Science fiction has long assumed the reality of organ transplants. The ability to use the organ or tissue of one person to save the life and health of another is the dream of doctors of all time. In the 21st century, it became a reality that requires not only a certain level of scientific progress, but also an established legal framework.
The state proceeds from the presumption of a citizen’s desire to survive in the event of illness or serious injury, using the achievements of modern medicine, including organ transplantation. In this case, a discussion arises about his voluntary participation as a donor for another. The solution is the presumption of consent to organ donation.
Transplantology Development
Scientists have struggled with the problem of organ transplants since the beginning of the 20th century. Only in 1965 was the first successful kidney transplant in our country made. In the 21st century, transplantologists learned to transfer more than 16 tissues and organs from a living or deceased donor.
The law of the Russian Federation “On transplantation of organs and (or) human tissues (as amended on May 23, 2016)” does not apply to blood, reproductive organs and tissues. The rest transplantation is strictly regulated by him.
Why are laws changing?
With the development of science, the number of possible organs for transplantation is growing. The attitude of people towards the problem of donation is also changing. Lawyers improve the laws as society develops and its needs.
Transplantology saves terminally ill patients and returns to the full life of people with disabilities. From a financial point of view, this is more profitable for the state than the payment of pensions or regular expensive treatment courses for unemployed citizens.
At the same time, more and more donor organs are required. Legislatively, the state seeks to protect donors, eliminate crimes in this area and increase the number of organs for transplantation. For this, the presumption of consent is introduced. Donation is promoted by the media as a manifestation of humanity and humanity.
Pros and Cons of Donation
Public opinion in Russia fluctuates when evaluating the idea of free transfer of a part of the body from one person to another. The advantages of donation include the ability to do a good deed: save a life or maintain the health of one's neighbor. This is a help not only to the dying, but also to his family. To save the life of the father or mother of young children means saving them from orphanhood. To give hope for a child's full life is to make his parents happy now and save them from lonely old age in the future.
But people in our country are afraid that donated organs will be sold. Or they themselves, declaring their desire to become a donor, will attract the attention of “black transplantologists”.
There are objective reasons for doubt:
- intravital removal surgery may cause complications or death;
- the donor will lose a job requiring excellent health and will suffer financially;
- the heartbroken relatives are deeply hurt by the thought of organ harvesting from a deceased relative;
- the transmission of part of one’s body is contrary to spiritual beliefs.
According to surveys, most members of our society strongly oppose personal donation or find it difficult to indicate the reason for the refusal. Moreover, almost 100% of people would like to receive a donor organ to save their life in the event of a fatal illness or accident.
Intravital Donation
A person during life can become a donor of blood, reproductive tissues or paired organs: lung, kidney, part of the liver.Organ removal should not cause substantial harm to the donor's health. The age of the donor is from 18 to 65 years. And he is necessarily a close consanguineous relative of the recipient. The patient’s husband or wife can become his intravital bone marrow donors.
Doctors insist that the damage from organ harvesting from a living person should be justified by the low risk of rejection from the recipient. And this is only possible with tissue similarity among relatives.
For example, the first successful kidney transplant operation was performed in twins. In the future, doctors faced rejection of donor organs in other patients. They found out the cause of numerous failures and realized that the first success occurred precisely because of the identity of the tissues and blood of the subjects.
To get directions for transplantation, the patient is examined. Its purpose is to determine whether it is possible to cure or significantly improve health in any other way than replacing the damaged organ. Intravital donation is allowed if there is no suitable tissue for the deceased donor, and its expectation will lead to the death of the patient himself.
Posthumous donation
With posthumous donation, timely recognition of the death of the whole brain becomes decisive. In order to avoid violations and abuses, this is done by the medical commission, which includes doctors with at least 5 years of experience who are not related to transplantology.
Bodies are seized by order of the head physician of a medical facility. In Russia, only 15 federal and 30 regional medical centers are entitled to this.
Private clinics and other hospitals outside the approved list are forbidden to remove, store and transplant organs for free or for free.
Until recently, child donation was not defined by law. Now it is possible with the consent of the parents. Guardians do not have the right to consent to the removal of organs from orphans.
Who will not become a donor
A child cannot consent to the transfer of his organ if his parents are against it. Donation of orphans is excluded by law. Persons over 18 years of age, whose legal incapacity is recognized by the court, can give their body away only with the consent of the guardian. People suffering from a number of diseases will be denied the right to be a medical donor.
