how organ transplantation works – Picture of the Day – Kommersant

What law regulates the transplantation of organs and tissues in the Russian Federation, where the donor should apply and how the patient can get on the waiting list for transplantation, where the operations are performed and whether they can be performed for a fee, or out of turn – in the material “Kommersant”.

About 2,000 transplants are performed annually in Russia. For some patients, this type of surgery is the only way to survive, but due to the coronavirus pandemic, their number worldwide has dropped to 40%. There are special lists of patients who need transplantation, but the main problem of such registries in Russia is the lack of a centralized “waiting list”.

What regulates organ transplantation in Russia

one.Law of the Russian Federation of December 22, 1992 No. 4180-1 establishes the conditions and procedure for transplantation. According to this document, in the list 25 points acceptable for transplantation of human organs and tissues, including:

• heart muscle;
• eyeball;
• trachea;
• Bone marrow;
• stem cells;
• lung;
• liver;
• bud;
• spleen and others.

The law is based on the presumption of consent, that is, the a priori recognition of any adult capable person as a donor of vital organs after his death. This means that the declaration of brain death while maintaining blood circulation gives doctors the right to take a heart, kidney, lung or liver from him for transplantation without asking any permission.

Important! This law does not regulate the issues of donating blood and its components, as well as the transplantation of organs and tissues related to the reproductive process, that is, embryos, sperm, eggs, etc.

2.Federal Law No. 323 “On the basics of protecting the health of citizens in the Russian Federation” establishes the rules for the removal of organs and tissues. For example, a transplant is allowed only in situations where other methods of treatment are not able to save the patient’s life.

“If we talk about lifetime donation, then its only possible form is related donation, that is, only a blood relative of the patient can donate a kidney or part of the liver: mother, father, brother, sister, aunts or uncles, grandfathers, grandmothers, etc. This excludes “market relations”, excludes the corruption component, the possibility of trafficking in organs or coercion to it. This is an extremely reasonable and humane approach. Such a system has been approved in many advanced countries.

Transplantation from a post-mortem donor involves placing the future recipient on a waiting list. I never tire of repeating that this is not a queue in which patients line up one after another and receive a serial number. This is the entry of data, parameters and results of patient analyzes into a special registry. The organ donation coordinating center analyzes the compatibility of the donor organ and the potential recipient, the patient is called, prepared and operated on. The severity of the patient’s condition, that is, the urgency of indications for transplantation, is also taken into account. Children and patients in an urgent (urgent) condition are a priority, ”said the transplant surgeon, deputy director of the National Research Center for Transplantology and Artificial Organs. ak. V. I. Shumakov” of the Ministry of Health of Russia Igor Miloserdov.

In the case when the donor is a living person, his voluntary written consent is mandatory. Coercion to alienate organs is prohibited. In the case when a deceased person is a potential donor, his close relatives (parents, spouse and children) have the right to prohibit transplantation. In addition, a post-mortem transplant cannot be performed when a potential donor, while still alive, declared a ban on removing his organs. It does not matter whether he did it orally or in writing.

Important! From September 1, amendments will come into force that will allow donors of stem cells and bone marrow to get to the place of the operation free of charge. At the same time, the amount of additional medical care is regulated. Now donors will be able to be examined, treated, and undergo rehabilitation exclusively within the framework of the state guarantees program. Previously, the volume of medical services was not regulated.

Remain unchanged:

• presumption of consent;
• a ban on operations in private clinics;
• a ban on intravital organ harvesting from children (post-mortem transplantation is possible with the consent of one of the parents).

Most wanted organs

Since the beginning of 2022, over 800 kidney transplants, almost 340 liver transplants, and more than 170 heart transplants have been performed in Russia. The Shumakov Center is considered the world leader in terms of the number of operations performed annually. In Russia, transplantation is performed in 34 regions.

“There are always more patients in need of an organ than organs, these are world realities. Nevertheless, it is necessary to strive to reduce this quantitative gap. And our center, as a leading institution, constantly contributes to the launch of new programs in the regions. Organ transplant technologies have been mastered and applied in 65 institutions throughout the country. In some places, kidney transplantation has just started, while in others, liver, heart, and even lung transplants are already being successfully performed. In total, 2,318 organ transplants for adults and children were performed in our country last year, including 1,384 kidney transplants, 618 liver transplants, 292 heart transplants, 15 lungs, etc.,” said Igor Miloserdov.

How to become a donor

An adult, able-bodied and free of diseases that can harm the recipient can become a lifetime donor. Written consent is required from him, as well as an extended medical examination.

Note! A subordinate cannot become a donor for his boss.

A healthcare worker who is involved in organ transplantation is prohibited from distributing any information about this process. For the disclosure of medical secrets, criminal liability is established under Art. 137 of the Criminal Code of the Russian Federation (“Violation of privacy”).

How to get an organ donor

An organ transplant is needed for a patient whose life is at risk, and therapy no longer helps. The patient is placed on a “waiting list” with a doctor’s referral. If the transplantologist recognizes the operation as the most effective method of treatment, then a donor is selected according to his recommendations.

“In Russia, transplantation assistance to all citizens is provided free of charge. If such assistance is not yet available in the region, then the patient is referred to the federal center, if necessary, having previously discussed with specialists his further treatment through telemedicine consultations. Further, the necessary procedures are carried out at the expense of the CHI policy, and the specialists select the most optimal treatment option for the patient and prepare for transplantation,” said Igor Miloserdov.

According to the order of the Ministry of Health, each medical institution that has the right to collect, harvest and transplant organs and tissues keeps records of donors and recipients separately.

Donor organs are allocated according to immunological criteria and other indications. Matching of the pair of donor and recipient can occur at any time. Due to the fact that the criteria for assessing compatibility are quite strict, the waiting time for a transplant is often from six months to two to three years.

Important! Buying and selling organs in Russia is illegal. For this, criminal liability is provided for under Part 2, Clause “g”, Art. 127.1 of the Criminal Code of the Russian Federation (“Trafficking in Human Beings”), which is punishable by imprisonment for a term of three to ten years, as well as Part 1 of Art. 120 of the Criminal Code of the Russian Federation (“Coercion to remove human organs or tissues for transplantation”) – up to four years in prison. It is also forbidden to sell organs to a medical institution, which is responsible for their removal and procurement from the deceased. The Ministry of Health keeps records of such transactions. According to the Ministry of Internal Affairs, no cases of trafficking in human organs have been recorded in the Russian Federation.

Arkady Komarov; group “Direct speech”