306.3: Transplantation legislations in Turkey.

Abstract

Organ transplantation became the preferred procedure for treatment of end stage organ failure. The success of any transplantation organization depends on legal, ethical, medical, social, psychological, economical and religious factors. An effective system should be created with regard to these issues; especially legislation. If transplantation legislation is lacking then it is better to stop or abandon transplantation in this country. In an attempt to start a deceased-donor donation program in Turkey, our group contacted and worked in cooperation with international networks, including the South Eastern Organ Procurement Foundation (Richmond, VA, USA) and the Eurotransplant Foundation (Leiden, The Netherlands). Thus, we were able to perform the first deceased-donor kidney transplantation on October 10, 1978, using an organ supplied by the Eurotransplant Foundation. During the early periods of transplantation, the lack of legislation in governing organ donation was the main hurdle in Turkey. To overcome this problem, we made attempts to convince members of Parliament, officials of the Department of Religious Affairs and the Ministry of Health that transplantation was a life saving procedure and should be supported. Our efforts were successful and we structured a law on organ procurement, preservation and transplantation, which was used as a model by many countries. On June 3,1979 the law was enacted by Turkish Government, and later that month on June 27, we performed the first local deceased-donor kidney transplantation. We worked with the Turkish public to provide education about the benefits of and social responsibilities involved in organ donation. In addition, we founded The Turkish Organ Transplantation and Burn Treatment Foundation in 1980 and printed standardized organ donation cards. On January 21,1982 additional articles were added to Law 2238, with the enacted Law 2594, which allowed for deceased donation without consent from next-of-kin. In 2001, the Ministry of Health established the National Coordination Center as an umbrella organization to promote transplantation activities, especially for deceased donor organ procurement. This system increased deceased organ procurement from 0.9 pmp to 7 pmp in 18 years. Until now, we have performed 3007 kidney and since 1988, 629 liver transplants. In over 40 years of solid organ transplantation history in Turkey, 38477 kidney transplants (8278 deceased, 30199 living); 14185 livers (4187 deceased, 9998 living); 1048 hearts; and 195 pancreas transplants have been performed nationwide in 82 different centers. Transplantation activities are accelerating day by day throughout the country, but deceased donors are still far below the desired rates. Efforts to increase awareness continue through the media, schools, and many public and private institutions. Improvements in legislation, education and coordination are key factors for increasing the quality and the quantity of transplantation activities in Turkey.