Russians are not ready for a mass organ transplant. Orthodox view on organ transplantation Law on Organ Transplantation in the Russian Federation

The problem of shortage of organs for transplantation is urgent for all mankind as a whole. About 18 people die every day due to the lack of organ and soft tissue donors, without waiting for their turn. Organ transplantation in the modern world is mostly performed from deceased people who, during their lifetime, signed the relevant documents on their consent to donation after death.

What is a transplant

Organ transplantation is the removal of organs or soft tissues from a donor and their transfer to a recipient. The main direction of transplantology is organ transplantation - that is, those organs without which existence is impossible. These organs include the heart, kidneys, and lungs. While other organs, such as the pancreas, can be replaced by replacement therapy. To date, great hopes for prolonging human life are given by organ transplantation. Transplantation is already successfully practiced. These are the kidneys, liver, thyroid gland, cornea, spleen, lungs, blood vessels, skin, cartilage and bones to create a framework in order to form new tissues in the future. For the first time, a kidney transplant operation to eliminate acute renal failure of a patient was performed in 1954, an identical twin became a donor. Organ transplantation in Russia was first performed by Academician Petrovsky B.V. in 1965.

What are the types of transplants

All over the world there is a huge number of terminally ill people who need transplantation of internal organs and soft tissues, since traditional methods of treating the liver, kidneys, lungs, and heart provide only temporary relief, but do not fundamentally change the patient's condition. There are four types of organ transplants. The first of these - allotransplantation - occurs when the donor and recipient belong to the same species, and the second type includes xenotransplantation - both subjects belong to different species. In the case when tissue or organ transplantation is performed in or animals grown as a result of consanguineous crossing, the operation is called isotransplantation. In the first two cases, the recipient may experience tissue rejection, which is caused by the body's immune defense against foreign cells. And in related individuals, tissues usually take root better. The fourth type includes autotransplantation - transplantation of tissues and organs within the same organism.

Indications

As practice shows, the success of the operations performed is largely due to the timely diagnosis and accurate determination of the presence of contraindications, as well as how timely the organ transplant was performed. Transplantation should be predicted taking into account the patient's condition both before and after the operation. The main indication for the operation is the presence of incurable defects, diseases and pathologies that cannot be treated by therapeutic and surgical methods, as well as threatening the life of the patient. When performing transplantation in children, the most important aspect is to determine the optimal moment for the operation. As experts of such an institution as the Institute of Transplantology testify, postponing the operation should not be carried out for an unreasonably long period, since a delay in the development of a young organism may become irreversible. Transplantation is indicated in case of a positive life prognosis after surgery, depending on the form of pathology.

Organ and tissue transplantation

In transplantology, autotransplantation is most widely used, since it excludes tissue incompatibility and rejection. Most often, operations are performed on adipose and muscle tissues, cartilage, bone fragments, nerves, and the pericardium. Transplantation of veins and vessels is widespread. This became possible thanks to the development of modern microsurgery and equipment for these purposes. A great achievement of transplantation is the transplantation of fingers from the foot to the hand. Autotransplantation also includes the transfusion of one's own blood in case of large blood loss during surgical interventions. With allotransplantation, bone marrow and blood vessels are most often transplanted. This group includes blood transfusion from relatives. Operations are carried out very rarely, since so far this operation is faced with great difficulties, however, in animals, transplantation of individual segments is successfully practiced. Pancreas transplantation can stop the development of such a serious disease as diabetes mellitus. In recent years, 7-8 out of 10 operations performed have been successful. In this case, not the entire organ is transplanted, but only part of it - islet cells that produce insulin.

Law on organ transplantation in the Russian Federation

On the territory of our country, the transplantation industry is regulated by the Law of the Russian Federation of December 22, 1992 “On transplantation of human organs and (or) tissues”. In Russia, transplantation of the kidneys is most often performed, less often of the heart, liver. The law on organ transplantation considers this aspect as a way to preserve the life and health of a citizen. At the same time, the legislation considers the preservation of the life of the donor as a priority in relation to the health of the recipient. According to the Federal Law on organ transplantation, the objects can be the heart, lung, kidney, liver and other internal organs and tissues. Organ retrieval can be carried out both from a living person and from a deceased person. Organ transplantation is carried out only with the written consent of the recipient. Donors can only be able-bodied persons who have passed a medical examination. Organ transplantation in Russia is carried out free of charge, since the sale of organs is prohibited by law.

