Sell a kidney: How donation works in Russia and the world
ON DONATION AND ORGAN TRANSPLANTATION THE MAJORITY KNOWS LITTLE - but there are many frightening legends about them: even adults are ready to retell horror stories about the "black market", children who are "stolen on organs", and finally, the ability to pay off creditors with their own kidney. We tried to figure out how the donation works in Russia and other countries and to what extent these bikes are true.
Blood and bone marrow
The most frequent case is blood donation; practically any healthy adult can be a donor. The procedure lasts from fifteen minutes to one and a half hours - longer, if in the process of donation the blood is divided into components. For example, you can take only platelets - the cells responsible for stopping bleeding. Before donating blood, no special preparation is needed, the procedure can not be called painful - but it provides an opportunity to provide real assistance. And although they are scarcely enough, many people become blood donors every year — and they even get certain benefits. Usually a person takes 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 in the first place to those who have lost its large volume, for example, in case of severe bleeding as a result of an accident. In other cases, when blood cells do not perform their tasks, the patient needs a bone marrow transplant - the organ where blood is produced. Such treatment is necessary for people with congenital blood diseases or its malignant changes: leukemia and lymphomas. Of course, the body can reject "alien" bone marrow, so potential donors are recorded in special registers and they are analyzed by the HLA phenotype - a set of genes responsible for tissue compatibility. The bone marrow, unlike blood, does not give up regularly: even after entering the register, a person may not become a donor. This will be required only when a patient appears, needing exactly the appropriate HLA-phenotype cells.
Organ donation in life
In addition to blood and bone marrow, a living person can become a donor of the 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 human organs and / or tissues. " It is clear that these are more serious interventions - but people go for them to save the lives of their loved ones. There are about 1,000 kidney transplants per year in Russia - only one fifth of them are from live donors. By law, an organ or a part of it can be removed from a living person only if he fully agrees to it. Finally, in Russia, you can donate an organ exclusively for a blood relative: for a husband, a wife or a stranger, donating a kidney will not work. No remuneration for this is provided for - and the law clearly states that the sale of human organs and tissues is unacceptable.
Although you can find several sites in RuNet with ads like “I’ll become a kidney donor for a reward,” it is unlikely that this can be done in Russia, primarily because the donor and recipient must be blood relatives by law. Today donations for money are made, for example, in Pakistan, India, Colombia, the Philippines - and WHO recognizes that this is a serious problem. Clinics and medical tourism companies bring patients to Pakistan for a kidney transplant - and the cost of these services for Americans can go off-scale for $ 100,000; the donor of them will get no more than two thousand. 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 the 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 donor screening, it may be that the kidney is infected with the hepatitis virus or HIV. There are problems with the recovery period after operations, and with the appointment of immunosuppressants - drugs that reduce the risk of rejection of the new kidney. Often, “tourists” return to their homeland without any statements or documents confirming the operation.
The main problem of transplantology is the lack of donor organs; There are always many more people on the waiting list. It is believed that to solve this problem it is necessary to conduct educational programs and inform people about how they can become organ donors during life and after death. In developed countries, donors are reimbursed for all medical expenses, can provide insurance in case of complications, pay for transport or part of their salaries lost in the postoperative period. Of course, in countries such as Pakistan, it is important not only to improve the laws relating to transplantation, but also to work to eradicate poverty. As the same transplantologist Nourani says in his article, selling a kidney to the poor people of Pakistan is the second opportunity to earn extra money. The first is the sale of their own children.
Posthumous donation
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 by default considered a donor. If the patient’s relatives or he himself expressed disagreement during his life, 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 deceased learned about organ harvesting only from postmortem 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 permission from relatives, there is always a chance of refusal - but it may be better to work on normalizing the very idea of donation.
For nearly twenty-five years, Spain has been the world leader in transplantation, where in 2015 there were 40 donors per million population and 13 organ transplants per day - for comparison, there are only 3.2 donors per million in Russia. Most often, kidney transplantation is performed again - this is a relatively simple operation (compared to transplantation of other organs), which usually does not even remove the “native” kidney, which has ceased to work. In Spain, there is also a presumption of consent, but relatives of the dead are delicately asked whether they are against it - this moment is shown in Almodovar’s film “Everything about My Mother”. The statistics speak for themselves: if there are failures, it is extremely rare - and this is due to the well-informed population and the fact that donation is practically considered the norm. Each hospital has personnel trained in relevant conversations with the family, as well as specialists and equipment for, in fact, organ harvesting.
In Russia, there are few transplant centers: in 2014, a kidney transplant was performed in 36 centers, the liver - at 14, the heart - at 9, and more than half of all operations occur in the Moscow region. Because of the considerable distances to residents of most parts of the country, transplantation is virtually inaccessible. There is a vicious circle: donation and transplantation remain rare, people know little about them and do not want to accept organ harvesting 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 the lack of equipment in clinics.
Reproductive donation
Speaking of donation, it is worth mentioning the delivery of sperm and eggs. Almost any young and healthy man can become a sperm donor (some clinics, however, express a wish for "good external data"); with a certain regularity on this you can earn up to 20 thousand rubles a month. With eggs more difficult: first you need to undergo a course of stimulation therapy - this is a daily injection 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 quite 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 placed either on a biological or surrogate mother.
Photo: Africa Studio - stock.adobe.com, benschonewille - stock.adobe.com
