Yegana Abbasova: "All patients in resuscitation are our donor source"
By decision of the Cabinet of Ministers, the “Coordination Center for Organ Donation and Transplantation” was established under the Ministry of Health in December 2020.
The Coordination Center organizes, coordinates, and facilitates organ and tissue donation and transplantation activities in our country. The institution ensures that a waiting list for individuals in need of donor organs is compiled and operations are carried out in sequence. The Center also monitors patients after operations and conducts public awareness campaigns in this field.
Modern.az presents an interview with Yegana Abbasova, Chairwoman of the Board of the Coordination Center for Organ Donation and Transplantation.
- Ms. Yegana, for the first time in the Caucasus, organ transplantation from a deceased person was carried out in Azerbaijan. What obstacles did you have to overcome to achieve this success?
- The first kidney transplantation in the Caucasus also took place in Azerbaijan in 1971, and Azerbaijan was also the first to perform organ transplantation from a deceased donor. Of course, all this was due to the preparation of the legal framework for organ donation and transplantation under the leadership of the Ministry of Health, the approval of these documents by the President, and the establishment and commencement of operations of the Coordination Center for Organ Donation and Transplantation. We started operations on December 1, 2022. Since 2023, awareness campaigns have been conducted, and brain death courses have been organized with resuscitators. I have worked in resuscitation for 35 years, and we have strived for our patients to recover. When they passed away, it also affected us negatively. But we must know that one deceased person can save the lives of eight people. After working as a resuscitator for 35 years, when I started working here, I realized that organ transplantation is the continuation of a life that ends in the resuscitation department.
- The number of post-mortem donors differs sharply from the number of living donors in some places. While the number of deceased donors is very high in countries like the USA, countries like Kazakhstan lag in this area because family consent is required. What is the situation in Azerbaijan, and is it mandatory to obtain consent from the family of someone who wishes to donate their organs?
- The Ministry of Health has a Unified Information System. We are the operators of this system. We sent letters to our hospitals that are organ sources (all hospitals with artificial respiration equipment in resuscitation departments across the republic) stating that if there are severely ill patients with a Glasgow Coma Scale score of 9/15 or lower, those patients should be indicated in the system. We connected all hospitals in Baku to the Unified Information System and conduct trainings with doctors to ensure they work efficiently and the process does not slow down. At the same time, 7 district hospitals have been connected to this system. Hospitals in Shabran, Agsu, Khizi, Shamakhi, Siyazan, Goychay, and Ujar have also joined our system and are operating. We see and monitor patients in the hospitals connected to the system. Globally, countries are divided into 2 categories for organ donation: “opt-in” and “opt-out”. Azerbaijan, Turkey, Kazakhstan, and Arab countries are “opt-in” countries in this field. In “opt-out” countries, if a person passes away, their family is not asked for permission to retrieve organs. Former USSR countries were “opt-out” countries at that time. That is, if brain death occurred in a potential donor, their organs belonged to the state. However, in Azerbaijan, an “opt-in” country, if you have not registered in the Unified Information System's registry to donate your organs, your family will be asked for consent regarding organ donation. If you have registered, your family is informed. For example, they are told that your spouse has donated their organs, and we will retrieve those organs. At that point, the family cannot object.
In countries like Kazakhstan and Turkey, even if a person has donated their organs, consent is still obtained from their family after brain death. If the family does not agree, the organs are not retrieved. Azerbaijani legislation, however, is more advanced in this regard. Since February, the number of individuals who have donated their organs after death has increased from 50 to 600. Employees of the Ministry of Health and our center are at the forefront. We regularly conduct awareness campaigns in universities in this field. Our observations also indicate that while the majority of older people do not view organ donation positively, this trend is completely different among young people. Despite all this, the leading role belongs to resuscitators; that is, even if 5 million out of 10 million people are donors, if no news of brain death comes from resuscitation, it will not be possible to retrieve the donated organs. We are doing serious work in this area. Previously, we had problems - the system was new. Doctors did not understand the seriousness of the work. However, these obstacles are gradually being overcome.
- We understand that every brain-dead patient in the resuscitation department is considered a potential donor. How is permission obtained from the families of these individuals?
