Gurbet Yavuz, whose life was cut short by a devastating traffic accident, had both her kidneys and her liver donated so that others could live. Her father, Şükrü Yavuz, is the first person to consent to organ donation in the city of Şırnak.
Yavuz said: “My daughter couldn’t make it, but I don’t want her organs to be wasted in the earth. At least, this way others can live. I found out that nobody in Şırnak had ever donated organs before.”
Gurbet’s liver was transplanted to two infant recipients -- a 2-year-old and a 10-month-old -- who had been on the transplant waiting list for some time, at the Malatya Turgut Özal Medical Center. Her kidneys were transplanted to a patient at the Gaziantep University Hospital. Dr. Mehmet Yılmaz, who performed the harvesting of the organs, said this was the first time they had found organs outside of Elazığ. He said that he hoped this would set a good example for the rest of Şırnak. The grieving father also said he hopes that others will follow his example.
The Turkish city with the highest level of organ donations is İzmir, with figures close to the EU average. Western and Mediterranean cities mostly do well, while other cities tend to fall behind. According to 2008 statistics from the Ministry of Health, the number of donors per million of population was 3.4 in Turkey, up from 2.0 in 2004; whereas this figure was 16 in İzmir. The Aegean region had 7 donors per million people in the same year.
In 2008, the country with the highest donation rate was Spain (38.2). Western countries usually have higher donation figures with the US registering 29.6 donors per million in 2008, followed by France (25.7), Italy (25.4), Germany (18.9) and England (16.2). Israel’s donation figure was 13.2, while it was 10.5 in Greece and 6.0 in Bulgaria. The only nation that did more poorly than Turkey was Romania, where the number of donors per million was 2.0.
The comparison of Turkey’s donor numbers between 2004 and 2008 as well as other statistics on the subject do confirm that the number of organ donors is increasing; however, this increase is not sufficient vis-à-vis the number of patients waiting for organ transplants, according to Nilgün Keçecioğlu, the organ transplant coordinator at Akdeniz University’s Organ Transplant Center.
Not enough organs
In Turkey, an estimated 6,000 patients lose their lives due to a lack of suitable organ donors. Currently there are 20,000 people listed on the Health Ministry’s kidney transplant list, about 2,000 patients waiting on the liver transplant list and about 1,000 waiting for new hearts. Notably, the number of patients being monitored for renal and cardiac failure is many times higher than those who are on the transplant list. Renal failure is the most frequent form of kidney related problems both in Turkey and in the world. In Turkey 55,000 people undergo dialysis treatments annually. At least 10,000 others are waiting for new corneas; which is strange because permission from the family is not a legal requirement for cornea transplants in Turkey.
Keçecioğlu says although Turkey has very good infrastructure including experienced organ transplant doctors and centers, but the number of donors remains very low, mainly due to a lack of public awareness. She argues that state-backed efforts are needed for large-scale public awareness campaigns. Most projects are often organized at a regional level (such as those that have been implemented in the cities of Antalya, İstanbul and İzmir which have higher rates of donors) but fail to create a wider reach and remain effective only in the region where they are promoted. There are many cities -- such as Afyon, Kars, Artvin and Şırnak (until very recently) -- where no organs had ever been donated, despite having cases where patients had been declared brain-dead.
Most difficult job in the world
Keçecioğlu, who has been an organ transplantation coordinator since 1992, is one of the few coordinators in the country certified by the European Transplant Coordinators Organization (ETCO). She emphasizes that no matter how good a coordinator is, the entire organ transplant cycle relies on teamwork. The team include patients, members of society, medical staff, state agencies, civil society and others. However, the most important person is the donor. As Keçeceioğlu puts it: “It is impossible to talk about organ transplants without organ donations. You could have the best surgeons in the world, nephrologists and hospitals equipped advanced technology, none of these matter if you don’t have an organ to transplant.”
This is where the organ transplant coordinators come in. These people are arguably doing the most difficult job in the world as they are the ones who have to ask grieving families for their loved one’s organs -- often also being the person who informs the family of the death. The responsibility carries the dual burden of sharing the intense pain of death by one family while also sharing the joy of hope of a new life with another. Family reactions are impossible to foresee, and coordinators need to be well trained in this field to handle this kind of pressure that is rarely experienced in any areas of the medical profession. Keçeceioğlu says: “You can never predict the reaction of the person or people you talk to and you have to know how to handle the situation in the instant you are faced with it. Motivation is the most important aspect of this. This is something you can only do if you put your heart into it. It is not a role that you can be assigned. You don’t have the luxury of having normal nights and days or vacations. This applies to all who work in the organ transplant sector.”
How to increase numbers of organ donors
Keçeceioğlu says important factors necessary to increase the higher number of donors include the smooth functioning of the overall health system, the adequacy of the infrastructure of health agencies and positive awareness by medical professionals and the public about organ donations.
Spain, where organ donation figures are highest, is a good example of how state agencies, civil society organizations and the media can work together to achieve a high rate of public participation in organ donation.
She also pointed out that according to a study conducted among 15,000 individuals by the Turkish Society of Nephrology, the percentage of chronic kidney disease in the Turkish population is 17 percent. In other words, 17 percent of the population are potential candidates for transplants. This means that at any given time, an ordinary individual’s chances of becoming an organ receiver candidate is 10 times higher than their possibility of ever becoming an organ donor.
Organ coordinators are weary of “organ mafia” stories frequently printed in the press. In an article posted on the Organ Transplant Coordinators Association (ONKOD) website, Dr. Serdar Aksünger notes that, unfortunately, most people associate the phrase “organ transplant” with “organ mafia.” He says that he found through his personal experience that rumors of people being kidnapped by gangs who steal organs are often spread by software or internet organizations hunting for e-mail addresses. Organ transplants make a sensational topic for chain-mail and these are often forwarded to hundreds, if not thousands, of new e-mail addresses in a matter of minutes.
Keçecioğlu says, “To date, there is no record in the Council of Forensic Medicine archives of anyone who has been kidnapped and had their organs removed.” However, in relation to cases of live donors who willingly -- but illegally -- sell organs, usually kidneys, she says the “problem of relationships based on personal gains between potential live donors and receivers is one that can be seen everywhere. All our efforts are aimed at increasing the number of donations from the deceased and minimizing the number of transplants from live donors.”