Prospect of Cadaveric Transplantation in Bangladesh

Not Available Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.112

The Peculiarities of Civil-Legal Regulation of Transplantation in Ukraine and Europe

In modern realities the issue of the quality and accessibility of health services, the cost of medicines, examinations and treatment in general is being increasingly frequently discussed. The attention is focused on such a narrow surgical field as transplantation, because in Ukraine thousands of patients are waiting in line for organ transplantation and very few operations are performed. The main, most secure and common type of transplantation is the transplantation of organs and tissues from a deceased person, the dead body. Cadaveric transplantation, which is used in most developed countries, is hardly carried out in Ukraine. This is due to the fact that the current regulatory base of Ukraine in the field of transplantation does not fully meet the needs of modern medicine and has many gaps. The aim of donation is a future transplantation (including and in cases of blood transfusion and reproductive cells use). The parts (tissues, organs, their parts, individual cells) extracted (separated) from the body in the process of donation can be used generally in the treatment process in a processed form (blood plasma) or in the original state (fertilized reproductive cells). The detailed analysis of the provisions of the national legal system makes it possible to conclude that, despite the absence of direct regulation of relations concerning organ donation and transplantation as material relations, the legal regulations provide the fundamental provisions, which determine their material nature, and therefore offer opportunities for agreementbased regulation. In our opinion, one of the essential legal means of ensuring the rights of participants in the relations of donation and transplantation can be their agreement-based regulation. The peculiarities of civil-legal regulation of transplantation in Ukraine and Europe are simultaneously analysed; and the grounds of its legitimacy are defined.

Drusen Formation in Type II Membranoproliferative Glomerulonephritis after Renal Transplantation

Type II membranoproliferative glomerulonephritis (MPGN) is a systemic disease that almost invariably recurs in renal allografts. This is a case of a 45-year-old woman with biopsy proven type II MPGN that led to renal failure 10 years after diagnosis. During the fifth month after cadaveric transplantation she was treated with pulse doses of methylprednisolone owing to acute T-cell mediated rejection without pathohistological signs of type II MPGN recurrence. One month later the patient was hospitalized due to acute bilateral vision deterioration. Ophthalmoscopy showed bilateral, multifocal drusen, concentrating in the posterior pole, and exudative ablation of the retinal pigment epithelium. Ocular coherence tomography (OCT) revealed focal retinal pigment epithelial elevation and detachments. The patient was treated with methylprednisolone (1 mg/kg) for 3 days. Therapy led to regression of exudation and flattening of the pigment epithelial detachments with discrete subjective visual improvement. Type II MPGN almost invariably recurs and leads to graft failure in 50% of cases. Our patient had evident chronic eye changes due to type II MPGN leaving allograft function intact during the first year of follow-up. Considering these potentially devastating effects of the disease, type II MPGN patients should be observed carefully from both the renal and eye point of view, because the severity of ocular changes, like in our case, is not always in line with allograft function.

Peritoneal dialysis - experiences

Peritoneal dialysis is the method of treatment of terminal-stage chronic kidney failure. Nowadays, this method is complementary to haemodialysis. It is based on the principles of the diffusion of solutes and ultrafiltration of fluids across the peritoneal membrane, which acts as a filter. The dialysate is introduced into the peritoneum via the previously positioned peritoneal catheter. The peritoneal dialysis is carried out on daily basis, at home by the patient, and the ?exchange? is repeated 4-5 times during the 24 hours. The first steps in peritoneal dialysis at the Department for Haemodialysis of the Clinical Centre of Vojvodina date back to 1973. Until 1992, the patients were subjected to this program only sporadically. Since 1998 the peritoneal dialysis method has been performed at the Clinic for Nephrology and Clinical Immunology. In the period 1998-2008 ninety nine peritoneal catheters were placed. Chronic glomerulonephritis, nephroangiosclerosis and diabetes were identified as the most common causes of chronic renal failure. Two methods of catheter placement were applied: the standard open surgery method (majority of patients) and laparoscopy. Most of the patients were subjected to continuous ambulatory peritoneal dialysis, whereas four patients received automatic dialysis. Transplantation was performed in 10 patients, i.e. cadaveric transplantation and living-related donor transplantation, each in 5 patients. Peritoneal dialysis was available as a service outside our institution as well. A ten-year experience in peritoneal dialysis gained at our Centre has proved the advantages and qualities of this method, strongly supporting its wider application in the treatment of terminal-stage chronic kidney failure.

Coordinating Organ Transplantation in Turkey: Effects of the National Coordination Center

In January 2001, the National Coordination Center, which brought tissue and organ procurement and transplantation under the Turkish Health Ministry, was established in Turkey. The main aims of this organization are to expand cadaveric donation and increase the number of transplantable organs supplied by cadaveric donors. We compared the proportions of cadaveric organ transplantations that were performed in Turkey before and after the national coordination system was established. Of all the cadaveric transplantations completed to date, 91.6% of kidney and 71.5% of liver procedures were done before implementation of the new system, and 8.4% and 28.5%, respectively, were performed after the system was established. The data show that the frequency of cadaveric donation has increased, as well as the number of cadaveric organ transplantations performed annually. The new national transplantation coordination system is making a good start at increasing cadaveric transplantation in Turkey. This system will hopefully lead to a larger organ pool and shorter waiting lists in future.