Key words : Clinical development, Transplant law

Introduction

If history is written, it becomes a memory; if it is not written, it is distorted.

The development of clinical transplantation in Azerbaijan has shown a particular parallelism with the development of transplantation in the world. During the USSR period (Soviet era), transplant procedures in Azerbaijan started with corneal transplant in the 1920s and then kidney transplant in the 1970s. After the period of independence (2002), bone marrow, liver, and stem cell transplants were introduced. Currently, there are 7 centers in Azerbaijan performing transplantation. Since the period of independence, there have been no deceased organ procurement programs in our country; therefore, all organ transplants have been done from living donors. We decided to write this article because there is not enough published information on the history of transplantation in Azerbaijan.

Materials and Methods

With limited published information on transplantation in Azerbaijan, we contacted transplant centers and presented questions to heads or members of transplant teams (correspondent member of the Azerbaijan National Academy of Sciences, Prof. Dr. Elmar Gasimov, Prof. Dr. Akif Bagirov, Prof. Dr. Kamran Musayev, Prof. Dr. Kamal Abdullayev, Mirjalal Kazimi, MD, PhD, Valeh Huseynov, MD, PhD, Rashad Sholan, MD, PhD, Dilara Valikhanova, MD, PhD, Dr. Shahlar Nasirov, Dr. Taryel Nadirov, Dr. Eldar Ahmadov, and Dr. Yusif Allahverdiyev). The following questions were asked: (1) “When, where, and by whom was the transplantation started?”, (2) “How many transplants have been performed until now?”, (3) “What are the results of the surgeries?”, (4) “Have you written any scientific articles and dissertations? And which are they?”, and (5) “Where have you specialized?” We prepared this article from the answers to this questionnaire.

Results

Laws
In the pre-independence period, the legal basis for organ transplantation in Azerbaijan was based on Soviet legislation. After independence, the law “on transplantation of human organs and (or) tissues,” which had been approved by the Milli Majlis in the late 1990s, came into force after being signed by the President of the Republic of Azerbaijan, National Leader Heydar Aliyev on October 28, 1999.¹ This law allowed human organ transplantation from living and deceased donors and was guided by internationally accepted principles. According to this first law, living donors must be healthy and willing to donate, consent from next of kin is necessary for deceased organ donation, and the purchase and sale of organs are prohibited. Members of Parliament of Azerbaijan (Eldar Abbasov, Shadman Huseynov, Mahir Asadov, Shamil Asgarov, Sudeyf Imamverdiyev, and Ahliman Amiraslanov) all contributed to the preparation of the first law.

In the 2000s, there was a need for many changes and innovations in the existing law because of the developments in transplantation in the world and its widespread use in Azerbaijan. Thus, a new transplant law was prepared under the leadership of the Chairman of the Health Committee of the Milli Majlis, Academician Ahliman Amiraslanov (2017-2020). Taking into consideration world experience, international law, and transplant laws of more than 20 countries, the new law “On donation and transplantation of human organs and tissues” was approved by the Milli Majlis. This law came into force after being signed by the President of the Republic of Azerbaijan Ilham Aliyev on October 20, 2020.²

This second law differs significantly from the previous one in many respects. First, the name of the law was changed to the “Law on Transplantation and Donation.” This is an indication of the importance of donation. The most important aspect of the new law was the establishment of a Transplant Coordination Center and its structure in our country. The main tasks of this state body are to create a central registry of patients waiting for transplant, recipients, donors, transplant centers and specialists, transplant coor-dinators in hospitals, and brain death teams, as well as to coordinate transplant and donation processes.

One of the important aspects of the new law is the establishment of the Ethics Commission. The purposes of Ethics Commission, which is intended as a public body, are to investigate whether a living organ donation is on a voluntary, nonprofit basis and to allow organ donation from an unrelated donor. In addition, the new law contains articles on insurance of living donors, consent for organ procurement from deceased donors, the establishment of brain death teams, expansion of the list of organs allowed for transplant, and the rights and responsibilities of specialists and institutions.

