Why does Bulgaria still not have contracts for lung transplantation? Natalia Maeva in front of FACT

Lung transplantation - do it yourself or do we still have a state… The question is not complicated if we look at it from the side. If our lives depend on having a lung transplant, things look much different. Natalia Maeva, chairwoman of the Bulgarian Society of Patients with Pulmonary Hypertension, spoke in front of FACT.

- Ms. Maeva, does Bulgaria still not have a contract for lung transplantation with another country?
- Unfortunately, yes. Bulgaria has not had a contract since 2019. That's been almost 6 years now. I call this period “ice“. The good news is that a Bulgarian patient is due to leave for the USA this month, where she will undergo a lung transplant. But the contact that was made was not through the Medical Supervision Agency, but on the principle of “patients helping patients“.

- What is not happening, what are we not doing as people, what is the reason why we have not had a contract for so many years?
- It is difficult for me to comment on the real reason, but as a side observer of everything that has happened during this period since 2019, we simply do not have enough will. We do not have enough image as a partner to prove that it is worth working with. And this is because we also have to donate organs. In Bulgaria, we have 30 donor bases, but I do not know what broke and things are not happening. Whether the problem is in regulatory documents, whether the coordinators' pay is low, but there is something that has clearly been hindering us for so many years. We have a very weak donor country.

- In our country, donation is definitely a problematic topic…
- It is interesting that young Bulgarians are ready to donate, while politicians are skeptical. A few years ago, we tried to suggest to various patient organizations that perhaps the donation law should be changed. At that time, politicians told us that our law was one of the best in Europe. I cannot say whether this is so, but I ask myself the logical question why in Austria, Germany, Serbia, France all people are potential donors - not to mention Slovenia and Croatia, but in our country it is not.

- How many people are waiting for a lung transplant in our country?
- According to the official list in the Medical Supervision Agency, there are currently six. But the doctors are aware that we do not have a contract with any European clinic, and they simply refuse to register new patients. So the waiting list is not updated, and the principle is “save yourself individually“.

- Like the woman in question, who will travel to the USA for a transplant …
- Yes.

- How many years has she had lung problems?
- She was diagnosed with pulmonary arterial hypertension in 2010. She may already be at the end of her life and her only chance to be saved is to have a bilateral lung transplant. A team from the USA confirmed that the patient is suitable, that they will accept her. The health insurance company allocated the necessary amount for the operation, in the amount of about $700,000. But another question arises. That the woman must stay in the States for at least a year until she recovers. She will spend about a month in the hospital after the transplant, but after that… Will the Bulgarian state provide the amount she will need for recovery, for check-ups in the first year? After such an intervention, long flights are not recommended. So the situation has not been clarified at the moment, but I hope that there are still people working in the Health Insurance Fund and the Ministry of Health who think and understand what lung transplantation means.

- We had very good contacts with Austria when it came to lung transplantation…
- I myself was transplanted in Austria.

- What broke down in the relations, do the Austrians continue to respond…
- We do not have Bulgarian donor situations. We turned out to be a bad partner - according to Austrian understandings, for donation, and so we were unable to continue this cooperation. In 2019, the contract with an Austrian clinic was extended for a short time, which worked for another six months, after which they agreed that they would no longer accept foreigners for operations, since the workload of the team is too high and for them, Austrian citizens are a priority. Thus, our contractual relations ended. Otherwise, we had very good cooperation, which was very active from 2014 to 2019. The only thing left from the contract is that we Bulgarians who were transplanted in Vienna continue to be monitored by doctors in Vienna every three months. Only this remained as some kind of commitment. This is some kind of their rule as an Austrian team, because they have taken great care and for them every life saved is important. It is important for them to follow up on their patients because they respect their work, and this is insurance for us that we are following up adequately.