Na inicijativu eurozastupnika iz Hrvatske, g. Ivana Jakovčića, u Europskom parlamentu je održana konferencija pod naslovom „Improving organ donation and transplant across the EU: A cross-condition campaign”.
Konferenciju je otvorio i vodio g. Jakovčić, a suvoditelji su bili belgijska europarlamentarka Hilde Vautmans i slovenski europarlametarac Lojze Peterle.
Svoja predavanja su održali pozvani gosti, predsjednik Hrvatske donorske mreže, dr. Nikola Žgrablić i Pisana Ferrari iz Europskog društva za plućnu hipertenziju, pa Rafael Matesanz – predsjednik Španjolske transpl. organizacije, kao i prof. Van Holder – predsjednik Europske bubrežne alijanse, te Stefan Van der Spiegel iz Europske komisije. Riječ su dobili i predstavnici nekih istaknutih europskih građanskih udruga, kao i transplantirani pacijenti.
Kroz predavanja i raspravu naglašena je važnost postmortalnog darivanja organa, kao i neprekidna izobrazba koordinatora i edukacija u javnosti. Konferencija će imati odjeka u daljnjem radu Europske unije za razvoj transplantacije organa.
U svojem uvodnom predavanju, predsjednik HDM-a prikazao je aktivnosti koje su Hrvatsku dovele do uspješne transplantacijske zemlje, naglasivši pritom usavršavanje organizacije, sustavnu edukaciju koordinatora, kao i informativna predavanja u srednjim školama. U nekoliko sljedećih predavanja istaknuti su izuzetni transplantacijski rezultati Hrvatske kao primjer za druge europske države.
Na konferenciju je bilo pozvano i petoro članova HDM-a. Zahvaljujemo našim domaćinima u Europskom parlamentu, g. Jakovčiću, g. Rosandi i suradnicima na ugodnom boravku u Bruxellesu.
Uvodno predavanje predsjednika HDM-a dr. N. Žgrablića u Europskom parlamentu 18. listopada 2016:
Mr. Chairman, ladies and gentlemen, dear guests,
Thank you for inviting me to present Donor Network of Croatia and its activities, as well as our recent successes in organ donation, here, in the European Parliament.
In my speech I’d like to address the significance of non-governmental organizations in the field of transplantation. Their role may be important, yet often not recognized, sometimes even neglected or underestimated. However, they can make a valuable contribution to the development of transplantation, especially in certain situations or countries.
In the middle of the 90’s of the last century, the Croatian transplantation medicine was at the rear of Europe. Not only because of the programs we developed at that time, but also because of the number of donors per million people. In that period Croatia had 2-3, sometimes up to 5 donors pmp. At the same time, we had long waiting lists, which was associated with a high mortality rate, because almost 50% of patients had been waiting for a kidney transplant for 5 or more years. This difficult situation required prompt undertaking of appropriate measures.
Unfortunately, there was no organization in charge of the transplantation program. Transplantation was left to the free initiative and enthusiasm of each transplant team. Further on, an explantation program existed only in few hospitals in Croatia. It is important to know that, at that time, Croatia did not have a national transplantation agency, but in the meantime the problem was solved in a satisfying manner within the Ministry of Health in the form of the Institute for Transplantations and Biomedicine.
In those years, it was thought that one of the major problems of transplantation in Croatia was the uninformed general public who knew little or nothing about organ transplantation and who were not prone to donate. Actually, almost 50% of families refused to consent to an organ donation. For this reason, a group of physicians from Pula, Croatia founded the Donor Network of Croatia in 1998 that started it’s already in 1996 by issuing the organ donor card. The main intention of the organization was to change the public attitude toward organ donation in order to increase the consciousness of the general public and organ donation rate. Furthermore, it was clear that without government’s full engagement it would be impossible to improve things significantly. Therefore, from the very beginning, the government was strongly recommended to start solving the problem. For example, DNC had an official advisory role in the Croatian Parliament when the Resolution on Organ Transplantation Promotion in the Republic of Croatia was passed in 1999.
