ROMTRANSPLANT

The professional association
of Romanian transplantologists

History of organ and tissue transplantation in Romania

The first attempt to perform an organ transplant in Romania dates back to the beginning of the XX-th century and was made by doctor Florescu who, working in the laboratory of experimental surgery of the Faculty of Medicine of Bucharest, performed several experimental kidney transplants. The operations were not successful, and Dr. Florescu considered that the unfavorable results were due to an incorrect angle of implantation of the blood vessels (the kidneys ultimately became necrotic); to overcome this problem he tried transplanting in different places of the organism, hoping he would find the appropriate angle. Of course, this did not happen and the experiments were abandoned.

In 1958 Prof. Dr. Agrippa Ionescu performed the first skin transplant in an organized hospital frame, and in 1962 the first corneea transplant was performed. In the second half of last century, Sergiu Duca in Cluj-Napoca and Vladimir Fluture in Timisoara as well as Dumitru Popescu-Falticeni together with Emil Papahagi at Floreasca Emergency Hospital of Bucharest performed experimental liver transplants.

The first successful transplantation of a human solid organ in Romania was performed by Prof. Eugeniu Proca in February 1980 in Fundeni Hospital, with a kidney from a living donor (the mother of the recipient). This transplant was soon followed by a kidney transplant from a deceased donor, performed in Timisoara by a team lead by Prof. Dr. Petru Dragan. Until December 1989 only kidney transplants were performed, and these only in relatively small numbers.

In 1992 the first modern program for kidney transplant in Romania was established by Prof. Dr. Mihai Lucan, in the Urology Clinic of Cluj-Napoca County Hospital (later to become the Clinical Institute of Urology and Kidney Transplant Cluj-Napoca).

Starting from 1995 the efforts for organizing a national transplant network were intensified, with several important moments :

• establishing the protocol for the diagnosis and declaration of brain death (Prof. Dr. Dan Tulbure)
• establishing the conditions for harvesting organs from deceased donors from a medico-legal point of view (Prof. Dr. Vladimir Belis)
• campaign in the mass-media for explaining the notion of brain death and for promoting organ donation
• the first multiorgan harvestings were performed (1997); in February a kidney was harvested from a brain-dead donor in the Clinic of General Surgery of Fundeni Hospital (surgical team Irinel Popescu, Ioanel Sinescu, Vladislav Brasoveanu, Radu Soare, anesthesiologist Dan Tulbure), and in June prelevation of kidney and liver was performed in Floreasca Emergency Hospital (surgical team coordinated by Prof. Dr. Irinel Popescu, and the anesthesiology team was coordinated by Dr. Ioana Grintescu). An important role was later played by Targu-Mures County Hospital, where Prof. Dr. Radu Deac and Dr. Pia Moldovan managed to preserve several brain-dead donors in physiological conditions, and the families of the donors consented to donation
• the formation of transplant coordinators begins, the first being Dr. Victor Zota, the current Director of the National Transplant Agency. The rules for distributing organs at a national level are established, as well as organ exchanges with other European countries with which agreements of cooperation are signed
• in 1997 the professional association "ROMTRANSPLANT" is founded, which will play an essential role in the development of Romanian transplantation, both on a scientific and on an organisatoric level. The 5 national congresses with international participation of this association (1998 : Cluj-Napoca - president Prof. Dr. Mihai Lucan; 2000 : Bucharest - president Prof. Dr. Irinel Popescu; 2002 : Targu-Mures - president Prof. Dr. Radu Deac; 2004 : Constanta-Eforie Nord - president Prof. Dr. Vasile Sarbu and 2006 : Cluj-Napoca - president Prof. Dr. Mihai Lucan) represented important moments from all points of view

The congress held in 2000 (Bucharest - Intercontinental Hotel) is particularly worth mentioning, when during the opening ceremony of the congress, His Eminence Teoctist, Patriarch of the Romanian Orthodox Church, presented an extremely important speech in which His Eminence expressed the approval of the Romanian Orthodox Church for organ prelevation from brain-dead donors and also expressed the support for organ donation, as a defining gesture for Christians.
The President of ROMTRANSPLANT has been, since 1997 to the present, Prof. Dr. Irinel Popescu, and General Secretary, Prof. Dr. Mihai Voiculescu.