Donors for transplantation

According to the Institute of Transplantation, each person can become a donor for organ transplantation. For persons under the age of eighteen, parental consent is required for the operation. When signing the consent for organ donation after death, a diagnosis and medical examination are carried out, which allows you to determine which organs can be transplanted. Carriers of HIV, diabetes, cancer, kidney disease, heart disease and other serious pathologies are excluded from the list of donors for organ and tissue transplantation. Related transplantation is performed, as a rule, for paired organs - kidneys, lungs, as well as unpaired organs - liver, intestines, pancreas.

Contraindications for transplantation

Organ transplantation has a number of contraindications due to the presence of diseases that can be aggravated as a result of the operation and pose a threat to the patient's life, including death. All contraindications are divided into two groups: absolute and relative. The absolute ones are:

• infectious diseases in other organs along with those that are planned to be replaced, including the presence of tuberculosis, AIDS;
• violation of the functioning of vital organs, damage to the central nervous system;
• cancerous tumors;
• the presence of malformations and birth defects that are not compatible with life.

However, during the period of preparation for the operation, due to the treatment and elimination of symptoms, many absolute contraindications become relative.

kidney transplant

Kidney transplantation is of particular importance in medicine. Since this is a paired organ, when it is removed from the donor, there are no violations of the body that threaten his life. Due to the peculiarities of the blood supply, the transplanted kidney takes root well in recipients. For the first time, experiments on kidney transplantation were carried out in animals in 1902 by research scientist E. Ulman. During transplantation, the recipient, even in the absence of supporting procedures to prevent rejection of a foreign organ, lived for a little more than six months. Initially, the kidney was transplanted to the thigh, but later, with the development of surgery, operations began to be performed to transplant it into the pelvic area, this technique is practiced to this day. The first kidney transplant was performed in 1954 between identical twins. Then, in 1959, a kidney transplantation experiment was carried out on fraternal twins, using a technique to resist transplant rejection, and it proved to be effective in practice. New drugs have been identified that can block the body's natural mechanisms, including the discovery of azathioprine, which suppresses the body's immune defenses. Since then, immunosuppressants have been widely used in transplantology.

Organ conservation

Any vital organ that is intended for transplantation, without blood supply and oxygen, is subject to irreversible changes, after which it is considered unsuitable for transplantation. For all organs, this period is calculated differently - for the heart, time is measured in minutes, for the kidney - several hours. Therefore, the main task of transplantation is to preserve organs and maintain their performance up to transplantation into another organism. To solve this problem, conservation is used, which consists in supplying the organ with oxygen and cooling. The kidney can be preserved in this way for several days. The preservation of the organ allows you to increase the time for its study and selection of recipients.

Each of the organs, after receiving it, must be subjected to conservation, for this it is placed in a container with sterile ice, after which conservation is carried out with a special solution at a temperature of plus 40 degrees Celsius. Most often, a solution called Custodiol is used for these purposes. Perfusion is considered completed if a pure preservative solution without blood impurities protrudes from the orifices of the graft veins. After that, the organ is placed in a preservative solution, where it is left until the operation is performed.

transplant rejection

When a graft is transplanted into the recipient's body, it becomes the object of the body's immunological response. As a result of the protective reaction of the recipient's immune system, a number of processes occur at the cellular level, which lead to the rejection of the transplanted organ. These processes are explained by the production of donor-specific antibodies, as well as antigens of the recipient's immune system. There are two types of rejection - humoral and hyperacute. In acute forms, both mechanisms of rejection develop.

Rehabilitation and immunosuppressive treatment

To prevent this side effect, immunosuppressive treatment is prescribed depending on the type of operation performed, blood type, degree of compatibility of the donor and recipient, and the condition of the patient. The least rejection is observed in related organ and tissue transplantation, since in this case, as a rule, 3-4 out of 6 antigens coincide. Therefore, a lower dose of immunosuppressants is required. Liver transplantation demonstrates the best survival rate. Practice shows that the organ demonstrates more than a decade of survival after surgery in 70% of patients. With prolonged interaction between the recipient and the graft, microchimerism occurs, which allows, over time, to gradually reduce the dose of immunosuppressants up to their complete rejection.

