| Abstract |
Background
In the last decade, most countries have been trying to raise organ donation rates across the population. However, despite efforts and publicity, there are still long waiting lists and long delays in transplants, with the World Health Organization reporting that in 2017 only 10% of global needs were met. The main source of solid organ donations comes from donors who have been diagnosed with brain death based on specific criteria and protocols. The necessary steps include the correct diagnosis of brain death, the detailed examination and characterization of the donor as appropriate, by the corresponding national institution (in Greece is called the National Transplant Organization), the appropriate life support of the life functions of the potential donor, and finally the provision of the necessary psychological support and compassion to the donor's family. Most of the organ donation procedures take place in the Intensive Care Units of the hospital, with the staff undertaking the process of diagnosing brain death, supporting the patient, and the difficult task of communicating with the donor's family. The legal framework of each country also plays an important role, with Greece having adopted the opt-out system, ie the need for a written request of the patient for exemption from the donation process. In addition, after law modifications in Greece the opinion of the relatives of the diseased is also taken into account, who must agree to the donation According to European Union data, Greece is placed very low on the list of organ donation performance as measured by the index donations per million population. More specifically, in 2017, Greece was in the last positions of this list with 6 donors per million population with Spain being the first with 47 donors.
Objective
The aim of this research is to collect and investigate the available data on brain death and organ donation in the Intensive Care Units of the Public Hospitals of Greece during the last decade.
Methods
The methodology used in the present study was a systematic review based on the PRISMA guidelines. The bibliography search was divided into two parts: 1) searching for English publications in peer reviewed journals using the PUBMED® database, and 2) searching for Greek literature using Google Scholar® and in graduate, postgraduate and doctoral thesis dissertations. The search and integration criteria were the terms (Greek or English) “Organ donation and Brain death and Greece and 2010-2020”. The final criterion for inclusion was the availability of transplant and brain death data for Greece, in the publication
Results
After the completion of the search and evaluation of the publications and the relative data, one English article and 7 Greek dissertation thesis were included in the present study. The obtained data included number of brain deaths, number of donors, donation rate per million population and the number of transplants of different solid organs. More specifically, in terms of the donation rate per million population during the years 2010-2020, the relative index it ranged from a lower value of 3.5 in 2015 and 2017 to a maximum value of 7.2 in 2011.
Greece has much lower rates than other European countries (France, Italy, Germany, Hungary, United Kingdom, and United States) in all transplant rates. In 2016, Greece has lower donation rates per million population compared to countries with a similar population size. Greece's donation index per million population value was 4.7 opposed to 30 in Belgium, 25.3 in the Czech Republic, 18.6 in Hungary, 32.7 in Portugal, 23.5 in Belarus respectively, while in 2017 it was in the penultimate position among the countries. of the EU, just above Romania. Hospital criteria and guidelines do not differ much between Greece and the aforementioned countries both in terms of confirmation of brain death and in the criteria for use or rejection of organs. Also, the legal framework of the "presumed consent" is similar in Greece and Spain, although the Greek system is considered more flexible. However, although 43% of Greeks would consider organ donation, when the time comes for a decision to provide consent in order to donate organs from a relative, the reasons for non-donation are 45% due to lack of trust in the system, 30% due to fear and 10% for religious reasons. Reasons directly or indirectly related to ignorance and inadequate information.
Conclusion
Compared to the European average, the organ donation index in Greece is lower in the last decade 2010-2020. Especially in recent years, Greece remains firmly in the last three places within EU countries without showing signs of improvement. The reasons have to do with the low information and awareness of the public as well as the reluctance and distrust in the transplant system. In addition, amendments are needed to the legal framework that determines the process of providing consensus on donation, making it more flexible and efficient. The Greek National Transplant Organization is called upon to take even more initiatives and interventions in medical matters, legislation and informing the citizens in order to immediately improve the number of organ donations in Greece.
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