Another public lecture by Minister of Public Healthof Ukraine Raisa Bogatyryova conducted on April 30, 2013, was devoted to transplantation, its present, future, legal and ethical aspects

mm_BogatyrovaMinister of Public Health of Ukraine, Corresponding Member of the Academy of Medical Sciences of Ukraine, D.Sc. in Medicine, Honored Doctor of Ukraine, professor, vice-president of World Health Assembly for European Region Raisa Bogatyryova conducted the on-line lecture at KharkivNationalMedicalUniversity. The lecture was listened by students, interns, academic teaching staff of medical and pharmaceutical education institutions, postgraduate education institutions of the IV accreditation level of Ukraine, representatives of practical medicine.

“None of the branches of medical science causes so much controversy, conflicts, ethical and religious debates as transplantology – said the Minister of Public Health. – Today we see transplantation as a complex of many issues. First of all, the issues of medical and biological nature, which decide how to detect biological incompatibility, and how to overcome and improve the techniques, etc. On the other hand, these issues are legislative (e.g. protection of patient’s rights as a recipient and as a donor) and ethical.”

Every year in the world 40-50 thousand transplants of organs and tissues are performed. Experts predict that by 2020 over 60% of surgeries performed in treatment of various pathological conditions and diseases will be connected with transplantation.

“During the period from 1996 to 2012 1354 kidney transplants were made in Ukraine, 130 – liver transplants, 8 – heart transplants – said Raisa Bogatyreva. – Their performance is regulated by the law on transplantation of organs and other anatomical human materials adopted in 1999. This law, in particular, defines the rights of the donor and the rights of the recipient. Thus, the donor is entitled to give homotransplantant (one of paired organs), or part of an organ or other anatomical material to the recipient when they are married or are close relatives. He/she has the right to refuse donation, to be subject to compulsory state insurance, particularly in the case of death while performing donor functions, to obtain compensation for damages caused by the injury as a result of donation and so on. Recipient has the right to use the methods of treatment if medical evidence and informed consent are available, on as long as the elimination of danger to life or health recovery is not possible by other methods (patient under 15 or a person declared legally incompetent by a court – with the consent of a parent or other legal representatives). Refuse to perform transplant. It should be kept in mind that in urgent cases, which is very common in practice of the physician when there is a real threat to the life of the recipient, his consent or his representatives to perform transplant is not necessary.”

In the way to the development of transplantation in Ukraine in the last decade stood the so-called presumption of dissent as a basis for active legislation.

“If before the date of adoption of the law, in Ukraine prevailed posthumous donation, but later the number of transplants from a living family donor began to dominate. Altogether today in our country the number of organ transplants is less than 120 per year. As an example, in Belarus in 2012 the liver was transplanted only to 110 patients. In the United States more than 24,000 organ transplants are performed annually, 70% – from postmortem donors. At the same time, each year in the Ukraine more than 2 thousand patients need a kidney transplant. Presumption of dissent has sharply reduced postmortem organ transplants from donors. Lack of organs intended for transplant is caused, primarily, by the refusal of relatives. Ukraine occupies the last place in Europe in terms of post-mortem organ donation.”

As a result of virtually absence of the system of transplant care, citizens of Ukraine are compelled to undergo medical treatment abroad, the state budget can finance a small number of such surgeries.

“Thus, during the years 2011-2012 from the budget was allocated for this purpose about $1 million, which is 9 transplants – said Raisa Bogatyreva. – In Ukraine liver transplantation costs 450 thousand hryvnia, a similar operation in Belarus – $ 100 000 USD.”

Transplantation causes a lot of debates. There was prepared a new version of the Law, were held public hearings, including how to protect a recipient and a donor against abuse.

“A lot of work had been done, we met with representatives of NGOs, doctors, representatives of all religious denominations. And have gained understanding, – said Raisa Bogatyreva. – Yes, the Orthodox Church said (quote) that “human organs can not be regarded as an object of sale, organ transplant from a living donor may be based only on voluntary sacrifice, for the sake of another human. In this case, the consent for transplantation is an act of love and compassion. Posthumous organ donation can be an act of love that stretches beyond death. This kind of gift or cannot not be considered a duty of man.”

In particular, the ethical issues resulted in active work in the legal field: development of legal and legislative acts regulating the activities associated with transplantation. Since its development it is necessary to improve and refine the standards and procedures.

“One of these documents is the Declaration of Istanbul, ratified by 120 countries, which refers to transplant tourism, organ trafficking issues, and clearly identifies the key ethical and legal principles of transplantation. At present, there are two types of legally regulated kinds of donation: living donation and posthumous donation. Let us consider a living donation. In most countries, including Russia, Germany, France, the legislation stipulates that organ for transplantation can be provided only by a close relative. In some Asian countries, the Netherlands, Sweden, Poland the living donation exists on the principles of charity, the so-called emotional donation. A system of free and anonymous donation of organs operates in the U.S. In Ukraine (regarding living donation) the regulation is legislated that organ transplant can be provided only by a close relative. The main principles of living donation are: a voluntary, informal consensus, no sale of body and minimization of medical and psychological trauma.”

To overcome public mistrust of transplantation is extremely difficult, and the difficulty of control over the commercialization of living donation is one of the problems that prevents the emotional living donation in many countries.

“That’s why 60% of transplantation surgeries in the world are performed using posthumous donation. Posthumous organ donation is based on two principles: the presumption of consent and presumption of dissent. Presumption of consent – is recognition of eternal human desire to do good and charitable action. But there is a veto of the relatives of deceased, if the person has not left alive consent. Presumption of dissent – is the human’s will not to give anything to anyone. Presumption of dissent is always in power. Presumption of dissent is fixed in practice in Ukraine. There is a need to change it to the presumption of consent. And at this the new version of the law is aimed.” – said Health Minister Raisa Bogatyreva.

Closing the meeting, Minister of Public Health once again turned to the medical community to conduct a comprehensive outreach on the importance of transpalantology and answered the questions from audience.

Elena Yakovleva

 

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