Organ transplantation has become a daily occurrence in modern society. Both positive and negative assessments of it, coming from various ecclesiastical or theological circles, are usually not systematic. The Orthodox Church has not yet expressed its position on this issue. This position should not be the opinion of its individual representatives or commissions holding traditional views, but should become an expression of its collective conscience.

The origins of organ transplantation date back to ancient times. Skin grafting was already done in ancient Egypt. However, only in our time, attempts to transplant vital organs and tissues of the human body have been crowned with success. The first successful kidney transplant occurred in 1954, the first successful heart transplant in 1967. In the future, organ transplantation, a method that is not content with symptomatic therapy, but eliminates the very source of the disease, became widespread and aroused enthusiasm all over the world.

Organ transplant: the search for earthly immortality?

The reason for such euphoria was not only the obvious advantages of transplantation, but also the fact that it was seen as the embodiment of the dream of modern man to achieve earthly immortality. And therefore, it will not be an exaggeration to say that in the resulting hype lies the danger of distracting a person from the ultimate goal of his existence and from his most important tasks. And if we take into account the fact that the number of lives that can be saved by organ transplantation cannot even approach one thousandth of the number of lives killed by abortion, it becomes even more obvious that transplantation can hardly be considered a panacea in saving humanity.

Excessive faith in organ transplants focuses a person's interest only on his bodily health, while at the same time giving him the illusion of a kind of, as already mentioned, earthly immortality. The desire for such "immortality" cannot be combined with the expectation of eternity and faith in victory over death in Christ. . This means that the Church cannot aim to spread slogans such as "Give and save", which, moreover, easily acquire consumer and commercial overtones. Such a position would mean secularization and concession to the trends of the times.

In the Church's vision, biological life and biological death do not oppose each other, but are interconnected. Not without reason, by their very nature, life and death always go hand in hand and are two sides of one whole. Life turns towards death. Death is present in every phase of life. First of all, death is a transition from one phase of life to another: from temporary life to eternal life. This view not only deprives death of its tragedy, but also creates the opportunity for a positive attitude towards it. Both humans and animals are equally subject to biological death. It is not at all necessary for a Christian to see in death only a destructive beginning. He can accept death with good will, receiving life for it.

And just as bodily death can be the beginning of spiritual life, so bodily illness can serve mental health. It does not follow from this, however, that bodily health and life should be neglected. It is not for nothing that church anthropology, which proclaims the psychosomatic integrity of a person, positively evaluates not only mental, but also his bodily health. Numerous church prayers for the health of the soul and body of a person testify to this. The Church has always blessed and blesses medical assistance to the sick.

Modern medicine, despite its amazing successes, is a reflection and development of humanistic anthropology, which was once rejected by Orthodoxy because it imprisons a person in the dungeon of his creatureliness and mortality. The interest of such an anthropology in man is limited to his biological functions, and life is reduced to biological existence. And therefore it is often noted that from where such medicine alone reigns, God is expelled.

Despite all of the above, one should not neglect the significance of medicine, which is a gift of God, for a person who is in a weak bodily or mental state. Christ Himself came into the world as a healer of human souls and bodies. The appearance of the Kingdom of God was marked, among other things, by the healing of the sick. Numerous miracles of healing the sick performed by the saints are considered signs of the special Grace of God. It is significant that among the healings there were also those in which a person was given a new organ, such as, for example, when the Lord healed a blind man from birth, as well as those in which an organ of the body was transplanted, such as, for example, transplanting the leg of a deceased person to a sick person, carried out Saints Cosmas and Damian. Finally, physical illness is in many ways similar to mental illness. And therefore, the healing of bodily ailments can be regarded as a model for the spiritual education and healing of a person. Just as in case of bodily illness it is required to abstain from harmful food, so in case of mental illness it is necessary to keep the commandments of the Lord.

Nothing prevents a Christian from resorting to medical help and seeking it from the most qualified doctors. But regardless of whether he relies on the help of doctors or not, his ultimate goal should remain the Lord and the good for his soul. He is called to strive for this alone with any of his actions, because as the apostle Paul said: “Whether you eat, drink, or whatever you do, do everything to the glory of God.” So, the believer, if necessary, resorts to doctors and to the achievements of medicine, without relying, however, entirely on them.

