Abstract

The paper describes 20 years of the thriving evolution of the organ donation system in Slovenia. Even before the turn of the century, Slovenia was a pioneering country in South-East Europe in terms of the organizational, legislative, medical, and ethical development of donor and transplantation medicine. Real progress came in the year 2000 when the national donation and transplant competent organization the Slovenija-transplant (ST) institute was established, modern national legislation was introduced, and the country met the demanding entrance requirements to join Eurotransplant (ET), an international foundation for organ and tissue exchanges. Joining the ET led to improvements in numbers of organs procured from deceased donors, allowed better transplant treatment options for Slovenian patients (especially urgent, hyper sensibilized, etc.), reduced patient waiting lists, while the larger ‘pool’ of patients meant that a suitable match could be found for procured organs. Over the 20 years of deceased donation development, priorities have included assuring the quality, safety, and traceability of human organs, tissues, and cells within an efficient, transparent and ethical transplant system. Great attention has always been placed on frequent, open, transparent, and high-quality communication with the public. Entailing a retrospective study, the article presents analysis of key figures and quality indicators of the Slovenian deceased donation program for the period 2000–2019. Slovenia has stood out for its rate of consent for deceased donation (the 20-year average exceeds 75%), been a world leader in the number of heart transplants per million population (at around 11 heart transplants pmp), and has a consistent deceased donor rate (around 20–22 deceased donors pmp). In the challenging pandemic year of 2020, Slovenia once more demonstrated its quality and professionalism. It was one of the countries that best adapted to the crisis. With regular videoconferences on a daily/weekly basis that included professionals and the frequent alteration of safety protocols, the national deceased and transplantation programs were able to remain active and without drops in numbers. The quality of organs and safety for patients was not under threat. Statistics for 2020 show that even more deceased donors and transplantations were performed than in 2019. The article provides an example of good practice of adaptation of the world renowned “Spanish donation model” to suit a specific national context. The findings are useful and transferable to clinical settings in other smaller countries that still need to establish national organ and tissue donation programs. Unfortunately, in many countries around the world (even in Europe), transplant treatment is neither available nor accessible to many patients in need.

Highlights

  • Slovenia was a pioneer in South-East (SE) Europe with respect to the development of donor and transplant medicine.The history of transplant activities dates all the way back to the 1970s when the first kidney transplant from a living donor was performed

  • At the transplant center located in the University Medical center (UMC) of Ljubljana, the first kidney from a deceased donor was transplanted in 1986, the first pancreas and heart in 1990, Danica Avsec and Jana Simenc: Twenty Years of Deceased Organ Donation in Slovenia: Steps

  • The need for assuring better transplant treatment options for Slovenian patients, urgent access to a bigger ‘donor pool’, the improved professionalism of the processes, adequate capacity management, sufficient public trust, voluntary organ donations, regulatory control and a suitable normative environment in harmony with the international directives on human organs, tissues, and cells led to intensive work on setting up a national transplant system

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Summary

Introduction

Slovenia was a pioneer in South-East (SE) Europe with respect to the development of donor and transplant medicine. The history of transplant activities dates all the way back to the 1970s when the first kidney transplant from a living donor was performed. The need for assuring better transplant treatment options for Slovenian patients, urgent access to a bigger ‘donor pool’, the improved professionalism of the processes, adequate capacity management, sufficient public trust, voluntary organ donations, regulatory control and a suitable normative environment in harmony with the international directives on human organs, tissues, and cells led to intensive work on setting up a national transplant system. A systematic approach to ensuring a comprehensively organized, connected, and well-managed donation and transplant network was developed in Slovenia under the leadership of the Slovenija-transplant (ST) institute. Priorities included assuring the quality, safety, and traceability of human organs, tissues, and cells, and educating professionals and the general public as part of an efficient, transparent, and ethical transplant system

Achieving Progress with a Systematic Approach
Establishment of the National Competent Institution
Development of the Legislative Framework
Joining Eurotransplant
Priority Actions
The Education of Donation Professionals
Appointments and Clearly Defined Roles of Transplant Coordinators
Management of Donors of Suboptimal Quality
Implementation of the Quality Assurance Program
Future Orientations
Findings
Conclusions
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