Organ donation in Croatia: the iportance of a national champion, a comprehensive plan, and international collaborations

The Republic of Croatia is a global leader in organ donation and transplantation despite having fewer resources and more modest healthcare expenditures than other countries in the European Union. The results of an extensive literature review were combined with expert input in an iterative multi-step data collection and evaluation process designed to assess trends in Croatian organ donation and transplantation and identify key elements, policy changes, and drivers of the system that have contributed to its success. Multiple sources of evidence were used in this study, including primary documents, national and international transplantation reports, and insights from critical informants and content experts. The results highlight several key organizational reforms that have substantially improved the performance of the Croatian transplant program. Our findings emphasize the importance of strong central governance led by an empowered national clinical leader acting under the direct auspices of the Ministry of Health and a comprehensive and progressive national plan. The Croatian transplant system is notable for its integrated approach and efficient manner of managing scarce health resources. Collectively, the results suggest that Croatia has become nearly self-sufficient due to its systematic implementation of the guiding principles for organ donation and transplantation

Health Disparities in Kidney Transplantation: An Equity Analysis

The growing incidence of end stage renal disease along with advances of the past 40 years that have improved the success rate of kidney transplantation have created an unprecedented demand for kidney transplant. Yet, certain racial and ethnic groups and women consistently have longer waiting times and lower rates of transplantation which makes a review of the kidney procurement and transplantation system in view of its equity imperative. Reasons given for these disparities have varied from cultural attitudes and beliefs on the part of patients and health care providers, socioeconomic status, rates of organ donation, and geographic location. The equity conceptual framework has proven itself to be a useful guide in identifying the symptoms of disparities in the procurement and organ allocation system but further studies are needed to identify the etiology of these disparities and target effective interventions and policies

Organ transplantation from deceased donors with cancer: is it safe?

Michael A Nalesnik1, Michael G Ison21Division of Transplantation and Hepatic Pathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburg, PA, USA; 2Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USAAbstract: The availability of donor organs continues to be insufficient to meet the needs of patients actively waiting for transplant. Consequently, there is continuing pressure to increase the donor organ pool while simultaneously assuring safety for the recipient population. The complication of donor malignancy transmission has been documented almost from the beginning of transplantation, and continues to be a concern today. The anecdotal nature of case reports and compiled series ensures that clinical decisions related to organ use from donors with malignancy will of necessity continue to be made on the basis of low-level evidence. Despite this limitation, the literature indicates that not all donor neoplasms have the same risk for transmission to the recipient, and it is necessary to consider the specific malignancy affecting the donor, as well as the condition of the recipient, before a decision is made to transplant or discard a given organ. Published cases suggest that certain forms of neoplasia, such as melanoma, choriocarcinoma, sarcoma, small cell carcinoma, or metastatic carcinomas serve as strong contraindications to organ donation. In contrast, considerable experience exists to suggest that certain tumors of the central nervous system, small subclinical prostate carcinomas, or small renal cell carcinomas resected prior to transplant, among other tumors, should not in themselves disqualify an individual from donating organs in the appropriate circumstance. This review presents the case for considering organ transplantation in the setting of certain donor malignancies and discusses factors to be weighed in such decisions. Additionally, donors with a history of cancer are considered, and features that may aid in reaching a conclusion for or against transplantation of organs from these patients are presented.Keywords: organ transplantation, donor organs, malignancy, complication

The relevance of EU directive 2010/53/EU for living organ donation practice

With the recent transposition of Directive 2010/53/EU into the transplant regulation of EU Member States, the time is right to have a closer look at its implications for living organ donation practice. We first discuss the relevance of the Action Plan which forms the basis for the policy of the European Commission in the field of organ donation and transplantation. We then analyze the impact of Directive 2010/53/EU which was adopted to support the implementation of the Priority Actions set out in the Action Plan. We more specifically focus on the obligations of transplant centers engaged in living organ donation and highlight their significance for clinical practice. Finally, we point out some strengths and weaknesses of the Directive in addressing living organ donation

A systematic literature review on the policies and economic evaluation of organ transplantations in EU

Background: transplantation of human organs and tissues saves many lives and restores essential functions in combination of high measurable quality indicators. In spite of the fact that organ transplants have saved thousands of lives and greatly improved the quality of life of thousands more, regrettably many people will not benefit from this therapeutic procedure. Methods: this review is based on economic evaluation studies published since 2000 and reviews published since 1987 for kidney, liver, lung, heart, pancreas, and small bowel transplantations that were conducted in 2010. Results: empirical evidence showed that the costs of organ transplantations have generally decreased over time due to improvements in medicine, while survival and quality of life have improved. This indicates that the cost-effectiveness of transplantation has also improved over this period. Conclusions: cost effectiveness studies on organ transplantations could contribute to the efforts of policy makers in maximising societal health benefits by managing society’s scarce resources. The differences between EU country are not only associated with different legal procedures but are also associated with social, organizational and several other factors