The 'Criminal' Issue of Kidney Transplantation

A patient with bad kidneys will have to visit a hospital three times a week to filter blood for four hours

A lot of doctors refused to talk. Those who agreed asked not to tape them and not to mention their real names. Those people fight with death, their wages are a lot smaller than the ones of lawyers or journalists, programmers or managers, for example. However, they have been categorized as criminals.

The republican clinical hospital for children, the hemodialysis and  kidney transplantation department. Children are slowly moving along the corridor. They have disproportionately big heads, short crooked legs: ill kidneys cannot provide the calcium balance in the body. Such children dream of new kidneys. 

Medical operations do not horrify those children. The tormenting procedure of the permanent hemodialysis is a lot scarier for them than a surgeon's scalpel. The lucky children can be recognized with doctor's masks that they wear on their faces: the immune system has to be subdued in order to help an alien kidney become accustomed to a new body. Any microbe can be fatal in this situation. However, there is a lack of donor kidneys. The number of kidney transplantation operations in the above-mentioned hospital stands 20 operations a year. This is a drop in the sea.

According to experts' estimates, 4.5 thousand Russian children are in need of such operations. There are only seven children's hemodialysis departments and kidney transplantation in Russia at present. Each of those departments can house not more than 50 patients. In the Moscow region, the need for dialysis and transplantation reaches 325 people a year. The Moscow regional research center can accept not more than 45 people. Thus, 85 percent of patients simply die.

A patient with bad kidneys can live with the help of hemodialysis. A sick person will have to visit a hospital three times a week to filter blood for four hours. This procedure costs the state up to $20,000 a year for one patient only. Furthermore, not less than ten percent of patients can receive this treatment. About 500 kidney transplantation operations are performed in Russia every year nationwide (up to 400 in Moscow). The cost of surgery and the post-operation treatment stands at $5,000 a year. After that, a person will be released. Kidney transplantation technologies have been developed and practiced - the major problem is the absence of donor organs. About 500 people have lined up for the operation in Moscow.

Let us imagine that a person with the cracked skull is taken to a hospital after an air crash. If ER doctors diagnose the death of the person's brain, they call the Moscow donor center. A team of surgeons arrives at the hospital, they withdraw the kidneys of the deceased person and take them to a special laboratory to examine their immune characteristics. The kidneys will then find new owners with similar immune profiles. The kidneys will have to be transplanted into a recipient within 24 hours (there are seven hospitals for such operations in Moscow).

There might be an absurd continuation of the story too. A group of police officers rushes into the operating room demanding to be paid. They believe that doctors will most likely sell the kidneys, so they want some money - otherwise they might start murder proceedings against the doctor. 

Russian doctors are afraid when they take a potential donor to a hospital. ER doctors prefer not to make any calls - they do not proft from such calls and can be easily be implicated in a criminal case.

Some doctors venture to take such risks and then they find themselves involved in criminal proceedings and scandalous investigations conducted by journalists, who try to enhance their careers with the help of "killer-doctors." It would appear the more controversial this issue becomes on television, fewer transplantation operations are performed and the more patients die.

Everybody tries to find something criminal about transplantations in Russia. There has recently been a scandal about surgeons who tried to cut kidneys from patients whose heart was still beating. Apparently, their colleagues did not know that one should distinguish the notion of clinical death (cardiac arrest) and biological death (death of the brain). A human being can recover from clinical death if doctors perform an electric shock procedure, but it is impossible to do anything to save a person from the state of biological death. Brain death causes irreversible processes in the cerebral cortex.

The point of all transplantation problems  is about special conditions to withdraw the organs from the body. Kidneys should not be taken from a corpse, because the organs will be dead too - they will be absolutely useless. Kidneys should be taken from a dying patient, whose heart is still beating. The line between life and death must be very thin. There is nothing criminal about it.

Aleksey Valov, chief surgeon of the transplantation department of the republican clinical hospital for children says: "It is unreal to perform a kidney transplantation operation in a basement, for example. Furthermore, the success of the operation depends on the post-operation treatment - it is extremely important. A patient has to take immune depressants, the blood biochemistry needs to be observed all the time. Who can become a potential client of the "underground transplantation clinic?" It is a person who can pay very good money for the operation. Are there a lot of such businessmen with bad kidneys in Russia? A transplantation operation is not like an abortion: a patient will have to wear a mask for a month, to take immune depressants. Russian law concerning transplantation needs to be seriously clarified to avoid criminal issues. 

Anna Gaganova

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Author`s name Margarita Kicherova