Medicine cares about the preservation and improvement of people's health. In doing this, she also takes care of prolonging a person's life. The Church does not interfere with medicine in such an aspiration, however, it understands well all its relativity. At the same time, the Church expresses its views on man and on his life, offering man not a way to survive, but a life that conquers death. Let us note that the church ascetic tradition prescribes the moderate use of medicine and drugs, so as not to fall into a sinful desire to make a cult out of life. Naturally, this primarily concerns the ascetics-monks. However, any Christian should not completely reject such an approach, because the desire for asceticism should be part of his life as well. And this desire is combined with the spiritual maturity of the believer, which naturally leads him to desire to give more, and not to take. Obviously, this also applies to the issue of organ transplantation.

Organ transplantation includes a wide range of procedures and covers a wide variety of forms. It begins with a blood transfusion, that is, with the transfer of liquid tissue, then proceeds to the transplantation of parts of double organs and ends with a liver or heart transplant. In recent years, genetic medicine has seen the transplantation of modified bone marrow cells to treat diseases such as cystic fibrosis. In addition, tissue transplantation can be carried out from one part of the body to another of the same person, or organs and tissues can be transplanted from one person to another. Finally, an organ donor can be either alive or dead. Well-founded fears, or categorical objections, have been expressed by various ecclesiastical and theological circles against the right of a person to participate in such actions. And these objections, of course, are especially strong in the case of a transplant of a vital organ, for example, a heart, carried out only after the death of the donor.

Arguments against organ transplants

Arguments against organ transplantation are based primarily on the concept of the sanctity of the human body and on the spiritual dimension that its main organs possess, according to Old Testament anthropology, preserved in the patristic tradition. In the Old Testament, the heart, blood, liver, kidneys are directly related to the spiritual life of the believer. In the Orthodox ascetic tradition, the corporeal heart interacts directly with the spiritual life. The path to the spiritual heart of a person passes through his corporeal heart. In addition, opponents of organ transplants argue that a person received his body as a gift from God and has no right to give it to another person. The body of a Christian is the temple of the Lord and a part of Christ. Moreover, the Christian is not wholly his own, but "bought at a price." Consequently, according to this view, he has no right to dispose of the body as he pleases.

In addition, a Christian not only can, but must also observe the will of God, expressed in His commandments. Acting according to the will of God, he always has eternal life as his goal, even if the path to it lies through death. A distinctive feature of Christian anthropology, which made a revolution in the views of man, was that the true life of man is viewed through the prism of death. The question arises: becoming donors of tissues and organs of our body, do we keep the commandments of Christ, the essence of which conveys the commandment of love for God and man, and whether we follow His example in this.

Christ taught self-sacrifice and offered himself as a sacrifice for the world. He nourishes people with His Body and Blood, of course, not in order to lengthen their earthly life, but in order to renew them and lead them to incorruption. However, by working miracles, He also prolongs earthly human life. Thus, He condescends to our weakness. His goal was not miraculous healing, but the liberation of man from sin: “But so that you know that the Son of Man has power on earth to forgive sins,” He says to the paralytic, “I say to you: get up, take up your bed and go to your house” .

Miraculous healings and resurrections from the dead, which Christ performed, are at the same time signs of the coming of His Kingdom. If these signs do not lead a person in the right direction, they lose their meaning. In the same way, the Church is called to act, showing signs of her love for man, while not forgetting her main goal. And the main goal of the Church is not the temporary deliverance of a person from biological death, but his final liberation from the fear of death and from death itself. For the Church "to make death despise is much more important than to free from death."

The constant striving for the most important, which is very important for a modern secular society, however, does not at all mean contempt for less significant issues. The Church operates not only acrivia(strictness), but also economy(indulgence). Theology itself cannot be economy, but economy has its own theological basis. The voluntary donation of bodily tissues or organs as a result of unselfish love is an act that certainly inspires respect and requires a serious and delicate pastoral attitude. It is hard not to admire the deed of a person who gives away his kidney or eye out of love in order to give life or sight to his neighbor. And all the more worthy of admiration when the donor is ready to sacrifice his own life for the life of his neighbor. Of course, in this case we are dealing with the true greatness of the spirit, which is revealed in its theological perspective, and not just the act of being included in the lists of voluntary donors.

