Over the past three decades only 3 heart, 58 liver, and fewer than 2,000 kidney transplants have been performed in Ukraine. The Ministry of Health says our country needs hundreds more transplant surgeries than are done every year. According to transplant specialists, the main reason is the lack of donor organs. Ukrainian legislation prohibits transplants from dead bodies without the next of kin’s knowledge and consent.
On the one hand, our law protects human rights even after death; on the other, many patients who are denied transplant surgery lose their last chance for survival. More than 200 people are on waiting lists at the Institute of Surgery and Transplants of the Academy of Medical Sciences (AMN) of Ukraine. Most of these people are not expecting any miracles. In the following interview with The Day , the institute’s director, Yurii POLIACHENKO, notes that the medical personnel under his supervision would be able to save considerably more lives if they were given the opportunity.
Dr. Poliachenko, who are the most frequent donors in Ukraine?
There are 2,500 patients in need of kidney, heart, and liver transplants. In other words, we have to perform nearly 5,000 transplants every year. Last year, there were only 254 such operations, mostly kidney and liver transplants. The main reason for the small numbers of transplants is the lack of donor organs. We mostly practice family transplants, when organs are transplanted from the patient’s family members. There are practically no transplants from dead bodies because this kind of surgery is forbidden without the next of kin’s knowledge and consent.
What are the main obstacles for transplant specialists trying to save the greatest possible number of lives?
Today, the main problem is that our society is not prepared to recognize transplant surgery as a necessary branch of medical science. People are not mature enough to realize that organs have to be removed and transferred to other humans to save their lives, even though Ukrainian legislation meets all of the European Union’s legal framework criteria. Spain and Germany have been able to cope with their donor supply problems by using this legal framework. In Ukraine, this problem can be solved by civic and religious organizations, with the media’s help; we must revive public trust in medical institutions. In Spain, for example, thanks to a powerful information campaign as well as help from churches and various religious denominations, incredible headway has been achieved in the field of transplants over the past decade. Spain has no problems with using organs from dead bodies. On the other hand, the government of Iran permits its citizens to sell their organs, but I am personally very much against using the Iranian experience in Ukraine. Our mentality has not matured to this, so lifting the ban on the sale of human organs may well result in a great many criminal cases.
However, the Spanish model could be very interesting to us. There is a Spanish television channel that broadcasts programs every day about people who have donated their organs to save people and individuals who have had transplants, along with discussions of this problem. As a result, Spaniards have formed a positive public view on this matter.
Transplant operations must be quite expensive.
They certainly are, but treating patients who have been waiting for a transplant is much more expensive. Most of the patients we have are able- bodied individuals aged between 25 and 35 years, so through full-time work these people could still bring considerable benefit to our country. We are impeded by lack of funding, but this is not as bad as the lack of donor organs.
How much does a patient have to pay for a transplant?
Nothing. This kind of operation is free of charge and the state provides patients with free drugs.
We keep hearing about illegal transplants and doctors being paid for transplanting organs from dead bodies of non-relatives.
This is impossible in Ukraine, both technically and morally. I can count on the fingers of my hand the surgeons who are capable of performing transplants. Each one has a team of qualified personnel, ranging from diagnostics to resuscitation. All of them examine every patient and donor and do all the required paperwork, and such operations can be done only with special hi-tech equipment, not in some basement. There is also an Ethics Committee that verifies documents submitted by the patient’s intermediaries or relatives.
But the European Parliament says Ukraine tops the list of black market organ donation countries.
Black market organ donation means that people agree to sell their organs. When this happens, such cases must be dealt with by law enforcement agencies. Naturally, there are cases when a patient brings someone to legally attest to his agreement to donate an organ, but we deny them transplants because the sale of human organs is forbidden by Ukrainian legislation, except in cases of in-family transplants or non-living donorship, with the knowledge and consent of the next of kin.
There are several thousand patients on the transplant waiting list. What are their chances?
Unfortunately, they are very small. If it is not possible to find a relative willing to part with an organ, provided it is compatible with the patient, a patient’s chances are nil.
Is a donor’s health severely damaged by the loss of an organ?
You can live a hundred years after donating a kidney, and a donated kidney can save the life of someone who is on hemodialysis. By the way, the first renal transplant was performed in Ukraine by Prof. Yurii Vorony in Kharkiv in 1933. In America, this kind of surgery started being practiced in 1951. Today, however, Ukraine lags behind the United States and other developed countries in terms of numbers of transplants: compared to 20-40 donors per one million residents there, Ukraine has a mere 1.5 transplant per million.
COMMENTARY
Tetiana BAKHTEIEVA, MP, of the 4th, 5th, and 6th convocations of the Verkhovna Rada:
Our law says that donors for transplants can only be the next of kin, but very often there are cases when a sick person doesn’t have any family members that could donate an organ. For example, we have an 18-year- old girl in our Donetsk Transplant Center. Her only relative is her sick mother. After a person dies tragically, a kidney can be removed within 12 hours and transplanted into a patient. But this requires the consent of the dead person’s relatives. Therefore, it is necessary to amend Article 16 of the Law on Transplants, so that people can agree to have their organs used after their death. For example, they would sign a document indicating that when they are declared brain-dead their organs may be used for transplants. Sometimes patients bring donors and notarized, certified documents with them, stating that the donor is willing to donate an organ, like a kidney, but we can’t do such transplants because this is forbidden by law.
