Did you know a single donor can save up to seven lives? And did you know six new patients join the waiting list for one or more organs every hour? Organ transplantation is one of the greatest achievements of modern medicine and the only treatment for organ failure. Countries around the world have developed impressive donation programs to help meet the growing demand for organs, saving thousands of lives every year… And then there’s Greece.

At the risk of sounding grim, happy endings are few and far between for patients in need of an organ in the country. In fact, Greece has been a contender for last place in the organ donation race for decades. To put the situation in numbers, while the average organ donation rate in Europe in 2022 was 46.7 per million population (PMP), in Greece it was 6.6 PMP. Similarly, while only 45 organs were donated in Greece in 2018, 344 were donated in both Belgium and Portugal (countries with a similar-sized population).

The average wait for a kidney transplant in Greece is 8.8 years, even though the average time patients survive on dialysis is three years, with less than half still alive after five years and a quarter dying within the first year of treatment.

Dr. Georgios Papatheodoridis, President of the National Transplant Organization (NTO), attributes Greece’s consistently low donation rates to the country’s lack of organization and systemic support on the issue. Understaffed and underfunded Intensive Care Units (ICUs) simply cannot deal with the extra work involved in retrieving and successfully donating organs. “It is a very complex and time-sensitive procedure, and something doctors in ICUs are often unwilling to take on, especially after they have lost the battle to save a patient.” To avoid this process, hospitals fail to report a significant number of brain deaths to the NTO, with dozens of vital organs going unused as a result.

Vassilis Papalois, Professor of Transplantation Surgery at Imperial College London, argues that the stubbornly low rates are due not to a lack of skill or intention, but rather a failure to recognize organ donation as an independent entity. “It had always been a parenthesis in another, more general, surgical program,” he explains, “which leaves the survival of the whole institution dependent on the heroic efforts of a few colleagues.”

The President of the Onassis Cardiac Surgery Center, Ioannis Boletis, adds some more perspective. “Think of it like this”, he says, “when, until very recently, Greece had patients dying waiting for an ICU bed, it is not hard to understand how organ donation was quite low on the list of hospitals’ priorities.”

2023: A New Hope

All hope is not lost, however, as 2023 proved a pivotal year in Greece’s efforts. Donation rates increased from 6.6 PMP in 2022 to 8.3 PMP, a jump experts regard as promising.

Dr. Boletis pinpoints the passing of the law to build the Onassis National Transplant Center (ONTC) in 2018 as the first domino to fall. “Just as it did when cardiovascular disease was rampant in Greece a few years back, the Onassis Foundation acknowledged organ donation as the next big issue that needed to be addressed.”

With funding from the Foundation, seven donor coordinators – responsible for the entire process of donation, from organ retrieval to transplantation – were hired by the NTO in 2022 and stationed in various ICU units across the country.

The Foundation also commissioned the first large-scale study on organ donations across several European countries. Co-author Professor Papalois explains: “We conducted case studies relating to five countries with advanced transplant programs, to see which paradigms could be translated into Greek practice.” The result of the research was a National Organ Donation and Transplantation Plan handed over to the Mitsotakis administration in 2021.

The real milestone, however, was the passing into law in March 2023 of the bill containing the proposals made in the National Transplantation Plan which signified a new chapter in Greece’s transplant journey.

Where Do We Go from Here?

Even though recent metrics and efforts are commendable, serious challenges lie ahead.

Dr. Boletis notes that “most proposals and policies look good in theory, but implementing them is a completely different, and much more difficult, feat.”

The first prerequisite is the adequate funding of, and effective resource allocation to, the National Transplant Organization, the centralized unit which supports the whole edifice. This will allow existing transplant centers as well as the ONTC, which will open its doors next year, to develop.

Professor Papalois also mentions the need to train the right people in the right positions. Apart from donor coordinators, hospital staff and doctors need to become better acquainted with the subject, as they are the human face of the system that interacts with the families of potential donors. He also stresses the need for research to be undertaken into transplantation, dubbing it the “oxygen” of the institution.

Dr. Boletis also calls for the negative perceptions that surround the Greek Healthcare System to be dealt with. “Whether this is a misrepresentation or not is irrelevant, as we need people to understand the quality of our institutions. Only then will they be open to the idea of donation; they need to know that their, or their loved one’s, organs will not go to waste.”

This is why the implementation of transplant programs needs to be accompanied by effective health literacy campaigns at every level, Professor Papalois stresses. “Such practices need to be instilled in, rather than imposed on, the mindset of our culture.” These programs must start in primary school and continue in all levels of education and extend into the army as well as places of work and worship. Several such efforts have been introduced, but on nowhere near the scale required to have a significant impact.

Still, Greece as a country is highly supportive of organ donations. Dr. Papatheodoridis mentions that the majority of families of people in the ICU are willing to donate their loved one’s organs to save the lives of others. “The people are ready to take such decisions,” he says, “and it is the duty of the system to honor them.”

Despite the widespread acknowledgment that these are just the first steps on a lengthy journey, there is an undeniable sense of optimism among experts who believe that, with systematic planning and action, organ donation in Greece can become an institution that the rest of the world will praise, and the country itself can be proud of.