“Conditional citizen who disagree with organ donation, unfortunately, died in the crash. In his pocket lay a piece of paper that he disagrees, but it is no one certified. What happens then? It is cut to pieces?”. In the Moscow city Duma held a meeting of the Advisory Council of political parties on the issue of posthumous organ donation. The members of the Council and the representatives of the professional community tried to agree on how should look like the Federal law on donation and transplantation. Been considering it for five years.
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Presumption of consent and black markets of organs
The debate began the public man Alexander Calvet, the head of the charity project to help people in need of donor organs “One accord seven lives”. He noted the lack of awareness about how organ donations, and cited the example of USA, where all information is open and accessible, talked about the need for public control, not just control from the state to “avoid any issue, and whether the person being on the 20th place on the waiting list, to pay and to receive a donor organ.”
The criticism said the chief transplant surgeon, Ministry of health of Russia, Director of the Center of Transplantology and artificial organs of a name of Shumakov Sergey Gaultier. He explained that the text of the bill in recent years, times have changed. In particular, the law removed a provision stating that people who failed to posthumous organ donation of their deceased relative are not eligible for medical assistance if they themselves need a transplant, as it caused a clearly negative reaction of the professional community. Gauthier noted that the do for 60 years since the first kidney transplantation neither the state nor the public, nor even the medical institutions have not addressed the issue of information and education, and the Ministry of health is trying to fix the situation, but till now no results.
– We have no black market transplant, unlike the us, we have no direct organs to foreigners for money. We don’t have prospects – if we are not something to constantly suspect and make excuses when someone will say something and the whole year you can’t get out. Is selected and suffers not only the institution, but suffer themselves sick, because it slows down the process of organ donation, doctors stop working. I can understand them because no one wants to invite to his prosecutors. Any misinformation about post-mortem organ donation and some “abuse”, carried out transplantation of institutions, is the anti-state activities, said Gauthier.
Alexander calve also drew attention to the fact that now in Russia it is impossible to Express agreement or disagreement on the posthumous donation of organs.
– The right to Express agreement or disagreement was enshrined in 1992. In 26 years of existence of this law, the Ministry of health has not developed a mechanism for its implementation – said the activist.
Gauthier said that it plans to establish a register of refusals. This is the most simple and common way to refuse post-mortem organ donation, because it does not bear so much criminalized opportunities, such as a register of consent, which must ensure integrity of personal data that, according to Gauthier, in modern conditions problematic and expensive.
How does the process of removal of organs posthumously, discussed especially actively. Now it’s either a failure in a medical facility in the presence of witnesses, or notarized written waiver, which somehow people have to carry.
The conditional citizen who disagree with organ donation, unfortunately, died in the crash. In his pocket lay a piece of paper that he disagrees, but it is no one certified. What happens then? It is cut to pieces? – had a question for Gauthier.
– It is not cut into pieces, and remove organs for the patient. You rightly say that this mechanism is imperfect. We are confident that the establishment of a register of failure will help to correct the situation. If the person is not bothered for some reason to go and give up, even if he does not agree, then this is the presumption of consent. Because it is the most humane way not to make a mistake. If people do not agree and have made themselves into the registry, then it is free, but if not, he is a member of the society and have to help him.
Interested attendees how to be with children who are not yet eligible to vote.
– The bodies of children are taken strictly with parental consent. If children have no parents and relatives, they live in orphanages, these children can not be posthumous organ donors, explained Gauthier.
30% organs, foreigners, and children’s transplantation
The meeting was also attended by the head of the division of organ transplantation, Russian scientific center of surgery named after Petrovsky Mikhail Mikhailovich CABAC.
Public control is important, and society to do this, first the desired registers. The activity of transplant in our country is governed by three public registers maintained by the Ministry of health: portal monitoring of high-tech medical aid, Federal register, Ministry of health, which takes into account the high cost of drugs issued to patients, as well as the register, taking into account the cases of transplantation. Last feature is that it’s anonymous.
Cross-sectional analysis of these registers revealed a discrepancy between the number of performed transplants and the number of people living in our country with transplanted organs: transplants performed approximately 30% more than an increasing number of people living with transplanted organs in the country people. Explanations for this impossible to find due to the anonymity nature of the register of transplantations. We can’t know who is doing these operations – he turned to a colleague for comment.
– According to your works, 30% organs go to foreigners in the territory of the Russian Federation are foreigners, which is an absolute slander. If these data will be published, I’ll sue you in court and win it, said Gauthier. We are all members of professional community, we all look each other in the eye. So the bodies went to foreigners, this speech can not be. Our foreign colleagues, namely the group of the Istanbul Declaration, which the UN monitors cases of transplantation in Europe and the middle East, all of these statistics are known.
If there is a person, transplanted to another country, then in this country there is a query, why and how this person got on in this country. For the past 10 years of me as the chief transplant coordinator of such issues were reported. And these people have enough progressive thinking, and no problems with asking uncomfortable questions. Yes, the registers are imperfect, difficult to control, but do not confuse the flies with cutlets.
Another question Mikhail addressed to the Department of health of Moscow. He was asked to explain why departmental instructions 2017 disappeared the priority of younger children in the allocation of donor organs.
– According to the Russian dialysis society, among children under 5 years the number of people living with functioning transplants is much less than 30%. In General among children of other ages, this number exceeds 60%. Moreover, among all the dead 90% were on dialysis and only 10% with functioning grafts. That means that life with a transplant greatly saves children from death, while the share of young children living with transplants embarrassingly small.
Health Ministry officials said that to balance all the rights of children was the decision including the legal and professional medical community. Gauthier explained how the process.
– There is also a purely professional relationship between the transplant center and organ donation, when they can go to discussion. If you have a transplant, 17-year-old and two year old children on dialysis, of course, for two-year-old dialysis presents great difficulties, and doctors understand this. Here a purely professional arrangement, which is officially fixed by the Council. But in many ways, Mikhail is right. Unfortunately, kidney transplantation for younger children, up to two years, in Russia is carried out only in two institutions. Therefore, the development of pediatric transplantation is a big problem that needs to be solved.
The outcome of the meeting was the decision that the law still needs revision and further discussion.