Black transplants. Where are the models operating?

According to Kommersant's information, a decision of the European Court of Human Rights is expected in the near future in the case of Alina Sablina, whose relatives complained that they were not notified about the posthumous organ harvesting. In June, the Moscow City Court will consider a complaint in a similar case. Aleksey Pinchuk, Head of the Scientific Department of Kidney and Pancreas Transplantation at the Sklifosovsky Research Institute for Emergency Medicine, told Kommersant's correspondent Valeria Mishina how one can agree or disagree with posthumous donation in Russia, how the system for distributing donor organs works, and how long patients have to wait for an organ for transplantation .

Russian officials are talking about a growing number of organ transplants. At the same time, lawsuits are filed in courts from relatives of those killed in road accidents and who have become posthumous donors: families complain about the removal of organs without notification. What is happening in Russian transplantology?

Unfortunately, we have not observed fundamentally significant changes in our industry over the past ten years. There are certain successes. For example, we began to actively implement those types of transplantation that were practically not performed in the country before: these are heart and liver transplants (in a few centers they even became routine), lung transplantation, pancreas transplantation... 10–15 years ago, these were rare , isolated cases. Now such operations, one might say, are put on stream, but, unfortunately, not throughout the country, but only in the leading, largest transplant clinics.

- What are these clinics? And what happened ten years ago that these operations became routine?

Nothing global has happened, we have probably already come to the point where we understand that without complying with global trends, without keeping up with world medicine, we find ourselves on the periphery. Therefore, they began to actively master these methods and try to introduce them into everyday clinical practice. There are not so many clinics that work with all types of organ transplants in our country, we can single out about five leading ones in this regard, no more. These are, first of all, the Shumakov National Center for Transplantology and the Sklifosovsky Institute, which is the largest city transplant clinic in the capital. All the rest are still inferior in scale - the regional hospital named after Ochapovsky in Krasnodar, MONIKI named after Vladimirsky in the Moscow region, regional transplantation centers in Rostov, Novosibirsk ... But, unfortunately, in the country as a whole, the pace of development of the industry leaves much to be desired. Leading clinics are still mainly concentrated in Moscow.

If we look at the map of transplants in the whole country, we will see that about half of all transplants are performed in just two institutes - Shumakov and Sklifosovsky.

There are more heart transplants at the Shumakov Institute, we have done more kidney transplants until recently. In Sklifa, more liver transplants are performed from cadaveric donors, and from relatives - in the Shumakov center. We perform almost 200 kidney and 100 liver transplants, about 10 heart and lung transplants every year. In other clinics, they transplant an order of magnitude less. But these round figures do not quite accurately reflect the current state of affairs, because from year to year the number of organ donors nationwide remains at a very low level.

- How many need organ transplants in Russia?

So many. We perform 200 kidney transplants a year, which is a decent number for one clinic. Nevertheless, we constantly have about 500 people on the waiting list, and these are only Muscovites - residents of the region, where, compared to the rest, this situation is not so acute.

On a national scale, the picture is more grim. Unfortunately, we, as a structure of Moscow healthcare, cannot provide assistance to regional patients. This is done in federal clinics - the Shumakov Center, the RSCH, the Research Institute of Urology. All these institutions are also located in the capital. Therefore, those who were able to get to Moscow have some chance.

- How to get to Moscow for a transplant?

So far, through the system of federal quotas for the provision of high-tech medical care. They are distributed by the Ministry of Health. This year the quota system is preserved. But if funding is provided through the compulsory medical insurance fund, I don't think the situation will change dramatically. After all, it doesn't matter where exactly we get the funding from, in any case, the available donor organs do not disappear. All fit ones that can save a life will be transplanted. In any region. Here the question is not about financing, but about the available quantity - we are able to perform not 200, but also 400, and 600 kidney transplants a year. This number corresponds to our level, both surgical and medical in general, but we do not yet have such a number of organs.

- How long do people wait for a suitable organ?

On average, in our clinic, if we talk about a kidney, then one and a half to two years. There are a number of patients who have to wait longer, because they have certain medical difficulties with the selection of an organ.

“It is not the organ that is “searched”, but the most suitable recipient from the waiting list is selected for the organ”

How is an organ searched for a patient?

It is very important to note that it is not the organ that is “searched”, but the most suitable recipient from the entire list of those in need, from the so-called waiting list, is selected for the already existing, withdrawn donor organ, with a certain set of medical characteristics. The selection of the recipient, in addition to a variety of medical indicators, is also carried out taking into account the length of the wait. When, unfortunately, it is not possible to save a patient with a stroke or a severe head injury in the intensive care unit, and if neither he nor his relatives actively spoke out against the possible removal of organs, after ascertaining death, they can be used for transplantation. Organs are removed by specialists of the donor service and preserved for a short time. For an existing organ, recipients are selected from the waiting list, to whom this organ is best suited. And from this shortened list - the one who is waiting for the operation the longest.

- What should match, in addition to, for example, blood type?

There are about 20 factors that must be taken into account in order for a patient's donor kidney to work, work well and work for a long time. The most important ones are blood type, age, initial state of the organ, immunological compatibility.

Also, if the donor for a long time suffered from hypertension, it is very important that the recipient's own blood pressure is not low. The kidney will work qualitatively in the conditions to which it is "used" and in which it worked last years donor life.

And there are many such nuances in transplantation, believe me.

- How long will the organ work if all the parameters agree?

Ideally, we want the patient to live happily ever after. old age and died due to age with a normally functioning transplant. Unfortunately, life makes its own adjustments, but there are survival rates that can be called record-breaking. The maximum time that a transplanted kidney has worked is 42 years. Transplanted heart - 36 years old. There is no doubt that with proper selection of the organ and recipient, impeccable surgery, and competent management of the patient after transplantation, a donor organ can work for several decades.

Organ transplant patients need to take immunosuppressants to keep the organ from being rejected. How do they affect health?

The arsenal of immunosuppressive drugs is constantly expanding. In fact, the problem of rejection - something that our predecessors and teachers faced all the time - is not as relevant now as it used to be. That is, in principle, to deceive the body and make it "believe" that the donor organ is its own, in most cases it is possible. On the other hand, it must be admitted that even the most modern immunosuppressive drugs have a number of side effects, which still do not add health to the recipient. But these undesirable phenomena are well studied, we know how to prevent them, how to prevent their development and how to deal with them, if they have already appeared.

