22 August 2016

Transplantation in Russia

"Will they take me apart for organs" and 10 more+ questions

Alice Orlova, "Orthodoxy and Peace"

The new law on donation in Russia may be adopted this fall and has already caused panic: "Anyone, including a child, can be grabbed on the street, cut, and then show papers? I don't believe that everything will be clean. It will be dirty and scary, because it's a lot of money," they write in social networks. So will it be possible to catch a person on the street and disassemble for organs? Pravmir figured it out.

It is very difficult to talk about organ donation in Russia. It seems that at the word "transplantation" our compatriots' logic fails and pure panic turns on, and at the words "child donation will be possible" its degree goes off scale.

Now in Russia there is a presumption of consent to posthumous donation, that is, it is believed that everyone is ready to become a donor after death. But the new law cancels the presumption of consent.

What will change with the adoption of the new law on donation?

The main innovation is that a register of expressions of will will appear. Similar registers of donors and recipients exist in all countries. It is assumed that the register will be in electronic form. The "Federal Register of Donor Organs and Recipient Patients" will include a sub-register that includes the will of citizens. Expression of will is a person's desire or unwillingness to become a donor after death. It does not provide any confidential information about the parameters of his health.

By the way, consent to donation does not mean that human organs will necessarily be used. Anyone can give consent, regardless of age and health status. But whether a person who has expressed consent will become a donor will be decided by doctors if this person is diagnosed with brain death. It is assumed that the register of expressions of will will give a person the opportunity to change his decision.

If a person's consent is not in the register, and brain death has been diagnosed, doctors will have to get consent from relatives. Without such consent, the removal of organs will be impossible.

And if I don't want to be a donor after death?

The new law has not yet been adopted, the presumption of consent is now in effect. But you can also express disagreement, the federal law "On the basics of protecting the health of citizens" (Article 47, paragraphs 6-10) allows this.

It says that an adult capable citizen can express his consent or disagreement to organ donation orally, in the presence of witnesses or in writing, certified by the head of a medical organization. If desired, the document can be notarized – if a person wants the document to have legal force. Information about the presence of a citizen's will is entered in his medical documentation. If there is no expression of will, the spouse has the right to declare his or her disagreement with the removal of organs and tissues from the body of the deceased for transplantation, and in his or her absence – one of the close relatives.

Under the new law, will all unidentified people in hospitals become donors?

It is impossible to use the organs of unidentified people for transplantation, firstly, a person could disagree, and secondly, doctors do not have information about his health, they will not take the risk.

Will all orphans become donors?

Only parents can consent to the use of organs of a deceased child for donation. Guardians and trustees do not have such a right, this automatically excludes orphans from the list of potential donors. However, this number is already small, not any deceased person can become a donor, but only a person with a diagnosis of "brain death". As a rule, these are people after severe traumatic brain injuries.

Is it true that organs are taken from living people?

In Russia, transplants from living donors are possible only to relatives. The relationship must be confirmed by documents. At the same time, even our spouses cannot become donors for each other.

If the transplant is not related, only a person with a diagnosis of brain death can become an organ donor. Brain death should not be confused with coma and vegetative state, it is a much more severe lesion, irreversible and incompatible with life. There is no chance that such a patient will recover, but he retains breathing (with the help of the device) and blood circulation (his own).

Brain death is stated independently by several specialists. A hospital where there are no such specialists has no right to engage in organ removal. Brain death is stated regardless of whether doctors intend to use organs for transplantation or not.

Are there black transplantologists and a black organ market in Russia?

Let's assume there is. The donor must not have chronic and infectious diseases, must be genetically compatible with the recipient, matching the blood type is not enough. Donor organs have a short shelf life, heart and lungs – 4 hours, liver and kidneys – up to 24 hours. The option "transplanted in any basement" does not stand up to criticism. For transplantation, we need: a modern intensive care unit, a laboratory, a dialysis center, artificial respiration and circulatory devices. The clinic where transplants are performed must be equipped with the latest technology and have at least 50 employees.

