that they have been conducting this education for 20 years. In May, they had their National Donor Day, and despite having great results, they distributed flyers, set up booths, and talked with people. So, there is no stopping, no giving up,” says Jović.

Moreover, the transplantation program particularly flourished in Croatia, Italy, and Spain when Pope John Paul II supported the organ transplantation programme. The Pope said, on the occasion, that “donating organs is a godly gesture and a humane act that opens the door to the heavenly kingdom.”

“The support of all religious communities, the church, would mean a lot to us. And whenever we present things this way, people ask us what’s the problem? Ultimately, it comes down to the need for political will. I think that’s the key. When there is political will, everything else somehow falls into place,” Jović adds.

To conclude, she tells a story about parents who signed the consent to donate their son’s organs:

“The parents of a young boy who tragically passed away gave their consent to donate his organs, and thanks to that, several children got a chance at a new life. These people are true heroes to me. When I told the boy’s mother that they were heroes to me, she responded that this act represented a connection for her because her son now lives through all the children who were given a chance at life thanks to his organs.”

(NIN, 27.06.2024)

This post is also available in: Italiano

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