Transplantation in Ukraine: From Middle Ages stereotypes to modern realities
Ukraine has always been considered a country with a sufficiently developed medical industry. In Soviet times, our country was one of the leaders in the qualification of doctors and medical infrastructure. Even the economic crisis in the 1990s did not significantly affect Ukrainian medicine, which remained of fairly high quality.
In 1991, Ukraine became an independent country, but Soviet stereotypes remained popular among Ukrainian citizens. One of them concerned transplantation. It is believed to be carried out only illegally, somewhere in the basement, with the human organs being sold abroad.
As a result of such misconceptions, as of last year, the transplantation industry was on the level of the Middle Ages. I will list the systemic problems that hindered the development of transplantation in Ukraine.
We did not have a registry through which the patient could find a donor. Due to the ban on donations from people who are not members of the family, the probability of finding a donor has decreased tenfold. The state donor incentive program did not work. Imperfect legislation, lack of mechanisms for regulation and control in this area made it easier for the state to prohibit organ transplantation than to control it.
According to experts, Ukraine lags behind developed countries in the field of transplantation by 10–15 years, and transplantation operations were not carried out systematically. Last year, Ukraine ranked last in Europe in terms of posthumous donation: only 0.1 cases per 1 million population. It is 100 times less than in Poland and 250 times less than in Spain.
As a result, with the annual need for 5 thousand operations, 127 were conducted in 2017, 129 in 2018, and less than 100 in 2019.
In order to meet the demand, patients had to be sent abroad for treatment. However, budget funding was only enough for 200–300 people each year. Last year, $ 26 million was allocated from the budget for these purposes. But despite the money, these 300 seriously ill patients have to wait until the quarantine restrictions are cancelled and the countries open their borders.
Most Ukrainian patients are either doomed or forced to seek money for surgery themselves, which is unaffordable for most families. For example, heart transplantation in India costs about $ 150,000. The same operation in Ukraine costs $ 26,000. For the price of one operation in India, five or six patients can be operated on in our country.
At the same time, Ukraine has everything to perform transplantation surgeries, including qualified doctors and medical equipment. A working transplantation system would save us hundreds of people’s lives and hundreds of millions of budget funds.
Last year, Servant of the People party won the parliamentary elections in Ukraine. Our party continues the course started by President Volodymyr Zelensky to combat Soviet stereotypes and the remnants of the outdated Soviet system.
One of the tasks facing the Committee on Public Health of the Verkhovna Rada of Ukraine, which I am the head of, is the development of the transplantation industry.
Worldwide, tens of thousands of people are being rescued through organ transplantation thanks to the rapid development of medical technology. Ukraine must overcome stereotypes in the society and follow the path of most civilized countries by improving the transplantation system.
We have already taken the first step. At the end of last year, Ukrainian deputies approved changes in legislation that launched the development of transplantation in the country. These are the changes:
1. The donor search system has been launched
Since April, a system with information about donors and patients has been working in test mode. Importantly, it is available online in a semi-automatic mode which prevents the human factor and corruption risks in the selection of the recipient. This system should be fully operational from January 1, 2021.
2. Access to non-governmental donor registries
We understand that it is difficult to find donors in Ukraine. Changes in legislation have allowed the use of private registries, which are already certified by the World Register of Bone Marrow Donors. It means that we have the opportunity to look for a bone marrow donor around the world.
3. 12 hospitals have received licenses
Simplification of licensing of medical institutions allowed 12 hospitals in different cities of the country to obtain a license. These medical institutions have become Transplantation Centers. Most importantly, ten of them have already received funding for this year, which will be enough for more than 100 operations.
4. Transplant coordinators are being trained
Additional staff is needed for systematic work in this area. In Ukraine, one can study to become a transplant coordinator, and transplantation surgeons undergo annual advanced training courses.
5. Doctors are now more protected
Previously, doctors refused to perform surgeries due to high responsibility and risks. Now, the doctor will be liable only in cases where there is a deliberate violation of the transplantation procedure.
6. 56 successful autotransplantations have been performed on patients
The National Cancer Institute has already performed 56 successful autotransplantation in patients with lymphomas and solid tumors. Also, for the first time in 15 years, two successful heart transplantation were performed.
7. A bone marrow transplantation from a non-family donor was performed
On April 1, for the first time in Ukraine, a bone marrow transplantation was performed from a non-family donor. The team of doctors recorded the engraftment of the bone marrow, and the patient’s body began to produce its own, healthy and fully functional cells. A donor for the patient was found in Germany. To recap, earlier, bone marrow transplantation not from a family member was possible only abroad.
In the future, among the urgent tasks of the transplantation industry, there is the necessity for the state to encourage donation, develop posthumous donation system, and establish the state information system of transplantation.
I would also like to remind you that the Committee on Public Health of the Verkhovna Rada of Ukraine asks the Ministry of Health to take a more responsible approach to the development of bylaws so that the new changes could run at full capacity.
I believe that the transplantation industry has got off to a good start. Ukraine has the potential to take the lead in transplantation. To do this, we need a coherent network that combines all the elements into one coordinated mechanism.
It is important to note that according to the adopted amendments to the legislation, transplantation is free of charge for the donor and patient. The cost of such operations in Ukraine is several times, and in some cases, ten times cheaper than in Europe. The potential of the industry is huge.
I also want to give the example of our neighbor, Belarus. From 1997 to 2007, only 7 kidney transplantation surgeries were performed in the country. After the country’s leadership implemented a state transplantation program, Belarus entered the top 10 countries in the world in this area. As of today, it has even bypassed countries such as Germany, Australia and the United Kingdom.
In Belarus, transplantation surgeries are provided for a fee to the foreigners, what makes it possible to conduct operations for free to the citizens. Thus, several citizens of Belarus are being treated for the money paid by one resident of another country (for example, $ 40,000 for a liver transplant).
Last year, 374 liver transplantation surgeries and 52 heart transplantation surgeries were performed in the country. Of these, only 16 patients were foreigners. In total, 900 residents of other countries joined the queue for the surgery in 2019, and Belarus earned $ 50 million from the treatment of foreigners. Isn’t is an example to follow?
For comparison, in 2019, the United States performed almost 40 thousand transplantation surgeries.
By setting up a transplantation system, in the future, Ukrainians can have access to surgeries for free while funds will be received from foreigners, the same as in Belarus.
It will allow saving the lives of Ukrainians and saving budget funds. It is important that Ukraine has already taken a step from the Middle Ages stereotypes towards modern realities.