At the same time, as we remember, all the activities of our hypothetical clinic are illegal, it is punishable not only under the Criminal Code, but also threatens the clinic with the deprivation of a license. Is it possible to maintain secrecy in such a situation? Let's also add the fact that after a transplant, a person must be under constant medical supervision and take expensive medications for life. The state issues them free of charge. But who will discharge them in an underground clinic? Where will they send you to be observed? A lot of people should have been involved in such a corruption scheme, each of whom risks everything: reputation, profession and freedom.

Where did the talk about "black transplantologists" come from?

In 2003, in the cycle "Special Correspondent" on the channel "Russia" there was a program about the "Orekhov case". Employees of the organ donation coordination center and resuscitators of Moscow Hospital No. 20 were accused of murdering a patient in order to remove organs for transplantation. All participants in the "Orekhov case" were acquitted for lack of corpus delicti – the investigation found that the patient died before the preparation of his body for organ removal. But after the broadcast, transplantation from posthumous donors in Moscow stopped for a year, leaving patients in need of transplantation without a chance.

The second precedent is the case of Alina Sablina. In 2014, this Moscow student was seriously injured in an accident. She was taken to the intensive care unit in a coma, and six days later she died. After Alina's death, her mother found out that organs had been removed from her daughter's body. She went to court and demanded compensation from the doctors for moral damage. However, all judicial instances, including the Constitutional Court, refused to satisfy the requirements.

"Black transplantologists" are loved by writers and screenwriters, including abroad. The fact that a human organ is more expensive than diamonds is an axiom of a detective story, scriptwriters have no time to check the facts. That's what is really unclear – why the expression "sell for organs" is used by officials. It was the fear that Russian orphans in the West would be "sold for organs" that was one of the reasons for the adoption of Dima Yakovlev's law. At the same time, there are no confirmed facts of illegal transplantation and "organ disassembly" of Russian citizens abroad – criminal cases, information about the illegal activities of clinics, the production of illegal operations – in the press. If you don't believe it, look for it.

Illegal transplantation was reported in foreign media in connection with the military events in Kosovo. But there are disputes about how proven these cases are. In addition, there are publications that organs of prisoners sentenced to death were seized for transplantation in China.

Is it possible to sell a kidney?

Letters with such proposals constantly come to large Russian clinics, but doctors send them to the trash. In Russia, such a sale is criminally punishable. It is possible to sell a kidney by traveling to another country. But not everywhere, the legislation of most countries prohibits it. Stories about the astronomical cost of kidneys are a myth, but the harm from such an operation can be huge.

In Russia, a person who is ready to become a donor for his relative is carefully examined, and if the loss of a kidney or part of the liver threatens the donor's health, there will be no operation. With commercial donation, the examination is unlikely to be so thorough, the clinic is not interested in this. Therefore, for an unauthorized donor-tourist, there is a high probability that he himself will be in the queue for a transplant, already in Russia.

There are modern technologies, they say that scientists have learned how to grow any organ. Why use human ones?

Modern science can really do a lot. But the cultivation of full–fledged organs is not yet possible, it is a matter of the distant future, science is only on the way to this. But modern technologies allow you to prolong your life.

At the beginning of the twentieth century, Mikhail Bulgakov died of kidney failure. He would be alive now, but he would have to go for hemodialysis three times a week. Perhaps the great writer would have survived until the transplant, the average waiting time for a kidney in Moscow is 2-3 years, the operation is free. But after the transplant, Bulgakov would have to take immunosuppressants for life, an annual supply of the drug costs hundreds of thousands of rubles. It saves that the state gives out all these drugs for free.

Have you transplanted an organ – have you become healthy?

After transplantation, a person should be under the supervision of a doctor. He must take immunosuppressants – special medications that reduce immunity. Even a common cold for such a patient can be deadly. If you stop taking medications, the graft will be rejected.

Is the church against transplantation?