For example, it is often necessary to deal with the development of diabetes mellitus. Or, against the background of immunosuppression, blood pressure may increase. An increased risk of developing infectious diseases, and not only the usual types of pneumonia and influenza, but also specific ones associated specifically with the suppression of immunity. For example, cytomegalovirus and herpes. For ordinary person they are not dangerous. But under conditions of suppression of immunity, they can pose a threat to the health and even life of the patient.

- Some patients should not receive an organ transplant. What is the reason and who are these patients?

There are fewer and fewer of these patients every year. We are now very liberal about, for example, the age factor. Until relatively recently, patients over 60 years of age were practically not considered as candidates for transplantation. Today, we successfully operate on patients much older than 70 years. If the patient can endure anesthesia and major surgery, if he potentially lives after transplantation for at least five years, we try to help him. The same applies to patients with autoimmune pathology - when the body itself "devours" its organs. Previously, such patients were almost never operated on - after all, just as the immune system damaged its own kidneys, it also dealt with the transplanted one in the shortest possible time. And now we have the ability to successfully prevent such situations. For example, a patient with diabetes mellitus undergoes a kidney and pancreas transplant at the same time. Kidney failure is eliminated, and diabetes is actually cured and does not further damage the transplanted kidney.

- Where are the organs available for transplantation taken into account in Russia?

Separately in each organ donation center. So far, there is no full-fledged register, as well as the so-called organ bank. After all, donor organs acceptable for transplantation have a very short “life period”. It is impossible, for example, to freeze an organ in order to then get the right one from the shelf, thaw it and transplant it.

A kidney transplant, for example, is kept fit for transplantation for 24 hours, this is the maximum. Subject to special conservation of course. For other organs, this period is much shorter: the heart is up to 9-10 hours, the liver is up to 16 hours, the pancreas is up to 15 hours, the lungs are up to 7-9 hours.

Therefore, the selection of the recipient, his call and preparation is carried out in parallel with the work of the donor service. Both the donor and transplant teams work around the clock, on holidays and weekends. This is a worldwide practice.

Organizes the whole process of the coordinating donor center. Its functions include notifying the teams, preliminary discussion of suitable recipients with the centers where they are waiting for transplantation. They try to take into account all the nuances initial stage when they are just starting to extract.

Thus, the entire organ distribution system is limited to the region or neighboring regions, otherwise there are difficulties with the successful delivery of the organ.

The kidney can be delivered in time to other regions, in some cases - both the liver and the heart. But why? Each region should have an organ donation process, and each region should have specialists and clinics that can transplant organs to patients living there. There is no need to organize the delivery of organs throughout our vast country on an ongoing basis - such a need can arise only in exceptional cases. Although we, for example, have experience in transplanting kidneys taken even in Krasnoyarsk. Colleagues did not have a suitable recipient on the waiting list (there was a rare blood type), they contacted us, we calculated the delivery logistics and met the deadline, everything went well. But this is a rare, isolated case. In a good way, the distribution of organs should remain within the region, with the availability of a potential recipient within 1–2 hours. Again, I repeat, this is a widespread, worldwide practice.

- What are the chances that the transplanted organ will take root?

The survival rate of organs is now very high for any organ and on average exceeds 95%: 98% - in kidney transplantation, in liver, heart and lung transplantation - above 90%.

- When transplanting a kidney and liver, how much is cadaveric donation, and how much is related?

Up to 20% can be related donation in different clinics. In other cases, patients are waiting for transplantation from a post-mortem donor. Related transplantation of a kidney or part of the liver, primarily for organ deficiency. With a sufficient level of development of organ donation, related transplantation will go into the area of ​​rare cases that are difficult in terms of medical selection. And the active development of related donation programs is due to unresolved problems and difficulties in organizing posthumous donation.

“Donors can be those dead people who could not be helped”

- Compared to other countries, what is the level of posthumous donation?

Unfortunately, we are among the lagging behind. In the world we are somewhere in the third ten.

- In other countries, the system is based precisely on cadaveric donation?

This largely depends on the duration of waiting for an organ transplant from a post-mortem donor. For example, our colleagues in Belarus actually do not have a waiting period for a transplant, because in terms of the level of development of organ donation, they provide the necessary number of transplants for all citizens of the country. That is, if a patient appears who needs kidney, heart, liver transplantation, then the operation is performed on him within a month, a maximum of two. Because the level of organization of the organ donation system, the level of administration made it possible to build a system in which all possible patients whom doctors could not save will be considered as organ donors.

- How is the situation in Russia different then? We have the same presumption of consent.

Our weak point is in the system of administrative decisions, in the interaction of the donor service with those hospitals where they try to save the lives of patients, but this is not always possible. For example, with an incompatible head injury or severe brain damage as a result of a stroke, circulatory disorders. When all such cases are covered by the attention of the donor service, believe me, our level of organ donation will increase significantly. Again, Moscow a prime example. The average level of organ donation in Moscow also leaves much to be desired, but at least this local example shows that with the proper approach, primarily through administrative and organizational efforts, it is possible to achieve a level five times higher than in the whole country .

Now the total donation rate does not exceed 4 organ donors per 1 million people. And in the capital - above 17. An acceptable level to which one should strive is 28-32 donors per 1 million people.

And it is quite achievable when the entire pool of potential donors is covered by the attention of the donor service.

But Moscow is currently unable to provide for all those in need throughout the country; this requires the development of donor services in the regions. And we see that there are areas where this development is very successful: Novosibirsk, Krasnodar, Rostov, Yekaterinburg, Tyumen.

- Large federal centers?

In principle, this is a global trend. Such a service as organ donation and organ transplantation is inappropriate to be developed at the level of central district hospitals. She needs flow. In a small hospital, even when reaching the most serious coverage, 5-10 transplants per year will be performed. And the specialists there will never accumulate the necessary experience and level so that all these operations end well for them, there are no problems and complications. It is better to attach patients to federal, large regional centers. But nevertheless, taking into account the scale of our country, in each region, in major cities with a serious level of medicine, surgery including this is possible. But this is not yet the case in all regions.

- Are the indicators you mentioned, 28-32 donors per 1 million people, possible now?

Possible now. These are the dead people who, despite the titanic efforts of doctors (who are actually trying to save patients, but doctors are not gods), could not be helped.

