Abstract

The first renal transplantation in Estonia was performed in 1968. The three important factors that paved the way to this event were: introduction of haemodialysis in Estonia in 1966, experience in diagnosing irreversible coma according to the Harvard criteria based on defining brain death in 1968 and interdisciplinary cooperation of neurologists, surgeons and specialists of forensic medicine. To date 800 renal transplantations have been carried out, 100 them from living donors. Currently there are 380 people living with a kidney transplant in Estonia.
1970–1990 was a difficult period with only a few wins and many losses. The survival rate of patients on haemodialysis was very low. The number of renal transplantations increased from 4–5 to 10–15 per year and the first successful operation resulting in lasting transplant function was performed in 1976. Despite the extreme scarcity and unavailability of proper immunosuppressive treatment, as well as negative attitude and strong opposition to the so-called `barbaric` methods of using living donors in the Soviet Union, further development of transplantation was strongly motivated by the hopeless situation of patients with end-stage renal disease.
The 1990s was a period of profound changes. The status of patients with renal failure improved considerably owing to the use of modern dialysis equipment and introduction of outpatient peritoneal dialysis in Estonia. The year 1996 marked a breakthrough with an increase in the number of renal transplantations up to 45 per year and with the establishment of dialysis centres in 10 cities across Estonia. Introduction of new methods of immunosuppression improved the outcome significantly.
In 2008 the Transplantation Act complying with the statement of the European Council was adopted by the Parliament of Estonia. In 2007, 40 kidney transplantations per million inhabitants were performed. Joining the Euro Transplant System is currently on the agenda.