The Republic of Kazakhstan is one of the fastest developing countries in the world and has a health care system that is unique in Central Asia. Its organ transplant services are also developing rapidly. We aimed to analyze and briefly report on the current status of organ transplant in the Republic of Kazakhstan. We analyzed organ transplant activities in that country for the period 2012 to 2014. All data were collected from the official database of the National Transplant Coordinating Center of the Republic of Kazakhstan. At the end of 2014, the number of transplant centers had increased to 10, three of which could perform multiorgan transplants; during the same period, the number of deceased-donor organ-donating hospitals increased up to 37. By 2013, the transplant activity rate for all centers had reached 9.22 per million population. During the previous 3 years (2012-2014), there was a 3-fold increase in the number of living donors and an 18-fold increase in the number of kidney transplants. Between 2012 and 2014, the number of living-donor liver transplants increased from 17 to 25, and the number of deceased-donor transplants increased from 3 to 7. During the last 3 years (2012-2014), the number of heart transplants increased to 7 cases. During the last 3 years (2012-2014), Kazakhstan achieved a significant improvement in the organ­ization of its transplant services, and a noticeable upward trend in the system continues.

Key words : Kidney transplant, Kazakhstan, Liver transplant, Organ transplantation, Heart transplant

Introduction

The Republic of Kazakhstan is one of the leading countries among the members of the Commonwealth of Independent States in terms of its socioeconomic development and health care system.¹ Its population is more than 17 million people, including 160 nationalities and multiple religious backgrounds. The country is situated between the continents of Europe and Asia.² In Kazakhstan, the first steps toward an organized organ transplant system began in the 1980s. During the 2012 through 2015 years, throughout the entire country, there has been a progressive development in this system. Among Commonwealth of Independent States countries, Kazakhstan is now one of the leading in organ transplant, along with Russia, Belarus, Ukraine, and Azerbaijan.³ We aimed to analyze and briefly report on the current status of organ transplant in the Republic of Kazakhstan. In this brief report, we analyzed organ transplant activities in this country for the period 2012 to 2014. All data were collected from the official database of the National Transplant Coordinating Center of the Republic of Kazakhstan.⁴

Structure of transplant care
In 2012, a national transplant coordinating center was established that reports directly to the Ministry of Health and Social Development of the Republic of Kazakhstan. The national transplant coordinating center cooperates with transplant centers, which provide organ transplants, and supporting centers, such as deceased-donor organ–donating hospitals, national centers for air ambulances, and human leukocyte antigen (HLA)–testing laboratories. To date, the number of transplant centers has increased up to 10, three of which can perform multiorgan transplants. The number of deceased-donor organ–donating hospitals increased to 37, and the transplant activity rate for the centers overall had reached 9.22 per million population by 2013.

Transplant activities
Significant increases have taken place in the number of organ transplants (eg, kidney, liver, and heart) from both living and deceased donors during the past 3 years (Figure 1). Between 2012 and 2014, kidney transplants from living donors increased from 56 to 164 (almost 3-fold), and kidney transplants from deceased donors increased from 1 to 18. During the same period, a 1.5-fold increase in the number of liver transplants from living donors occurred (from 17 to 25) and liver transplants from deceased donors increased from 3 to 7. One of the main achievements in Kazakhstan has been implementing a system of heart transplant from deceased donors. From 2012-2014 years, the number of heart transplants increased to 7. Despite this progress, the number of patients waiting for organ transplants in Kazakhstan remains high (Table 1). According to a report published in 2014,⁴ the organ transplant waiting list had registered 1787 adult recipients and 20 pediatric recipients for kidney transplant; 542 adult recipients and 13 pediatric recipients for liver transplant; and 53 adult recipients and 12 pediatric recipients for heart transplant.

Current problems of the organ transplant system
Several major problems affect the organ transplant system in Kazakhstan: (1) a shortage of donor organs (especially from deceased donors); (2) large distances between deceased-donor organ–donating hospitals and transplant centers; (3) insufficient numbers of HLA-testing laboratories; (4) a deficit of experienced transplant teams; (5) a lack of alternative immunosuppressive medications such as sirolimus, everoimus and others, which have not registered yet in Kazakhstan; and (6) insufficient posttransplant patient care related with limited number of experienced nephrologists in the regions of Kazakhstan.

Now, the Ministry of Health Care of Kazakhstan in cooperation with the national transplant coordinating center are working to solve these problems, for which the following steps must be taken: (1) undertaking development activities that aim to promote organ donation (organ donation programs); (2) ensuring that transplant centers and supporting centers have the necessary medical equipment; (3) opening transplant centers and HLA-testing laboratories in major metropolitan regions; (4) establishing active training programs on transplant in medical universities; (5) training transplant teams (eg, surgeons, coordinators, phy­sicians) in countries that have more developed transplant programs; and (6) encouraging international cooperation and the development of scientific research in the field of transplantation.

Conclusions

During the years 2012 through 2014, Kazakhstan has achieved marked success in the organization of its transplant system, and there are noticeable trends toward improvement. Increased cooperation with international transplant societies, resolving the aforementioned problems, and beginning to take the above-listed steps toward their solution would further improve transplant services in Kazakhstan.

References:

1. Ardichvili A, Gasparishvili A. Socio-cultural values, internal work culture and leadership styles in four post-communist countries: Russia, Georgia, Kazakhstan and the Kyrgyz Republic. International Journal of Cross Cultural Management. 2001;1(2):227-242.
   CrossRef
2. Sinnott P. Population politics in Kazakhstan. J Int Affairs. 2003;56(2):103-113.
3. Ghods AJ. Current status of organ transplant in Islamic countries. Exp Clin Transplant. 2015;13(suppl 1):13-17.
   PubMed
4. Doskaliyev Z. Statistics of National Transplant Coordinating Center Astana: National Transplant Coordinating Center; 2014. http://transplant.kz/statistika.html. Accessed June 30, 2015 [in Russian].