Take my heart
What prevents posthumous donation in Russia
Contrary to popular belief, becoming an organ donor posthumously is not as easy as it seems at first glance. In countries where transplantation programs are supported by the state and are based on a trusting dialogue with society, posthumous organ donation is strictly regulated, and criminal liability is provided for any violations in this area by any participant in the process.
About how posthumous donation is arranged in Russia, why there is still a shortage of donor organs in the country, and patients from the waiting list do not always have a chance to wait, as well as about why not everyone will be able to become organ donors after death, read our material.
Beyond Death
At the moment, more than 16.5 thousand people in Russia live with transplanted organs and more than 9 thousand people are on the waiting list. Patients who have undergone organ transplantation live for decades, these people have children, they have the opportunity to see and raise grandchildren. The quality of their life after surgery, as a rule, improves significantly. A man with a transplanted kidney no longer needs to go on dialysis three times a week. A young woman after a heart transplant can get out of bed on her own and on the first attempt, a boy with transplanted lungs a few weeks after the operation already climbs the stairs himself.
Patients waiting for organ transplantation may be on the waiting list for donor organs for years. A patient enters this list only when all treatment methods have already been tried and only transplantation can save a life. The condition of these patients is deteriorating – someone is counting for weeks, someone for days.
As transplant surgeons themselves often admit, the development of medicine has reached such a level that, in fact, sewing a donor organ and making it work in another body is not the most difficult. Of course, this is still high-tech medical care, dozens of highly professional specialists are involved in this work at various stages, who have been improving their skills and accumulating knowledge in various fields of medicine for years.
On the part of state policy, there are also no obstacles to post–mortem or lifetime donation - there are all the necessary mechanisms for this, as well as the corresponding budget, says the head of the V. I. Shumakov National Medical Research Center for Transplantology and Artificial Organs, Sergey Gauthier.
Difficulties with the organization of work on organ transplantation and donation now lie in a different plane – and they are associated with a shortage of donor organs. Gauthier calls this deficit "artificial", and it is connected with the rejection of the idea of posthumous donation in society, as well as with the fact that many medical organizations, realizing that transplantation is a complex and very responsible process from the point of view of coordination, prefer not to get involved with the removal of organs from a deceased person.
In addition, it is important how a person lives: according to the World Health Organization, human health depends on behavioral factors by more than 60%. These include lifestyle, prevention, and adherence to prescribed treatment. As a rule, it is risk factors (smoking, alcohol abuse, poor nutrition and a sedentary lifestyle) that cause cardiovascular diseases and cancer. And these are the most common causes of death in Russia and in the world, and, as a rule, a deceased person in this situation will no longer be able to help someone after death, since the organs will be unsuitable for donation. Long–standing infections, untreated pancreatitis, diabetes - all this can cause a person's death and at the same time reduces the possibilities for donation.
The reasons for the ambiguous reaction
The topic of posthumous organ donation causes an ambiguous reaction in society, and this is not only a national feature of our country. This stage has been passed by all countries that have achieved significant results in the development of organ donation and transplantation and continue to increase the number of lives saved by posthumous donation every year. Spain is considered a reference country in this regard, where the number of posthumous donors per million of the population is 45-47 per year. At the same time, Spain has the same legal model for posthumous donation as in Russia – the presumption of consent. It implies that a person may be against posthumous donation, and his position should be entered in the register of refusals.
According to Oleg Reznik, a leading transplant surgeon in St. Petersburg and chairman of the Association of Transplant Coordinators, the difficulties of public perception of the problem of posthumous donation are largely related to the basic fear of death of any person: "A person does not want to think about death in general and about his own death in particular." The collective perception of death, which is reflected in religion and art, also plays an important role. "Since the "I" and our body are inextricably linked, any mental constructions regarding the posthumous fate of our organs are rejected by our consciousness as unacceptable and traumatic" ("Society's rejection of the problem of posthumous donation: causes and structure of mortal fears", journal "Bulletin of Transplantology and Artificial Organs", 2019).