What does presumption of consent mean?
All other citizens of the Russian Federation are potential posthumous donors. This is called a presumption of consent.
Only the refusal of donation expressed during life and voiced by relatives after death becomes a ban on organ harvesting. In all other cases, the person is considered the default donor. The presumption of consent works on the principle of “What is not prohibited is permitted”.
Why is this presumption valid in the Russian Federation
In world practice, there are two approaches to this problem: the presumption of consent and disagreement for transplantation. Each country makes a choice in favor of one or another installation. The presumption of consent to organ removal in Russia was adopted in 1992.
It is believed that the presumption of disagreement is more democratic, but requires enhanced propagation of donation by the state. This is not so much campaigning in the media or a noble image of a donor on the screen, but the skillful work of specially trained people in medical institutions. Their task is to help make a decision to give up the organ or to convince the inconsolable relatives of the deceased for the sake of his blessed memory to give a chance to the terminally ill.
The presumption of consent also has its supporters. In countries where the need for donor organs is many times greater than their availability, this method is used to provide transplant centers with material for work, and patients need to reduce the waiting time for help. The presumption of consent to organ donation meets the expectations of the inhabitants of the countries that have chosen it.
Both options - consent or disagreement - lead to a decrease in the failure rate in the case of high social responsibility in society and trust in the state.
How to refuse a donation
A person can always issue a ban or permit, so as not to fall into a situation where the presumption of consent for a posthumous donation will work automatically. The new version of the law involves the creation of registers of permits, refusals, or applications for in vivo transfer of the body. It is also planned to make the federal line of recipients open on the Internet for its participants.
Now you can record the refusal in writing, assure it by a notary and always keep it with you or transfer it to relatives in case of sudden death. After creating a register of will, information on consent or prohibition will be available to doctors in a timely manner, the need to search for relatives to clarify the will of the deceased will disappear. Moreover, the time for their notification is limited to 2 hours.
The registry will contain reliable information about the will of the potential donor. Often the relatives of the deceased refuse, based on their own convictions and moral principles, and do not know the plans of the deceased.
Donor and Recipient Rights
Even before signing the contract for the transfer of the organ for transplantation, the donor receives full information about the operation, its possible consequences and the risk of complications. After it, all necessary treatment and rehabilitation are carried out at the expense of the state. The donor can change his mind and terminate the contract at any time before the operation. This will not entail penalties or forced exclusion from the registry of donors. The presumption of consent to withdrawal does not apply to this case.
When making a decision, a person proceeds from the interests of his own health and personal desire to help a relative. To interest him in money is an unlawful act. It is also unacceptable to exert psychological pressure or use the dependence of the donor on the recipient of the organ.
The recipient has the right to refuse to accept the body at any stage of preparation for the operation. The patient examines information about the upcoming transplant, assesses the risks of complications and tissue rejection, his moral responsibility for the damaged health of a donor relative. If the recipient is conscious and competent, he has the right to refuse a transplant, even if this is the only way to save his life.
ROC and public opinion about donation
The Russian Orthodox Church attributes donation to charitable deeds. At the same time, priests have no right to persuade or insist on the transfer of organs if parishioners turn to them for advice. Confessors in private conversation help to understand the true motives of the donor, his readiness for such charity, but do not use the presumption of consent as an argument.
Secular society also has no right to impose on everyone the desire to become a donor. During the discussion of the latest amendments to the law, the idea was expressed that a person whose name is registered in the list of those who refused to donate should be automatically excluded from the list of recipients. Human rights activists did not support this proposal. But the amendment was included that wished to become a donor during life or after death, receives benefits for promotion in the queue for organ.
Responsibility of medical institutions
Regardless of whether a person is in the register of wills, in the list of donors or in need of an authority, his personal data is not transferred or published. The disclosure cannot be justified by the presumption of consent to the removal of organs. In the event of an intravital organ transplant, information on the donor and recipient is also considered confidential.
Medical institutions are responsible for the examinations, operations, the safety of the seized tissue and subsequent rehabilitation.
Transplantation centers are not entitled to offer patients an experimental organ transplant operation.They carry out exclusively approved by higher authorities interventions. Only specialists from the Ministry of Health and Social Development of the Russian Federation and the Russian Academy of Medical Sciences evaluate how ready the clinic is for this or that operation, whether the necessary equipment is available, and whether the qualifications of the medical staff are sufficient.