“As a rule, we have opinions that doctors killed”

In Russia, there is a presumption of consent to the removal of organs - if the patient and his relatives have not indicated that they do not want the removal, according to the law, the organs have the right to take them. Doctors have no obligation to ask the opinions of relatives. How ethical do you think it is?

In the world, two systems have developed and are developing in parallel. The first is when it is considered by default that if a refusal has not been declared, then in the event of the death of a patient, if his organs can be removed, they will be removed for transplantation. This is the so-called presumption of consent, which is practiced in our country. The presumption of disagreement, or the presumption of requested consent, on the contrary, states that if the will of a person is not known, then by default it is considered that the person was categorically against it. And in this case, it is necessary either to find out the opinion of the patient, while it is still possible, or to introduce some documents that, during life and in full health, will register his consent. And here we can still talk about registers ... Or you need to ask for the consent of relatives if the patient, due to the severity of his condition, cannot already say this. In fact, both models have pros and cons. And there are ethical disputes between their supporters.

- Where are the models operating?

IN North America, Canada, the US, the requested consent is valid, in Europe - 50/50: for example, Spain is the requested consent, the UK is the presumption of consent. In some countries, these models smoothly flow into one another: at first they worked according to one model, then they switched to another. It seems to me that if we choose the model of requested consent, when we require people to fix their opinion in the register, put a mark in the rights, then in this case success comes only to those countries that have a high degree of public trust in medicine in general. We in Russia cannot, unfortunately, boast of such a situation. We, as a rule, have opinions that “the doctors killed, the doctors treated them negligently, they didn’t pay money to the doctors - therefore no one will come to you.” This is regularly heard in the media, from the pages of newspapers, from the TV screen, the Internet is full of such reviews, regardless of whether we are talking about transplantation or the treatment of the common cold. And all this speaks of the degree of public trust in doctors and medicine as a system as a whole. Of course, when people hear all this, even if they do not have a clearly formed negative opinion, then under the influence of all this informational noise, if they are put before a choice for or against, a person will say “no” just in case, without bothering to understand the issue in detail . The existing legislative base in our country is absolutely adequate to the social state. But at the same time, any person has the absolute right and opportunity to record in advance their disagreement with posthumous organ harvesting.

- How to fix it?

In practice, this does not apply, but by law, when hospitalized for any reason, a person can tell the attending physician that in the event of a fatal outcome, sudden, accidental, unpredictable or expected, he categorically refuses to be an organ donor. With this patient, the donor service will not work by default, due to the refusal of the patient himself. The same applies to relatives: when a patient was brought to the hospital already in a severe agonal state, or something happened, and he ends up in the intensive care unit and cannot express his will, it is enough for relatives to tell the attending physician that they are categorically against: “If you if it is not possible to save him, we ask you not to consider him for the possibility of posthumous donation.” All. The organ donation service will not be called for this patient, and even if they have already arrived and the condition leaves no doubt that death inevitable, the brigade will simply turn around and leave. Believe me, you don't need to fill out any paperwork, you don't need any signatures, you don't need any petitions, you just need to tell the attending physician, the head of the intensive care unit. This will be enough.

“No one will come to him, sit, rub his hands and think about what will be cut out now ...”

- When do doctors begin to understand that they have a potential donor in front of them?

Based on forecasts. If there is any significant percentage of the probability that we will not be able to save the patient in his current state. An experienced resuscitator can assess the situation and say that, probably, in a day or two a fatal outcome is highly expected, and call the organ donation service for a preliminary assessment so that they take it on a pencil. If they come or ask by phone how this patient is doing, and they are told that he is on the mend, there is a positive trend, the patient is removed from observation. No one will come to him, sit, rub his hands and think about what will be cut out now ... This will not happen. Doctors work here. Some more, some less, but they are all very highly moral people.

But a doctor who treats a patient and, unfortunately, cannot cure him, has two options - either inform the organ donation center or not. He understands that in one case one of the relatives can later file a lawsuit with the prosecutor's office, and in the other he will sleep peacefully.

And this is the peculiarity Belarusian model: they have a failure to report such a case, about a potential donor, is equated to a failure to provide medical assistance. Those patients that this doctor does not see, who are in transplant waiting centers and who the organs of this deceased (or dying at the moment) person can help. He died here - a doctor will not be punished for this (if there were no serious errors in treatment), and many colleagues will also approve: “Well done, otherwise, God forbid, in six months a lawsuit will come and you will be dragged to the prosecutor’s offices and investigative committees". I know from the inside how the system works, I am absolutely sure that when removing organs, everything is done ethically and within the framework of the law. Neither transplantologists nor donor service specialists participate in any way in ascertaining death. But in the event of a lawsuit from relatives, both the resuscitator and the head of resuscitation will be put under pressure, they will be put under pressure, a lot awaits them sleepless nights, thoughts about the family, all this moral burden. And then the person will say: “Why do I need it all? Yes, it would be better if I did not tell anyone, I would sleep peacefully and with clear conscience. As for other people - those who need organs - I have not seen them, I do not know them, I cannot help everyone in the world.

In the USA, as well as in Belarus, if the resuscitator does not notify the donor center about a potential donor with minimal chances or about a patient in the process of ascertaining death, or it has already been ascertained, he will face fines (up to revocation of his license), censure of colleagues, administrative collections and so on. We have neither a stick nor a carrot for this. Not all doctors, unfortunately, or perhaps fortunately, can work for the idea. It is one thing to make every effort to save the patient that you have in your hands, for whom you are responsible, and another thing is somewhere there is someone in the transplant center, and this is even another hospital ...

- That is, propaganda is needed not only among the population, but also among doctors?

Among doctors too. And not just among doctors, but from the school, from the student bench. Departments of transplantology are slowly beginning to appear in the regions. Two are currently operating in Moscow. And for any medical student, it is necessary to make transplantation and organ donation a normal civilized part of the work, especially for a doctor who works at the intersection of life and death, in intensive care, in emergency medicine. Everyone should have understanding.

“At times like these, every minute counts.”

There is still a bill in the government on organ transplantation that has been in preparation for several years. It actually provides for the requested consent. What is happening with the document now? And what are the positive or negative points in it, in your opinion?

