ASTANA — More than 4,000 patients in Kazakhstan await organ transplants, with kidneys accounting for over 90% of all cases. In this article, The Astana Times delves into how the donor system operates, and what legal, cultural, and systemic factors limit the growth of post-mortem donation.
Organ donor illustration. Photo credit: rightasrain.uwmedicine.org
According to Kazakhstan’s Center for Coordination of Transplantation and High-Tech Medical Services, as of April 10, the national transplant waiting list included 4,199 patients, among them 108 children. Majority of them – 3,808 patients, or 90.6% – were waiting for kidney transplants.
The list also included 213 patients awaiting liver transplants (5%), 145 for heart (3.4%), 27 for lungs (0.6%), and six for heart-lung complexes (0.4%).
Between 2020 and 2025, 1,326 organ transplants were performed.
Kidneys accounted for 800 procedures (60%), followed by 259 cornea transplants (19.5%), 237 liver transplants (17.8%), 21 heart transplants (1.5%), and nine lung transplants (1.2%). Of these, 975 (73.5%) involved living donors, while 351 (26.5%) came from post-mortem donors.
Centralized matching and allocation system
Aidar Seitkazinov, a head of Kazakhstan’s center for coordination of transplantation and high-tech medical service. Photo credit: Seitkazinov’s personal archives
Kazakhstan uses a centralized medical information system to match donors and recipients. The system evaluates compatibility based on certain factors.
According to Aidar Seitkazinov, head of the center, when a deceased donor becomes available, the system evaluates candidates based on waiting time, human leukocyte antigen (HLA) typing, blood group, and medical urgency. It then automatically generates a list of the 20 most compatible candidates.
“There are patients listed from all regions of the country, including children. The list is national. The 20 highest-scoring patients are identified and then reviewed by transplant centers to confirm medical readiness and logistics,” Seitkazinov told The Astana Times.
He explained that points are assigned based on specific criteria, including how long a patient has been on the waiting list.
“Priority is given to children, followed by the patient’s medical condition. In the case of kidney transplants, patients must submit quarterly HLA test results. If they fail to do so, they will not be included in the top 20 on the list,” he added.
Consent system and family approval
Kazakhstan permits both living and posthumous organ donation. The country operates under a requested consent system, meaning individuals may voluntarily declare their agreement or refusal to post-mortem donation.
The transplant coordination center highlighted that the issue of posthumous donation often triggers mixed reactions in society, a trend not unique to Kazakhstan.
Every nation that has made significant progress in organ donation and transplantation has experienced such a phase and continues to increase the number of lives saved through posthumous donors each year.
“Despite advances in modern medicine and the introduction of new methods to treat patients with end-stage failure of vital organs, organ transplantation remains the only effective treatment option for such cases,” said the center.
As of April 25, 108,407 citizens (93%) had registered refusals, and 8,218 (7%) had registered consent.
“We have what is known as the presumed requested consent system. A person expresses their will during their lifetime, either by providing written consent or by indicating refusal. The total number of such declarations is relatively low, representing only a small percentage,” said Seitkazinov.
“Regardless of a person’s consent or refusal, permission from relatives is still mandatory. This is defined in our legal code. For all individuals diagnosed with brain death, we speak with their family members,” he added.
Seitkazinov noted that while no documented cases have emerged where a family opposed a donor’s prior written consent, there have been instances where families agreed to donate based on the deceased’s supportive attitude toward donation during life.
“Earlier this year in Astana, we had a potential posthumous donor. The person had officially refused donation during their lifetime. Although we had already planned to speak with the relatives, once we received the written refusal, the donation process was immediately stopped,” he said.
When asked whether Kazakhstan’s consent model, which requires voluntary agreement and does not follow a presumed consent system, affects overall donor activity, Seitkazinov highlighted that posthumous donation is more widespread in countries with presumed consent.
“Of course, it has an impact. That is because it is supported at the legislative level. Doctors still inform the family, of course, but their opinion doesn’t carry decisive weight if the person didn’t register a refusal during their lifetime. That is how it works under a presumed consent system,” said Seitkazinov.
