There are long lists of patients throughout the region who are waiting for the call that means life - the call for an organ transplant.
In Montenegro, Bosnia and Herzegovina and Serbia, the most patients are waiting for a kidney, liver, cornea, heart...
There are 89 citizens on the waiting lists for organ transplants in Montenegro, including six children who need liver or kidney transplants. 59 patients are waiting for a kidney transplant, 17 liver, 10 lungs, while three patients are on the waiting list for a heart transplant.
In Serbia, a total of 1.553 patients are waiting for a heart, liver and kidney transplant. 55 patients are waiting for a heart transplant, 65 liver, 750 cornea and 683 kidney patients, of which four are children.
Those who need a kidney are the most numerous on the transplant lists in Bosnia and Herzegovina, and there are about 260 of them.
Montenegro: Patients left to fend for themselves due to state negligence
Patients from Montenegro who are waiting for an organ transplant from a dead donor are forced to collect money from humane individuals and companies and to take out loans in order to perform a transplant at their own expense in a foreign country, most often Belarus.
People from Montenegro who have failed or insufficient kidney and liver function, and do not have a living related donor, cannot perform an organ transplant at the expense of the state. Patients who need lung, heart and pancreas transplants are in the same situation, because the only solution is a transplant from a brain-dead (cadaveric) organ donor, so they are left to their own devices and are looking for a way to get the money needed for treatment.
The transplant program in Montenegro has been dead since 2019, when the last kidney transplant was performed at the Clinical Center of Montenegro (KCCG). Since then, not a single transplant has been performed in Montenegro, and patients who have a donor, a living relative, performed operations at the expense of the state in Turkey.
The patient Milena Žižić she is one of the hemodialysis patients who is a candidate for a kidney transplant from a cadaveric donor.
She tells "Vijesti" that this category of patients is marginalized and that they are treated on their own initiative.
"We don't have a sufficient number of doctors who would deal with this topic because there are a large number of patients who are nephrology patients, and this does not only mean dialysis but also long-term treatment protocols before reaching this stage," Žižić believes.
She says that patients waiting for a kidney transplant from a living donor usually opt for a transplant in Turkey.
"If they don't have a donor, they go to Belarus, where they transplant an organ from a cadaveric donor. The health insurance fund does not yet cover the costs of this treatment, so patients are forced to collect funds in various ways," Žižić points out.
She says that the transplant program can be improved only with strong institutional support and additional education of the population.
"First of all, we are thinking of signing donor cards, which would ensure a sufficient number of organs for all patients. All developed countries of the world use this model. In this way, patients are not forced to undergo difficult dialysis, which does not always have a positive outcome, and in this way the state would have a greater financial benefit", Žižić believes.
The informal association of patients "Hrabro u novi život" launched a petition a few months ago, which requests the establishment of cooperation with the Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, in order to perform organ transplants from dead donors at the expense of the state to patients who have kidney failure, as well as other organs.
The Ministry of Health said earlier that due to the bilateral relations between Montenegro and Belarus, it is not certain when the cooperation could be implemented, and they also remind that referral to another country for cadaveric transplantation is not a practice, due to doubts about the origin of organs.
However, after the protest of some patients, the Minister of Health Vojislav Šimun he said that they sent a series of letters to the Ministry of Foreign Affairs, to the countries where transplantation can be performed.
Montenegrin doctors and representatives of the Ministry and FZO visited the Scientific and Practical Center for Surgery, Transplantology and Hematology in Minsk, and as Šimun said, they were convinced that "the conditions in the hospital are excellent".
Serbia: Among the last in the world in terms of the number of donors
In 2022, according to the published data of the International Register of Organ Donations and Transplantation (IRODaT), Serbia is among the last in the world in terms of the number of organ donors, followed only by Kazakhstan, Oman, the Philippines, Nicaragua and Vietnam.
Acting Director of the Directorate for Biomedicine of the Ministry of Health Ružica Jovanović says that a total of 1.553 patients are waiting for organ transplantation in Serbia, of which four are children.
"55 patients are waiting for a heart transplant, 65 liver and 683 kidney patients, four of whom are children. Also, 750 patients are waiting for a corneal transplant," she points out.
According to her, in the period from January to June of this year, two kidneys were transplanted from one cadaveric donor.
"In the same period of time, when it comes to the so-called 'living transplants' of kidneys, 19 of them were realized," says Jovanović.
Commenting on the IRODaT data, Jovanović sees the biggest obstacles preventing a greater number of cadaveric transplants "in the insufficiently developed awareness of the population about the importance of organ donation and transplantation".
"Serbia and the Ministry of Health are making efforts to improve the legal framework and program for donating and transplanting human organs. Special importance should be given to the activities of continuous national promotion and campaign to develop a system to raise citizens' awareness of the importance of donating human organs in order to increase the number of donors, and thus the number of successfully performed transplants, i.e. the number of human lives saved," she explains, adding that is a very low donation rate in Serbia, as well as kidney, liver and heart transplant rates, compared to neighboring countries and Western Europe, which requires joint activities of the state, the Ministry of Health - the Directorate for Biomedicine, the non-governmental sector, religious communities and every individual.
Ivana Jovic (36), a patient rights activist, found out about her kidney disease when she was 17 years old. She was on hemodialysis for years, and last year she received a new organ.
"I did not understand my diagnosis dramatically. I thought that when I was in my 50s I would end up on dialysis and then go for a transplant. However, I ended up on dialysis at the age of 33. I lived only thanks to the machine that worked instead of my kidneys," she describes.