The first liver transplant was performed in 1997 by Prof. Dr. Irinel Popescu at Fundeni Hospital, but was not followed by the survival of the patient. Also in 1997 the program for kidney transplantation in Fundeni Hospital was taken over by Prof. Dr. Ioanel Sinescu, after the retirement of Prof. Eugeniu Proca. In 1999 the first heart transplant was performed by Dr. Serban Bradisteanu in Floreascs Emergency Clinical Hospital, followed very shortly by the second transplant performed by Prof. Dr. Radu Deac in the Center of Cardiac Surgery of Targu-Mures County Hospital.

Also since 1999 Romania has had a representative in the Transplant Committee of the Council of Europe (Prof. Dr. Irinel Popescu), which allowed for the immediate adoption of European stipulations regarding transplantation and which would eventually lead to the introduction in Romania in 2006 of a new transplantation law, adapted to European requirements.

In April 2000 the first liver transplant followed by the survival of the patient was performed by Prof. Dr. Irinel Popescu in Fundeni Hospital, and in October 2000 the first living-related liver transplant was performed by the same team (transplant from mother to daughter).
In 2001 Prof. Dr. Margit Serban performed the first bone marrow transplant in Timisoara University Center, followed shortly by the taem of Fundeni Hospital (Prof. Dr. Dan Colita, Prof. Dr. Constantin Arion).

In 2003 the team from Constanta County Hospital (Prof. Dr. Vasile Sarbu, Dr. Simona Dima) perform the first autotransplant of pancreatic islets, in 2004 Prof. Dr. Mihai Lucan performs the first combined kidney-pancreas transplant in the Institute of Urology and Kidney Transplant Cluj-Napoca, and in 2005 in Fundeni Clinical Institute (Prof. Dr. Irinel Popescu, Dr. Simona Dima) the first allotransplant of pancreatic islets is performed in a patient with cirrhosis and diabetes, for which a combined transplant of liver and pancreatic islets is done. Stem cell transplantation was first performed in 2004 for a miocardial condition (Prof. Dr. Stefan Dragulescu, Prof. Dr. Virgil Paunescu - Timisoara Institute of Cardiology), and in 2005 for liver disease (Prof. Dr. Irinel Popescu, Dr. Simona Dima - Fundeni Clinical Institute). During this whole period, both legislation and the organisatoric framework were constantly improved.

In 1998 the first modern law for transplantation was passed in Romania - Law nr. 2/1998 "regarding the prelevation and transplantation of human tissues and organs", in which all the conditions for harvesting and transplanting organs and tissues were specified. This law was replaced by Title VI "Performing prelevation and transplantation of organs, tissues and cells of human origin with therapeutical purposes" of Law 95/2006 "regarding the reform in the field of health", in which a detailed chapter regarding transplantation of cells and tissues also exists, and the reglementations regarding organ transplantation are updated. The alignment to European legislation is also the result of the presence of a Romanian representative (Prof. Dr. Irinel Popescu) in the Committee for organ and tissue Transplantation of the Council of Europe.

In 2004 the National Transplant Agency was founded through Law nr. 588, and Dr. Victor Zota is named Executive Director of the Agency. Prof. Dr. Irinel Popescu becomes President of the Scientific Council of the Agency. The Scientific Council is composed of 33 members, reknown personalities of Romanian medicine, its composition being regulated through the Order of the Minister of Health nr. 183/2005, later supplemented by the Order of the Minister of Health nr. 814/2005.

Starting with the year 2005 the National Day of Transplantation is celebrated in Romania during the month of April, following the European model.

A new law for organ and tissue transplantation was passed in 2006 (Title VI of Law 95/2006), updated and aupplemented, especially in the sections regarding cells and tissues.

To date, in Romania the transplant teams have performed over 1000 kidney transplants (in the centers of Bucharest, Cluj-Napoca, Timisoara, Iasi, Constanta and Oradea), over 100 liver transplants in Fundneni Clinical Institute, over 50 bone marrow transplants, over 30 heart transplants etc. The accomplishments in the field of transplantation received an important acknowledgement at a national level in 2000, when the President of Romania, Emil Constantinescu, awarded high distinctions of Romania to the following: Prof. Dr. Eugen Proca, Prof. Dr. Irinel Popescu, Dr. Serban Bradisteanu, Prof. Dr. Radu Deac, Prof. Dr. Mihai Lucan, Prof. Dr. Ioanel Sinescu, Prof. Dr. Dan Tulbure, Prof. Dr. Petru Dragan si Prof. Dr. Vladimir Belis.