Another "case of transplantologists"
And cut out the liver
In Germany, the largest medical scandal in recent times is breaking outSergey Sumlyonny, "Expert" No. 32-2012
In Germany, the largest medical scandal in recent times is breaking out – for many years doctors have been falsifying patient data in order to circumvent the rules of organ transplantation. The scandal in transplantology shows that Western society must find answers to the most important economic and ethical questions of modern medicine
"An emigrant from Russia sold her kidney for 8,100 euros. A terminally ill German bought it for 81,892.72 euros" – the fresh cover of the German magazine Der Spiegel looks darker than usual. This is not surprising: in recent weeks, German society has discovered with horror that one of the most emotional areas of medicine, transplantology, is associated with the most disgusting and criminal frauds.
The story that the journalists of the weekly Der Spiegel unearthed is not particularly new: a few years ago, the heroine of the report, an emigrant from Russia, sold her kidney through intermediaries to an elderly German who was desperate to wait for a legal transplant in his homeland. Like many illegal donors, with the help of the operation, the woman hoped to improve her financial situation, but the money received very soon ran out, and health problems remained for life. Although the story happened a few years ago, right now it falls on the excited public opinion of Germany in the best possible way. For the second week now, Germans have been feverishly discussing the scandal surrounding the illegal transplantation of human organs – and for the second week, German journalists have been asking citizens of the country if they are ready to sacrifice a piece of themselves, having no guarantees that their kidney or liver will really go to a good cause. Citizens clench their teeth and stubbornly say "no".
Bypassing the queueThe scandal related to organ transplants broke out at the very end of July, when information about strange medical reports from the university clinic in Göttingen leaked to the German media.
Since 2008, the number of organ transplantation operations in the clinic has increased dramatically. A twofold increase in the number of liver transplants occurred at the beginning of the work of a new doctor. Now the investigation suspects the doctor that he regularly falsified the test data of his patients. Thanks to this, on paper, the condition of patients looked much worse than it actually was, and patients were much more likely to get an organ transplant operation. The prosecutor's office, studying the materials from the clinic, is sure that it is dealing with an organized criminal group, and declares that "this could not have happened without criminal intent."
Ordinary Germans are also sure of this, according to polls. According to the German Organ Transplant Foundation, in the last week alone, five previously confirmed donors have refused to undergo surgery, citing their doubts about the cleanliness of doctors. The reason for the doubts was the scandal in Göttingen. "I used to be ready to become a donor. But after what I heard about doctors and their machinations, I will never go for it. I'm afraid that my organ will get to a rich man or someone else, and a really needy person will not get it. It's so unfair!" – this is the standard answer of a passerby on the street to the question of German journalists whether he is ready to become a potential donor now.
Who will get a kidneyThe manipulations of the doctors from Göttingen fit perfectly into the complex German procedure of transplantation.
It is by carefully correcting the patient's medical history that a skilled doctor can deceive the control authorities and get a long-awaited quota for a transplant for his patient.
Transplantation procedures in Germany are carried out in 50 transplant centers. All the centers are united into a national organization – the German Foundation for Donor Organ Transplantation (DSO). In turn, the DSO is subordinate to the European structure Eurotransplant – this organization located in the Dutch town of Leiden regulates organ transplants in Germany, Austria, Belgium, the Netherlands, Slovenia and Croatia.
All patients from the above countries awaiting organ transplantation are registered first at the national center of each country, and from there the data is transmitted to Eurotransplant. Here, in the unified register, data on available organs are stored – most often suddenly deceased people who filled out special papers during their lifetime authorizing the removal of their organs after death for transplantation. Consent to the removal of organs from a deceased person can also be given by his relatives. Next, the seized organ is sent to a patient in need – it can be any patient living in one of the Eurotransplant member countries.