Members of Parliament of Azerbaijan (Ahliman Amiraslanov, Musa Guliyev, and Rashad Mahmudov), transplant specialists (Nuru Bayramov, Mirjalal Kazimi, Kamran Musayev, Rashad Sholan, Taryel Nadirov, Valeh Huseynov, Elmar Qasimov), and lawyers (Mehdi Gurbanov, Mahammad Bazigov, Nigar Gurbanova, and Elkhan Azizov) have provided exceptional services in the preparation of this new law.

Kidney transplantation
Kidney transplant in Azerbaijan was first performed by a team of doctors on November 16, 1971, which included Kamal Ismailov, Ismat Figarov, Stanislav Linyev, Soltan Aliyev, Pavel Malkov, and Russian colleague Dr. Ioseph Yarmolinsky, who were under the leadership of Academician Mirmammad Javadzade. Kidney transplant was conducted from this time until 1983. During these years, 31 kidney transplants were performed from living and deceased donors.³ This group was awarded a government award in 1974 for these activities.

In 2002 (the period of independence), kidney transplant was resumed and developed. In 2002, 5 living donor kidney transplant procedures were performed by Drs. Kamal Abdullayev and Akif Bagirov, with Iranian colleague Dr. Ali Tagizade, at the Republican Clinical Hospital. From 2005 to 2009, Drs. Kamal Abdullayev and Ali Tagizade performed 21 living donor kidney transplant procedures.

In 2010, kidney transplant was resumed at the Republican Clinical Urological Hospital. Here, Drs. Shahlar Nasirov, Ismat Figarov, Khagani Huseynov, and Turkish doctor Dr. Shener Yilmaz started living donor kidney transplant and performed 55 kidney transplants from living donors until 2016.

Living donor kidney transplantation was started at the Central Hospital of Oil Workers by Drs. Mirjalal Kazimi and Eldar Ahmadov in 2011, with work continuing until 2019. During these years, these doctors performed 504 living donor kidney transplants.

At the Central Clinic Hospital, kidney transplant was started by Drs. Taryel Nadirov, Zaur Khalilov, and Dr. Ayhan Dinckan from Turkey in 2012, with transplants still being performed today. They have performed 44 living donor kidney transplant procedures.

Drs. Nuru Bayramov, Ruslan Mammadov, Orkhan Guliyev, and Turkish colleague Dr. Barish Akin started living donor kidney transplant at the Azerbaijan Medical University in August 2015. They have performed 11 living donor kidney transplants and still continue.

In 2017, Dr. Rashad Sholan and Turkish Dr. Ibrahim Berber started living donor kidney transplant at the Republican Treatment and Diagnostic Center, which has continued today. Since 2017, 108 living donor kidney transplants have been performed.

At the Central Customs Hospital, kidney transplant was started by Dr. Mirjalal Kazimi in 2019, with 119 living donor kidney transplants performed since then.

Nephrologists Drs. Mehman Agayev, Jabrayil Zeynalov, Farhad Shirinov, Ilham Hamidov, Elnur Farajov, Orkhan Guliyev, and anesthesiologists Drs. Javid Pashayev, Kamil Hajimuradov, and others, along with surgeons, have contributed to kidney transplantation. Up until 2021, 898 kidney transplants have been performed, with most being living donor transplant procedures.

Liver transplantation
Dr. Mirjalal Kazimi and Drs. Murat Kilich, Murat Zeytunlu, Mehmet Alper, Sezai Ulukaya from the Transplantation Center of Ege University at Central Hospital of Oil Workers were the first to start liver transplant in Azerbaijan on December 12, 2008. Liver transplants continued under Drs. Mirjalal Kazimi and Eldar Ahmadov until 2019. So far at this center, 135 living donor liver transplants have been performed.

At the Central Customs Hospital, which is the second liver transplant center in Azerbaijan, living donor liver transplant was started on November 28, 2010, by Drs. Nuru Bayramov, Namig Novruzov, and Ruslan Mammadov from Azerbaijan and Drs. Sezai Yilmaz, Cuneyt Kayaalp, Huseyin Toprak, Ramazan Kutlu, and Volkan Ince from the transplant team of Inonu University (Malatya, Turkey). These specialists continued to perform liver transplants until 2014, with 9 patients receiving living donor liver transplants during these years.⁴ Since 2019, Drs. Mirjalal Kazimi and Kamran Beydullayev have carried out living donor liver transplant procedures at this hospital. To date, 98 patients have received liver transplants.