“In our case, I believe family ties are very strong. Even with what is called soft presumed consent, where families are still informed, if they are firmly opposed, steps are taken to avoid any legal issues later,” he added.
Religious, ethical and systematic barriers
Seitkazinov highlighted three main barriers to donor registration. They are religious beliefs, ethical considerations and distrust in the healthcare system.
“There is a widespread belief that a person is born with all their organs and should be buried with them, despite religious teachings that support transplantation. While religion may support transplantation, there is no active information campaign conducted within its framework,” he said.
A second barrier is distrust in the medical system.
“People fear that organs might be sold on the black market. More broadly, there is general distrust toward the healthcare system. When people face issues such as difficulty accessing specialists or receiving a delayed diagnosis, they tend to project that frustration onto the entire system,” said Seitkazinov.
“Some also fear that if they officially declare consent, they will not receive full treatment in intensive care, and that instead of trying to save them, doctors will prioritize harvesting their organs,” he added.
Seitkazinov also noted that awareness campaigns are usually led by the coordination center and transplant institutions.
“There is no large-scale campaign involving ministries of culture or education. Related events are typically tied to European Organ Donation Day on Oct. 9 and include marathons, tree-planting ceremonies and regional open days,” he said.
Living donors and cross-border programs
According to Seitkazinov, in 2024 alone, more than 230 transplants were performed using organs from living donors, compared to 23 from deceased donors.
“One deceased donor can save multiple lives – with two kidneys, a liver, heart, lungs, corneas, even the pancreas. All organs are in demand, but kidney patients dominate the waiting list. Unlike others, they can survive on dialysis for years, though with limitations. Liver, heart and lung patients don’t have that option. Over 300 patients drop off the list annually, often due to death,” said Seitkazinov.
According to the transplant coordination center, Kazakhstan cooperates with Spain, Türkiye, South Korea and Belarus in transplantation, mainly for staff training and knowledge exchange. However, it does not participate in cross-border transplantation or organ exchange programs.
Bone marrow registry and transplants
According to the Ministry of Health, as of March 1, Kazakhstan’s national bone marrow donor registry included 13,070 registered donors.
Bone marrow transplantation is recommended for 1,021 patients, including 535 requiring autologous (self-derived) transplants and 486 needing allogeneic (donor-derived) transplants, mainly involving relatives. Finding unrelated matches remains difficult, with odds of success at about 1 in 10,000 due to medical and immunological factors.
At the National Scientific Oncology Center (NSOC) in Astana, bone marrow transplant services continue to scale.
According to Vadim Kemaikin, head of the center’s oncohematology department, the institution has performed 80 bone marrow transplants annually for the past three years. After relocating to a new facility with 15 transplant beds, the center plans to increase capacity to 120 transplants per year.
Vadim Kemaikin, a head of the National Scientific Oncology Center’s (NSOC) oncohematology department. Photo credit: Kazakh Ministry of Health
The center conducts both autologous and allogeneic procedures, including haploidentical matches. Kemaikin noted that access to unrelated donors resumed via a contract with the Russian registry this year. The center also plans to connect with European and Turkish registries by fall.
“We previously conducted unrelated donor transplants starting in 2013, but stopped due to legal limitations. Now the framework is in place,” Kemaikin told The Astana Times.
According to Kemaikin, genetic matching with foreign registries remains difficult due to the homogeneity of the local population.
“Unlike Europe, where the gene pool is mixed, we often rely on large families here,” he said.
Patients recommended for transplant are reviewed by a multidisciplinary board that includes the department head, treating physicians and psychologists.
“We explain the risks, complications and prognosis. Approximately 95% of patients agree. There are no major difficulties,” said Kemaikin.
Islamic guidance on bone marrow donation
According to the Ulema Council of Kazakhstan’s Spiritual Administration of Muslims, bone marrow donation is permissible under Islamic law. The fatwa, which refers to Islamic legal ruling, compares it to blood donation, citing Quranic principles.
“And help one another in acts of righteousness and piety (…) And whoever saves a life, it will be as if they saved all of humanity,” reads the Quran.
The ruling outlines four conditions: the transplant must be medically necessary, the donor’s health must not be harmed, consent must be voluntary and the procedure must be overseen by qualified physicians.