Scientific and ecclesiastical definition of death

In heart transplantation, accurate determination of death is of paramount importance. The Church refers to the death of a person as a sacrament of separation or separation of the soul from the body. Modern medicine often equates the death of a person with the death of the brain. Thus, death, from the standpoint of the mechanistic anthropology of modern medicine, is defined as an irreversible cessation of brain activity, accompanied by a final loss of consciousness. If the irreversible cessation of brain activity can be established on a purely biological level, then the final loss of consciousness, which, according to church anthropology, goes back to the categories of the human soul, cannot be reduced to biology alone. The identification of the separation of the soul from the body with the irreversible cessation of the activity of the brain, in other words, the identification of death, from the point of view of church anthropology, with the death of the brain, is not justified in any way. According to church anthropology, the soul as a special entity fills the entire human body, being present in all its parts. The brain is not its container, but its organ. The death of the brain means the cessation of the manifest manifestations of the soul, but not necessarily its separation. However, according to modern medical anthropology, which reduces the soul to mental phenomena or mental actions, brain death is identified with the final loss of consciousness. Thus, it becomes obvious that the disagreements about the death of the brain come down, ultimately, to a confusion of the concepts of the essence and energy of the soul. For church anthropology, the soul is a special essence and energy. In contrast, for modern medical anthropology, the soul is simply energy. Thus, if, according to medical anthropology, the stoppage of the brain is identified with the final loss of consciousness, then for church anthropology it comes down to the cessation of the manifestation of its energy.

Ultimately, death as separation or separation of the soul from the body does not cease to be a sacrament. It is impossible to say with certainty that it coincides with brain death. It may coincide with, may precede and even follow brain death. People who survived clinical death and returned to life felt the separation of the soul from the body and left many stories about the unforgettable experience of going beyond their body. This can be considered evidence of the possibility of separation of the soul and body before the death of the brain, because the cessation of brain activity is irreversible and returning to life after it is impossible. Other people came back to life after cardiac arrest and temporary cessation of cardiac and respiratory activity. This means that the cessation of cardiac and respiratory activity is not the final and irreversible separation of soul and body. What can be said about the separation of soul and body in cases of artificial maintenance of respiration and cardiac activity? The question still remains unanswered.

Perception and evaluation of man as the image of God

Any kind of donation of an organ or tissue of the body is a kind of act of self-sacrifice. Despite this, it is unreasonable to liken this act to the sacrifice of Christ. Christ sacrificed His Body and Blood so that people would receive not temporal, but eternal life, the acquisition of which may be accompanied by the sacrifice of temporal life. The temporal life must not be separated from the eternal life and become independent. However, excessive attachment to temporal life dulls the desire for eternal life. “For whoever wants to save his life will lose it, but whoever loses his life for My sake will find it.” “He who loves his soul will destroy it; but he who hates his soul in this world will keep it to eternal life.” In other words, he who loves his life loses it. The one who is able to renounce his life in this world retains eternal life. This evangelical path, which is in conflict with ordinary human logic, along which Christ was the first, undoubtedly lies on a different plane in relation to transplantation logic. Despite all of the above, the compassion and courage required for voluntary organ donation do not lose their significance. It is impossible not to pay attention to the need for pastoral support for people experiencing serious health problems.

The concerns raised by some about the destruction of the post-mortem integrity of organ donor bodies are clearly scholastic in nature. A person is identified neither with his body, nor with his soul, nor simply with their mixture or with their addition. However, there is something that transcends and unifies all this, is not contained in any way in any of them and is not determined in any way by any of them. Man, created in the image of God, is always comprehended and evaluated through the image of God. This comprehension and evaluation relate simultaneously to the whole of humanity, and to each individual person and to his individual activity. Despite any separation of matter and spirit, body and soul, individual and society, people who are the image of God, observing the commandment of love, abide with God, who is love, and together form the one body of the Church of Christ.

In the categories of this multifaceted and developing anthropology, each drop of blood given out of love for one's neighbor is the common sacrifice of the whole person. In this case, the scholastic search for the consequences that organ or tissue donation can have for the posthumous integrity of the body loses its meaning. At the same time, however, it becomes obvious how incompatible with this anthropology is the mechanistic view of man and the consideration of the tissues and organs of his body as medical raw materials or spare parts.

