Taking into consideration that the first succescssful solid organ transplantion was performed in 1975 and the organ transplant act was passed in 1979, it is unfortunate that the national coordination system as the constituent component of organ supply efforts was founded with a 20-years delay. The importance of bureaucratic and political commitment should not be underestimated with regard to health policy in general and organ transplantation in particular.

Although Turkey has had important achievements in transplant applications in recent years, it still has a long way to go to improve its current organ supply system. Systematic working of transplant coordination system, incorporation of transplant coordinators into the system and practices of the importance of intensive care unit professionals have lead us to a different understandig of organ supply. However, our efforts to improve organ supply have not resulted in a significant success yet. Organ shortage brings about serious differences in clinical applications of transplant centres. Nothwitstanding the fact that the supply does not meet the demand in organ transplantation, the central coordination authority has put great effort into sustaining the system for the last 10 years. It should be noted that the countries with considerable success in donation and transplantation reached their goal in a time period of 20 to 25 years. Bearing this time period in mind, we should continue working to develop the transplant coordination system in Turkey.

Referring to this point, we can analyse our efforts during the last 10 years and thus see clearly what we have got so far:

Strengths;

• Air, land, sea ambulance systems
• Adequate technological equipments and ease of access to intensive care units
• Intensive care experience
• Fair and transparent allocation/sharing of organs
• Sufficient number of certified organ transplant coordinators
• Ease of access to transplant centres
• Experience in organ transplants, especially in living donor transplants
• Organ transplant treatments to be guaranteed by pay back system
• The adequacy of the legal regulations in major issues

• Shortage of deceased donors
• Inefficiency in donor detection system
• High refusal rates in organ donation
• Inadequate use of extended donor criteria
• The lack of a methodological professional training
• 75% of transplant centres work with very low activity
• The lack of quality and audit system
• The lack of organ transplant logistics system
• Challenges in organ supply chain to meet social demands
• Overwork in national transplant coordination system and insufficiency in qualified task force

Threats;

• Dramatic decrease in donation rates
• Aggressive increase in the number of patients with chronical organ failure
• Uncontrolled expansion of waiting lists
• Increasing number of candidates on the waiting lists, who are not suitable for transplantation
• Imbalances in mortality, morbidity and survival rates
• Excessive inclination to living donor transplantation and the risk of organ trafficking
• Inability to sustain experience in transplant centres with low activity
• Demotivation of organ transplant coordinators due to uncertainty in work conditions as a result of the new organisational structure of the Ministry of Health

Opportunities;

• Political and bureaucratic commitment and possibility to change legal regulation
• Young and dynamic work force
• Donor transplant centres and transplant team meeting the expanding pool of donors
• Our ability to express ourselves in the field of transplant practices in neighbouring countries
• Constituting an attraction centre for foreign patients in organ transplant services due to high quality and economic reasons
• Interest of non-governmental organisations in the development of organ donation
• Potential significant contribution of educated young people to the social awareness about organ donation

As a result, our efforts would play a key role in improving the innovative ability of central health authority, decreasing the workload by integrating non-governmental organisations into the system, adopting and applying sustainable and reformist donation and transplantation policies in compliance with international norms without ignoring the health care system and social structure of Turkey, and developing organ transplant services.