What is transplantation?
This is a transplantation of a human organ taken from a donor by a surgical procedure. Artificial implants and cloned tissues are also transplanted.
See also: Legal transplantation in Ukraine: why not be afraid
For many patients, transplantation is the only chance for life. Then, as soon as one donor can save 6-8 lives, you can transplant:
lungs both kidneys heart liver pancreas intestine bone marrow
One donor can save up to 8 lives
Organ transplant in Ukraine
In Ukraine, organ transplants are carried out, but not at an adequate level. Also, since 2010 there is a program "Treatment of Ukrainian citizens abroad". According to the Ministry of Health, every year the number of people who are paid from the budget for treatment in other countries is growing.
So, in 2017, 226 Ukrainians were sent for treatment (organ and bone marrow transplantation), in 2018 – 278, and only in the first half of 2019 – 301. As of August 20, 2019, 255 cases were submitted to the Ministry of Health of Ukraine for consideration.
In which cases, Ukrainians are sent abroad for treatment and how the procedure goes is prescribed in the Cabinet of Ministers Resolution No. 1079.
See also: Transplantation in Ukraine: Suprun told the details
This year, Ukrainians are sent for treatment to Italy, Germany, Poland, Switzerland, the UK, Austria, Belarus, India and Turkey. Transplantation itself is carried out most often in Belarus and India.
However, for example, not all patients are taken to Belarus – there are limitations. The patient’s kidney waiting time there is from a year to 5. At the same time, patients are constantly forced to travel to Belarus to take tests, spending 200-300 dollars on such trips every three months to be on the active waiting list.
Organ transplants in other countries are long and expensive.
The ministry assures that this program is a temporary solution. The only correct way to solve the problem is to restore transplantation in Ukraine. This will increase the number of treated Ukrainians at least 3-4 times.
In Ukraine, in 2017, 127 organ transplants were performed, in 2018 – 129, in 2019 (as of July 22) – 38.
To develop transplantation in Ukraine, the Ministry of Health launched a pilot project "On changing the mechanism of financial support for surgical treatment for organ transplantation and other anatomical materials."
See also: Suprun named hospitals that will be the first to conduct transplant operations
Almost 50 million UAH from the pilot was directed to the purchase of modern medical equipment for four transplant centers: the National Institute of Surgery and Transplantology named after A.A. Shalimov, Zaporizhzhya Regional Hospital, National Cancer Institute and the National Children's Specialized Hospital "Okhmatdet" of the Ministry of Health of Ukraine.
Tenders are being held now, equipment should be brought this fall. It is also planned that the money from the pilot will be used to pay for transplants carried out in the above centers.
What is the problem?
In total, in Ukraine, more than 200 hospitals by law can ascertain the death of the brain and remove donor organs. However, not all of them have the necessary equipment for this, and some also lack qualified personnel.
Today, the main problems in the system of organ transplantation are:
– failure to comply with orders by medical personnel,
– lack of the necessary equipment to ascertain brain death in hospitals,
– lack of knowledge of doctors.
According to the NGO National Movement For Transplantation, the above-mentioned institutions do not record brain death and donor organs, as most hospitals simply do not have the equipment necessary for this. In particular, there is no equipment to record brain death.
There is also the problem of a lack of communication with institutions, where these bodies are then transferred. Cooperation should establish a focal point, which is not yet working in Ukraine. All hospitals should have a person in charge who will be in touch with the transplant center. Under the new law, this is a transplant coordinator.
Another problem is the lack of qualifications of specialists in medical institutions. Some of them advised redirecting the request for information about the removal of donor organs … to the morgue. Although brain death is diagnosed in the intensive care unit, the chief physicians of several institutions are still convinced that it is the employees of the pathology department who need to raise the question of equipment.
There are hospitals where there is all the equipment to ascertain the death of the brain and specialists are needed, but not a single organ removal has been carried out. Thus, order No. 821 "On the establishment of diagnostic criteria for brain death and the procedure for stating the moment of death of a person" is violated.
Transplantation is a complex system and it ends at the Institute, where an organ is sutured. And it begins – it is in the intensive care unit, where they ascertain the death of the brain and conduct a conversation with the relatives of the deceased person. Further, hospitals should contact the focal point for transplantation and transfer those organs to hospitals that sew: kidneys, hearts. Unfortunately, this system does not work for us,
– explained Yuri Andreev.
That is, the main reason why transplantation from a cadaveric donor is not enough today is the lack of appropriate donor material, organs that are lacking precisely because of the aforementioned problems.
As Channel 24 in the Ministry of Health noted, medical institutions that are allowed to carry out organ harvesting will be equipped with the necessary equipment. But after the full launch of four pilot centers. When exactly they will start to do it – so far there is no information.
What and when will it change?
January 1, 2020 will come into force "On the application of transplantation of human anatomical materials."
As Channel 24 was told in the Ministry of Health, four centers in Kiev and Zaporozhye will be re-equipped first: the National Institute of Surgery and Transplantology named after A. A. Shalimova and Zaporizhzhya regional hospital for organ transplantation, the National Cancer Institute and the National Children's Specialized Hospital "Okhmatdet" of the Ministry of Health of Ukraine – for the development of bone marrow transplantation. And only then similar centers will work in other cities.
Changes will start from four centers, then spread to other health facilities
In order for transplantation to work in Ukraine in full, you need to establish a system:
• Develop a culture of donation – transplantation does not exist without a donor. First of all, it is a question of ethical field. As for the technical implementation, right now the experts of the Ministry of Health are testing the purchased Unified State Transplant System (EDIST), which consists of 9 registries of donors and patients who need transplantation. The system automatically selects a pair of donor-recipient, without human intervention, therefore, excludes any manipulation from the outside. The launch of the system is scheduled for January 1, 2020.
• Introduce the death of the brain into the practice of doctors, after which it is possible, with the consent of relatives, to remove organs. This issue should be considered not only in the context of transplantation. Our doctors have no experience stating brain death. If you look at the statistics, in Ukraine in rare cases they diagnose brain death. We need to introduce this practice, namely, to change the qualification characteristics for neurologists, anesthetists and neurosurgeons so that they know and are able to make a statement of brain death.
• Teach doctors, transplant coordinators and laboratory assistants. On February 15, 2019, the profession of transplant coordinator was officially approved in Ukraine. She is included in the classifier of professions. The course is based on the installation and practice of transplantation of the EU (in particular, Spain) and the USA. To date, 33 transplant coordinators have completed training.
• Establish interaction between intensive care units and intensive care units, seizure bases and transplant centers. Retrofit laboratories and hospitals.
• Establish logistics – fast organ delivery to a patient who needs transplantation.
More distant relatives will be able to become kindred donors. An important point is that the consent of patients to a posthumous donation can be obtained and submitted to EDIST by family doctors. And a decision will be made about the organ transplantation from an inanimate donor and the priority of patients in the waiting list will be a consultation of doctors of the transplantation medical institution.
In addition, the list of people who are close relatives has been expanded. That is, cousins, uncles, aunts and nephews can also be donors for family transplantation. Bone marrow donors can also be siblings under the age of 18 years.
The Ministry of Health is now conducting an awareness campaign, urging Ukrainians not to be afraid to agree to a posthumous donation. After all, only one donor has the opportunity to give life to at least six people.
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