Transplantation crisis at the time of economic recession in Greece

Objectives: Aim of the study was to assess the effect of economic recession on organ donation and transplantation in Greece. Methods: Retrospective data (2002-2016) provided by the Hellenic Transplant Organization (HTO), International Registry in Organ Donation and Transplantation, Eurotransplant, Scandiatransplant, National Health Service Blood and Transplant (NHSBT), and United Network of Organ Sharing (UNOS) databases were analyzed. HTO database was divided into the precrisis (2002-2008) and crisis (2009-2016) era. Donation and transplantation rates between the two periods were compared. Trend estimation analysis was applied on the latter period. Results: Since 2009, organ donation significantly declined without significant change in the reported brain deaths. Overall solid organ transplantations decreased (319.63 +/- 70.4 from 460 +/- 55.25 transplants/year, P = 0.001). Kidneytransplantation rates declined(139.38 +/- 29.7 from 209.43 +/- 20.9 transplants/year, P = 0.000), with dramatic reduction in both deceased (99 +/- 27.5 from 136.43 +/- 131.4 transplants/year, P = 0.030) and living donor kidney transplantations (40.38 +/- 6.1 from 73 +/- 12.5 transplants/year, P = 0.000). Liver, heart, and lung transplant rates were not significantly affected; however, they have been low throughout both periods. Convertion to donation has not been affected by the crisis. Time series logistic regression of the crisis period demonstrated declining trends in organ donation, total solid organ transplantation, and deceased donor kidney, liver, and lungtransplantation. In 2015, Greek organ donation rates were inferior to Eurotransplant, Scandiatransplant, NHSBT, UNOS, and Italy. Conclusions: There has been a temporal correlation between the economic recession and organ donation and transplantation crisis in Greece. Irrespective of the cause, measures should be taken to reverse this in order to avert the increased morbidity and mortality on the transplant waiting list. (C) 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.