The only positive thing that I see in it is that it proposes the same mechanism that exists now, but in practice no one knows how to implement it. This is when a person is preoccupied with the problem of how to make sure that in the event of death, his organs would by no means be removed and used for transplantation. Now, hypothetically, a person can go to any medical institution, say that he is against, even write by hand, but there is no official form. Put the seal of the institution on a piece of paper, fold it, put it in your passport and walk with this piece of paper. And the bill introduces the possibility of electronic registration of one's will. The way is clearly spelled out, how you can get into the unified registry for the whole country and express your will. The law provides for the creation of such a registry, and this is perhaps the only thing we lack in the current situation from the point of view of legislation. After all, if we simply, without changing the law, create a register of people who are categorically against the use of their organs in the event of death, this will solve a maximum of problems: a patient dies, he is checked against this database. If they do not find it, it is automatically considered that he agrees. Or they see that he is against it. And this removes the ethical moment that we are talking about.

On the other hand, given the peculiarities of our mentality, I doubt that more than 5% of the adult population of the country will be registered in this register. By the way, both against and for. There is always a superstition: “I am alive and well, I will go to register posthumous disagreement, and suddenly higher power something moved to push me towards it. Let everything go as it goes.”

In the law, in addition to creating registers of those for and against, it is proposed to give relatives after the death of a person who has not decided, two hours so that they remember that the authorities can withdraw, call or come to the department and say that they are against . But even under this law, doctors are not required to actively seek out the opinion of relatives.

Is two hours a long time?

Of course. In fact, at such moments, every minute counts - not all donors manage to maintain blood circulation, ventilation of the lungs, that is, gas exchange, after death, in a state sufficient to avoid critical damage to organs. Therefore, I advocate simplifying this paragraph as much as possible: let there be only two registers - for those who do not mind, and for those who cannot "neither eat nor sleep", because their disagreement is not registered anywhere. Please, here is an online will mechanism for you, refuse - no problem.

When I came into transplantation, we spoke with the media about how our society was not ready to accept the requested consent for post-mortem donation. 20 years have passed since then, the situation has seriously changed, but we continue to say that society is not ready. So when will our society finally be ready? And what have we done during this time to make it ready? But we, doctors, and specifically transplantologists, as we were a closed community, so we remain so. Until we ourselves take a step forward, until we open up, until we show the people, the law enforcement agencies that oversee the observance of the rule of law in this country, it will be difficult to convince people that we have no abuse, no corruption, no organ market, no black transplants. Trust me though, they don't really exist.

- How can this be proven?

We need to open up, take the first step towards society in this regard. First, in transplantation random people does not happen: only enthusiastic doctors get there and survive there. Those who went into medical practice, medical art, with a high moral position - and as a result of their development reached transplantation, which is now an advanced area of ​​\u200b\u200bmedicine. I personally know most of them - they are ambitious, they protect the "honor of uniform", and it is impossible to close their mouths if they see any serious abuses in this industry.

- In addition to ethical aspects, what else says about the impossibility of black transplantation?

Secondly, the number of people involved in the process of donation, organ distribution, transplantation is very large.

It is impossible to perform a transplant in some semi-underground organization, because this requires a developed donor service, an immunological laboratory to determine compatibility.

The operating room, where surgeons and nurses of the highest qualification, anesthesiologists should work. Transplantation is the result of the work of a large number of people, each of whom must be a professional who has reached the heights of his profession. And they do not work at the same time in one place: only surgeons cannot agree to sew something on someone there. The donor service is engaged in one thing, the immunological laboratory - in another.

After transplantation, high-quality resuscitation is needed for a long time. And it cannot be just one resuscitator, even a brilliant one. Depending on the situation after transplantation, resuscitation assistance is needed for 6, 8, 12 hours, and sometimes it takes a week, 10 days ... And all this time, the patient undergoes a huge amount of intensive therapy, correction of all organs and systems. Doctors must change, resuscitation nurses must change, the resuscitator on duty must change. Often, a large amount of blood transfusion is required, certain specific drugs, determination of the concentration of these drugs in the blood - that is, another laboratory, no longer immunological. We need a transfusiology center that prepares and dispenses blood and plasma for this patient. We need specialists in hemocorrection, hemodialysis, oxygenation. We need drivers who transport organs in special vehicles; nurses are needed to prepare operating rooms. A lot of people work in the system - they see everything, they know everything and will not be silent in case of violations. It is artisanal to achieve this somewhere “in garages”, to rent a room from veterinarians - it is so funny for us to hear this. We, doctors, sometimes get unsatisfactory results, despite the concerted efforts of a large number of people who care for each patient around the clock. Therefore, anyone who has at least a little work in practical transplantology, tales about black transplantologists cause a sad smile.

The press service of the prosecutor's office of the Kyiv region on October 2 announced the arrest of four people who were taking Ukrainian citizens abroad, where they were seized for kidney transplantation. “Two citizens of Turkey and two citizens of Ukraine from September 2015 to April 2017 through worldwide network The Internet was looking for victims with a difficult financial situation and persuaded the latter to sell their organ for a monetary reward, ”the official statement says.

After being tested for AIDS and viral hepatitis, all those who agreed to donate a kidney were taken to Turkey and France, where illegal transplants were performed. People were not warned about the negative consequences of kidney deprivation.

Organ donors were promised to pay between $10,000 and $15,000 for a kidney, but after the removal of the organ, they were given much less money. The price of a donor kidney in the global transplantation market ranges from $40,000 to $60,000.

Those arrested face 8 to 15 years in prison.

Appointed acting Minister of Health, Ulana Suprun made no secret from the very beginning that one of her main goals was the adoption of a law on organ transplantation. Upon taking office, she stated: “This is very important point. I have good friend, who has been waiting for a transplant for 16 years. I personally will make every effort to pass this law as soon as possible. Now people are dying, getting sick, and they need some kind of action. I will work with the Verkhovna Rada (Verkhovna Rada - ed.) to ensure that this law is adopted as soon as possible.” Now the law on cadaveric donation has already been prepared and is waiting for its approval. However, there is one detail in it that turns Ukrainian citizens into a disenfranchised herd of donor organ suppliers. Article 4 says: “If an international treaty of Ukraine, the consent to be bound by which is provided by the Verkhovna Rada of Ukraine, establishes other norms than those provided for by this Law, then the norms international treaty". It means that adopted law turns into a simple piece of paper, and the wishes of Western partners will act.

