The Republic of Croatia is a global leader in organ donation and transplantation despite having fewer resources and more modest healthcare expenditures than other countries in the European Union. The ...results of an extensive literature review were combined with expert input in an iterative multi-step data collection and evaluation process designed to assess trends in Croatian organ donation and transplantation and identify key elements, policy changes, and drivers of the system that have contributed to its success. Multiple sources of evidence were used in this study, including primary documents, national and international transplantation reports, and insights from critical informants and content experts. The results highlight several key organizational reforms that have substantially improved the performance of the Croatian transplant program. Our findings emphasize the importance of strong central governance led by an empowered national clinical leader acting under the direct auspices of the Ministry of Health and a comprehensive and progressive national plan. The Croatian transplant system is notable for its integrated approach and efficient manner of managing scarce health resources. Collectively, the results suggest that Croatia has become nearly self-sufficient due to its systematic implementation of the guiding principles for organ donation and transplantation.
ABSTRACT
Background
Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor and living donor KT rates ...over the last decade.
Methods
KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle and high KT rate countries based on the KT rate at the start of study period in 2010.
Results
Experts from low KT rate countries reported more frequently that they had taken measures regarding staff, equipment and facilities to increase the total KT rate compared with middle and high KT rate countries. For donor type–specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators and (inter)national exchange of donor kidneys. Once a measure was taken, experts’ opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients’ lack of knowledge and distrust in the healthcare system.
Conclusions
Particularly in low KT rate countries, the KT rate might be stimulated by optimizing staff, equipment and facilities. In addition, all countries may benefit from measures specific to deceased and living donors.
Graphical Abstract
Graphical Abstract
During the past ten years, the efforts to improve and organize the national transplantation system in Croatia have resulted in a steadily growing donor rate, which reached its highest level in 2011, ...with 33.6 utilized donors per million population (p.m.p.). Nowadays, Croatia is one of the leading countries in the world according to deceased donation and transplantation rates. Between 2008 and 2011, the waiting list for kidney transplantation decreased by 37.2% (from 430 to 270 persons waiting for a transplant) and the median waiting time decreased from 46 to 24 months. The Croatian model has been internationally recognized as successful and there are plans for its implementation in other countries. We analyzed the key factors that contributed to the development of this successful model for organ donation and transplantation. These are primarily the appointment of hospital and national transplant coordinators, implementation of a new financial model with donor hospital reimbursement, public awareness campaign, international cooperation, adoption of new legislation, and implementation of a donor quality assurance program. The selection of key factors is based on the authors' opinions; we are open for further discussion and propose systematic research into the issue.
Patients with a solid organ transplant can have many different complications in the mouth, as a result of immunosuppression and side effects of drugs. The aim of this study was to examine the ...frequency and type of oral lesions in renal transplant patients, dental status, oral hygiene, oral lesions related to drugs which patients take and the time of transplantation as well as the frequency of patient's visits to the dentist in the post-transplant period.
The study was performed in a period of two years and included 100 subjects with a renal transplant during their regular control visits to the Department of Nephrology and Dialysis, Clinical Hospital Centre Zagreb and the Department of Oral Medicine, School of Dental Medicine, University of Zagreb and 100 randomly selected control subjects at the Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb.
Results showed a significantly higher incidence of oral lesions in patients with renal transplant (31%) compared to control subjects. The most frequent were erythematous (inflammatory changes), keratotic lesions and gingival hyperplasia. The average DMFT index was significantly lower in patients with renal transplant than in the control group. One third of patients had a subjective feeling of dry mouth. Oral hygiene was poor overall, and only a small number of subjects used the additional sustainers for oral hygiene. Most patients did not visit the dentist after the transplantation.
Renal transplant patients need a comprehensive and regular dental care during the pre- and post-transplant period and a doctor of dental medicine should be part of a multidisciplinary team of medical specialists.
Although overall donation and transplantation activity is higher in Europe than on other continents, differences between European countries in almost every aspect of transplantation activity (for ...example, in the number of transplantations, the number of people with a functioning graft, in rates of living versus deceased donation, and in the use of expanded criteria donors) suggest that there is ample room for improvement. Herein we review the policy and clinical measures that should be considered to increase access to transplantation and improve post-transplantation outcomes. This Roadmap, generated by a group of major European stakeholders collaborating within a Thematic Network, presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation. This framework can be adopted by countries and institutions that are interested in advancing transplantation, both within and outside the European Union. Within this framework, a priority ranking of initiatives is suggested that could serve as the basis for a new European Union Action Plan on Organ Donation and Transplantation.
