Fierce competition for the few beds in intensive-care units sometimes leads to the ‘rejection’ of organ transplants

The following paradox can be observed in Greece: We have the highest rate of road deaths in the European Union, but also the fewest organ transplants from cadavers. According to EOM, there were 101 kidney transplants from cadavers in 2007, compared with 144 in 2006. What is to blame? The official line is that we are to blame. It is regularly pointed out that, despite campaigns to raise awareness, only 91,000 Greeks are registered donors (0.8 percent of the population). The fact that there are 6 cadaver donors per 1 million people (compared to 37 in Spain) is attributed mainly to the refusal of relatives to consent to organ donation when their relatives have died. Not only ignorance Indifference and ignorance are not the only causes of the problem. To start with, due to the shortage of beds in intensive-care units (ICUs), many patients end up in neurosurgery wards so the donation process cannot be carried out. That is because the law stipulates that organ donations from cadavers can only be conducted in an ICU. Moreover, there is a battle for beds in ICUs. When an organ is donated, a precious bed is occupied for longer, while people outside the unit are dying. In 2007, only 166 potential donors were recorded by ICUs, compared with 179 in 2006, and only 64 of these were used, each yielding two organs on average. It is not by chance that the largest hospitals in Athens report the lowest number of potential donors (ICUs must report all cases of brain death to EOM). Few know that in many cases relatives are informed only at the last minute and without any knowledge that their consent to organ donation may save up to 10 lives. «The grim truth is that ICUs don’t produce transplants; the doctors haven’t taken the idea on board,» said Christos Svarnas, president of the Panhellenic Association of Kidney Transplant Recipients, which has 1,000 members. There are 2,400 kidney transplant recipients living in Greece. «Information and awareness are needed. They have to tell people that one body can save five to 15 people,» said Svarnas. «It really is chaotic at ICUs,» Yiannis Boletis, director of the transplant unit at the Laiko Hospital and president of the Greek Nephrology Society, told Kathimerini. «Some doctors could definitely make a bigger effort in this respect. Unfortunately, there are some doctors who do not have one donor to their credit. On the other hand, the doctors and nurses who work in ICUs are among the hardest working Greeks. When someone dies and relatives consent to organ donation, it means that the deceased will occupy the bed for another two days. The procedures are time-consuming. By the time the doctor’s next shift comes, it’s time to look at the living again.» In only 15 percent of cases is a refusal by relatives due to religious convictions. Seventy percent are due to anger with the system. It is worth noting that donations are not accepted, even from patients who have declared themselves donors, if relatives do not give their consent. «The public see the state as their enemy, and justifiably so,» said Boletis. «Put yourself in the position of someone whose child has been in a road accident. The parent starts off being angry with the traffic police. Then they try and find an ICU and can’t. They wander past beds and corridors, and by the time they get to the ICU, they hear that their child is dead. In such an atmosphere, who can think positively about organ donation? Outdated legislation Then there’s the issue of outdated legislation, which blocks donations from living donors. While some countries permit organ donations from any living donor, Greek Law 2737.99 allows donations solely from first-degree relatives (parents, siblings, children and spouses). The intention was to prevent commercial transactions, but the shortage of donors has become so serious that there is a growing demand for the law to be updated. «At the moment, someone may want to donate an organ to a cousin and not be allowed to,» explained Svarnas. «What we have been demanding for years is to extend the right to donate to the fourth degree on both sides of the family and across generations. So a first cousin could save a cousin, a father-in-law his son-in-law, a grandparent his grandchild. It is incredible that someone might know that there is an organ that could save them and not be able to get it.» Besides, as Boletis noted: «Who can rule out trade-offs between family members? I feel we don’t want to face facts. I am in favor of extending the conditions of organ donation, without restrictions. An independent committee whose members do not belong to EOM and are not doctors can determine to what extent it is done out of altruism. In any case, people have to see that organ donation after death is a good thing. It creates a protective circle. Someone has to get things moving, and that has to be the state. It is not doing so at present, unfortunately.»