There is already tacit information that in the war zone in the Donbass and Ukrainian clinics in Dnipro (decommunized Dnepropetrovsk) and Kyiv, teams of foreign doctors are working, carrying out organ sampling from the seriously wounded and dying.

After the adoption of the law on transplantation of organs and other human anatomical materials, human organs may become the most demanded Ukrainian export product in the near future. The man in the "dismantling" is worth more than a million dollars. Everything is used, from the heart, which costs about $150,000, to bones and cartilage.

Ukraine is among the top ten countries leading in human trafficking. In 2016, Ukraine was placed at risk for human trafficking in the Trafficking in Persons Report published by the US State Department. The authors of the Report placed Ukraine in the second group with the note “needs attention”. In addition to Ukraine, it includes Afghanistan, Bulgaria, Congo, Cuba, Pakistan, Serbia, Thailand and Tunisia.

Ukraine is seen as "a country whose government does not fully comply with the standards of the law on the protection of victims of trafficking in human beings, while making efforts to get closer to meeting the standards."

Trafficking in living people and donor organs in Ukraine can become a Klondike for all kinds of swindlers. Only during the first half of 2017, the police of Ukraine revealed almost 150 crimes that are related to the facts of human trafficking. This is twice as much as last year. There is no doubt that the detained group of “black transplantologists” is not the only one, and after the adoption of the law that Suprun pedaled, their number will increase significantly.

Inc. Correspondent "One Motherland"

1520

Have you ever wondered how much you can earn by selling your whole body, including blood, hair, internal organs and DNA?

But in vain! It turns out that we are all insanely expensive!

True, it must be borne in mind that the sale of human organs is illegal in all countries of the world, except for Iran. “Offal is sold and bought on the market, while organs for living people are distributed through specially organized institutions,” doctors at a Moscow transplant clinic say.

The main difficulty of transplantology is that legal sources are not always able to provide the required number of organs and tissues for transplantation in a timely manner. For example, in the United States, more than 110,000 patients are waiting in the queue for organs, and less than 15,000 people are provided by donors per year. And even in America, 18 people die every hour without waiting for a transplant.

Plus, bodies and organs are also necessary for scientific purposes: according to current estimates, medical and biological research require tens of thousands of bodies annually. Scarcity creates demand, and demand creates supply, and many patients, waiting for a transplant, are ready to pay considerable sums for new organs.

But already on the black market.

And the black market is good only for criminals, and for normal people he always threatens with problems, often fatal. Patients risk getting not only an organ, but also a new disease: AIDS and hepatitis are common companions of “black transplantation”. Unfortunate donors, often driven to such a step by banal poverty, receive only a small part of the proceeds. The lion's share of the money goes to intermediaries. For example, the average global cost of a kidney on the black market is about $150,000, of which the donor receives on average only about $5,000. In 2010, a liver in China could be purchased for $21,900 and sold for 3.7 thousand

According to some reports, more than 2 million drugs illegally obtained from human organs, fluids and tissues are sold and bought annually in the United States alone. There are persistent rumors about the existence of entire “blood farms”, the “workers” of which are only engaged in the production and donation of blood.

How much can you earn for own body? Now you will know about it, just keep in mind that the prices indicated in different sources, differ by an order of magnitude. Much depends on the legality of the operation itself, on the country of origin of the organ and, of course, on the physical condition of the donor. These are just indicative numbers.

Renewable resources

Blood: up to $400 per liter (only $25 in India)

Practice has shown that volunteers bring much more “healthy” blood than forced donors, so you won’t earn serious money on blood. Moscow blood transfusion stations offer for her monetary compensation food (or a food package), two days off from work, and "a high sense of self-awareness from having helped other people." However, about 5 liters of blood can be squeezed out of an average person - and in a good scenario, this is already $ 2,000.

Plasma: $200 per month

The yellowish liquid part of the blood is noticeably more expensive than itself, and the cells filtered from the plasma will be returned to the donor's bloodstream.

Hair: from 100 to 4 thousand dollars per 1 kg

It all depends on the natural color of the hair and on their length. Red and light ones are more expensive, and if they are longer than 50 cm, then you can earn quite a lot on them. For firms, such a business brings considerable income - it is enough to recall that in 2011, the stocks of one of the beauty salons even attracted robbers who stole hair for 150 thousand dollars. It is often mentioned that the Hindu temple of Sri Tirumalai, where believers traditionally donate hair, annually helps out more than 12 million dollars for them.

Eggs: $8,000 each

In the US, a woman can sell up to six of her eggs during her lifetime, and the income received is taxed.

Sperms: $100 per "serving"

Note that this simple way to make money is fraught with unexpected dangers: in the summer of 2015, the court ordered the sperm donor to pay child support from an unknown woman.

Bone marrow: $3,000 per "serving" (about $23,000 per gram)

A unique source of hematopoietic stem cells - one of the hematopoietic organs of our body - is highly valued. In Russia, the sale of bone marrow is completely illegal, and in the United States it is allowed only in a few states, and the amount of remuneration is often not given to the donor in the hands, but is transferred directly to pay for real estate, education or charity expenses. Considering that the body has about 1,000 g of bone marrow, this is a very valuable resource for our body: it can bring up to $ 23 million. But even if you find a doctor who is ready for an illegal operation, this will be the last income in your life.

Placenta: cost unknown

It is in great demand on the black market, as it is part of some means of "folk" oriental medicine and cosmetics.

Human milk: $30 to $60 per liter

A popular means of feeding babies whose mothers have problems with milk. Many wet nurses who have a surplus of milk prefer to sell it - there is a known case when one of them earned $ 20,000 in this way in a year.

Uterus (surrogacy): $50,000 to carry someone else's embryo

Banned in some countries and in a number of US states, legal in Russia.

Feces: $50 to $200

Yes, yes, money can be made even from ... waste! The procedure of fecal transplantation (bacteriotherapy) has been gaining popularity in recent years: medical practice has shown that it allows you to restore the intestinal microflora in severe disorders and dysbacteriosis.

A loud scandal erupted in 2005 in the state of New Jersey, when, after the replacement of a couple of vertebrae for a patient with donor ones, it turned out that they were obtained illegally - they were simply removed from a dead man. Even more famous is the story of 2010: a Southwest Airlines employee accidentally discovered a refrigerated container with dozens of human heads. Criminal cases against "black transplantologists" were initiated in Ukraine and Latvia. IN Russian history so far there has been no such scandal.