Orthodox approach

The Orthodox approach to all the problems of our time must be based on the measure of perfection, the fullness of which we find in Christ. This measure, which every Christian should see before him, should not, however, be turned into a sword that strikes those who are weak in faith. Without a doubt, Christian perfection exists for all and should not be hidden from any believer. But human weakness is inherent in everyone and it is not permissible to blame anyone because of it. The Church values ​​human freedom without limit and, in order to preserve it, is capable of exhausting the full depth of her indulgence. The Church says her resolute "no" only in those cases when the freedom of a person is infringed and his holiness is desecrated. Nothing can justify the facts when people were forced against their will to become donors of organs or tissues of their body, both before and after death. The human body must be holy. And this sanctity of both the living and the dead body must be respected. The body cannot be regarded as a medical raw material or as a warehouse of spare parts. For the use of a person as a donor, the alleged consent of a person to this is not enough, and even more so, the absence of a documented refusal to be a donor cannot be regarded as consent. Finally, nothing justifies the arbitrary elevation of brain death to the rank of an absolute criterion for determining the moment of death in the minds of those for whom death is the mystery of the separation of soul and body.

Will the new transplant law work?

It is possible that soon a new law “On the donation of organs, parts of human organs and their transplantation (transplant)” will appear in Russia. The draft of this law has already been discussed in the State Duma. The project provides for a novelty for Russia - a mass expression of the will of citizens in their lifetime about their consent (or disagreement) to the removal of organs after death. In this way, the authorities want to solve the ethical problems associated with transplantation and increase the number of possible donors.

Dmitry Suslov (pictured), Deputy Chief Transplantologist of St. Petersburg, Head of the Laboratory of Experimental Surgery of the St. Petersburg State Medical University named after academician I.P.

Lifetime consent to donation: are the Russians ready for this?

— Dmitry Nikolaevich, as a surgeon who has been performing transplant operations for many years, and has been heading the city’s medical service for the collection of donor organs for several years, how do you feel about the draft new law and, in particular, about the alleged lifetime consent to donate?
- Relationship is ambivalent. On the one hand, lifelong informed consent (on these principles, for example, transplantation services operate in the USA, Germany) is evidence of a very high development of a civilized society. On the other hand, as a transplantologist practicing in Russia, the existing presumption of consent to donation is closer to me. That is, when doctors, not having information that a given person refused posthumous organ donation during his lifetime, may not ask the consent of relatives for the removal. Consent is considered by default. Of course, it is impossible to remove organs if the relatives expressed disagreement or if, when the patient was admitted to the hospital, the relatives warned that the patient during his lifetime expressed disagreement to become a donor.

- That is, there are already cases when people officially express their disagreement in advance?
— Yes, I saw entries in the medical records of patients: when they enter the hospital for hospitalization, people write that they do not agree to become donors if something happens. I saw notarized refusals to donate, which our fellow citizens carry in their passports. But these are still isolated cases. And so, I repeat, the rule applies: those who did not say no (or relatives did not do it for them) can be donors.

- Where is it supposed to fix lifetime consent - disagreement?
- The project provides for the creation of several registers, which will include all citizens of Russia with an expression of will, and patients who need transplants, and so on. The creation of such registers, which have a very high degree of protection, is extremely expensive. Therefore, I am not at all sure that the new law on donation will be adopted. Most likely, its further discussion will be postponed. For comparison: we in St. Petersburg wanted to create a register that would include all citizens with transplanted organs (and I note that there are not so many of them - only 580 people). But we were told that such a register, with all degrees of protection, would cost several billion rubles.

- Maybe, as in the USA, just make a note in the driver's license, in the passport?
- Do we have a lot of people walking everywhere with passports? And motorists do not get behind the wheel every day. In addition, there are corresponding registers in the USA.

