Kidney transplantations in the Slovak republic, Hungary, and Austria Stacey Geisel The University of Central Florida

KIDNEY TRANSPLANTATION OVERVIEW Surgical procedure to place a healthy kidney from a live or deceased donor into a person whose kidneys no longer function properly Most common type of transplant The First Cadaveric Kidney Transplantation in the Slovak Republic was performed in June 1972 at the Department of Urology at the Dérer’s Hospital in Bratislava The National Transplant Organization Transplant centers located in Bratislava, Banská Bystrica, Martin and Košice

TRANSPLANT VS. DIALYSIS People with end-stage renal disease need to have waste removed from their bloodstream via dialysis or a kidney transplant to stay alive Better quality of life and more freedom 93% survival rate 1 year following transplantation Annual savings in dialysis post kidney transplantation ~€17,000/year/patient

LIVING DONOR CRITERIA Adult blood relative, partner or friend Two healthy kidneys Similar blood type Negative cross-match Absence of disease

DECEASED DONOR CRITERIA Implied consent for donation after death Every citizen has the right to refuse to donate If refusing to donate, one must fill out a form and send it to the National Transplant Organization The NTO keeps a register of people who have refused to donate organs, tissues, and cells after death

CHALLENGES 2% of the health care budget in Europe goes towards kidney failure Waitlist Average wait of 3 years Low rate of living donors Related to substantial morbidity risk Continuous follow-up after surgery & access to healthcare and social care No rules concerning medical treatment after transplantation Example: if country of residence changes

AUSTRIA First Kidney Transplant Vienna, Austria 1965 4 Transplant Centers Austria Kidney Transplant: €17,200 first 13-24 months & €12,900 25 months+ Austria Dialysis: €43,600 first 13-24 months & €40,600 25 months+ Only 15% living donors in Austria

HUNGARY First Kidney Transplant Szeged, Hungary 1962 5 Transplant Centers Presumed Consent Eurotransplant: Support for deceased donation

AUSTRIA & HUNGARY (Eurotransplant, 2016)

2013 KIDNEY TRANSPLANTS PER MILLION POPULATION, COUNCIL OF EUROPE (European Commission, 2014)

2013 KIDNEY TRANSPLANTS PER MILLION POPULATION, COUNCIL OF EUROPE 954 119 291 421 60 (European Commission, 2014)

LIVING DONOR BEST PRACTICE Highest living donation: Netherlands Nephrologists actively search for potential donors within patient family and approach directly Living donation priority over deceased Only put on waitlist for donation if no suitable living donor could be identified Increase number of transplant donor coordinators

OPPORTUNITIES FOR IMPROVEMENT Address difficulties Exchange best practice Create action plan Prevention Donor education Increase living donor participation Decrease waitlist time Formal pre-transplant counseling & follow-up care

REFERENCES   Asztalos L., Csajbók E., Kalmár N., Langer R., Perner, F., Szederkényi E., & Szenohradszky P. (2013). 50 year history of kidney transplantation in Hungary. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23708984 Conklin, A., Hatziandreu, E., Janta, B., Ling T., Patruni, B., Rabinovich, L., Tiessen, J., & Vries, H. (2008). Improving Organ Donation and Transplantation in the European Union. Retrieved from http://www.rand.org/content/dam/rand/pubs/technical_reports/2008/RAND_TR602.pdf European Comission. (2013). 4th Journalist Workshop on Organ Donation and Transplantation. Retrieved from http://ec.europa.eu/health/blood_tissues_organs/docs/ev_20131007_rd3_en.pdf European Commission. (2014). Organ Donation and Transplantation Recent Facts and Figures. Retrieved from http://ec.europa.eu/health/blood_tissues_organs/docs/ev_20141126_factsfigures_en.pdf Eurotransplant (2015). Eurotransplant International Foundation: Annual Report 2015. Retrieved from http://eurotransplant.org/cms/mediaobject.php?file=AR_ET_20153.pdf Eurotransplant. (2016). Kidney transplants per million population, per year, by country, by donor type. Retrieved from http://statistics.eurotransplant.org/index.php?search_type=transplants&search_organ=&search_region=&search_period=by+year+chart&search _characteristic=&search_text= Gutjahr, G., Haller, M., Harnoncourt, F., Kramar, R., & Oberbauer, R. (2010). Cost-effectiveness analysis of renal replacement therapy in Austria. Retrieved from http://ndt.oxfordjournals.org/content/early/2011/02/10/ndt.gfq780.full Kofler, B. (2012). Danger of kidney disease underestimated. Retrieved from http://www.ehfg.org/kidneys.html Margreiter, R., & Mühlbacher, F. (2014). The history of organ transplantation in Austria. Retrieved from http://link.springer.com/article/10.1007/s10353-014-0248-x National Transplant Organization. (2016). Retrieved from http://www.nto.sk/home.html Prihodova, L., Nagyova, I., Rosenberger, J., Majernikova, M., Roland, R., Groothoff, J. W., & Dijk, J. P. (2014). Adherence in patients in the first year after kidney transplantation and its impact on graft loss and mortality: a cross-sectional and prospective study. Journal Of Advanced Nursing, 70(12), 2871-2883. doi:10.1111/jan.12447