Will the transplant system work in Ukraine?
At the beginning of September this year, the newly elected head of the Ministry of Health of Ukraine Zoryana Skaletska made the first press conference in this position, where she clearly outlined the main and priority activities of the ministry officially entrusted to her. Among them, the key focus is on launching the transplant system by the end of this year.
According to official statistics, 9 patients die every day in Ukraine who have not had a transplant of the required donor organ. About 5,000 Ukrainians need transplant operations every year. For example, the queue for kidneys is 2.5 thousand patients, for the new liver - 1.5 thousand, and for a healthy heart to beat in the chest waiting for 1000 patients.
What is a "transplant" and why do people often give this word a negative connotation?
First of all, it should be realized that for many patients transplantation is the only chance at life. And each potential donor can save up to eight lives doomed without a transplant. Thanks to the development of medical science, it is now possible to successfully transplant the lungs, kidneys, liver, heart, pancreas, intestines, bone marrow and even the cornea. However, unfortunately, most Ukrainians are not ready to become donors after their death. According to the Heart Institute, for example, less than 10% agreed to donate after death. The general director of the institution, cardiac surgeon, Boris Todurov believes that the reason lies in public ignorance. "Unfortunately, in Ukraine, most of the media talk about transplantology as people who sleep and see how to remove organs, and present transplantology as a science of organ harvesting.
The misconception of transplantation of "black transplantologists" in 2010 also contributed to society’s misconceptions about transplantation. This undermined the credibility of the transplant phenomenon itself, although no evidence of surgeons’ guilt was provided. And in 2013, the case was completely closed by statute of limitations. This unfortunate case can be explained by the fact that in Ukraine, unfortunately, there is still no transplant system, and isolated cases of organ transplants are considered by people in power as a deviation from protocol norms or a disciplinary violation. Although it is thanks to such courageous enthusiastic doctors, who take all the risks personally, that such a branch of medicine as transplantology is still alive in the country, and the patients operated on by them, who recently said goodbye to life, are living fully!
What about the legal framework?
The first steps on the way from a paper to a real and effective Law on Transplantation in Ukraine began in May 2018, when a new Law "On Amendments to Certain Legislative Acts of Ukraine on Health Care and Transplantation of Organs and Other Human Anatomical Materials" was adopted ». The authorship belonged to Olga Bogomolets, who called it "a victory and a breakthrough that can save thousands of lives."
The law provided:
one can consent to a donation for life;
organs can be exchanged between living non-native donors, so-called "cross-donation";
the emergence of a transplant coordinator - a link between donor and recipient;
creation of the Unified State Information System on Transplantation (EDIST), which will provide data on all people who are ready to become donors and where you can select a donor-recipient pair.
The law was to take effect on January 1, 2019. This did not happen because the Ministry of Health did not create a register of donors, the Cabinet of Ministers delayed approving the procedure for donor consent to organ harvesting, and the profession of transplant coordinator appeared only on February 18. And most importantly, the state budget did not include funds for the implementation of this law (by the way, the state has been seeking these funds since the early 2000s, when it also promised to finance programs for the development of transplantation).
There is also a rather controversial issue in the new law - the presumption of disagreement. This means that doctors cannot take the organs of the deceased if he has not agreed to it for life. After death, only a relative who is currently experiencing the loss of a loved one and finds it difficult to make a decision to save another can give consent. In the United States, for example, there is also a presumption of disagreement, but there it does not hinder the development of transplantology. To persuade people to become donors, there is a system of coordinators who talk to the relative of the deceased. Such a transplant coordinator himself has a donor card, a document stating that in the event of death he is ready to donate his organs. In America, there is also a well-developed information campaign and the topic of donation is introduced in kindergarten.
But in neighboring Belarus, on the contrary, went the other way - in 2012, Belarus passed a law on the presumption of consent to the removal of internal organs of the deceased. That is, after death, every Belarusian agrees to become a donor, if he did not give it up for life or his relatives did not do so after his death at the stage of organ harvesting. After that, the number of transplants increased tenfold. As a result, Belarusian doctors now perform paid surgeries for foreigners and free surgeries for Belarusians, but at the expense of citizens of other countries.
Are Ukrainian doctors and local clinics ready to implement a transplant system?
During the August press conferenceYuriy Andreev, head of the National Movement for Transplantation, answered in the negative. Andreev said that the public organization he headed conducted a survey of about 200 clinics, which, according to the current resolution of the Cabinet of Ministers №695 of April 24, 2000, have the right to remove organs for cadaveric transplantation. "Many hospitals that could remove organs for transplantation do not have the equipment to diagnose brain death, and there is no coordination of clinics that can perform organ transplants. The Ministry of Health has recently trained 40 transplant coordinators, but they cannot work because the system has not been set up. In some clinics, even chief physicians think that brain death should be diagnosed in a morgue and that pathologists should do so. But even where such equipment is available, organ removal is not performed, doctors do not perform organ collection, in particular because there is no communication between these hospitals and those clinics that have the right to perform transplant operations. Centralized procurement is needed, even through the same international organizations, so that clinics have the equipment to diagnose brain death to launch a transplant program, rather than buying ordinary medical furniture on their own, ”said the activist.
