Useful after death
The shortage of donor organs will be filled at the expense of the deceased
Anush Dolukhanyan
One deceased person, becoming an organ donor, can potentially save at least five lives, transplant doctors say. However, the current legislation does not allow taking full advantage of such a chance. The Ministry of Health is preparing to submit to the State Duma a new bill that will regulate the relationship between the donor, recipient and surgeon. The correspondent of RIA Novosti learned how the problem of shortage of organs for transplantation is being solved in Russia.
There are not enough kidneys
Among those suffering from kidney failure in In Russia, only 30 thousand patients have the opportunity to undergo substitution therapy – dialysis several times a week. At the same time, there are many more patients who need this procedure. According to Sergey Gauthier, the chief transplantologist of the Ministry of Health of Russia and director of the V. I. Shumakov National Medical Research Center for Transplantology and Artificial Organs, the rest "either do not reach this type of treatment and die from other complications, or patiently wait for them to be taken for dialysis."
Dialysis is a very expensive procedure, and the need for appropriate centers is constantly growing – now there are about 500 of them all over the country. "The most logical and realistic way out," says Gauthier, "is to provide an opportunity for a person on hemodialysis to receive a donor kidney."
According to him, transplantation reduces the cost of treatment and gives the patient the opportunity for a full recovery, at the same time freeing up a dialysis place, which will immediately receive another person in need of therapy.
"Now the doctors and the Ministry of Health face the task of developing kidney transplantation as intensively as possible. According to statistics, we perform more than a thousand such operations in the country a year, and we need ten times more," the transplant specialist believes.
One of the main problems faced by doctors and patients is the shortage of donor organs. "The state has a huge resource of donor organs that can be obtained from the deceased, but it is important to organize the work correctly. We are not talking about any violations of rights or criminality. The basis of transplantation in the country should be the posthumous donor potential," explains Gauthier.
Donor or corpse
A donor organ is an organ received from a deceased person and capable of functioning in the recipient's body, or an organ of a living healthy person. In the second case, without risk to their health, the donor can donate only one kidney or part of the liver.
According to the current legislation, only a genetic relative can become a lifetime donor. It follows from this that, for example, spouses are not donors to each other. "Of course, this narrows the possibility of lifetime donation. But it excludes financial dependencies. We have been actively conducting operations with live donors for many years. Usually they become parents for their children," explains Gauthier.
At the same time, all transplantation operations in the country – both from a living and from a posthumous donor – are performed exclusively free of charge. In addition, living donors are still subject to a certain risk. "Statistically, this risk is minimal, but nevertheless it is an intervention in the body," says Gauthier.
It is possible to withdraw a kidney for a cadaveric transplant only if a potential donor has been diagnosed with brain death. At the same time, it is necessary to maintain the vital activity of organs with medication and with the help of an artificial respiration apparatus: the heart should beat, the kidneys and lungs should function, the pancreas should receive blood supply. Only a person who has no blood diseases, as well as oncological and infectious diseases, including tuberculosis, active hepatitis and HIV, can become a donor.
According to Sergei Gauthier, there are often situations in hospitals when a deceased patient is suitable in all respects as a potential organ donor. And this resource must be used to save the population, the transplant specialist is convinced.
What will the bill change
The current law on transplantation of human organs and tissues, adopted back in 1992, is based on the so-called presumption of consent, that is, if a person has not previously refused posthumous donation, then automatically falls into the category of "consonants". "If a person has died and there is no evidence that he has ever declared his unwillingness to be a donor after death, then he is potentially such. There is no mention of the possibility of recording this consent in the law. This is his Achilles' heel," says Gauthier.
This gap in the legislation has repeatedly become a cause for scandals and discontent, mainly among relatives of posthumous donors. So, the case of 19-year-old Alina Sablina received a great resonance. The girl died in hospital after an accident, and her internal organs were removed by doctors for further transplantation. After that, Alina's relatives turned to The Constitutional Court of Russia, however, confirmed the legality of the removal of organs. Sablina's parents filed a lawsuit with the European Court of Human Rights. However, this did not bring results, as the doctors acted within the law.
The new bill will take into account the lifetime expression of will. "We believe that the most correct thing would be to create a register of refusals: if a person wants to express his lifetime will, it is entered into an electronic database. Further, if he dies, in this database you can see if he refused. If he is there, he cannot be a potential donor," explains Sergey Gauthier.
According to the doctor, it is equally important that people be prepared for the fact that they can save someone even after death. But at the same time, it is necessary to take into account the wishes of a person and inform him about a possible donation.
Another problem with the current rules is that now doctors are not obliged to monitor the preservation of potential donors and their organs. According to Gauthier, after the adoption of the law in the new wording, hospitals will have to pay more attention to patients who, due to a serious illness, are likely to die and could potentially become donors. At the same time, they need to be treated no less actively than those with a good prognosis.
According to Sergey Gauthier, in Spain the frequency of post–mortem organ seizures is 34-35 cases per million people per year, in France – 26-25, in Italy – 25, in Russia - 3.3 per year. At the same time, there are separate regions in our country in which a donor coordination system has been established. For example, in the Kemerovo region, 11 seizures per million people per year are made, and in Moscow – 15.
Successful experience
In Moscow, four institutions are mainly engaged in transplantation: the V. I. Shumakov National Medical Research Center for Transplantology and Artificial Organs, the Sklifosovsky Research Institute, the B. V. Petrovsky Surgery Center and the N. A. Lopatkin Research Institute of Urology and Interventional Radiology. There are 47 centers in Russia where such operations are performed. Waiting lists for a transplant are located in a specialized coordination center. And as soon as a donor organ appears, the computer system gives the result to whom it can be given.
Lidiya Zotova, coach and deputy director of Sports Training at the sports school under the Department of Sports and Tourism, underwent liver transplantation 15 years ago. "I've been wasting my time looking for a doctor for 15 years. I was slowly dying, went to different cities, went to psychics and sorcerers. But everyone refused: I had Karolyi's disease and cirrhosis of the fourth degree," Lydia says.
After another consultation, the woman was hospitalized. One of the doctors at the local hospital referred her to the Petrovsky Surgery Center, where Sergei Gauthier was working at the time. "Sergey Vladimirovich said: "You are our patient." I was put on the examination, and then put on the waiting list. Five months later I had an operation – a cadaveric liver transplant," the woman shares.
The liver was found at the Sklifosovsky Research Institute. Lydia urgently organized an operation, which was successful. "All these years I feel great. Doctors keep in touch with me constantly, and once every six months I undergo a full-fledged examination. I have almost no physical limitations," she says.
Lydia believes that the operation was a "return from the dead" for her: "Before consulting with Gauthier, I didn't know anything about transplantation. For me, it was something out of magazines and books. I thought I'd have to sell everything to have the operation. But these doctors don't need money or fame, they only care about the person. I would like as many people as possible to know about what these doctors are doing."
About 400 kidney transplants are performed in Moscow annually for all residents of Russia and more than 300 liver transplants. For the year not yet ended 2017, 145 heart transplantation operations were performed at the Center, which is "unthinkable", according to Gauthier, for world practice.
Portal "Eternal youth" http://vechnayamolodost.ru