Dear Editor:

Montenegro, which is situated in southeast Europe, became independant in 2006. It has a population of 680 000 citizens, and a dialysis population of 230 patients in 12 dialysis centers. Transplant procedures have been performed in medical institutions in neighboring countries with existing transplant programs such as Croatia, Serbia, and Bosnia and Herzegovina if patients had living related kidney donors. However, many patients have had no living related donors, and their only alternative, besides hemodialysis or peritoneal dialysis, is kidney transplant from a deceased donor. Montenegro is one of the states that signed the Istanbul Declaration, which strictly prohibits trafficking in human organs.^1,2 Nevertheless, some patients from Montenegro have decided to receive kidney transplants in countries with a black market of organs or seek transplant options in places that legally allow foreigners to be placed on wait lists for kidney transplant if they can financially afford it. Many have returned to Montenegro with various medical problems.

In February 2011, Montenegro became a full member of the Regional Health Development Center (RHDC), which is part of the South East European Health Network, with a center in Zagreb, Croatia. The RHDC is an organization and project supported by the Council of Europe, with an aim to establish all necessary conditions for the development of transplantation in southeastern Europe. Connections and support from the RHDC helped to establish collaboration between Montenegro and Croatia.³

On September 25, 2012, the first renal transplant procedure was performed in Montenegro with the support of a renal transplant team from the University Hospital Centre in Zagreb, Croatia. Since then, 39 transplant procedures have been performed. However, of these, only 3 were transplants from deceased donors; others were living related-donor or emotionally related-donor transplants.2 With the establishment of diagnosis of brain death and maintenance of deceased donors and their realization, Montenegro has signed an allocation agreement with Eurotransplant. This has provided an important opportunity for our patients with irreversible organ failure to get the organs that they need from the Eurotransplant system.

Over the 6-year follow-up since the first trans-plant, all of our kidney transplant recipients are in good condition and without serious complications in the posttransplant period. There were com-plications in 2 kidney recipients in the perioperative period, which resulted in delayed graft function. We also had 1 recipient with urinoma, 1 patient with deep venous thrombosis, and 1 patients with episode of acute pancreatitis after sirolimus introduction as immuno-suppressive therapy. One patient had a lymphocele treated by marsupialization, and 1 patient had calculosis of the kidney graft, which were sucessfully treated. Serum creatinine levels posttransplant reached reference levels in both recipients and donors. There were no episodes of hyperacute and acute rejection, and there were no complications with immunosuppressive therapy, besides the afore-mentioned case of acute pancreatitis. All kidney donors have been carefully followed in our center; no evidence of impaired residual kidney function has been shown.

From the first transplant procedure in Montenegro to today, 5 patients have traveled abroad for transplant procedures from unknown donors. This number is significantly lower than the number of patients who payed for kidneys in the period before introduction of our transplant program.

In conclusion, the development of a transplant system has improved many medical fields and has resulted in continuous education for our medical staff. Our next steps are the improvement of the deceased-organ donor transplant program and achievement of higher rates of deceased-donor kidney transplant and a kidney transplant program with incompatible blood groups. Development of our national transplant program significantly decreased travel abroad for transplant for citizens of Montenegro. However, if we do not develop a deceased-donor transplant program, we may expect further transplant tourists. More efforts of the government, authorities, and media should be invested if we want to improve results.

References:

1. International Summit on Transplant Tourism and Organ Trafficking. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Clin J Am Soc Nephrol. 2008;3(5):1227-1231.
2. Delmonico FL. The development of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Nephrol Dial Transplant. 2008;23(11):3381-3382.
3. Spasovski G, Busic M, Pipero P, et al. Current status of transplantation and organ donation in the Balkans—could it be improved throug the South-eastern Europe Health Network (SEEHN) initiative? Nephrol Dial Transplant. 2012;27(4):1319-1323.