In the meantime, Ivana has become aware of the situation she is in, the very bad position of kidney patients.
"And the fact that it is very likely that I will be on dialysis for years and will not live to receive a transplant. At that moment, in 2021, the number of transplants in Serbia was in single digits, while more than 2.000 people were on the waiting list. Together with patients from the Dialysis Center, we are launching the petition 'Donation is heroic', which was signed by more than 13.000 people, and we submitted it to the Ministry of Health. We also sent an open letter to the president of the state Aleksandar Vučić, the then prime minister Anna Brnabić and the Minister of Health Zlatibor Lončar”, says Ivana and continues:
"My story had a happy ending, as did the stories of 12 other patients who underwent kidney transplantation in Belarus last year. The funds were collected thanks to humane citizens."
Ivana also reminds of the performance they held - "Appeal for Life" in front of the Presidency on Andrićev venc, the goal of which was to raise awareness of the problem and send a message to decision makers "to feel that the state washes its hands of us".
He assesses that "definitely the darkest period of Serbian transplantation is the declaration of unconstitutionality of Article 23 of the Law on Transplantation of Human Organs, when the Constitutional Court left a deadline of six months for the Law to be corrected."
"As no correction was made, transplants were suspended for 10 months, until Minister Lončar signed the Instruction, according to which we are still working today," she says, adding that the Law was not corrected for three full years, until 2023. Then, he continues, it was adopted at the session of the Government of Serbia, "dropped" to the Assembly, but to this day it is not on the agenda.
"Meanwhile, we also met with Zlatibor Lončar, received support for improvement proposals related to the Law, but also positive information about the relaunch of the national campaign, the improvement of transplants in the health system, as well as the agreements that began with Belarus, so that our patients could be transplanted in that country at the expense of the Republic Health Insurance Fund until the situation in Serbia regarding transplants improves", she pointed out.
BIH: Amendments to regulations lead to more transplants
Waging a difficult battle for his life, a young Mostar Adnan Semić he is awaiting an urgent liver transplant at the Tuzla University Clinical Center, which will be performed by doctors from Turkey or Croatia. The struggle of this young man suffering from the rare Wilson's disease did not leave anyone indifferent in the country, but also in the surrounding countries. After dozens of years, our politicians and federal representatives finally made it possible to transplant an organ from an unrelated donor to a person by amending the law on transplantation at an emergency session of both houses of the federal parliament. In Adnan's case, the donor is a person from Serbia who reached out via social media and is ready to donate an organ.
By amending the law on transplantation, it will be possible to perform these organ transplants in Bosnia and Herzegovina, and the so-called "Adnan's Law", ie the Law on Transplantation of Organs and Tissues for the Purpose of Emergency Treatment, will start the country from a standstill when it comes to organ and tissue transplantation.
Until now, only about ten of them per year, in clinical centers in Sarajevo and Tuzla, were according to the letter of the law - only cadaveric transplants.
The proposed law envisages the addition of a new paragraph specifying that an organ or tissue can be taken from an unrelated donor exclusively if there is no possibility of donation in the case of family ties, marital and extramarital partnerships and kinship.
In BiH, there is no common list for transplantation at the state level, but the Federation of BiH has its own list for transplantation at the Center for Transplantation Medicine of the Federal Ministry of Health, while Republika Srpska, as the president of the Donor Network of Bosnia and Herzegovina said Halima Resić, does not have its transplant list.
Thus, on the lists for transplantation in Bosnia and Herzegovina, kidney transplantation is in first place, followed by liver and cornea transplantation. According to data from the Federal Ministry of Health, the largest number of patients are waiting for a kidney transplant, and there are about 260 of them.
"Most of them, 70 percent of all those waiting for a transplant, are patients on hemodialysis. Most of them do not have a related donor, but they have to wait for a transplant from people who have experienced brain death, from potential donors who are in intensive care," emphasizes Resić and adds that there are about 2.600 patients on hemodialysis throughout Bosnia and Herzegovina.
"Although there should be a much larger number of patients waiting for a kidney transplant, there are slightly less than 200 such patients on the waiting list. If we take into account that there are close to 2.000 dialysis patients in FBIH and that a third could be transplanted, which means that it is at least 600, then the number of 200 is not realistic", emphasizes the president of the Association of Dialysed and Transplanted Patients in BiH Tomislav Zuljević.
The reason for this, the interlocutor explains, is the patient's refusal to get on the list, because in BIH there is a very long wait for a transplant.
"Another reason is that some managers of dialysis centers do not refer patients for treatment in order to put them on the waiting list. As for the liver, there are about 35 patients on the list, and about 30 are waiting for a heart transplant, which is not yet done here in Bosnia and Herzegovina, but we sincerely hope that it will happen soon," says Žuljević and warns that the big number of patients wait too long for a transplant, which is a lifesaver for patients with terminal failure of internal organs.
"We would like FMZ to devote more attention to the topic of dialysis and transplantation, however, we are aware that there are other seriously ill patients who are also seeking their rights and better treatment conditions. We believe that the flourishing and progress of transplantation medicine in Bosnia and Herzegovina depends on the managers of clinical centers. "Transplantation is saving lives, returning a sick person to life, to family, to work... Dialysis is a very expensive method of treatment, and transplantation is actually a financial saving in health care," says Žuljević.
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