Lack of public awareness means fewer donors
Although organ transplants have increased significantly over the last few years, the number of operations performed is still falling short of demand due to a lack of public awareness, transplant specialists said last week.
According to Poltransplant, the country's only transplant coordination center, about 119 heart transplants were performed last year, 45% more than in 1995. Kidney transplants increased to 601 last year from 351 five years ago. By the end of 1999, 21 transplant centers had performed more than 8,000 procedures.
"Yes, the number of donors is increasing, but in small increments," said Jerzy Skucinski, a surgeon and the head of the transplant office in the department of general surgery at Jagiellonian University's Collegium Medicum in Krakow. The medical college currently performs kidney transplants but plans to do liver transplants in the near future.
"Money is not the greatest obstacle," Skucinski said. "Considering the low level of social awareness (about the importance of donating organs), we are at the very beginning (in Poland)."
Statistics appear to support this claim. According to European Transplant Coordinators Organization estimates, the annual rate of cadaver donors per million people in 1998 for Poland was 7.5, compared to 19.2 in the Czech Republic, 12.2 in Hungary and 31.5 in Spain, Europe's donor leader. Of European countries, only Croatia, Greece, and Lithuania had worse results than Poland.
"Today, we are absolutely prepared to perform transplants," Skucinski said. "But it's a matter of (having enough) donors."
Before 1995 when a law on transplants was passed explaining all legal aspects of obtaining and transplanting cells, tissues, and organs there had been almost no public discussion on the importance of using a cadaver's organs. Poltransplant was established in 1996 after this law came into effect. Since its start, the state-run Poltransplant has maintained a Central Register of Objections (CRS) listing the names of those refusing to have their organs used for transplants after their death.
According to Poltransplant, 20,440 people had registered with the CRS by the end of 1999. "The greatest number of objections came in the first half of 1997," states Poltransplant's news bulletin (No. 1, 2000). That year, 14,658 objections were recorded compared with 1,707 in 1999.
"In reality, the number of objections hasn't influenced the number of donors," Skucinski said.
From 1996-1999, only 0.05% of Poles registered objections to having their organs used for transplants, according to Poltransplant estimates. Skucinski cited a different reason for the low annual rate of donors.
"(The small number of donors) is sometimes caused by a lack of awareness among some doctors who should be able to detect potential donors immediately," he said. "In addition, some families of the deceased tend to say 'no,' even though they should know how important organ donations are."
According to Poltransplant, roughly 10% of 375 potential cadaver donors last year were made unavailable due to family protests.
The problem of finding donors is not limited to Poland. "It's a general problem in the world," said Roman Kostyra, a surgeon who heads the transplant team at the Pomeranian Academy of Medicine's transplant surgery center in Szczecin. Kostyra's team works on kidney and liver transplants. The Szczecin center performed 30 liver transplants since 1996.
"The most serious problems in general are linked with heart and liver donors, as these two organs are in the greatest demand," Kostyra said.
In addition, he said such complicated transplants have to be subsidized by the Health Ministry. "The necessary funds are contracted at the very beginning of the year (when it's not possible to predict the demand.) What we get is enough for 15-20 transplants in total," Kostyra said. "It doesn't satisfy the real demand."
According to Skucinski, there are other sources of funds besides the state that he can apply to. "After all, we can also collect money from sponsors," he said. "We're not sitting on our hands."
