Introduction

Organ transplantation is presently a method of choice in treatment of certain renal, heart, pulmonary, hepatic as well as diseases of other organs. Organs for transplantation may be removed from living-related donor or from cadavers. The entire process of organ transplantation should be strictly directed by appropriate legislation.

Summary of Course

The following topics will be discussed:

• Historical survey of organ transplantation in Yugoslavia (before 1991)
• Legislation concerning organ transplantation in Yugoslavia (before 1991)
• Current organ transplantation legislation
• State of art in organ transplantation
• Plans for improvement the process of organ transplantation

• OT - organ transplantation
• SFRY - Socialist Federate Republic of Yugoslavia (until 1991), i.e. Former Yugoslavia
• FRY - Federal Republic of Yugoslavia (after 1992), i.e. Serbia & Montenegro

There used to be a few centres (Belgrade, Sarajevo, Zagreb, Rijeka and Ljubljana) where OTs were performed let us say as a routine method of treatment within specific indications

Topic Two - Legislation Concerning OT I SFRY

First Act in regard of OT dated back to 1981 - Explantation and Transplantation of the Parts of Human Body for the Treatment Act

• Consiliar estimation of death in donor
• Exemption of the physician in charge of patient to take part in any phase of OT
• Interdiction of organ taking if there is a living will of the decased against taking his/her organs after death
• Regulations for living-related donor (age, written consent, no potential harm, etc.)
• Interdiction of any sort of compensation for organs and tissues taking for OT
• Obligation for physicians to inform potential donor before obtaining their written consent
• Any data concerning organ donor as well as their recipients should be considered as a professional secret

• Allowance for importing to and exporting from SFRY parts of the human body taken for the purpose of OT in accordance to the law, international contracts and within international co-operation
• Possibility of criminal prosecution in the cases of taking of any form of compensation for organs (imprisonment not less than one and no more then three years)

• Estimation of irreversible cessation of brain functions (i.e. Brain death) should be undertaken in comatose patients without spontaneous respiration. Such conditions may be caused by brain injury, intracranial tumour or any sort of cerebrovascular disease
• Brain death should be diagnosed upon a clinical examination which must be repeated for three times within a six hour interval. The obtained diagnosis of brain death must be confirmed either by means of cerebral angiography, EEG or radioisotope examination of brain blood circulation

• There must be adequacy for OT as well as OT should me considered as a method of choice for the treatment in the particular patient
• Consiliar certification of death in donor
• Written consent should be obtained from the organ recipient, too Foundation of the National Centre for OT. The Centre should serve for collecting data about donor, preparing of waiting list for the candidates for transplantation, tissue compatibility analysis, co-ordination of OT at the national level, etc.
• Unification of medical records in the process of OT

• Regulation for Uniform Documentation and Evidence in Organisations working on OT (1991)
• Records in regard of organ donor, their identity, cause of death, explanted organs, etc.
• Report of organs taken for the purpose of OT
• Organ transfer report and evidence
• Report upon surgery for OT
• All the data must be passed to the National OT Centre within 30 days

• Estimation of irreversible cessation of brain functions (i.e. Brain death) should be undertaken in comatose patients without spontaneous respiration. Such conditions may be caused by brain injury, intracranial tumour, cerebrovascular disease, hypoxic brain damage as well as heart beating - Broadening of the previously listed conditions
• Diagnosis of brain death should be made upon a clinical examination which must be repeated hourly for the three times. The obtained diagnosis of brain death must be confirmed either by means of brain stem evoked potentials, Doppler sonography or EEG - Introducing of up-to-date methods

• OTs (kidney, heart, liver, cornea) are performed exceptionally in Belgrade

• 50 Kidney transplantation were performed during 1996
• 9 Liver transplantation were performed between 1995 and 1997. One patient died after transplantation
• 5 Heart transplantation were performed between 1995 and 1997. Two patients died after transplantation
• There are about 100 corneal transplantation performed annually

• Waiting for transplantation:

• More than 1000 patients for kidney
• 26 Patients for liver
• 13 Patients for heart
• 6 Patients for pancreas

• Research work in pancreas transplantation
• Attempts for improvement of work of the National Centre for OT through a network of health professionals throughout the country
• Attempts toward introduction of ORGAN DONOR CARDS
• Active participate in the OT organisations
• European Society for Organ Transplantation

• There are extended legislation in regard of OT in Yugoslavia since 1981 which is regularly updated to keep up with growing requirements
• OT is performed as a routine therapeutic method in treatment of particular diseases
• There is increasing needs for organs transplantation