At the same time, in 2000, the Russian Orthodox Church formulated its position on organ donation after death and recognized it as a high act of Christian love and compassion. "However, posthumous organ and tissue donation can become a manifestation of love that extends beyond death," says the basics of the social concept of the ROC.
Death can help the living
The explantation (surgical receipt) of organs from a posthumous donor is performed only with the established death of a person, with the diagnosis of brain death or irreversible cardiac arrest, says transplant specialist Reznik, while the statement of death in this case is made by the hospital staff separately from the participation of transplant teams: "The decision is made collectively, and the doctors who are responsible for the recipient are equal like the transplant coordinator, they do not participate in making this decision," is the main requirement of the Law on Transplantation and instructions on determining the death of a person.
Only patients with severe traumatic or vascular brain catastrophes incompatible with life become organ donors. Most often, in such patients, when all the possibilities of modern medicine have been exhausted, death inevitably occurs. And as a result of the death of the brain.
Brain death refers to the complete and irreversible cessation of blood circulation in it. Diagnosis of brain death is a long–term collegial procedure in which many specialists participate. This decision cannot be made by any doctor alone. Marina Minina, head of the Moscow Coordination Center for Organ Donation, explained: "This medical commission includes a neurologist and a resuscitator, an attending physician – and each of them must have at least five years of work experience in their specialty." First of all, this is due to the fact that in the conditions of the intensive care unit, where such patients are on artificial ventilation, the heart in some cases retains its automatism and sometimes can "supply" the remaining living organs for several hours. After that, it is depleted and stops – and the biological death of the organism occurs.
But legally, a person's death can be stated with an established diagnosis of brain death. And this is the "window" after the diagnosis of brain death to complete cardiac arrest and can serve as a source of saving other lives. Although maintaining the life of organs in a deceased person is an extremely difficult task, which is more difficult than resuscitation measures.
If the deceased person had an oncological or infectious disease or for other reasons cannot be an organ donor, then after six hours after the brain death is confirmed, the ventilator is turned off.
If the deceased person can be an organ donor, the whole process after the death is confirmed is controlled by the transplant coordinator. This specialist is not connected with either the donor or the recipient, and his task, according to the head of the Moscow Coordination Center for Organ Donation, is to synchronize the actions of all involved medical specialists – there may be several dozen of them.
After removal, the organs should be delivered as soon as possible to the institution where the transplant operation will be performed. The life span of organs outside the body is very limited: for the kidney it is a day, for the liver it is 12 hours, and the preservation of the heart or lungs allows you to save them for six hours. At the same time, as experts note, the procedure for removing organs from a deceased person, as a rule, does not affect the timing of burial in any way.
In 2019 alone, 1,473 kidney transplants, 584 liver transplants, 337 heart transplants and 25 lung transplants were performed in Russia. Over the past 13 years, the number of transplants has increased fourfold. At the same time, according to Gauthier, the real need only for a kidney transplant (and this is the most popular transplant in the world) is about ten times higher than existing indicators.
An experience full of compassion and altruism
Posthumous donation is supported in other countries and other religions. The support of the Catholic Church is also of great importance for the development of donation. In 2008, the media wrote that Benedict XVI had a so-called donor card, which he started even before he was elected Pope.
And at the beginning of last year, Pope Francis received representatives of the non-governmental organization "Italian Donors Association" at his residence in the Vatican.
"It is important to promote a culture of donation that, through information, awareness-raising and your constant and precious commitment, supports organ donation, avoiding the risk or disproportionate consequences of transplantation from a living person or all organs after death. From our death and our gift, the life and health of other people, sick and suffering, can awaken, strengthening the culture of help, gift, hope and life," the Vatican News edition quotes him as saying.
Pope Francis also called posthumous donation not only an "act of social responsibility", but also "an expression of universal brotherhood that binds all people together."
Find detailed information about organ donation on the portal donorstvo.org .
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