Partially renewable resources

Cornea of ​​the eye (one): from 4 thousand dollars

An organ that is easy to transport and transplant - operations have been put on stream for more than half a century ago. Today, donor corneas are rapidly being replaced by artificial counterparts.

Kidney (one) from 15 thousand dollars in India to 262 thousand in the USA

The most demanded organ for transplantation - it accounts for about 75% of the world market. However, many patients never live to see a donor organ: the queue is too long. Replacement may be required for patients with diabetes, cardiovascular disease, and a variety of other problems.

Liver (part): $54,000

The liver has an amazing ability to regenerate - to destroy it to a state of non-recovery, you need to try very hard. However, for the same reason, only a portion of a healthy liver from a donor is usually sufficient for a transplant.

Intestine (fragment): about 69 thousand dollars

As a rule, a part is used for transplantation small intestine, but in case of serious violations, it may be required along with other organs of the gastrointestinal tract.

Bones and Ligaments: $5,500 for an ACL Replacement "Kit"

Unlike other organs, which become useless for transplantation in a matter of hours or even minutes after the death of a donor, bones and tendons last much longer. Therefore, criminal cases against doctors and mortuary workers who “collect” bundles from unclaimed corpses appear especially often. For example, in 2005 Biomedical Tissue Services was closed down and its CEO received a 50-year prison term: it turned out that its employees illegally used and sold bone tissue obtained from 244 bodies.

Leather (section): $10 per square inch (6.5 cm2)

Skin tissue grafting is usually required for severe burns of various nature - thermal, chemical, electrical. Often, for this, it is possible to use the skin of the patient himself, but sometimes they also resort to the help of donors - usually these are dead people who, during their lifetime, agreed to use their body for the benefit of the living.

Lung (single): $58,000

A donor can be a person who is either a non-smoker or smokes no more than 20 packs a year. On the other hand, non-smokers have every chance of enriching themselves: with especially serious diseases, the patient may need to transplant a whole complex of organs - both lungs along with the heart - and the cost of transplantation will be almost astronomical. Such an operation in the United States is estimated at 1.5-2 million dollars.

Non-renewable resources

Heart: from 57 thousand dollars

Hearts are almost unavailable on the black market: organ transplants are so complex that they require a large team of specialists and expensive equipment, and the cost of the operation (legal) is close to $1 million.

Pancreas: up to $44,000

Organ replacement may be required in severe forms of diabetes. And although not all of the iron can be used for transplantation, it is removed entirely, and even together with the liver and duodenum.

Skeleton: $3,000 to $5,000

Until 1985, the famous "skeletal workshops" of Calcutta supplied the world market with tens of thousands of samples annually. However, today this practice is banned, and there are not so many legitimate sources of skeletons left - far less than the real needs of medical students for the education of students. India remains the leader in the market: numerous bodies of beggars are boiled or cleaned in an acidic environment - and sold illegally. Fragments of the skeleton can also be sold separately - already for transplantation: the shoulder joint, for example, will bring up to a thousand dollars.

Whole body: from $45,000

The plastination procedure was invented in the 1970s and is used to create specimens of organs and systems for the study of anatomy, as well as simply exhibition pieces for the curious. The body is immersed in ice-cold acetone, which replaces water in the tissues, and then the acetone is replaced in a vacuum with a biopolymer. Plastinated samples today are quite a profitable area of ​​business, hundreds of laboratories are involved in their creation. different countries peace.

Maximum Profit

A few years ago, a columnist for Wired magazine found that the most reasonable thing would be to put on sale not organs and tissues, but complex chemical compounds that they produce. Hormones, neurotransmitters, enzymes - many of them are extremely difficult to synthesize and can boast of a corresponding cost. If you look at the high prices of 2003 and squeeze everything you can out of your body, you can get some serious money: according to the magazine's calculations, the total amount will exceed $ 46 million. Here are just a few important examples.

Resource Price per gram, USD
Apolipoproteins 496,000
Ceruloplasmin 179 240
Cell DNA 1,290,000
Prolactin 4 662 500
Immunoglobulin (IgG) 67,000
Prothrombin 71 400
Sphingomyelin 960
Cerebrospinal fluid 47 500
Thyrotropic hormone 55 650
Insulin 3 500 000
Progesterone 508
Transferrins 18 900

Apparently, illegal transplantation was, is and will be ...

We are constantly frightened by myths about transplantation, both "black" and real.

On the one hand, in blogs you can read obvious "horror stories" about children who wake up in an ice bath and without one kidney. On the other hand, one may encounter statements that organs are selected according to hundreds of parameters, and since tissue compatibility is very low, there is no queue for organs as such.

Here's how things really are.

1. Compatibility is not determined by hundreds, and in just a few key parameters - blood type, six tissue compatibility antigens (two HLA-A, B, DR of the donor to pairs of the recipient's antigens of the same name). In addition, the kidney must be functional, and the donor must not have any current or history, and must not have some infections (for example, HIV). It's enough.

2. Even with these parameters you can play. For example, with all the desire, it is very difficult to select an organ that is suitable for all six antigens of tissue compatibility. Then preference is given to similarity in only one pair - DR, provided that the donor does not have HLA antigens, to which the recipient has antibodies.

3. There are waiting lists in all countries of the world where transplant programs operate. Except for one country - Iran, where healthy people officially allowed to sell one of their kidneys. The entire transaction is monitored by the state, which not only controls the amount of remuneration and its honest transfer into the hands of the seller, but also adds a certain amount of monetary compensation for rehabilitation and restoration.

4. In other countries with transplant programs there is a queue and it is big. For each cadaveric (cadaveric) kidney, there is a list of about twenty recipients, arranged in order of "suitability". To compile the list, a special formula is used, which takes into account tissue compatibility, waiting time, the degree of immunization of the recipient (it happens that a person has a huge amount of antibodies, and the risk of immediate rejection of an organ in case of incomplete compatibility approaches 100%; such patients receive absolute priority, regardless of the waiting time), age (in children - an advantage) and several specific conditions (mainly after operations on the genitourinary system, when it is important that a person “wet” as quickly as possible and not remain on dialysis).

