Presumption of consent
Valery Vyzhutovich, Rossiyskaya Gazeta
The Ministry of Health has developed and submitted to the government a bill "On organ donation, parts of human organs and their transplantation".
It provides for the creation of a federal register of organ donors, recipients and human organ donors. The register is needed for greater transparency of the transplantation process. "Thanks to him, a single database of donors and those in need of donation will appear in the country," commented Sergey Gauthier, Chief transplantologist of the Russian Federation, director of the Federal Scientific Center for Transplantology and Artificial Organs. – And most importantly – there will be a real mechanism of lifetime expression of will." According to the doctor, in this case, a person who has reached the age of majority will be able to go to a medical institution (or to a notary) and declare his desire to be a donor after death or, conversely, his desire not to become a donor. "The bottom line is that this information should be contained in a single register," Sergei Gauthier said, "and all people who refused to be donors after death should be entered there."
In March, the Constitutional Court spoke on the same topic. He confirmed the legality of the removal of organs for transplantation after the death of a person without the consent of his relatives. The decision was made in connection with the appeal to the COP of relatives and friends of a woman who died in the hospital, whose heart, kidneys and other internal organs were removed without permission. The applicants demanded that the relevant provisions of the law on transplantation be declared unconstitutional. The Constitutional Court issued a verdict: "The presumption of consent to the removal of organs is aimed at the development of donation and transplantation in the country, and does not violate the Constitution." At the same time, the court recalled that if it is known about the negative attitude to the transplantation of the deceased, his close relatives or legal representatives, then this procedure cannot be carried out. The Constitutional Court stated that the substance of the applicants' claims actually boils down to the need to switch from the existing model of presumption of consent to the removal of human organs after his death to the system of requested consent. "However, the resolution of this issue – despite the fact that both the one and the other normative model is permissible both from the point of view of constitutional provisions and from the point of view of the provisions of international legal acts - is the prerogative of the federal legislator and does not fall within the competence of the Constitutional Court," the Constitutional Court explained.
Why ordinary people are wary of organ transplantation can still be understood, but why do the doctors themselves not show enthusiasm in this matter? "There are absolutely wonderful people among professionals who deny the very possibility of organ transplantation. They say: I don't understand this and therefore I won't do it," says Sergey Gauthier. "Others shun transplantology, because many things are still insufficiently regulated here, and no one is going to take risks." Meanwhile, in foreign clinics, the qualification requirements for a resuscitator include the preparation of donor organs. It is believed that if a person has died, you can try to get his organs, and, therefore, they cannot be spoiled. "We have not set such tasks yet," Gauthier says. – Although I can imagine how difficult it is organizationally. And financially: all the work to ensure organ donation must be paid for. It's the same job as nursing the sick."
The first heart transplant in Russia was done in 1987. Academician Shumakov did it, and he did it at his own risk. Russian medicine was quite conservative, the concept of "brain death" did not exist then. And the criterion for the death of a person who can become a donor is precisely brain death. The heart can still work. The kidneys and liver can also work, but if brain death has occurred, then there is no personality, there is no person. At the same time, the consent of his relatives is not required to take the organ from the deceased. Doctors in such cases work on the presumption of consent. This is one of the forms of organization of posthumous donation in many countries. It means that if a person did not express his will during his lifetime and if his relatives do not mind in the event of his death, then there are no obstacles to donation. But this does not deprive relatives of the right to come and say: we are against it! In this case, the presumption of consent will not apply. It happens that relatives do not know that the deceased has become a donor, but this happens very rarely. According to the law, doctors do not have to ask their permission, they are obliged to respond only to a refusal. And the more rejections, the fewer people get a chance for a second life. No transplant can develop without posthumous donation.
Over the past ten years, the number of organ transplantation operations in Russia has doubled. But this is less than 16 percent of the number of transplants that patients need. In the country, it is necessary to do nine thousand such operations a year. The possibility of obtaining organs for transplantation is only 5-6 percent of the required amount. Because the mass consciousness resists it.
Readiness to serve people after death should be brought up from school. When organs were being transplanted in Spain, there were so many television broadcasts and newspaper articles about it! There were trailers in Madrid where volunteers donated blood. It was a nationwide movement. It was led by the Catholic Church and gave a powerful impetus to the development of the so-called Spanish donation model. Doctors-transplantologists are trying to introduce this model in Russia, but society is not ready for it. Few people understand why this is necessary. Organ transplantation is in many ways a social problem in Russia related to our mentality. Educational work is needed here.
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