Nevertheless, it should be noted that there are professional doctors who could perform organ transplants in Ukraine. The fact that Ukrainian doctors know how to transplant is a proven fact. Let’s remember at least 2011, when Zaporizhzhya doctors transplanted organs to six patients in one day. This was possible due to successful coordination between the Dnieper and Zaporizhia. Then the chief physician of the Mechnikov Dnieper Hospital, Volodymyr Pavlov, identified two potential donors at his hospital, and a team of Zaporizhzhya doctors took organs to Zaporizhia for patients who needed them.
So what changes to expect?
The Ministry of Health informs that the previously deferred Law will come into force on January 1, 2020. Initially, four centers will be re-equippedin Kyiv and Zaporizhia: National Institute of Surgery and Transplantology named after OO Shalimov and Zaporizhia Regional Hospital for Organ Transplantation, National Cancer Institute and National Children’s Specialized Hospital "Okhmatdyt" of the Ministry of Health of Ukraine - for the development of bone marrow transplantation. And later similar centers will work in other cities. In order for transplantation in Ukraine to work in full, you need to set up a system:
1) develop a culture of donation - without a donor there is no transplant. First of all, it is a question of the ethical field. Regarding technical implementation, the Ministry of Health is currently testing the purchased Unified State Transplant System (EDIST), which consists of 9 registers of donors and patients in need of transplantation. The system automatically selects a donor-recipient pair, without human intervention, so it prevents any manipulation from the outside. The launch of the system is scheduled for January 1, 2020;
2) to introduce into the practice of doctors the statement of brain death ;
3) train doctors, transplant coordinators and laboratory assistants, where the course is based on guidelines and practices for transplantation in the EU (in particular, Spain) and the United States; 4) to establish cooperation between resuscitation and intensive care units, extraction bases and transplantation centers, to equip laboratories and hospitals.
5) to establish logistics - rapid delivery of the organ to the patient in need of transplantation.
So, going back to whether the transplant system will work in Ukraine, as always, it is worth starting with yourself… And this can only be answered by question-to-question rhetoric: " Am I ready to become a Donor ?"
Author Kateryna Stebelska
Read also: Disability is not a sentence: five successful examples of inclusion
According to official statistics, 9 patients die every day in Ukraine who have not had a transplant of the required donor organ. About 5,000 Ukrainians need transplant operations every year. For example, the queue for kidneys is 2.5 thousand patients, for the new liver - 1.5 thousand, and for a healthy heart to beat in the chest waiting for 1000 patients.
What is a "transplant" and why do people often give this word a negative connotation?
First of all, it should be realized that for many patients transplantation is the only chance at life. And each potential donor can save up to eight lives doomed without a transplant. Thanks to the development of medical science, it is now possible to successfully transplant the lungs, kidneys, liver, heart, pancreas, intestines, bone marrow and even the cornea. However, unfortunately, most Ukrainians are not ready to become donors after their death. According to the Heart Institute, for example, less than 10% agreed to donate after death. The general director of the institution, cardiac surgeon, Boris Todurov believes that the reason lies in public ignorance. "Unfortunately, in Ukraine, most of the media talk about transplantology as people who sleep and see how to remove organs, and present transplantology as a science of organ harvesting.
The misconception of transplantation of "black transplantologists" in 2010 also contributed to society’s misconceptions about transplantation. This undermined the credibility of the transplant phenomenon itself, although no evidence of surgeons’ guilt was provided. And in 2013, the case was completely closed by statute of limitations. This unfortunate case can be explained by the fact that in Ukraine, unfortunately, there is still no transplant system, and isolated cases of organ transplants are considered by people in power as a deviation from protocol norms or a disciplinary violation. Although it is thanks to such courageous enthusiastic doctors, who take all the risks personally, that such a branch of medicine as transplantology is still alive in the country, and the patients operated on by them, who recently said goodbye to life, are living fully!
What about the legal framework?
The first steps on the way from a paper to a real and effective Law on Transplantation in Ukraine began in May 2018, when a new Law "On Amendments to Certain Legislative Acts of Ukraine on Health Care and Transplantation of Organs and Other Human Anatomical Materials" was adopted ». The authorship belonged to Olga Bogomolets, who called it "a victory and a breakthrough that can save thousands of lives."
The law provided:
one can consent to a donation for life;
organs can be exchanged between living non-native donors, so-called "cross-donation";
the emergence of a transplant coordinator - a link between donor and recipient;
creation of the Unified State Information System on Transplantation (EDIST), which will provide data on all people who are ready to become donors and where you can select a donor-recipient pair.