5. Usually, the list of compatible donors is generated by a special computer program, doctors only enter the parameters of a potential donor: age, gender, histocompatibility antigens and blood type. Neither doctors nor other staff have any influence on which place in this list a particular patient will receive. In countries where transplantation is poorly developed, the choice of a recipient can be made by the doctor "manually", but taking into account the same parameters. The whole algorithm can be re-passed and re-checked, since the criteria are very clear, that is, it would be very difficult to cover up the traces in case of unscrupulous actions.

6. Donors are divided into living donors, brain dead donors with a beating heart, and donors after cardiac arrest. The largest share of transplants falls on the share of the second type of donors. The brain death of a potential donor is determined according to a clear algorithm, and a group of doctors is involved in the examination, not associated with the transplant group that cares for the recipient. In different countries, the criteria for determining brain death are slightly different, but several requirements remain unchanged: firstly, the ascertainment must be carried out by two independent specialists with a certain time interval. s m interval. Secondly, it is necessary to confirm with the help of objective instrumental clinical studies: EEG (assessment of the electrical activity of the brain), angiography and / or perfusion scintigraphy (assessment of blood flow in different areas of the brain). Instrument readings and documents remain in the medical history, it is extremely difficult to fake them.

7. The media gives the impression that the decision from whom, to whom and when a kidney will be transplanted is made by one person, but, as can be seen from the previous points, this is not the case. Selection of donor and recipient is a cumbersome procedure, violate the rules of which in medical institution very difficult. This is not tiptoeing with a flashlight from the donor to the recipient, this is a ton of documentation, a mandatory conversation with relatives, a mandatory compatibility test (cross-match test) carried out immediately before the operation, when the recipient is already in the clinic, and in each case, the involvement is more dozen professionals.

8. Black transplantation exists. Most of all - in underdeveloped countries with a large stratum of the unprotected and poor population. But this is not at all an initiative of hospital enthusiastic doctors, with their protocols and guidelines for each item of the “official” transplant process, and besides, they are in close connection with other professionals who are required to take part in the procedure. In fact, this is a large and profitable criminalized business, controlled by criminal groups and located outside the boundaries of public hospitals. Under it, small private clinics, underground offices are created, donors usually do not go through any official documents, the procedure for selecting and determining compatibility is either minimized or completely excluded from the process.

This practice causes enormous harm to recipients.- after transplantation without determining compatibility, as a rule, the kidney is rejected very quickly, while “sensitizing” the patient, which complicates the selection of the next organ for him and puts his life at risk. In a sensitized, difficult patient (and such patients, tired of waiting for an "official" transplant, are more likely than others to turn to illegal methods of transplantation), blind transplantation usually leads to immediate graft failure and often to death.

9. Given the high demand for organs, profitability of illegal transplant business and the cumbersomeness of the official procedure for selecting a “donor-recipient” pair, looking for “black” transplantologists in clinics, within the framework of the transplant program, and placing false blame on lone doctors - it’s like looking for a coin lost in a dark entrance by moving under a street lamp, because which is brighter.

10. Quite often, witch hunts are initiated by the relatives of the donor, who, having lost a loved one, direct their anger and irritation at the doctors for the fact that they, as it seems to them, did not do everything possible. With no medical training, no understanding of procedures, they succumb to emotions, and the media gladly inflates unfounded accusations. Sometimes this is partly the fault of the doctors themselves. who, in a hurry (during transplantation from a deceased donor, indeed, every minute counts - it depends on how well and how long the transplanted organ will function), do not pay due attention to relatives, giving them the impression that no one was interested in patients how patient, but only as a donor. But it is not. For each patient, doctors fight with all their might. However, at the time of death, priority shifts in favor of the living, and this shocks the relatives of the deceased. Therefore, the hospital should have a clear procedure for communicating with relatives of a potential donor, including talking with a staff member. I'm not sure that this is practiced in Russia, and perhaps this is the reason for such frequent scandals initiated by the donor's relatives.

11. Every bout of hysteria surrounding allegedly illegal organ harvesting in public hospitals, "right under the noses of relatives," inflicts colossal harm to the development of official transplantology in the country, hinders the development and improvement of relevant programs, deprives many people of the hope of getting a new organ and, as a result, only supports black transplantation. Please remember this.

The doctor told how the Russians became kidney incubators for the Turks
The specialist frankly voiced all the nuances of the black market of transplantation in Russia.
05:03, April 23, 2016 19252
organ transplant
Exclusive
Andrey Zvonkov, therapist emergency care one of the capital's polyclinics, in an exclusive interview with REN TV, told how the black market for human organ transplantation developed in Russia.
According to him, at some point the Russian capital turned into a donor appendage. Those wishing to receive, for example, a donor kidney went to Moscow weekly.
The heyday of the criminal business came in the dashing 90s, when the hospital where Andrei worked, kidney transplantation to the Turks was put on stream.
"I graduated from a medical institute in 1991 and immediately went to an internship. An internship in anesthesiology and resuscitation. I worked in one of the Moscow clinics and saw myself as a resuscitator in the cardio intensive care unit. So, in the intensive care unit, since this hospital was associated with neurosurgery , brought autoinjury in large quantities, including autoinjuries that are incompatible with life.These are severe craniocerebral injuries, when the patient still seems to be alive formally, his heart is beating, it seems like he is even trying to breathe, but the brain is already gone. in this case, the head of the department simply dialed the phone of the transplantologists, the group-brigade that left, arrived. In fact, they carried out the diagnosis of biological death, they registered it as a corpse. And they carried out the so-called first stage of the autopsy, taking everything that could be taken away, "says Zvonkov.
According to him, no one asked for any permission, of course.
“The carcass was then sent to the morgue, already partially opened, partially freed from the organs that burdened it,” he adds. “Actually, I did not interfere in this. I am an intern, bribes are smooth from me. "Our doctors were earning a little extra money. To be honest, I don't know what kind of money was spinning around this. Surely, everything was not free. Someone was paid something. But how much - I won't say, I don't know. I won't lie."
Rates, at least partially, Andrey learned when he moved to work in another clinic in 1992, at the most difficult time for Russia.
“The earnings were minimal, minimal. Naturally, for a doctor without experience. And what is an intern? This is a doctor of zero, zero level. The salary was very small, 900 rubles, less than 1000 at the then prices. 900 is very hard... I switched to private company"Russian hospital" in one of the Moscow clinics, where we organized paid medical care on the basis of a regular department. We had a perfectly normal office in this sense, absolutely law-abiding. But we all know each other. The department on the second (floor) ... I know that one of the departments was engaged in kidney transplantation, - says the doctor. - And for some reason, the Turks came to them, to whom these kidneys were transplanted. Where these kidneys were taken - I do not know. The living or the dead. Well, in general, there was a company that organized such medical tours for the Turks who came, paid for the tour itself, treatment, transplantation, organs. I know that the amount was given to the department, the cost of this transplant was about $ 2,000. Whether for the operation, or for the kidney - I do not know. But this figure sounded.
Andrey Zvonkov
“Technically, transplanting a kidney is not as difficult as any other organ, the initial rehabilitation after surgery for a patient took even then a week, after which the operated person could be returned to their homeland,” Zvonkov explains.
“I started working there somewhere in the spring of 1992. And in the spring of 1993, we had already moved to a different address, and I no longer dealt with them,” says the doctor. “Mechanics itself can still exist. There is nothing complicated about it, and, in general, illegal too, because officially everything was formalized as a tourist trip. Soviet Union was getting medical care in full, regardless of their citizenship. They actually used it."
Why exactly Turkish citizens mastered the so-called transplant tourism, Zvonkov can only speculate: “I don’t know if they were from other countries. Maybe. You see, there is one more nuance here. Europe would not go for this. They have their own characteristics. their rules, their zealots. The doctors there are very sensitive to the fact that someone leaves and is treated somewhere other than by them. It is always very painfully perceived. The Turks, apparently, had no problems with this."
In the clinic where Andrei Zvonkov worked, according to him, kidney transplant operations were performed once or twice a week:
“I talked to the guys there. They said that they (the patients) are waiting. They are waiting there at home. even in the middle of the night. That is, he flew in, he was immediately taken from the plane to the car, taken to the clinic. A brigade immediately appeared, immediately brought the organ. I believe that this was still the result of an accident. In the 90s, we also had a lot of shootings ... In general, there were materials."