At the Central Clinic Hospital, living donor liver transplant was started in 2018 by Drs. Taryel Nadirov, Zaur Khalilov, and Dr. Ayhan Dinckan (from Turkey), who performed procedures in 5 patients. In 2019, Drs. Eldar Ahmadov and Jeyhun Isayev performed procedures at Bona Dea Hospital in 5 patients and continue working today. In total, 252 liver transplants have been performed in Azerbaijan until 2021, with all transplants from living donors.

Bone marrow transplantation
The first bone marrow transplant in Azerbaijan was performed by Dr. Valeh Huseynov and Dr. Suleyman Dincer (from Turkey), with 3 bone marrow transplant procedures in total. At the Thalassemia Center, bone marrow transplant was started by Drs. Rauf Rzayev and Nargis Aliyeva and Belorussian colleague Dr. Yuriy Strongin in 2014. Currently, bone marrow transplant is routinely performed under the guidance of Drs. Valeh Huseynov and Nargis Aliyeva.⁵ As of 2021, a total of 112 bone marrow transplants have been performed.

Stem cell transplantation
Stem cell transplant was started in 2015 by Drs. Nuru Bayramov, Ruslan Mammadov, Galib Imanov, Rasim Bayramov, Valeh Huseynov, Fuad Ismayilov, Nigar Agayeva, and Javid Pashayev at the Surgical Clinic of Azerbaijan Medical University. This group performed 7 autologous stem cell transplants into the liver by the intra-arterial route.^6,7 Dr. Kamran Musayev and colleagues performed the first intramyocardial stem cell implantation during surgery at the Central Clinic Hospital in 2015 (15 patients). At the present time, stem cell transplant is used for the treatment of various diseases.

Left ventricular assist device implantation
The first left ventricular assist device implantation was performed by Dr. Kamran Musayev at the Central Clinic Hospital on January 2, 2013, and by Drs. Anar Amrah and Latif Arusoglu at the Republican Treatment and Diagnostic Center in 2019. Since then, 3 left ventricular assist devices have been implanted in our country.⁸

Corneal transplantation
In our country, unpreserved cornea transplant was started by Dr. Sona Valikhan in the 1920s, which was then was continued by Drs. Bilgeyis and Pasha Musayev, with approximately 2000 transplants performed. At the National Ophthalmology Center, named after the Academician Z. Aliyeva, preserved cornea transplant was started by Dr. E. Gasimov and colleagues in 2018 with corneal grafts provided by the Eye Bank accredited by the Eye Bank Association of America, with 72 patients receiving corneal transplants.

Training of specialists
The generous Republic of Turkey has played an exceptional role in the specialization of Azerbaijani specialists in all fields of medicine, including transplantation. The Organ Transplant Hospital of Baskent University and especially the Rector of the University, Prof. Dr. Mehmet Haberal, who performed the first kidney and liver transplantation in Turkey and was the chairman of the World Transplant Association from 2018 to 2020, have played substantial roles in training our transplant specialists. At Baskent University, Nuru Bayramov received specialized training in liver and kidney transplant and conducted scientific research from 1994 to 2000. The results of liver transplant procedures from living donors were presented in Nuru Bayramov’s doctoral dissertation (Table 1). At Baskent University, Teymur Musayev has specialized in kidney transplantation, Rauf Shahbazov has specialized in liver transplantation, and Hikmet Ismayilov, Fariz Babayev, and Orkhan Guliyev have specialized in transplant nephrology.

Between 1993 and 1996, Akif Bagirov received specialized training in kidney transplant under the supervision of Prof. Dr. Muzaffer Sayiyar at İstanbul University, Cerrahpaşa Faculty of Medicine, with research performed on this topic. This research was reported in his doctoral dissertation (Table 1).