- There are 12 pairs of cranial nerves in the brain. There are tests that check the function of these nerves. If brain death is confirmed after a patient in resuscitation undergoes all tests, their family is informed about it. However, neither the p is given to the family, nor are the organs retrieved. After 12 hours, the resuscitator and neuropathologist repeat the tests. If the person is truly alive only by being connected to an artificial respiration machine and through medications that prevent the heart from stopping, their death is confirmed. The resuscitator has no right to say anything to the patient's relative about transplantation. Our representative comes and talks to one of the closest relatives of the potential donor, and if they give permission, a specially approved document indicating the donation of the deceased's organs by the relative is presented. There is a list of all organs there. Some people donate all, some donate just one. This depends on the individuals. I should also note that if the patient's organs are not suitable, we do not engage in discussions with close relatives. Because we have all the data when the patient is admitted to the hospital.
- To date, how many organs in total have you been able to retrieve from individuals who lost their lives in resuscitation?
- After brain death occurred, a total of 15 organs were retrieved as donations from individuals who lost their lives in resuscitation.
- What were the ages of your youngest and oldest donors?
- Our youngest post-mortem donor was approximately 30 years old, and our oldest donor was 68 years old.
- What is the main factor hindering your work in this field, and what should be done to prevent it?
- The costs of organ transplantation are fully covered by Compulsory Medical Insurance. As we know, for kidney and bone marrow transplantation, HLA typing (a type of genetic test that identifies specific proteins found on the surface of white blood cells – Ed.) analysis is required. In short, both blood compatibility and genetic compatibility are needed for the transplantation of these organs. We have a kidney waiting list. If the genetic analysis of recipients on this list is included in the Compulsory Medical Insurance service package, the results of all patients on the waiting list will be uploaded to the system. The blood of each potential donor is genetically analyzed in the typing laboratory at the National Center of Hematology and Transfusiology, and at the same time, we send 5 recipients of the same blood group for their examinations. Thus, if the genetic results of individuals on our waiting list are also in the system, the system itself will indicate a genetically compatible recipient.
- Are there any restrictions to becoming a donor?
- All citizens of Azerbaijan – sick, healthy, young, old – can donate their organs. There are no conditions restricting organ donation. Those who wish to become donors must visit the website //odtkm.gov.az/az , register their intent, and confirm it with a SİMA signature. Subsequently, the person is entered into the registry, thereby becoming a donor. At the same time, you may not donate all 8 of your organs. When you wish to become a donor, you indicate this in the system. But none of us know how we will pass away. For example, a person who applies to be a donor at the age of 18 may pass away at 80. If that person's organs are healthy, they will be retrieved for donation. Or it is difficult to know whether we will pass away due to brain death or not.
- If we donate our organs ourselves, our family is informed about it. If we have not provided any information about this while alive, our family's consent is obtained. But how can a person generally refuse to donate their organs?
- There are two registries in the Unified Information System. One is for those who wish to be donors, and the other is for those who do not wish to be donors. Even if brain death occurs in a citizen registered as unwilling to be a donor, permission to retrieve organs is not obtained from their relatives.
- For years, we have seen living individuals donate to close relatives or others. Generally, how is this process regulated in Azerbaijan, and should it be prevented?
- In our country, there is only a list of post-mortem donors. If we wish to donate an organ to a relative, we apply to the center and choose our doctor. Once the documents are ready, both the donor and the recipient are sent for examination to the hospital where their chosen doctor works. Because not every living person can be a donor. Their weight compatibility, presence of diabetes, and other diseases are investigated. Consequently, there is an informed consent form for both donor and recipient. The donor's closest relative must witness and give consent. According to the legislation of the Republic of Azerbaijan, close relatives are permitted to be donors. At the same time, unlike in several countries, individuals who are not relatives at all and distant relatives can also be donors. However, in such cases, documents are collected and sent to the Ethics Committee. The Ethics Committee includes a lawyer, a representative from the Main Department for Combating Human Trafficking of the Ministry of Internal Affairs, and a psychologist. When they interview the donor, they ascertain whether the donor is providing their organs for a certain sum of money. Consequently, they may refuse permission with justification. That decision can only be reviewed through legal proceedings. Since the Ethics Committee began its operations in Azerbaijan in 2023, such incidents have been completely prevented. Naturally, if we gain the opportunity to transplant organs from a sufficient number of potential donors, this process will also completely cease on its own.
