Russians will become organ donors by default
Give everything away
Over the past year, the document has been constantly criticized and edited. When the next version appeared, experts argued that it had only gotten worse, the law would complicate the system of donation and transplantation so much that even fewer operations would be performed than now.
Anyway, the work on the new version of the document is completed. It has already been approved by several departments, the National Medical Chamber and even – just in case – the Orthodox Church. Most likely, the law will be adopted and it will come into force in 2016. For the first time, there will be child donation, a single database of donors and recipients, and most importantly, the opportunity to dispose of their organs in case of sudden death. But experts still see big flaws in some innovations.
What is the dispute aboutThe previous law regulating this area is noticeably outdated – it has been in force since 1992.
The rules of transplantation are spelled out in detail in it, but little is said about the donation itself, said Sergey Gauthier, chief freelance transplant specialist at the Ministry of Health. The old law did not allow child donation and did not give the opportunity to dispose of their organs in case of sudden death during their lifetime. Even the very concept of "organ donation" was not there, not to mention the rules, financing and control.
The imperfection of the legislative system has led to the fact that less than 16 percent of the necessary transplants are still carried out in Russia. For comparison, 935 kidneys were transplanted in our country in 2013, and 18 thousand in the USA.
A year ago, a draft of a new law appeared, and since then, disputes have not stopped around it. Doctors were outraged that the Ministry of Health cancels regular examinations of lifetime donors, leaves loopholes for bribes and does not consult with the professional community. The authorities were also dissatisfied with the document: the Ministry of Finance rejected it altogether because of the murky financing system.
In the new – and, apparently, the final version of the law – the Ministry of Health added the missing articles, clarified financial issues, but did not change the main points – the presumption of consent and the system of expressions of will.
Donation "by default"The law approves the presumption of consent to posthumous donation.
This means that doctors will by default consider a deceased patient a potential organ donor if he did not declare the opposite during his lifetime. Doctors will have the right to remove his organs and transplant them to another patient.
Everyone will have the opportunity to refuse posthumous donation. To do this, it will be enough, once in the hospital, to verbally inform doctors and witnesses about it. And soon it will be possible to record your refusal in advance in a special database.
The presumption of consent still exists today. But it only works if doctors cannot contact relatives within a few hours after the death of a potential donor. This is a big problem, because during the search, organs for transplantation may become unusable. And if the removal of organs takes place without the knowledge of relatives, they can sue the hospital. And doctors will have to explain why they could not contact the family in time.
Recently, the Federation Council proposed to abandon the presumption of consent, and instead put marks in passports, driver's licenses and other identity cards, whether a person agrees to become a posthumous donor or not. The doctor will not need to spend time searching for families – it will be enough to look at his documents. Such a system operates in some Western countries.
In countries where there is a presumption of consent, there are much more such donors than where the reverse law applies – the presumption of disagreement. So, in 2012 in the USA, where the "default refusal" is in effect, in 2010 there were 25 cases of posthumous donation per million population, in Spain (presumption of consent) – 38.5; in Russia – 3.5.
To be or not to be... a donor?The Ministry of Health did not support the senators' idea and did not cancel the presumption of consent.
But Russians will still have the opportunity to think in advance whether they are ready for posthumous donation. They will record their decision not in a passport, but in electronic form in a special database. The country will have registers of posthumous and lifetime donors, registers of recipients and transplanted organs, and most importantly – a register of the will of citizens.
Everyone will be able to choose whether to donate their organs for transplantation after death. A note about the decision will appear in the register, which can be changed at any time. In the event of a person's death, the doctor will fulfill his will, and the objections of relatives will not play any role.
The Ministry of Health assures that all information will be confidential, and access to the database is strictly limited and protected. Doctors will receive it in order to promptly decide whether they have the right to withdraw organs from the deceased. However, each person will be able to make sure that his will about posthumous donation got into the database.
"Horror stories" about self-serving doctorsAfter learning for the first time about the presumption of consent to posthumous donation, some Russians begin to panic: no matter how doctors "staged" their death in order to remove organs and save the life of someone else.
This concern gives rise to "horror stories" that doctors allegedly benefit from quickly disconnecting a person in a coma from the devices or not taking him to surgery after a serious injury. Many are afraid that doctors will hastily recognize the patient as dead in order to remove his organs for transplantation.
The Ministry of Health took care of this. The law clearly states that a commission of doctors who do not represent the interests of recipients and do not even participate in the process of organ removal and transplantation should state the death of a potential donor.
Hospitals will have a new full–time position - transplant coordinator. This is a doctor with a higher medical education who will deal with organizational issues related to the removal and transportation of donor organs. He will also enter data into the Federal Register of Donors. The coordinators will not have the right to state the death of a potential donor, participate in operations or express the interests of recipients.
Moreover, the Ministry of Health will prohibit donation on the basis of monetary or other remuneration. And private clinics will not get the right to perform such operations at all. The Antimonopoly Committee insisted that they could engage in transplantation, but the ministry categorically refused. The donation will be fully funded by the state as high-tech medical services.
Foreign experience has shown that if private clinics are allowed to undergo transplantation operations, problems will begin. For example, five years ago a big scandal broke out in the UK: it turned out that private clinics give donor organs to foreigners who pay a lot of money for it. At the same time, British citizens are waiting in line for a transplant in free hospitals. After that, private hospitals in the United Kingdom were banned from performing transplant operations. The only exceptions are cases of lifetime donation.
