LEGISLATION

CROATIA

In Croatia, presumed consent legislation states that any deceased person is considered a possible organ donor if they have not explicitly objected to it during their lifetime. Although the law doesn’t prescribe an obligation to seek permission from a family of a deceased person prior to organ donation, in practice, the wishes of family members are respected. For this reason, it is important to inform your family about your organ donation wishes. Additional information can be found on the following LINK .

SERBIA

New legislation passed in July 2018 made all Serbian citizens potential organ donors by default. Organs from a deceased person can be taken for transplant if the donor has not objected to it verbally or in writing during their lifetime. However, family members of the deceased can object to organ donation at the time of death and the donation will not proceed. Additional information can be found on the following page LINK .

SLOVENIA

All citizens and residents of the Republic of Slovenia retain the right to decide on the donation of their organs and tissues after their death. Slovenians can formally confirm their decision for or against donation by enrolling themselves in the national organ donor register. However, like in Croatia and Serbia, family members of the deceased can object to organ donation. The decision of an individual to donate their parts for the needs of a transplant treatment after death is recorded in the Slovenian health insurance system, and the identification of the individual is recorded by Slovenia Transplant in an appropriate protected database at the Health Insurance Institute on the basis of a completed accession statement. Deceased (cadaveric) donor’s data can only be accessed by certified transplant coordinators through a dedicated computer program and by using designated access cards. Citizens can check their personal information through Slovenia Transplant. Additional information can be found on the following page LINK .

FAMILY CONSENT

Croatia, Slovenia and Serbia are among the countries where relatives are asked to consent to the donation of the deceased person’s organs. This can be highly stressful for family members, particularly if they are unaware of the deceased’s wishes. Communicating an individual’s position regarding organ donation when the person was still alive can remove part of the emotional pressure on relatives and has been shown to facilitate their willingness to consent to donation. Most countries with opt-out policies still consider the families’ wishes in practice, and families are allowed to veto donation, even if the deceased individual previously registered or otherwise expressed a preference for donation.

POLICY ACTIONS AT THE EU LEVEL

Within the European Union, organ donation is regulated by the Member States.

Consequently, legislation regarding organ donation and transplantation varies greatly, depending on the country’s cultural values and legal, administrative and organizational issues.

The EU is continuously working on the enhancement of transplantation systems efficiency and accessibility. The aim of the policy actions taken at the EU level is to ensure the quality and safety of human organs, safeguard the wellbeing of donors and recipients and to improve the co-operation between member states in the field of transplantation medicine.

EUROTRANSPLANT – MEDIATOR BETWEEN A DONOR AND A RECIPIENT

Eurotransplant is an international non-profit organization playing a key role in the organ exchange. There are eight Eurotransplant member countries – Austria, Croatia, Germany, Hungary, Luxembourg, the Netherlands, Slovenia and Belgium. The Eurotransplant system uses a software to generate a ‘match list’, connecting potential donors and recipients. In this way, the organ transplantation is carried out on time and the number of saved lives is increased.

TRANSPLANT RECIPIENTS

Transplant recipients

All potential candidates for organ transplantation are registered on waiting lists which are a part of Eurotransplant, the international organization for organ allocation. Eurotransplant provides services to the transplantation centers, laboratories and to the donation hospitals who collaborate in eight countries. In countries which are not Eurotransplant members, each national transplantation center settles an arrangement with the hospitals in other countries in whose waiting lists they are included. Belgium, the Netherlands, Germany, Luxembourg, Hungary, Austria, Slovenia and Croatia are currently the members of Eurotransplant. The total population living in the territory of the aforementioned member states is nearly 137 million. The advantages of Eurotransplant are two-sided: there is only one donor identification system and only one waiting list. Doctors and scientists collaborate and create regulations concerning organ allocation based on scientific proof and medical expertise.

Organ allocation

Organ allocation to an acceptable organ recipient from the national waiting list is performed in the Eurotransplant allocation office in Leiden, by using sophisticated computer software (ENIS) which compares the potential donor’s data with the recipient’s data. There are several criteria taken into consideration when performing the allocation, including expected results after the transplantation, medical urgency level, waiting time and the national organ balance as well as additional criteria depending on the organ type (for example tissue compatibility for a kidney).

The compatibility list is made in accordance with the established criteria and the compatibility level, so that the adequate recipient is chosen for each available organ. There are almost 14,000 patients on the Eurotransplant active waiting list. The size of the patients’ group enables matching a recipient with each available organ. Thanks to the group size, almost perfect compatibility is assured. During the allocation process, Eurotransplant takes into account different patient data such as the donor’s and recipient’s blood group and tissue type.

Based on the list of available organs, a proposal is given to the transplantation center regarding the patient’s priority on the list. It is important to point out that personal donor and recipient data are coded and kept anonymous.

Waiting lists

For security reasons, the information about the patient who is second on the list is sent to the transplantation center along with the primary proposal. In this way, if the first patient’s organ is rejected, the organ will be used for the next patient on the list. After a transplantation center confirms that the organ has been accepted, the organ allocation is organized. Software based donor-recipient matchmaking prevents possible manipulation and misuse.