- We would also like to learn the latest statistics on post-mortem donors from you. At the same time, how many people currently have their lives dependent solely on organ transplantation?
- The number of post-mortem donors is 600. Meanwhile, 1021 citizens of Azerbaijan are awaiting organs, and their lives depend solely on this. Approximately 500 of those awaiting organs are kidney patients. And 4642 citizens of Azerbaijan are receiving dialysis. Globally, 90 percent of patients receiving dialysis need transplantation to be freed from dialysis. However, because they have no hope of a deceased donor becoming available, they believe there is no point in preparing documents. Worldwide, the number of patients awaiting kidneys is much higher than for other organs, but this is not the case for us. Because people do not want to donate the organs of a relative who passed away in resuscitation. Yet, this is the last chance for the deceased person to gain merit. Every year, approximately 50 of our citizens awaiting liver, as well as those awaiting heart, pass away. Because there is no artificial liver or heart. Patients with kidney failure can survive by being connected to an artificial respiration machine.
- Are there also minors among those awaiting organs? What organ deficiencies do they primarily suffer from?
- We have children under 18 awaiting kidney, liver, and heart. Typing analysis is not required for heart and liver transplantation. Especially for the heart, it is important that the donor's and recipient's weight and height are compatible with each other. At the same time, blood groups must match. Other nuances – age, gender, etc. – are not important.
- How is the transparent distribution of organs retrieved from potential donors regulated? What are the main codes governing this?
- There is no human factor here. The Unified Information System itself indicates individuals awaiting donors. There is an urgency status. This category primarily includes heart and liver. Transplant surgeons perform monthly “check-ups” on patients, and if a patient's condition worsens, they are entered into the system with an urgency status. For example, after a potential donor passes away in resuscitation, a liver of blood group II will be given to a patient of the same blood group who has an urgency status, because that patient might die. Furthermore, the condition of a patient with an urgency status is regularly evaluated. For liver and kidney, this is re-checked after 48 hours, and for the heart, after 24 hours. Because the patient might pass away or return to the normal list.
- In such a case, if a relative of the potential donor needs an organ, is the deceased's organ not transplanted to their relative?
- The process is like this worldwide. When a potential donor donates their organs, if they have a relative on the waiting list, they can give the organs their relative needs after death. However, that person must definitely be on the waiting list. This is a quite logical situation. If the deceased person gives one kidney to a relative, they can also provide healing to others with 7 organs. Recently, we had such a potential donor; after speaking with the family, the relatives stated that they could donate the organs, but a close relative also needed a kidney, so they asked to give one organ to them. We agreed, but stated that we needed to conduct a typing test and that transplantation would occur if there was a match. The other party, however, considering the possibility of incompatibility, did not donate the organs.
- Can someone who has undergone organ transplantation later donate their own organs?
- Of course, there are people who, after receiving an organ transplant themselves, also donate their other organs as a donor. Such cases are also possible; other healthy organs, excluding the transplanted one, can later be transplanted to those in need of that organ.
- You have been operating for almost 3 years now. What are your future plans?
- A joint platform called “Turk Transplant” for countries within the Organization of Turkic States was established at the initiative of the Minister of Health of the Republic of Azerbaijan, and the countries have signed a Protocol of Intent. All countries will soon join our Unified Information System. As a result, all countries included will be able to assist each other. Furthermore, Turkic-speaking states are genetically very close to each other. The main project will start with stem cell transplantation.
- Public awareness is important in your field of work. Finally, what would you like to say to our readers?
- The media's awareness work is very important. I address all citizens of Azerbaijan and say that among the 4642 individuals on dialysis, there could be our relatives, our loved ones. No one is immune to this, and when our loved ones experience it, we understand those patients better. Let's do good before experiencing this suffering. Primarily, I can address resuscitators and say: report your severely ill patients in a timely manner, diagnose brain death, and if any assistance is needed, the Center's phone lines are open 24 hours. If you provide timely information, we can speak with close relatives and become a beacon of hope for those awaiting.