Summary
Donation after circulatory death (DCD) has become an accepted practice in many countries and remains a focus of intense interest in the transplant community. The present study is aimed at ...providing a description of the current situation of DCD in European countries. Specific questionnaires were developed to compile information on DCD practices, activities and post‐transplant outcomes. Thirty‐five countries completed the survey. DCD is practiced in 18 countries: eight have both controlled DCD (cDCD) and uncontrolled DCD (uDCD) programs, 4 only cDCD and 6 only uDCD. All these countries have legally binding and/or nonbinding texts to regulate the practice of DCD. The no‐touch period ranges from 5 to 30 min. There are variations in ante and post mortem interventions used for the practice of cDCD. During 2008–2016, the highest DCD activity was described in the United Kingdom, Spain, Russia, the Netherlands, Belgium and France. Data on post‐transplant outcomes of patients who receive DCD donor kidneys show better results with grafts obtained from cDCD versus uDCD donors. In conclusion, DCD is becoming increasingly accepted and performed in Europe, importantly contributing to the number of organs available and providing acceptable post‐transplantation outcomes.
Procjenjuje se da u Europi oko 10 % odraslih osoba (75 milijuna) ima početni stupanj kronične bubrežne bolesti. Kod velikog broja pacijenata bubrežna bolest otkrije se tek u uznapredovalom stupnju, ...često praćenom komplikacijama i drugim bolestima koje uvelike umanjuju kvalitetu pacijentova života te povećavaju smrtnost i troškove liječenja. Učestalost primjene pojedinih metoda nadomjesnog bubrežnog liječenja razlikuje se između europskih država, no sveobuhvatni podaci o učinku tih metoda manjkavi su ili nedostupni. Projekt EU-a EDITH ima za cilj istražiti čimbenike koji utječu na odabir metoda nadomjesnog bubrežnog liječenja u državama Europske unije (EU) te analizirati ishode liječenja i troškove za svaku od pojedinih metoda, kako bi se mogao usporediti njihov učinak na pacijente i zdravstvene sustave. Praćenje zdravstvenog stanja primatelja presatka i ishoda transplantacije kao najučinkovitije metode nadomjesnog bubrežnog liječenja planira se provesti uspostavom nacionalnih i zajedničkog Europskog registra. Za pouzdanu procjenu rizika povezanog s darovanjem bubrega potrebno je dugoročno i sveobuhvatno praćenje zdravstvenog stanja (živih) darovatelja bubrežnog presatka kroz jedinstveni registar na (nacionalnoj) i europskoj razini. Sveobuhvatna analiza i usporedba učinka pojedinih metoda nadomjesnog bubrežnog liječenja, u pogledu uspješnosti odnosno ishoda, kao i troškova liječenja, preduvjet su za kreiranje učinkovitih strategija i održivih javno-zdravstvenih politika na nacionalnoj i/ili razini EU-a. Očekuje se da će rezultati ovog projekta dati snažan poticaj široj stručnoj zajednici, nadležnim tijelima i pacijentima za zajedničko djelovanje u cilju unapređenja preventivnih mjera te ujednačavanja dostupnosti optimalnih modaliteta liječenja bubrežnih pacijenata na razini EU-a.
In Europe, early stages of chronic kidney disease (CKD) are present in nearly 10% of adult persons (75 million). In most of the patients, however, CKD is discovered at an advanced stage, often leading to complications and comorbidity with a strong impact on the quality of life, and an increase in mortality and higher treatment costs. Large variations in practice regarding the frequency of different modalities of renal replacement treatment (RRT) in European countries have been noticed, however comprehensive data on treatment outcomes are often incomplete or missing. The aim of the EDITH EU project is to investigate the factors influencing RRT modality choice in EU Member States and analyse outcomes and treatment costs, to compare the impact of different modalities on patients and healthcare systems. Development of national and common European registries for the long-term follow-up of living kidney donors and kidney recipients will be enhanced and piloted to ensure safeguard and a more accurate assessment of the risks associated with organ donation and transplantation. A comprehensive analysis and comparison of the impact of various RRT methods, measured by outcomes and treatment costs, are the key preconditions for creation of efficient strategies and public-health policies on a national and/or EU level. It is expected that the results will provide a strong stimulus to the professional community, competent authorities and patients’ joint efforts in implementation of effective strategies and sustained funding models for prevention of kidney disease and optimisation of its treatment in the EU member states.
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