The law was to take effect on January 1, 2019. This did not happen because the Ministry of Health did not create a register of donors, the Cabinet of Ministers delayed approving the procedure for donor consent to organ harvesting, and the profession of transplant coordinator appeared only on February 18. And most importantly, the state budget did not include funds for the implementation of this law (by the way, the state has been seeking these funds since the early 2000s, when it also promised to finance programs for the development of transplantation).
There is also a rather controversial issue in the new law - the presumption of disagreement. This means that doctors cannot take the organs of the deceased if he has not agreed to it for life. After death, only a relative who is currently experiencing the loss of a loved one and finds it difficult to make a decision to save another can give consent. In the United States, for example, there is also a presumption of disagreement, but there it does not hinder the development of transplantology. To persuade people to become donors, there is a system of coordinators who talk to the relative of the deceased. Such a transplant coordinator himself has a donor card, a document stating that in the event of death he is ready to donate his organs. In America, there is also a well-developed information campaign and the topic of donation is introduced in kindergarten. But in neighboring Belarus, on the contrary, went the other way - in 2012, Belarus passed a law on the presumption of consent to the removal of internal organs of the deceased. That is, after death, every Belarusian agrees to become a donor, if he did not give it up for life or his relatives did not do so after his death at the stage of organ harvesting. After that, the number of transplants increased tenfold. As a result, Belarusian doctors now perform paid surgeries for foreigners and free surgeries for Belarusians, but at the expense of citizens of other countries.
Are Ukrainian doctors and local clinics ready to implement a transplant system?
During the August press conferenceYuriy Andreev, head of the National Movement for Transplantation, answered in the negative. Andreev said that the public organization he headed conducted a survey of about 200 clinics, which, according to the current resolution of the Cabinet of Ministers №695 of April 24, 2000, have the right to remove organs for cadaveric transplantation. "Many hospitals that could remove organs for transplantation do not have the equipment to diagnose brain death, and there is no coordination of clinics that can perform organ transplants. The Ministry of Health has recently trained 40 transplant coordinators, but they cannot work because the system has not been set up. In some clinics, even chief physicians think that brain death should be diagnosed in a morgue and that pathologists should do so. But even where such equipment is available, organ removal is not performed, doctors do not perform organ collection, in particular because there is no communication between these hospitals and those clinics that have the right to perform transplant operations. Centralized procurement is needed, even through the same international organizations, so that clinics have the equipment to diagnose brain death to launch a transplant program, rather than buying ordinary medical furniture on their own, ”said the activist.
Nevertheless, it should be noted that there are professional doctors who could perform organ transplants in Ukraine. The fact that Ukrainian doctors know how to transplant is a proven fact. Let’s remember at least 2011, when Zaporizhzhya doctors transplanted organs to six patients in one day. This was possible due to successful coordination between the Dnieper and Zaporizhia. Then the chief physician of the Mechnikov Dnieper Hospital, Volodymyr Pavlov, identified two potential donors at his hospital, and a team of Zaporizhzhya doctors took organs to Zaporizhia for patients who needed them.
So what changes to expect?
The Ministry of Health informs that the previously deferred Law will come into force on January 1, 2020. Initially, four centers will be re-equippedin Kyiv and Zaporizhia: National Institute of Surgery and Transplantology named after OO Shalimov and Zaporizhia Regional Hospital for Organ Transplantation, National Cancer Institute and National Children’s Specialized Hospital "Okhmatdyt" of the Ministry of Health of Ukraine - for the development of bone marrow transplantation. And later similar centers will work in other cities. In order for transplantation in Ukraine to work in full, you need to set up a system:
1) develop a culture of donation - without a donor there is no transplant. First of all, it is a question of the ethical field. Regarding technical implementation, the Ministry of Health is currently testing the purchased Unified State Transplant System (EDIST), which consists of 9 registers of donors and patients in need of transplantation. The system automatically selects a donor-recipient pair, without human intervention, so it prevents any manipulation from the outside. The launch of the system is scheduled for January 1, 2020;
2) to introduce into the practice of doctors the statement of brain death ;
3) train doctors, transplant coordinators and laboratory assistants, where the course is based on guidelines and practices for transplantation in the EU (in particular, Spain) and the United States; 4) to establish cooperation between resuscitation and intensive care units, extraction bases and transplantation centers, to equip laboratories and hospitals.
5) to establish logistics - rapid delivery of the organ to the patient in need of transplantation.
So, going back to whether the transplant system will work in Ukraine, as always, it is worth starting with yourself… And this can only be answered by question-to-question rhetoric: " Am I ready to become a Donor ?"
Author Kateryna Stebelska
Read also: Disability is not a sentence: five successful examples of inclusion