1. Bosnia and Herzegovina Current status and ways to improve transplantation
Halima Resic
ERA-EDTA Congress, Istanbul, May 2013

2. BASIC HUMAN RIGHT
STATE HAS COMMITMENT TO RESPECT AND FULLFILL EXPECTATIONS OF ITS CITIZENS FROM THAT RIGHT
THIS RIGHT DEMANDS STATE DEDICATION TO ENSURE HIGHEST POSSIBLE STANDARDS OF PHYSICAL AND MENTAL HEALTH TO EVERY PERSON

3. International standards
Eurotransplant – Annual Report 2011
Kidney transplantation has special status in the world.
There are between kidney transplantations every year.

4. International standards
Europe's waiting lists has more than people
30% of patients will have organ
35% will die waiting

5. International standards
12 people die daily because of lack of transplant organs.
’’Transplantation heritage’’ has been compromised by organ trafficking and transplant tourism.

6. International declarations and resolutions
Istanbul Declaration, 2008 Clarifies the issues of transplant tourism, trafficking and commercialism and provides ethical guidelines for practice in organ donation and transplantation.
Madrid Resolution, 2010
On organ donation and transplantation is an additional step in overcoming donor organs shortage and transplantation needs and a global call of national responsibility in organ transplantation
2/3 out of 2000 transplanted kidneys in Pakistan were given to foreigners in 2006.

7. B&H Legal Frame Ministry of Health of Federation of B&H
Ministry of Health of Republic of Srpska
Health Department in Brcko District

8. Ministry of Health of Federation of B&H
B&H Legal Frame
Ministry of Health of Federation of B&H
Health Care Legislation in FBiH.
Health Care Insurance legislation in FBiH.
Decision on Basic health care rights package in FBiH.
Organ and tissue transplantation legislation with the purpose of treatment.
Center for Transplant Medicine (Ministry).

9. Ministry of Health of Republic of Srpska
B&H Legal Frame
Ministry of Health of Republic of Srpska
Health Care Legislation in RS
Health Care Insurance legislation in RS
Organ and tissue transplantation legislation.
Co-ordinating Center for Transplant activities.
Donor Registry.

10. Health Department in Brcko District
B&H Legal Frame
Health Department in Brcko District
Health Care Legislation in BD BiH
Health Care Insurance legislation in BD BiH

11. TRANSPLANTATION HISTORY IN BOSNIA AND HERZEGOVINA
1972 – FIRST KIDNEY TRANSPLANTATION - Clinical Center University of Sarajevo, Prof Dr Sreten Bošković.
180 related kidney transplantations have been performed at the Institute for transplantation Clinical Center University of Sarajevo until 1992.
WAR in B&H – Without transplantation...
1997 – First after-war living related kidney transplantation in General Hospital in Sarajevo (14 related transplantations until 1998).
1998 – First after-war living related kidney transplantation in Clinical Center Tuzla (110 related kidney transplantations until 2012).

12. TRANSPLANTATION HISTORY IN BOSNIA AND HERZEGOVINA
2000 – First after-war living related kidney transplantation in Clinical Center University of Sarajevo (total of 30 living related kidney transplantations).
2006 – First cadaveric transplantation of kidney and liver in Clinical Center Tuzla.
From 2006 – cadaveric transplantations of kidney and 9 liver transplantations in Bosnia and Herzegovina.
2011 – None cadaveric kidney transplantation.
2012 – Only ONE cadaveric transplantation
10 living kidney transplantations in Republic of Srpska from 2010

13. Reasons for small number of cadaveric transplantations in B&H?13

14. VITAL CYCLE
PUBLIC
ORGAN DONATION
TRANSPLANTATION
EXPLANTATION

15. REASONS FOR LOSS of DONORS
NOT-IDENTIFING ALL POTENTIAL DONORS
FAMILY CONSENT REJECTION
FAMILY REJECTING TO GIVE CONSENT FOR ORGAN DONATION 15

16. Donor Network of Bosnia and Herzegovina
FOUNDED IN 2002

17. Bosnia and Herzegovina IS A NON-GOVERMENT ORGANISATION
Donor Network
IS A NON-GOVERMENT ORGANISATION 17

18. GIVE HOPE
Bosnia and Herzegovina Donor Card 18

19. Donor Network of Canton Sarajevo – founded in 2007
European Donation and Transplantation Days celebrations
Prof.dr. Rafael Matesanz
Dr. Mirela Busić
Prof.dr. Mitra Mahdavi-Iran- 2011

20. B&H Donor network goals
Promoting transplant medicine in general.
Promoting organ donation after brain death with a goal of transplantation treatment.
Education of health professionals in the field of organ transplantation and public awareness. 20

21. Transplant medicine Centers in BiH
Kidney Transplantation – most common
CENTERS:
University Clinical Center Sarajevo
University Clinical Center Tuzla
Clinical Center Banja Luka

22. Kidney Transplantation in B&H through the years

23. Total number of transplanted patients on the 31.12.2011.
Renal Registry of B&H

24. Transplant rates on the 31.12.2011.
USRDS

25. Transplantation practice in B&H
Brain death determination must be top priority.
Local coordinators must play vital role in brain death recognition
Increasing the number of recognized brain deaths elevates the chances for the higher number of transplantations.

26. Cadaveric kidney transplantation waiting list in Federation of Bosnia and Herzegovina
From 2006.
180 patients from Federation of Bosnia and Herzegovina.
600 patients are potential cadaveric kidney transplantation candidates.

27. Conclusions
Bosnia and Herzegovina has accepted a number of international commitments in the area of human rights, including necessary health and life insurance to every person under its jurisdiction.
Many strategic documents in the area of health have been adopted.
Although, all subordinate legislation is not yet established in both entities, nor have been established key bodies responsible in the area of transplantation.

28. Conclusion
Potential donor identification and donor organ approval from the family are the key prerequisites for good transplantation practice in B&H.
B&H still, unfortunately, does not have fully developed potential donor identification system as well as potential recipients.

29. GIVE HOPE

30. “Idea of solidarity and donorship is without a doubt one of the ways to build new Europe”
Rafael Matesanz
European Council