Not all people are lucky enough to be donors, to donate an organ after death. This is a great reward and happiness, they say. Because one organ donor can save the lives of eight and sometimes ten people. Therefore, it is thought that a person’s greatest legacy is the lives they save. However, lack of donors is one of the problems facing the entire world today. Every year, hundreds of people die while waiting for an organ.
“Caspian” The newspaper presents an interview with the president of the board of directors of the Coordination Center for Organ Donation and Transplantation of the Ministry of Health, Yegane Abbasova, about the attitude towards transplants and organ donation in our country, as well as innovations in this field:
– Mrs. Yegana, where should those who want to donate organs in Azerbaijan apply and what is the procedure?
– Every citizen of Azerbaijan can donate an organ during life and after death. It is possible to donate live stem cells, bone marrow, kidney and liver to close family members. A person who wants to donate an organ must apply at the Organ Transplant Center. We have a special application form for this. This form was approved by the Board of Directors of the Ministry of Health. The citizen chooses which organ they want to donate after their death, marks it and signs it. Signing this does not mean that you will necessarily donate your organ after your death. Not all organs of a dead person are usable. For organ donation, the deceased person must be subjected to artificial respiration so that oxygen reaches the lungs. If the patient is brain dead, the heart is functioning. If a person wants to be a living donor or their family members accept the extraction of their organs, resuscitating doctors can retain them for two, maximum three days. Because the heart can beat for two days even if no signal comes from the brain due to its own nervous system. There is also a person who wants to be a donor at age 18, signs the form, but dies of kidney failure at age 90, his organs are no longer useful. That is, not everyone is lucky enough to donate their organs.
– If the brain death of the person signing this form occurs, if their organs are useful, how is this information communicated to them? Is there such a structure in Azerbaijan?
– If there is a patient in a coma, we receive a message. We follow all the hospitals in the country. Every day we call the intensive care unit of these hospitals, we are interested in the condition of the patients. If we receive information that the patient’s condition is deteriorating, our representative goes there and meets with the intensivist. There is a brain death protocol that we developed in 2023 and approved by the Medical Scientific Council of the Ministry of Health. The protocol is published on the isim.az website. According to protocol, if a patient is diagnosed with brain death and their name is in our registry, their organs are removed.
– There are consent protocols for organ transplants in the world. Which one applies to Azerbaijan?
– There are countries in the world that apply the Opt-In (Voluntary system) and Opt-Out (Involuntary system). Azerbaijan applies the Opt-In system. Our unified information base contains a registry of people who want to be donors after their death and who do not want to be. If a person comes alive, signs the form and says “no”, the organ transplant is not discussed with their relatives either, because they did not give their consent from the beginning. The organs of people who sign and confirm this form are removed without consulting their families. The third type of people are neutral. That is, they neither agreed nor said no. He is talking to his relatives. The former Soviet location was Opt-Out. In other words, the corpse belonged to the State and it had the right to use its organs. So, if the deceased was connected to an artificial respiration machine and brain death was confirmed, his organs were removed. It is for this reason that in the Soviet era people said that when their patients got sick, let’s take them home. Because they didn’t want the dead to be dissected. Currently, the United States and Spain apply this system. In our case, the citizen must decide for himself. If you don’t want it, you must get permission from your relative, and if your relative doesn’t want it, then the organs from the corpse cannot be removed.
– I wonder if you had a conversation with the relatives of a non-donor in Azerbaijan and what was the result?
– Yes, we were informed of two cases of brain death. We went, we spoke to the patient’s relatives, they refused. One of the patients even needed a kidney, she was a lady on dialysis. You could donate your liver to a person waiting for two organs. But the family did not agree.
– Is there anyone currently requesting to be a donor?
– There is. At first I signed it myself, but the number is small. We are sure that this number will increase.
– Does the lack of people who want to be donors bother you?
– No, it’s normal. 10 years after the creation of a center like ours in Spain, people began to donate their organs. The center was established in Türkiye in 1979 and they started donating organs in 2005. During this period, they also spoke and received the answer “no.” This barrier can only be overcome with time and education. Currently, 4,000 Azerbaijani citizens are on dialysis. About 60 patients waiting for a liver transplant die each year.
– Which organism is most necessary?