Relatives will not be askedThe new law will allow doctors not to waste time searching for relatives: it will be enough to punch the data of a potential donor in the database and read his will.
If a person has not decided during his lifetime, then doctors will have to act according to the old scheme: look for relatives and negotiate. But the time for reflection was reduced: previously, the family had three hours to refuse, and now – only two.
Experts fear that doctors still have the opportunity to cheat. For example, the law states: the operation can be started if a relative cannot be contacted within two hours of death (for example, the subscriber is unavailable by phone). "Doctors will shy away from communicating with relatives, denoting an unsuccessful attempt to get through, for example," explained Mikhail Kaabak, head of the kidney transplantation department of the Russian Academy of Medical Sciences.
He also said that in Russia there are no training programs for medical staff to communicate with relatives of deceased patients. Accordingly, you will have to hire foreign consultants or "reinvent the wheel" – both require money.
Donor organs to donors?Recently, the Minister of Health Veronika Skvortsova said that Russians who refused to become donors after death will not be able to apply for transplantation, even if they really need it.
"If you want this kind of help to be provided to you someday, if you need it, then, first of all, you must express your will for a posthumous donation yourself, if you can be a potential donor. Otherwise, you have no moral right to use the organs of another person," Skvortsova explained her point of view.
The Minister invited experts to discuss this when drafting the law on donation, which caused serious controversy in society. But Skvortsova's idea did not get into the latest version of the bill.
But there is an advantage for lifetime donors: if they suddenly need a transplant, they will receive a donor organ faster than other patients. Children and seriously ill people who need emergency transplantation will also have an advantage. But here the difficulties of transportation may come out on top. The organ will most likely be taken to the nearest hospital where there is a suitable recipient.
Not everyone will be a donorThe law prescribes prohibitions on donation and transplantation.
Doctors will not be able to remove organs if a person refused posthumous donation during his lifetime or did not leave clear recommendations, but his family is against it. For the same reason, it is impossible to withdraw organs from unidentified persons – suddenly they or their relatives did not agree with this. Violators will face criminal liability.
Transplantation is not allowed if the donor suffers or has suffered from diseases that affect the condition of organs and can be transmitted to the recipient during transplantation.
What should I do if the recipient is against it?According to the law, doctors do not have the right to transplant organs to a person without obtaining his consent for transplantation.
Moreover, the patient will have the right to refuse at any time – even if everything is already ready for surgery. In this case, doctors will have to politely explain to him all the possible consequences of such a decision. But they will not be able to blame the patient for the fact that because of his indecision, an organ that could have saved someone's life disappeared.
The question arises: what to do if an urgent transplant is needed, but the patient is unconscious (or for other reasons cannot express his will), and his legal representative is not around? Only in this case, surgeons are allowed to perform the operation without his consent. The decision on transplantation will be made by a consultation of doctors. But if there is no time and opportunity to convene a consultation, it will be decided by the attending or even the doctor on duty.
It's hard to imagine someone complaining that his life was saved by a donor organ transplant. But this happens: there are many opponents of transplants in the country who are sure that you can always find an alternative method of treatment. It even happens that parents refuse to transplant organs to a child. In this case, the law allows a medical organization to go to court to protect the interests of its patient.
The difference between lifetime and postmortem donationLifetime donation will be allowed only if we are talking about relatives, regardless of the degree of kinship.
In all other cases, it falls under the ban. Separately stated: if the donor is in service or otherwise dependent on the recipient, he will not be able to give him an organ or part of it. Posthumous donation will be allowed in any case if the donor's organs are suitable for the recipient.
The law will allow posthumous child donation for the first time. It will be possible to take organs from victims aged 1 year and older, the decision on this will have to be made by parents. Only a person aged 18 and older can become a lifetime donor.
In case of posthumous donation, the following can be taken for transplantation: heart, lung (lungs), lung lobe, trachea, heart-lung complex, kidney, liver (part of it), pancreas (part of it), pancreas with a 12-duodenum, intestine and its fragments.
Lifetime donation will be allowed only if there is no alternative treatment method or a suitable organ from a posthumous donor. At the same time, a person should not feel pressure or coercion from the outside. Donor organs in this case can be: kidney, part of the liver, part of the small intestine, lung lobe, part of the pancreas.
Lifetime donors will have the right to lifelong medical supervision. In addition, they will have an advantage in obtaining a donor organ if they themselves need a transplant.
Experts admit that a lot has been corrected and supplemented in the new version of the law on organ donation and transplantation. However, the main drawback of the document, according to doctors, is that society is simply not ready for the new rules.
"Maybe it (the law) is good for a certain European country in which organ donation has existed for many years, the population is ready for compassion and registers consent for the posthumous use of their organs, and everything that accompanies donation and transplantation works as it should. The same cannot be said about our country, in which the level of distrust of everything, including medicine, is very high, the level of responsibility and compassion is low, and the development of transplantation has been delayed for decades," says Fyodor Zherebtsov, the chief transplant specialist of St. Petersburg.
Sociologists have found out that only a fifth of Russians agree to posthumous donation (and it is not a fact that many of them will register in an electronic database). For comparison, in the United States, four out of five want to donate their organs for transplantation after death.
Portal "Eternal youth" http://vechnayamolodost.ru27.10.2014