Such a business would not be possible without connections on the "customer" side.
“There must be a partner on the other side. Someone is sitting in Turkey. The partner on this side is the coordinator who holds the information field in his hands. An agreement with the department and the brigade, which are always ready to accept here. And with the specialists who are engaged in the procurement of organs "And there is some kind of queue. Surely people sign up there, wait, sit on hemodialysis. And when information comes to them, the only task is to get a visa. A tourist visa, most likely. Everything is issued very quickly, in an organized manner. They arrive by the nearest plane. There were channels for hospitalization What are our main channels for hospitalization? Ambulance, the so-called RGV is the order of the chief physician, Zvonkov explains. I don't know if it still exists or not. Then there was. It was possible to write a statement "please be hospitalized", and chief physician made the signature "put in such and such a department if there are places," and the places were in advance. Here on such channels somehow worked. Well, we paid off with all interested people at the same time. And the brigade received its own, and the chief, apparently, had something too. Without this, it would not be interesting for him to do this in his clinic, and he would be left out."
In previous publications, we talked about how REN TV journalists managed to find an intermediary who is ready to send anyone who wishes to such an operation to Pakistan. The film crew was also lucky to talk to the happy owner of a donor kidney purchased in this country. More recently, a scandal erupted in Moscow over a kidney transplant in one of the capital's clinics, which a woman was forced to sell due to mortgage debts. According to Andrei Zvonkov, the black market for transplantation is thriving.
“With the kidneys, yes, now they are reaching the same level. Only the price is in millions. I think that the scheme will be exactly the same,” he says. “The black market develops when the white market cannot cope. If the white market is not able to fulfill certain tasks, a black market always arises in parallel. This is the law of the market. You see, if we cannot do something legally, then there is an opportunity to do it illegally. The question is different - who to blame? In this case, here a person went and passed He says I want to donate, but I don't want to give it away for free. Why am I ... On the other hand, left with one kidney, I am disabled. And he cannot go to apply for disability. So, in order to explain, where did his kidney go, why did he stay with one, it is necessary to falsify the problem and justify the removal of the kidney with some kind of disease. Here is the edge of the law for you. Some kind of forgery is already beginning. A healthy person, and we are making a patient out of him. How else? On what grounds would the organ be taken away from him? On the other hand, this organ must be healthy in order to be transplanted. Again, to somehow justify that a good organ has appeared, found somewhere on the street. We walked past, suddenly lying around, we saw. Well, how? So it's not his body. Whose? Some found a corpse, it was seized. All. Issued. It's not his kidney anymore. And so on. Guilty is the one who organizes this case. And who is taking over. Here at this link you can say: you are to blame for breaking the law. Because here there is a registration of forged documents and falsification of data. Everything else is legal. These are waiting for the organ, the organ arrives, the organ is transplanted. And people say we don't know anything. The donor himself says he is also satisfied, he received his own. The main thing is not to be deceived. All. But those who took this organ, they are under attack and are to blame."
Watch a special investigation about black transplantologists on REN TV on Sunday, April 23 at 23:00 in the Dobrov on Air program.

The first rocket launch from the Vostochny Cosmodrome - 04/27/2016 was canceled.
The automation signaled the launch of the Soyuz-2.1a space rocket from the Vostochny cosmodrome 1.5 minutes before launch. The reserve launch date, April 28, is retained. The commission is studying the reasons for the release of the launch. The commission's findings will be announced later.

A loud scandal is unfolding in Ukraine: some unidentified corpses were burned in the Kiev morgue on Oranzhereinaya Street for a whole month, The Russian Times reports.

The bodies were destroyed by the 24th "hundred" self-defense of the Maidan, not allowing strangers into the premises. According to the investigation, about fifty people passed through the hands of Ukrainian “black transplantologists”. At the same time, there is evidence that the dead were previously “gutted”, removing their organs. And they also say that organs are seized there not only from the dead, but also from still living people. It is impossible to check, doctors and law enforcement officers are not allowed into the territory. And in general, it is not clear why the nationalists needed this crematorium - right now, when power has been seized and the country has returned to peaceful life, according to the Ukrainian authorities. The “revolution” is over, but the flow of its victims is not yet? I remember that in Kosovo, local nationalists, having seized power, organized real fairs of human "spare parts" for foreigners in morgues and maternity hospitals - are the Kiev impostors repeating the sad experience of the Kosovars?