The patient's place in the transplant queue depends on many factors. Of course, at the very beginning there are patients with the most severe health condition. However, citizenship also plays an important role (for example, citizens of countries where more donor organs come from have priority, so Germans, for example, receive organs less often than Austrians), and, of course, the issue of organ compatibility. In some cases, a healthier patient has a better chance of receiving an organ – this happens, for example, when an organ comes from a person who was treated with drugs that cause serious complications on organs shortly before death: it is simply dangerous to transplant such "second-rate" organs to terminally ill patients.
The complexity of the Eurotransplant system is compounded by the fact that it does not unite all European countries. In addition to sovereign national organ accounting systems, such as in France or the UK, there are two other similar regional organizations in Europe: Scandiatransplant, which unites patients from Denmark, Iceland, Norway, Finland and Sweden, and Balttransplant, which operates in Latvia, Lithuania and Estonia. Finally, the legislation of different countries describes the procedure of transplantation in different ways. So, if in the UK it is possible to start organ removal after cardiac arrest, then in Germany they must first establish the final death of the brain, and this further reduces the pool of donor organs.
At a dead endThe situation with organ transplantation in Germany has really reached a critical point.
According to the statistics of German doctors, at the moment more than 12,000 people are waiting for transplants of various organs in the country, 8000 of them - a donor kidney. At the same time, only 1,200 people were organ donors last year. Since we are mainly talking about dead people, the number of transplanted organs eventually exceeded 4,000, but still the gap between the number of people waiting for a transplant and the availability of donor organs is measured in thousands. As a result, 900 to 1100 patients die in Germany every year without waiting for an organ transplant. German media regularly report that one of the representatives of the German political elite sacrifices his organ to save a loved one: for example, in the summer of 2010, the ex-candidate for Chancellor of Germany and leader of the Social Democratic Party Frank-Walter Steinmeier gave a kidney to his seriously ill wife, otherwise she could easily replenish the statistics of patients, not waiting for a life-saving operation.
However, even with voluntary lifetime donation, society faces serious moral challenges. For example, what is the recipient's responsibility to a voluntary donor? Two years ago, the United States was shocked by the story of a 47-year-old employee of Atlantic Automotive Group, Deborah Stevens. An employee of a car sales company donated a kidney to her boss, who was fifteen years older than her. After that, Stevens was given almost no time for postoperative rehabilitation, and soon she was fired altogether, which deprived her of the opportunity to use medical insurance. Now Stevens, who is suing her former boss, claims that she used her in cold blood: in particular, the boss allegedly emphasized their friendship in every possible way before she asked her subordinate to give a kidney, and immediately after a successful operation she cooled down to an unnecessary donor.
Meanwhile, the case of Deborah Stevens is just a vivid incident from the field of kidney transplantation. Most often, dubious transplantations of this most frequently transplanted human organ occur not with the help of deceived trust, but thanks to ordinary money. Although the sale of organs by one person to another is prohibited in almost all countries, the illegal market is thriving. In Asia, kidney donation costs from 500 to 2000 dollars. In Moldova and Romania, where such a business is also developed, – from 2000 to 3000 dollars. According to statistics from the World Health Organization, every year in the world about 20,000 people voluntarily sell their kidneys – all of them hope to get out of poverty in this way, and almost all of them will be severely disappointed. The use of poor young donors from third world countries to support the lives of residents of developed countries who are desperate to wait for their turn for transplantation is another wall of the impasse that modern medicine rests against.
Life after deathWhat can we say about the moral challenges posed by the removal of donor organs from deceased people.