Here is what is said in the Fundamentals of the Social Concept of the Russian Orthodox Church: "Organ transplantation from a living donor can only be based on voluntary self-sacrifice for the sake of saving another person's life. In this case, consent to the explantation (organ removal) becomes a manifestation of love and compassion." At the same time, the Church is categorically against the commercialization of this field of medicine, in this domestic transplantology fully agree with it.

Are children's transplants possible in Russia?

A kidney or part of the liver has been transplanted to children for a long time, from adults, most often from relatives. If there are no relatives, or their organ is not suitable, then – from deceased adult donors. That's right in the center of them. Shumakov was rescued by a small Buryat orphan Ayur, who was dying of liver failure.

It is more difficult – with a heart and lung transplant for children, the size matters here, the lungs or the heart of an adult are not suitable for children. Heart transplantation in Russia is performed only for teenagers, if the recipient is of sufficient weight, and the donor was small.

No transplants to children from deceased children have been performed to date. At the same time, there are no legislative obstacles to organ transplantation for children in Russia today. The only thing that prevents children's transplants in Russia now is the moral unpreparedness of doctors. What should they be ready for? Take all possible measures to save the life of a small patient with a severe traumatic brain injury, and if it is impossible to save the patient, tell the parents about it and ask if they will consent to their child's organs to save other children. Let's clarify once again – we are talking about a patient with a traumatic brain injury, who was diagnosed with brain death by several independent experts.

What to do? One of the grief-stricken parents who lost a child should show good will. In Italy in 1994, the situation with child donation was exactly the same as it is now in Russia. The story of Nicholas Green changed everything.

The "Nicholas effect" is what transplantologists called a sharp, more than twofold increase in the number of organ transplants from posthumous donors. The story happened in 1994, when the Green family from California traveled to Italy. They were attacked by robbers, and as a result of the incident, seven-year-old Nicholas died.
After Nicholas' death, his parents decided to donate his organs for transplantation. The boy's organs were transplanted to seven patients: a teenager with a congenital heart defect, a woman with non-functioning kidneys, a girl with a rare liver disease, a blind man.

Why are we so afraid?

In Russia, it is not customary to talk about the disease. It is not customary to prepare for death in advance and leave some orders for this case, so as not to "invite". It is impossible to talk about the death of a child. And the resuscitators also know this. They already have a very difficult profession, and they often do not know how to talk to patients at all and tend to avoid such conversations. Doctors should be taught difficult conversations. This is done all over the world.

Laws regulating donation and transplantation in Russia

In 2015, Article 47 of the Federal Law No. 323-FZ of November 21, 2011 "On the Basics of Protecting the Health of Citizens in the Russian Federation" was amended concerning organ donation, in particular, the concept of medical activities related to organ donation for the purpose of transplantation was regulated.

The old law on donation, now in force – the federal law "On Transplantation of organs and (or) human tissues" dated December 22, 1992 No. 4180-1.

The new law on donation exists in the form of a bill. It is called "On the donation of human organs and their transplantation". It is currently being finalized and may be submitted to the State Duma in the fall of 2016.

Another important document – "Procedure for the diagnosis of human brain death" No. 908n dated December 25, 2014 – a document adopted by the Ministry of Health of the Russian Federation defines the criteria and procedures for determining human death, approved by the Decree of the Government of the Russian Federation dated September 20, 2012 No. 950.

The main international document regulating organ and tissue transplantation is the "Convention on Human Rights and Biomedicine" (Oviedo Convention, 1997). This document protects the dignity and identity of all people and guarantees everyone respect for their inviolability. The Convention is an international legal act on the rights of patients, in particular, it addresses the issues of organ and tissue transplantation.

There is an addendum to the Convention – "Additional Protocol to the Convention on Human Rights and Biomedicine concerning the Transplantation of Organs and Tissues of Human Origin" (ETS No. 186), Strasbourg, 24.01.2002

Portal "Eternal youth" http://vechnayamolodost.ru  22.08.2016

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