EXPERIMENTAL AND CLINICAL TRANSPLANTATION

As life expectancy continues to increase and the human population ages, we are witnessing that chronic kidney failure is becoming more prevalent worldwide together with transplantation becoming the gold standard for treating patients in the final stage of kidney failure.¹ Transplantation is a life-saving solution for patients with terminal renal insufficiency.² In 2018, the Global Observatory on Organ Donation and Transplantation reported that 140?964 transplants were performed worldwide, with data from 2017 showing that kidney and liver transplants were the most common and both specified and unspecified organ donations were 2 of the important classification types for the donor-recipient relationship.² Since the mid-20th century, when the first organ transplants were performed, new therapeutic methods and transplant techniques have been developed, along with modern immuno-suppressive therapy protocols, which have made transplant procedures highly successful. However, in contrast to biomedical science, the field of transplantation is constantly under pressure from numerous legal, ethical, moral, and religious principles and dilemmas.^3,4

Eurotransplant has reported a 26% increase in the number of patients with end-stage chronic kidney failure on wait lists for kidney transplants, and literature has suggested that the number of kidney transplants performed has remained almost the same.³ Shortages in the number of organs from potential donors have led to investigations to allow different types of living related donors and an increase in the number of transplants from living related donors, both globally and in Montenegro. Increasing life expectancy of the human population has led to more demand for transplant, and literature has suggested that the number of patients worldwide needing a kidney transplant has tripled, with Montenegro not lagging behind.⁵

In September 2012, the first kidney transplant was performed in Montenegro, which has led to a decreased numbers of patients needing to go to other regional, European, and global centers for organ transplant, mainly for kidney transplant, either from living donors or deceased donors.⁶ Given the high material costs and the risk of postoperative compli-cations for transplanted patients, the question arises of what the medical profession and science can do for the benefit of patients.⁷ Montenegro is a signatory of the Istanbul Declaration, and, with the support of Regional Health Development Centre, international cooperation was established. The first kidney transplant in September 2012 was conducted with the help of medical teams from the Republic of Croatia and the Clinical Center of Montenegro.⁸ After 2019, and up to today, a kidney transplant from a living donor was next performed in Montenegro in February 2025 after a 5-year hiatus, thus reestablishing the transplant program for kidney patients in Montenegro. The procedure was performed in collaboration with the expert medical team of the Military Medical Academy in Belgrade, Serbia, and the medical team of the Clinical Center of Montenegro. The procedure also focused on educating medical staff and nurses caring for transplanted patients to enable them to independently run the program as soon as possible.⁹

The Law on the Removal and Transplantation of Human Organs for Medical Purposes in Montenegro (Official Gazette of Montenegro, No. 43/2016 and 67/2019) defines in Article 28 that organs may be removed for transplant only from a living donor who is of legal age, legally competent, and capable of judgment. In accordance with the aforementioned provisions, a living related transplant was performed in our country.¹⁰ The organ donor was a middle-aged man ?18 years of age who was related by second degree of consanguinity to the adult organ recipient.9

Understanding variations in willingness to donate organs among family members may be an important factor in understanding the racial/ethnic, sex, and age categories in kidney transplant donations from living donors.^7,11-13 The willingness to donate organs in Montenegro is greater among the female population (mothers, sisters, and wives of patients needing organ transplants) compared with the male population.^11,12 Literature, as well as our experience with the transplant program in Montenegro, has suggested that guidelines for transplant should be standardized for both donors and recipients, alongside educational initiatives to ensure patient safety and raise global awareness.^2,8

New and effective research plans and initiatives are needed if we are to avoid gaps between the supply and demand for transplanted organs. However, we must continue respecting legal, ethical, moral, and religious dilemmas; sociological norms; legal regulations; and other provisions related to organ transplant and donation, to avoid contro-versies in this still sensitive field of biomedicine and health care, both in our country and in most countries worldwide. Such respect can be of mutual benefit to science, ethics, and the tradition of a civilized society, to which our country belongs.

Montenegro is a signatory of the Istanbul Declaration and is a traditional society in which many cases have reported on women (sisters, wives, and mothers) who donated organs to family members; however, there are only 2 recorded cases where a brother donated a kidney to his sister. These cases are encouraging for breaking down sex-related, social, and traditional barriers in Montenegrin society.

Volume: 23 Issue: 4 April 2025

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