Our first and most well – known product is the organ donor card. It is not a legally binding document and it was not intended to be one. It is more a kind of promotional material, a medium to provoke, to raise discussions, above all, among family members. And, last but not least, it shows the willingness to donate organs after death.
In the last 20 years it has been distributed in one million copies by handing it over in presentations or by ordering it online or on social networks. The card has been distributed twice in large quantities to all family doctor practices in Croatia who then handed it further on. In the same way it was twice distributed through in daily newspapers, and once as a prepaid telephone card.
Famous people as politicians, sportsmen, singers and others have been asked to sign their donor cards in public. A council of DNC has been established and joined by numerous university professors and scientists, members of Croatian Academy of Sciences and Arts, and even the former president of Croatia, as an honorary member. In this manner we have succeeded in gaining credibility, creating an impact on general public and gaining support to organ donation.
Many presentations have been held for the general public, but also for some specific groups as catholic priests, university and high school professors and students. Special attention has been given to health professionals because of their crucial role in transplantation process. Unfortunately, about 20 years ago their knowledge and attitude were unsatisfying. For that reason, many lectures have been held in hospitals, medical centres and expert medical associations.
We are extremely proud of the lessons we are holding for the students at the third grade of high school in the Istrian Region since 2005. It’s a unique program in Croatia covering all the students of one generation, making them acquainted with organ transplantation and creating preconditions for new generations to be able to understand the need for organ donation. We are trying to extend this program across the whole country, first of all, by training new educators among medical students, which is currently not possible due to the lack of financial means.
It is commonly accepted that positive public opinion on organ donation is one of the most important issues which can cause an increase in the number of donors. Hopefully, the education of school population will lead to “generational change” and further on to positive attitude of the present and future population in our country.
Despite the ingrained opinion that public education creates the positive public opinion on organ donation, not a single country possesses a permanent school program on the whole territory. The existing programs do not usually cover the whole generation of students. We strongly believe that launching such programs can significantly change situation in the future.
Meanwhile, we understood that the uninformed public was not the only problem of the Croatian transplantation system. The lack of educated transplant coordinators emerged as one of the key factors. This is why we decided, since the beginning of 2000, to finance and send some coordinators on TPM training courses in Spain. We soon wanted to start similar education ourselves, thus we have organized several major training courses since 2003, on which more than 120 specialists have been educated, not only transplant coordinators directly involved in the donation, but also other specialists like neurologists, because we believed that they too needed to be actively involved in this problem. In that way we have achieved to include 2 or 3 physicians educated in transplantation in each hospital. Since 2014 we have been organizing TPM courses in Croatia, in collaboration with TPM DTI foundation from Barcelona for Croatian specialists, but also for doctors from neighbouring countries such as BiH, Montenegro, Serbia, Macedonia, Bulgaria, Romania and Moldova. This is an excellent example, how a successful country and organizations may help other countries in their region start educational process and creation of pool of highly trained transplant coordinators.
Finally, DNC was the local congress organizer of 24th European Transplant Coordinators Organization congress in Dubrovnik, Croatia in 2012, which was the biggest congress on organ donation that year in the world.
We believe that our engagement has been of immense importance to the recent successes in organ donation in Croatia. Just to remind you of that in 2015, Croatia has over 39 donors p.m.p. which is best result ever in the world. However, it is important to mention that without strong involvement of the state administration and their political decision to engage themselves into resolution of this problem, as well as their financial investments, these successes wouldn’t have been possible.
Nonetheless, the model of the DNC can be applied on the countries that do not have, as Croatia didn’t, a national transplant agency. The DNC has even helped the foundation of similar organisations within the region, by financial means or activities.
The involvement of nongovernmental organizations can facilitate the resolution of many aspects of this problem by their activities, such us, by sensitizing and educating the public but also the health professionals. We emphasize the importance of the education of special groups of population, such as students and, even more importantly, the education of dedicated medical specialists, transplant coordinators. These people are crucial in organ donation process. Finally, in the countries that are just starting to implement the transplantation programs and where the health system isn’t yet organized to deal with them, it is obvious that initiatives are to be started from below towards above, in order to launch the system.