Bosnia and Herzegovina Current status and ways to improve transplantation Halima Resic ERA-EDTA Congress, Istanbul, May 2013

BASIC HUMAN RIGHT STATE HAS COMMITMENT TO RESPECT AND FULLFILL EXPECTATIONS OF ITS CITIZENS FROM THAT RIGHT THIS RIGHT DEMANDS STATE DEDICATION TO ENSURE HIGHEST POSSIBLE STANDARDS OF PHYSICAL AND MENTAL HEALTH TO EVERY PERSON

International standards Eurotransplant – Annual Report 2011 Kidney transplantation has special status in the world. There are between 50 - 70.000 kidney transplantations every year.

International standards Europe's waiting lists has more than 50.000 people 30% of patients will have organ 35% will die waiting

International standards 12 people die daily because of lack of transplant organs. ’’Transplantation heritage’’ has been compromised by organ trafficking and transplant tourism.

International declarations and resolutions Istanbul Declaration, 2008 Clarifies the issues of transplant tourism, trafficking and commercialism and provides ethical guidelines for practice in organ donation and transplantation. Madrid Resolution, 2010 On organ donation and transplantation is an additional step in overcoming donor organs shortage and transplantation needs and a global call of national responsibility in organ transplantation 2/3 out of 2000 transplanted kidneys in Pakistan were given to foreigners in 2006.

B&H Legal Frame Ministry of Health of Federation of B&H Ministry of Health of Republic of Srpska Health Department in Brcko District

Ministry of Health of Federation of B&H B&H Legal Frame Ministry of Health of Federation of B&H Health Care Legislation in FBiH. Health Care Insurance legislation in FBiH. Decision on Basic health care rights package in FBiH. Organ and tissue transplantation legislation with the purpose of treatment. Center for Transplant Medicine (Ministry).

Ministry of Health of Republic of Srpska B&H Legal Frame Ministry of Health of Republic of Srpska Health Care Legislation in RS Health Care Insurance legislation in RS Organ and tissue transplantation legislation. Co-ordinating Center for Transplant activities. Donor Registry.

Health Department in Brcko District B&H Legal Frame Health Department in Brcko District Health Care Legislation in BD BiH Health Care Insurance legislation in BD BiH

TRANSPLANTATION HISTORY IN BOSNIA AND HERZEGOVINA 1972 – FIRST KIDNEY TRANSPLANTATION - Clinical Center University of Sarajevo, Prof Dr Sreten Bošković. 180 related kidney transplantations have been performed at the Institute for transplantation Clinical Center University of Sarajevo until 1992. 1992-1997 WAR in B&H – Without transplantation... 1997 – First after-war living related kidney transplantation in General Hospital in Sarajevo (14 related transplantations until 1998). 1998 – First after-war living related kidney transplantation in Clinical Center Tuzla (110 related kidney transplantations until 2012).

TRANSPLANTATION HISTORY IN BOSNIA AND HERZEGOVINA 2000 – First after-war living related kidney transplantation in Clinical Center University of Sarajevo (total of 30 living related kidney transplantations). 2006 – First cadaveric transplantation of kidney and liver in Clinical Center Tuzla. From 2006 – 2012 - 17 cadaveric transplantations of kidney and 9 liver transplantations in Bosnia and Herzegovina. 2011 – None cadaveric kidney transplantation. 2012 – Only ONE cadaveric transplantation 10 living kidney transplantations in Republic of Srpska from 2010

Reasons for small number of cadaveric transplantations in B&H? 13

VITAL CYCLE PUBLIC ORGAN DONATION TRANSPLANTATION EXPLANTATION

REASONS FOR LOSS of DONORS NOT-IDENTIFING ALL POTENTIAL DONORS FAMILY CONSENT REJECTION FAMILY REJECTING TO GIVE CONSENT FOR ORGAN DONATION 15

Donor Network of Bosnia and Herzegovina FOUNDED IN 2002

Bosnia and Herzegovina IS A NON-GOVERMENT ORGANISATION Donor Network IS A NON-GOVERMENT ORGANISATION 17

GIVE HOPE Bosnia and Herzegovina Donor Card 18

Donor Network of Canton Sarajevo – founded in 2007 European Donation and Transplantation Days celebrations Prof.dr. Rafael Matesanz - 2007 Dr. Mirela Busić - 2009 Prof.dr. Mitra Mahdavi-Iran- 2011

B&H Donor network goals Promoting transplant medicine in general. Promoting organ donation after brain death with a goal of transplantation treatment. Education of health professionals in the field of organ transplantation and public awareness. 20

Transplant medicine Centers in BiH Kidney Transplantation – most common CENTERS: University Clinical Center Sarajevo University Clinical Center Tuzla Clinical Center Banja Luka

Kidney Transplantation in B&H through the years

Total number of transplanted patients on the 31.12.2011. Renal Registry of B&H

Transplant rates on the 31.12.2011. USRDS - 2012

Transplantation practice in B&H Brain death determination must be top priority. Local coordinators must play vital role in brain death recognition Increasing the number of recognized brain deaths elevates the chances for the higher number of transplantations.

Cadaveric kidney transplantation waiting list in Federation of Bosnia and Herzegovina From 2006. 180 patients from Federation of Bosnia and Herzegovina. 600 patients are potential cadaveric kidney transplantation candidates.

Conclusions Bosnia and Herzegovina has accepted a number of international commitments in the area of human rights, including necessary health and life insurance to every person under its jurisdiction. Many strategic documents in the area of health have been adopted. Although, all subordinate legislation is not yet established in both entities, nor have been established key bodies responsible in the area of transplantation.

Conclusion Potential donor identification and donor organ approval from the family are the key prerequisites for good transplantation practice in B&H. B&H still, unfortunately, does not have fully developed potential donor identification system as well as potential recipients.

GIVE HOPE

“Idea of solidarity and donorship is without a doubt one of the ways to build new Europe” Rafael Matesanz European Council