But the main problem is that if a lifetime mandatory declaration of will is introduced, then we will have an even more catastrophic shortage of donors than now. Because, firstly, few people will go to make an entry in the register. And if he does, then, most likely, in order to write a refusal. And if we introduce the mandatory consent of relatives (if there is no information about the will of the deceased), then in many cases we will also receive the same refusals. There are two main reasons for this. First, the population is not inclined to trust doctors. Secondly, there is no conscious attitude towards transplantation in society. Society is not inclined to think about the problems of a relatively small group of people who are in vital need of a transplant. After all, patients who need heart and liver transplants are doomed without transplantation. In patients who need a kidney transplant, however, there is an alternative - dialysis, which must be carried out every other day. The state explanatory policy in terms of the need for transplantation and donation would have saved the situation. To talk about it politicians and officials.

For example, I discussed issues related to living consent with Australian colleagues (in Australia, consent is required for organ harvesting). And so: cases of refusals - are isolated. Why? Because the high consciousness of the population. And also the fact that if you refuse for your deceased relative, neighbors and friends will condemn you.

I would say that the draft of the new law needs serious revision.

— Excuse me for the indiscreet question: would you yourself express your consent to donate after death?
- Yes. Both me and my family members. We understand that we will not need organs THERE. This is a universal duty towards the society in which we lived.

Mother to daughter, but not wife to husband

- How do you feel about allowing child donation - with the consent of the parents?
- It is already allowed, and it is with the consent of the parents, and not other representatives of the child. This norm is absolutely correct (the norm is prescribed in the legislation of the Russian Federation on the protection of the health of citizens). But in reality, we do not use child donors. Because until now, instructions for ascertaining brain death in children have not been approved. And accordingly, in Russia there is no practice of such a statement.

“But you do transplants for children!”
— Yes, but we take organs from adults. including from living donors. One of the parents gives the child his kidney, part of the liver (the liver has the ability to recover).

— What are the most urgent problems in transplantology now?
— Lack of donors, despite the presumption of consent. Because the diagnosis of brain death is rarely made in our country, while, for example, in the USA it is made quite often. Making such a diagnosis is a complex and lengthy procedure; it is easier to mistake another diagnosis for the cause of death. No donors, no transplants. As a result, 400 people are on the waiting list in St. Petersburg for a kidney transplant. We perform up to 50 operations per year.

As for living donors, only genetically related donation is allowed in Russia. There is no permission for cross donation, for emotional donation. And they are also not provided for in the draft of the new law. Cross donation is when, for example, there is a couple: mother and daughter, mother is ready to donate a kidney to her daughter, but according to the results of special immunological tests, they are incompatible with each other. And there is another mother and daughter, and also incompatible with each other. But at the same time, the kidney from the first mother suits the child from the second, the kidney from the second mother suits the daughter from the first. These are the transfers we have banned. Meanwhile, in civilized countries, surgeons can build large chains - more than a dozen people for cross-donation. Emotional donation - from non-blood relatives - is also prohibited in our country.

I was recently on a business trip to Spain. I will tell you one case from the practice of Spanish doctors. Grandpa is 80 years old. He received a kidney transplant from a deceased donor 20 years ago. After twenty years, the transplanted kidney ends its function. Grandfather needs to be either urgently transferred to dialysis (which, given his age and habits, is undesirable), or a second transplant should be done. When a suitable donor will be found (and in Spain it is also problematic with donors) is unknown. And then the desire to save her husband by giving him a kidney is expressed by his 72-year-old wife, with whom he lived all his life. They began to check for compatibility: it fits. And the transfer took place. I saw this couple a year after the operation: happy, contented elderly people.

In such situations, we are forced to refuse. For example, I was once approached by a woman who wanted to donate a kidney to her sick daughter-in-law. She motivated this by the fact that the daughter-in-law managed to make a man out of her son, saved him from bad inclinations. I had to refuse a transplant.

Now it is not clear what awaits transplantology in connection with the rise in prices. Before the collapse of the ruble, the cost of a kidney transplant was 300-350 thousand rubles. Plus, the need for life-long medication that prevents the rejection of a donor organ. This amounted (before the rise in the exchange rate) from 120 thousand to 470 thousand rubles a year. The numbers are big, of course. But in comparison, dialysis is more expensive. Now we have a very good dialysis, it is possible to compensate for the lost functions of the kidney with good expensive drugs. The cost is approximately 15 thousand rubles for the procedure. And you need three of them a week, for life. Simple calculations show that transplantation is cheaper. In addition, it radically changes a person's life: he becomes free, his life is no longer tied to an artificial kidney machine, there is no need to go to dialysis every other day. Outwardly, the life of an operated patient will not differ from the life of a healthy person. We have operated women who received a donor kidney or liver, even give birth to children! The last case: a 38-year-old patient who underwent a liver transplant became a mother.

