The New Era of Organ Transplantation in Greece: Time to Converge With the Western World

Abstract

Greece has a relatively long history in organ transplantation with the first successful kidney transplant being performed in 1968. Over the last decade, in the midst of the worst financial crisis in the history of the country 1 , due to the brain drain and the lack of political and administrative vision, the organ donation and transplantation reached a historic low 2,3 . Over the recent few years, a reversal of the trend is noticed. The current momentum, the rising donor rates, the establishment of an Academic Department for Liver Transplantation in Athens, the Pancreas Transplant Unit in the University Hospital of Patras and the Onassis National Transplant Center, structural reforms of the Hellenic Transplant Organization (HTO; including placement of local transplant coordinators in Intensive Care Units)and the brain regain, might facilitate the effort that Hellenic Transplant System is making to converge with the international transplant standards. Compared to our analysis from almost 10 years ago 2 , there are some changes in the number and structure of the transplant programs. Greece has 5 kidney transplant programs (with 1 program that has extensive experience of > 4000 deceased-donor and 1000 living-donor kidney transplants) and another 1 new kidney transplant program expected to be fully operational in the next few years. Currently, Greece has 2 active liver transplant programs performing deceased-donor liver transplants, based in Thessaloniki and Athens. The latter recently successfully performed the first couple living-donor liver transplants, with the assistance of foreign collaborators. Two of the kidney programs are licensed to perform pediatric kidney transplants. Moreover, now there are 2 pancreas transplant programs established, and 1 cardiac and lung transplant program. Currently, there is no active small bowel or dedicated pediatric transplant program. As mentioned before 2 , children older than 14 years are registered and get priority on the adult kidney list, whereas children younger than 14 years are still referred to centers abroad. All transplant programs are public, and no transplantation license has been issued in the private health sector.In a closer look of the transplant frame in Greece, a ''soft opt-out'' consent system has been in effect since 2023 (an opt-in system was in place since 2017) and there has been clear transplant legislation that defines brain death. Ongoing convergence of our legislature to the international guidelines on the role of ancillary tests to confirm brain death, could mitigate the high levels of public distrust in the system. Pediatric live donation is prohibited. There are some provisions for donation after circulatory death since 2023 but unfortunately no DCD organs have been transplanted to date as well as no clear guidelines regarding donor warm ischemia time have been defined. Moreover, no provisions exist regarding directed or non-directed altruistic donation: all policies that, if implemented, will definitely increase the pool of available organs 4 .A recent workforce analysis that pioneered the use of conceptual frameworks as resources to guide the evaluation and the transformation of organ donation and transplantation in Greece 5 , showed that medical staffing levels in Hellenic Transplant System were below the average of other European and Mediterranean countries across all specialties (including surgeons, physicians, anesthesiologists, and others) 6 . There is also an urgent need to expand operating room capacity for both donation (national donor center) 7 and transplantation procedures, and to improve access quality of ancillary services (radiology, transplant infectious diseases, endoscopy, interventional radiology, pathology and histocompatibility testing etc.) across all existing units.Using data from IRODaT (International Registry on Organ Donation and Transplantation), since 2019 (time of financial recovery of Greek Economy after 10 years of financial regre