Czech medical transplantation forty years after first organ transplant

Forty years ago, Czech surgeons conducted their first ever successful organ transplant. Their patient was 24-year old Karel Pavlik, who received a kidney from his mother. The operation was performed at the Prague-based Institute of Clinical and Experimental Medicine, IKEM, by Dr. Vladimir Kocandrle:

Dr Vladimir Kocandrle,  photo: CTK
"The first transplant always gives excitement but when it is something new on a world-wide scale or something that doesn't happen that often then, of course, the emotion is much much higher. It was in 1966 and I was young, you know, but it was already completely different with the second transplant. After fifty transplants it already became routine, and after one thousand it's a routine and a widely accepted therapeutic method."

And how did the procedure in 1966 differ from the procedure today?

"From the technical point of view it's completely the same. The connection between the renal artery and the renal vein and the donor are the same as they were fifty years ago. The only changes that we see from time to time involve the reconstruction of the urinary tract - how the urethra of the donor kidney is connected to the urinary system of the recipient. But otherwise, there is no difference."

Czech medical transplantation has come a long way since 1966. Today an average 450 kidney transplants are done every year in this country. Unlike Karel Pavlik, who had only three years to live, patients today can expect to live a normal life for decades. Czech surgeons are able to transplant almost all vital organs. Dr Eva Pokorna is from the IKEM transplantation department:

"The most frequently transplanted organ is the kidney because it's the organ that most people need. A donor has two kidneys and they are given to two different recipients. Lungs can also be transplanted from one donor to two recipients. Then there is the heart, liver, and pancreas; each of which is transplanted as a whole."

Back in 1972, 67-year old Dana Sulcova underwent a kidney transplant. She received her organ from a deceased donor.

"I knew that transplants existed. As a young woman, I was 23 at the time, I believed that my new kidney would work just like my own after the transplant. Just before I went into the operating room, I overheard the doctor say that kidney receivers have about three years to live. So I monitored the first year, the second year, third year - expecting my kidney to fail. After five years I stopped. I lived a normal life just as I did before the operation. And, my new kidney made it possible for me to live just like any other person. I continued to do sports, had a baby girl, and now I have a granddaughter."

Finnish Dr. Pekka Hayry is one of the world's experts on transplantation surgery and immunology. He says Czech medical transplantation has come surprisingly far in the last forty years:

"You are making about 450 kidney transplants in a year, 80 liver transplants, and 60 heart transplants. So, in terms of procurement - removing organs from deceased bodies - and in terms of transplantation, you are doing much more than the European average. The second thing is the survival rate. Right now, your kidney transplant one-year survivals are 95 percent. The statistics for the liver are the same and for the heart a bit lower, just as the pancreas. This means that, again, you are doing quite as well as any country in Europe or in the world."

According to the head of the IKEM transplant centre, Dr. Stefan Vitko, one area that the Czech field of transplantation can be particularly proud of is the relatively short waiting time:

"The average waiting time for kidney transplantation is less than twelve months. There are people who wait a few weeks because the waiting time is related to biological factors involving the donor and the recipient. It's a kind of lottery."

Dr Eva Pokorna says there is a simple reason why patients in need of a new organ do not wait as long in the Czech Republic. All Czech citizens are automatically considered donors while in most other countries citizens have to agree to organ donation first:

"Here in the Czech Republic the law is based on a principle that's called 'presumed consent'. This means that anyone who does not want to donate his organ has to enter his name into a national registry of those who do not agree with the post-mortal donation of organs or organ tissue. Of course, children are an exception. Their families have to be consulted and the families have the right to refuse.

"But the chances of us being donors are slim. We will more likely be organ recipients. Of those who pass away every year, only some 200 end up being donors. That's because they are specific cases. The donor has to be brain dead and his organs have to be in such a state that they can continue to function for a while with the help of machines."

But in what areas does the Czech field of transplantation need to develop further? The transplantation of the Islets of Langerhans, the small intestine, and the combined heart and lung transplant are procedures that Czech surgeons have yet to perfect. There are also different ways of conducting transplants - for example what is called the domino transplant of the liver, in which the organ is removed from one patient and immediately transplanted into a second patient. The first patient receives a new liver from a deceased donor. But Dr Vladimir Kocandrle is sceptical that the country has the means to excel in the field:

"It's like with everything. If you work harder and get more financial resources you may achieve better results. But it is not guaranteed. You need a team of people who are really enthusiastic and willing to work. Then you have a chance to succeed. When we started with the transplantations in 1966, the money that was put into the medical sector was about 4.5 percent of GDP. Now it is 8-9 percent. In the USA, it is about 14 percent. But transplantations are expensive primarily because of the drugs that patients have to take for a lifetime to prevent the rejection of transplanted organs and these drugs are very expensive."