Where does the soul go?

- You were engaged in the removal of donor organs after ascertaining the death of the brain and could not help but ask yourself the question of what happens to a person after death ...
“I have not seen the soul separated from the body. But I won't argue that this is happening. Where is the soul located? In my opinion, all over the body. When the structure that realizes the aspirations of the soul dies (and the human brain controls, and hardly anyone will argue with this), the soul is forced to leave. Because there is no brain.

I foresee your next question: does the soul partially transmigrate into the recipient, to whom the organ of the deceased was transplanted? I think no. But some cellular memory may remain. For example, a man who received a kidney transplant from a woman who cultivated flowers suddenly felt the need to plant flowers and take care of them. He was very good at it, although he had never done it before. There were cases when, after transplants, preferences in music, food and drinks changed. But if women were transplanted with kidneys from men who were not alien to tobacco and alcohol, the ladies did not show these inclinations after the operation.

- Have your patients tried to find out who gave them the organ, and therefore the chances for a new, full life? Did they get to know the families of the departed people?
- Information about donors is confidential. The maximum that we can say is the gender of the donor and his age. By the way, many of those who have been operated on, their relatives go to church, put candles in memory of donors.

In our conditions, it is not necessary to disclose information about donors. It is still unknown how the family of the deceased will perceive the appearance of a rescued patient on the threshold of their apartment. The reaction can be from "plus infinity" to "minus infinity".

There is no crime in transplantology in Russia

Could there have been clandestine organ transplants in Russia?
- Not! I declare this with full responsibility! Because there can be no secret patients in principle. They will definitely make an official announcement. First, after transplants, you need to take immunosuppressive drugs for life to prevent rejection of donor organs. Their cost is extremely high, and they are not sold at every corner. The state pays for these drugs. Secondly, patients again need to do tests for the concentration of these drugs in the blood and some other indicators for life. This is done only in well-defined laboratories. So the patient will definitely be in the field of view of official doctors. If an operated patient arrives in St. Petersburg from another city, we will definitely contact his former doctors and ask for details about the patient. Transplantologists from other cities, where patients from St. Petersburg arrive, do the same.

By the way, for the entire time of the existence of transplantation in our city (and the first transplant - kidneys - we had in 1976) there was not a single lawsuit, not a single criminal case related to transplantation.

But in a number of countries, the sale of organs does exist. These are countries where unrelated donation from living people is allowed. Yes, from our point of view, it is terrible. And from the point of view of a poor person living in a poor country, selling a kidney even for 5,000 US dollars can mean solving certain financial problems. And with one kidney, you can still live fully for decades.

- Have you been approached with an offer to sell an organ from a living person?
— Yes, there are such appeals from time to time. For example, last year a man called and offered to sell his kidney for $50,000. I explained that this was not possible.

In 2013, 1,400 transplantations were performed in Russia.

In the US, 20 times more.

Of the 83 constituent entities of the Russian Federation, only 22 have transplant services.

Sensational in transplantology was 1967. On December 3, 1967, Christian Barnard, a cardiac surgeon from Cape Town, transplanted a donor heart into a human chest for the first time in history. As the newspapers wrote at the time, "the astronauts who set foot on the moon didn't make as much noise as Barnard did with his scalpel." Barnard's patient lived only 18 days. Now people with transplanted organs live full lives for decades.

Before the collapse of the ruble, the cost of a kidney transplant was 300-350 thousand rubles. Plus, the need for life-long medication that prevents the rejection of a donor organ. This amounted (before the rise in the exchange rate) from 120 thousand to 470 thousand rubles a year.

Dialysis is more expensive. Its cost is approximately 15 thousand rubles for the procedure. And you need three of them a week, for life.

Meanwhile

In a number of countries, transplantation has become so routine that organs are even transplanted into pets. For example, in the US, you can transplant a donor kidney to a cat. From a live cat. A stray cat is taken as a donor. But with one condition: the owner of the recipient cat undertakes to take this street cat after the operation and create decent living conditions for it.