The Liver Transplantation Institute, Inonu University, and the director of this institute (Prof. Dr. Sezai Yilmaz) have had exceptional roles in the specialization of Azerbaijani doctors in liver transplantation. Up to 15 Azerbaijani doctors (Prof. Dr. Nuru Bayramov, Assistant Prof. Dr. Ruslan Mammadov, Namig Novruzov, MD, PhD, Assistant Prof. Dr. Parviz Abbasov, Dr. Elvin Isazade, and others) and nurses have specialized at this institute. From collaborative research with this institute, many articles have been published, including 1 defended doctoral dissertation (Parviz Abbasov) (Table 1), 1 completed doctoral dissertation (Ruslan Mammadov), and 3 dissertations underway (Namig Novruzov, Tarana Bayramova, Mehriban Huseynova).

In addition, Ege University, Akdeniz University, Dokuz Eylul University, Ankara University, Yeni Yuzyil University, Gulhane Military Medical Academy, Izmir Kent Hospital, Memorial Hospital, Florence Nightingale Hospital, and the Asan Medical Center in Korea have provided great support to training of transplant specialists for our country. Mirjalal Kazimi has defended a doctoral dissertation based on his research at Ege University.

Clinical and experimental research and conferences
In our country, experimental research investigations on transplant have been initiated under the leadership of Academician Boyukkishi Agayev and Dilara Valikhanova, MD, PhD, at the Experimental Laboratory of Clinical and Experimental Surgery Institution since 1989. The experimental studies, which were performed at the Experimental Laboratory, have been reflected in I. L. Kazimov’s doctor of philosophy dissertation on pancreas transplantation and E. Isgandarov’s doctor of medical science dissertation on liver transplantation (Table 1).

In 2018, by the Decree of the Presidium of the Azerbaijan National Academy of Sciences, the Experimental Transplantation Laboratory was established at the Institute of Physiology named after Academician A. Garayev.

Several local and international scientific-practical conferences are held in our country every year. The following major international congresses can be mentioned: the International Transplantation and Anesthesia Congress organized by Azerbaijan Medical University and the Turkish Anesthesiology and Reanimation Specialists Society (presidents Prof. Dr. Meral Kanbak and Prof. Dr. Nuru Bayramov) in 2013, The World Congress of Transplantologists organized by Prof. Dr. Mehmet Haberal in 2016, and the Baku-Malatya Transplantation Days, which have been held annually at Azerbaijan Medical University since 2015.

Until 2021, 5 doctor of medical science disserta-tions and 2 doctor of philosophy dissertations have been defended, with 4 dissertations underway, 5 monographs, and more than 50 articles published by scientists from our country (Table 1).

It should be noted that the heads of hospitals, along with specialists, have had great support in initiating and organizing organ transplant in Azerbaijan. The role of Chief Physician Fakhraddin Javadov at the Central Hospital of Oil Workers, Chairman of the State Customs Committee Safar Mehdiyev at the Central Customs Hospital, and Academician Ahliman Amiraslanov and Asiman Hasanov at the Surgical Clinic of Azerbaijan Medical University should be especially noted.

Limitations
During the preparation of this article, the main difficulty was that we could not obtain information on recipient and graft survival, immunosuppression, complications, and other important issues. These limitations are related to the absence of a single registration center. We hope that these problems will be eliminated with the establishment of the Transplant Coordination Center intended by the new organ transplant law.

Discussion and Conclusion

In Azerbaijan, transplant started with corneal transplant in the 1920s and kidney transplant from living and deceased donors in the 1970s. Organ transplants, except corneal transplants, were stopped from 1983 to 2002. Living donor kidney transplant and bone marrow transplant were started after 2002. Living donor liver transplant and stem cell transplant have been performed since 2008 and 2015, respectively. As of 2021, 898 kidney, 252 liver, 112 bone marrow, 22 stem cell, approximately 2000 unpreserved and 72 preserved corneal transplants, and 3 left ventricular assist device implantations have been performed in our country. The dynamics of the transplant activity is shown in Figure 1.

Currently, organ transplant procedures are performed in 7 hospitals of Azerbaijan (Surgical Clinic of Azerbaijan Medical University, Republican Treatment and Diagnostic Center, Central Clinic Hospital, Central Customs Hospital, Thalassemia Center, Bona Dea Hospital, and National Ophthalmology Center).

We hope that the enactment of the new law on transplantation and the establishment of the Transplant Coordination Center and Ethics Committee in the near future will create great opportunities for further progress in transplantation and will allow the thousands of patients waiting for transplant to regain their health.

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