THE MOST KNOWS LITTLE ABOUT ORGAN DONORATION AND TRANSPLANTATION – but there are many frightening legends about them: even adults are ready to retell horror stories about the “black market”, children who are “kidnapped for organs”, and finally, the opportunity to pay off creditors with their own kidney. We tried to figure out how donation works in Russia and other countries and how these stories correspond to reality.
Blood and bone marrow
The most common case is blood donation; almost any healthy adult can become a donor . The procedure lasts from fifteen minutes to one and a half hours – longer if the blood is separated into components during the donation process. For example, you can donate only platelets – cells responsible for stopping bleeding. Before donating blood, no special preparation is needed, the procedure cannot be called painful – but it makes it possible to provide real help. And although there are hardly enough of them, many people donate blood every year – and they are even entitled to certain benefits . Usually, a person donates about 450 milliliters – about a tenth of the volume in the body. Such a loss is not accompanied by serious risks, and the complete restoration of the blood composition takes about one and a half months.
Blood is transfused primarily to those who have lost a large amount of blood, for example, with heavy bleeding as a result of an accident. In other cases, when the blood cells do not fulfill their tasks, the patient needs a bone marrow transplant, the organ where blood is formed. Such treatment is necessary for people with congenital blood diseases or its malignant changes: leukemia and lymphomas. Of course, the body can reject the “foreign” bone marrow, so potential donors are registered in special registers and they are analyzed for the HLA phenotype – a set of genes responsible for tissue compatibility. Bone marrow, unlike blood, is not donated regularly: even after entering the registry, a person may not become a donor. This will be required only when a patient appears who needs cells that are suitable for the HLA phenotype.
Organ donation during life
In addition to blood and bone marrow, a living person can donate a kidney, part of the intestine, liver or pancreas – that is, “a paired organ, part of an organ or tissue, the absence of which does not entail an irreversible health disorder,” as stated in the Law on Transplantation organs and (or) human tissues “. It is clear that these are more serious interventions – but people go to them in order to save the lives of their loved ones. In Russia , about 1000 kidney transplants are performed a year, of which only a fifth are from living donors. According to the law, an organ or part of it can be removed from a living person only on condition of his full consent to this. Finally, in Russia it is possible to become an organ donor exclusively for a blood relative: for a husband, wife or stranger, it will not work to donate a kidney. No remuneration is provided for this – and the law clearly states that the sale of human organs and tissues is inadmissible.
Although you can find several sites on Runet with advertisements like “I will become a kidney donor for a fee,” it is unlikely that this can be done in Russia, primarily because the donor and recipient are legally required to be blood relatives. Today donation for money is carried out, for example, in Pakistan, India, Colombia, the Philippines – and the WHO recognizes that this is a serious problem. Clinics and medical tourism companies bring patients to Pakistan for kidney transplants – and the cost of these services for Americans can go off the charts for $ 100,000; the donor will receive no more than two thousand of them. The Pakistani transplant doctors themselves confirm that the regulation of this issue is weak, and there are obvious inconsistencies in the law: for example, husband and wife are considered blood relatives. According to Dr. Nurani, women in Pakistan are so limited in their rights that in 95% of cases, a related donor organ is taken from them: wives, sisters, daughters.
Canadian professor Leigh Turner says that “transplant tourism” leads to disastrous results for organ recipients: due to insufficient thorough examination of donors, it may turn out that the kidney is infected with hepatitis or HIV. There are problems with the recovery period after surgery, and with the appointment of immunosuppressants – drugs that reduce the risk of rejection of a new kidney. Often “tourists” return to their homeland without any extracts or documents confirming the operation.
The main problem in transplantation is the lack of donor organs; there are always many more people on the waiting list. It is believed that in order to solve this problem it is necessary to conduct educational programs and educate people about how they can become organ donors during life and after death. In developed countries, donors are compensated for all medical expenses, they can provide insurance in case of complications, they pay for transport or part of the salary lost in the postoperative period. Of course, in countries like Pakistan, it is important not only to improve laws regarding transplantation, but also to work to eradicate poverty. As the same transplantologist Nurani says in his article, selling a kidney to the poor population of Pakistan is the second opportunity to earn extra money. The first is the sale of your own children.
The list of organs that can be used after death is much broader – it even includes the heart and eyes. In Russia, as in many countries, there is a presumption of consent to organ donation, that is, any deceased person is considered a donor by default. If the patient’s relatives or he himself expressed disagreement during his lifetime, then the organs cannot be taken, but doctors are not obliged to actively ask this question. This led to several scandals , when the families of the victims learned about the harvesting of organs only from posthumous extracts. No matter how indignant the relatives are, the law in this case is on the side of the medical institution. It is clear that the need for donor organs is high, and if you ask the permission of relatives, there is always a possibility of refusal – but it may be better to work on normalizing the very idea of donation.
For almost twenty-five years, Spain has been the world leader in transplantation, where in 2015 there were 40 donors per million of the population and 13 organ transplants per day were performed – for comparison, in Russia there were only 3.2 donors per million. Most often, kidney transplantation is again performed – this is a relatively simple operation (compared to transplantation of other organs), in which usually the “native” kidney, which has ceased to work, is not even removed. In Spain, there is also a presumption of consent, but the relatives of the deceased are delicately asked if they are against – this moment is shown in Almodovar’s film “All About My Mother”. The statistics speaks for itself: if there are refusals, then it is extremely rare – and this is due to the good awareness of the population and the fact that donation is practically considered the norm. Each hospital has staff trained in appropriate family interviews, as well as specialists and equipment for the actual organ harvesting.
In Russia, transplantation centers is not enough: in 2014 a kidney transplant was carried out in 36 centers of the liver – in 14, the heart – at 9, and more than half of all transactions accounted in the Moscow region. Due to the considerable distances, transplantation is practically inaccessible to residents of most of the country . A vicious circle arises: donation and transplantation remain rare, people know little about them and do not want to agree to the collection of organs from their loved ones, as a result of which the prevalence of donation does not increase. The situation again rests on the lack of awareness of patients, as well as in the insufficient equipment of clinics.
Speaking of donation, it is worth mentioning the donation of sperm and eggs. Almost any young and healthy man can become a sperm donor (some clinics, however, express a desire for “good external data”); with a certain regularity , you can earn up to 20 thousand rubles a month on this. It is more difficult with eggs: first you need to undergo a course of stimulation therapy – these are daily injections of hormones. The procedure itself takes about half an hour and is performed through the vagina, that is, without skin incisions. In Russia, an egg donor can legally receive compensation of about 80 thousand rubles. In case of difficulties with the onset of pregnancy, a woman can become an egg donor for herself: after fertilization in vitro, the embryo is implanted either with a biological or a surrogate mother.