– The most necessary organ in the world is the kidney. Then comes the liver, the heart, the lungs. There is also a great need for stem cell and bone marrow donors.
– A stem cell bank will be created in Azerbaijan. What is the meaning of this?
– Since 2014, around 200 bone marrow transplants have been performed in Azerbaijan. But these operations were only carried out if the brothers were compatible. There cannot be an operation without a donor and this number is quite large. If we have a stem cell bank, we can provide them with a donor ourselves. This is a normal blood donation procedure. People agree to be a donor, sign the form, we examine it and it is registered in the stem cell bank and registry. If there is a suitable patient, only 300 ml of blood is taken from the donor and it gives someone life. People don’t know it and think it’s dangerous, but it’s very simple. Simply donate blood and save lives. In addition, the person can refuse to be a donor at any time, even if they are registered.
– Among the people, even in the specialty, there are expressions like “they cut this or that”, “they cut” and they are considered terrible. Which scares people who want to be donors. How to extract an organ from a corpse?
– Organs are removed from a corpse in the same way that a living person is operated on. While the corpse is in the machine, it is taken to the operating room, the abdomen is opened, the organs are removed, and then silicone is placed in place of the organs and carefully sutured. Later, the body is handed over to his relatives and buried. There doesn’t seem to be anything terrible there. The organ is already buried in the ground, but when it is a donor, it lives in someone’s body, it gives life to someone.
– Does the family know the donor?
– No, it is completely confidential. The reward of this work comes from its secrecy. A living donor knows who he or she is donating the organ to, excluding bone marrow and stem cells. Because it usually happens between close family members.
– Is a living donor only among relatives, or can a stranger also be a living donor?
– Could be. But there is also a danger. Being a living donor from a stranger can lead to organ trafficking. For this reason, an Ethics Commission dependent on the Ministry of Health was created in February 2023. In Azerbaijani legislation, a close relative is considered to be father, mother, grandmother, grandfather, sister, brother and spouse (if married for more than two years). If the living donor is not a close relative, we collect all documents and present them to the Ethics Commission. The commission investigates and makes a decision. Even if the donor familiarizes himself with all the documents and signs the consent, the final decision regarding the unrelated donor is made by the Ethics Commission.
– Transplant operations are considered expensive operations. Are there currently any concessions applied by the State?
– Yes, it’s expensive. But the State also makes certain concessions to these patients. For example, since 2016 there has been a program for the treatment of chronic kidney diseases and the state allocates a certain amount of funds each year. Every year, between 30 and 35 patients undergo a kidney transplant. Since 2014, within the framework of the program to combat thalassemia, funds are allocated every year, if there is a donor, bone marrow transplants are performed. Starting in 2023, the President of the Republic of Azerbaijan signed a relevant legislative act to improve bone marrow transplant services. Under this legislation, citizens of Azerbaijan who do not have a donor and need a bone marrow transplant are searched at a bank in Turkey, and if a donor is found there, those citizens are sent to Turkey and operated on there. In addition, as of August 4, 2023, a corresponding number of kidney, liver and bone marrow transplant operations were included in the service provision of the State Agency for Compulsory Health Insurance.
– Some people consider it a sin to extract organs from a corpse. That is why they oppose the process. How do you feel about it?
– I worked in the intensive care unit in Saudi Arabia for five years. Every day they called us from the center asking us if you have a donor for the body. Among Arab countries, Saudi Arabia ranks second in terms of organ donation, followed by Kuwait. There people usually donate their organs after their death.
– Are xenotransplants (animal organ transplants) practiced in the world? Can we apply it?
– Our legislation does not allow xenotransplants. The legislation has its subtleties, for example, throughout the world the organ can be removed from a brain-dead corpse from the moment a child is born, but in our country it can be removed from one year of age. Even if a diagnosis of brain death is made before one year of age, organ harvesting is not permitted.
– Unique lady, how many people can a dead person give life to?
– One donor can give life to eight people. The cornea, liver, kidney and lung are transplanted to two people and the heart to one. Transplantation of the pancreas and small intestine is also possible.
– If a person who is a living donor needs a donor in the future, are there any concessions?
– Yes. All over the world, discounts are applied to donors who have donated their organs. People who have ever been living donors are placed at the top of the organ waiting list if they need a donor in the future. The system sees them and highlights them.