This is the only way to get, for example, a donor heart. The inviolability of the body of the deceased, however, is firmly connected with the cultural and religious context of European culture. In Germany, Great Britain, the Netherlands and Switzerland, the medical and legal consensus is that a human organ can be removed after a person's death only with the consent of his relatives or with the will of the deceased clearly expressed during his lifetime. The need to establish such consent runs into a natural biological limitation: the period during which organs can be transplanted is usually limited to a few hours after a person's death. So, the heart can be transplanted only within six hours, the liver within twenty hours, and only the kidney will last more or less a long time – as much as forty-eight hours. That is why it is so important to have a lifetime consent of the donor. However, only very few citizens declare their willingness to become donors. So, in Germany, only no more than 20% of residents have a so–called donor passport - a small card with medical data that is put into a wallet and entitles doctors to remove the organs of this person in the event of his sudden death. The protection of the inviolability of the body of the deceased actually turns into a refusal to stop the suffering of living people.
A year ago, the German Cardiology Center in Berlin (DHZB) tried to solve this problem. In its massive advertising campaign, the center urged citizens to enroll as potential organ donors. From the walls of houses and from advertising stands, a man and a woman – superheroes looked at the inhabitants of Germany. They jumped after people falling from roofs, and also carried them out of the fire. The advertising campaign called on citizens to also become potential superheroes capable of saving people's lives. "You can also save a life!" – comic book characters said from posters and offered to fill out a donor certificate for this. The criminal scandal with illegal liver transplants in the Göttingen clinic has crossed out all the successes of this campaign.
Unexpected support for transplantologists came from the German parliament. In the spring of this year, the Bundestag adopted a law according to which, from 2017, every German will regularly receive letters from his insurance company asking if he is ready to become an organ donor in the event of his sudden death. Those who respond positively will be given the same donor certificate authorizing the removal of organs after death. According to the deputies, the new law will help to increase the pool of potential donors from 20 to 50 and even 70% of the population. Thus, it can be assumed that the number of donors in Germany will increase from 1200 to 2000-3000 people per year.
Meanwhile, the new bill has already been severely criticized by migrants living in Germany. According to representatives of the German Union of Muslims, migrants already face discrimination in the provision of medical care and are therefore afraid that in the case of mass distribution of donor certificates, situations will become possible when a foreigner injured, for example, in a serious accident, will be considered primarily not as a patient, but as a potential donor soon. Even worse, according to representatives of migrant unions, the situation will develop if legislation is passed in Germany declaring as a donor every resident who has not explicitly protested against organ removal during his lifetime. Such standards are already in force in Austria, Belgium, Spain, Italy, Poland, Portugal and France.
Old, rich, sickThe passivity of potential donors within the EU countries is not the only challenge facing the transplant industry.
The very development of modern medicine, which allows citizens to live to a very old age more and more often, leads to two serious economic and ethical problems. Firstly, universal access to high-quality medicine means that the number of elderly patients is increasing, and with them the number of patients in need of an organ for transplantation is also growing. At the same time, after several years of living with a transplanted kidney, the chances of organ rejection increase – according to statistics, every second transplanted kidney fails for ten years due to the rejection reaction, and the patient has to get back in line for a transplant. Thus, improving the quality of medicine entails an increase in demand for donor organs. On the other hand, the development of medicine also reduces the number of young relatively healthy patients who suddenly die, who can become ideal donors. Even in those EU countries where organ removal after death is allowed by default, only two dozen people per million of the population become such donors (for example, in Italy – 21 people per million, in France – 24, and in the record-breaking countries of Portugal and Spain – 31 and 34, respectively).
If the current success in life extension continues, the gap between the growing demand for organs and the dwindling number of potential donors will only increase. Already since 2007, the number of German residents aged 65 and older exceeds the number of residents under the age of 20 – today the difference in the number of young and elderly residents of the country is 2 million people. According to demographic calculations of the German social insurance funds, by 2060 the gap will increase to 20 million people. This gap is not only causing serious economic problems of insurance medicine (in 2011, state subsidies to support social insurance medicine amounted to 15 billion euros, and by 2020 may amount to 28 billion euros per year). Among other things, it means that the European donation system will continue to remain at an impasse – until society finds not only medical and technical, but also moral and ethical answers to questions related to organ transplantation.
Portal "Eternal youth" http://vechnayamolodost.ru13.08.2012