ART OF MEDICINE 2017
PRIMARY BILIARY CIRRHOSIS: APPROACHES TO DIAGNOSIS AND TREATMENT IN REAL CLINICAL PRACTICE
V.M. Kulayets, M.M. Bagriy, L.O. Popovych, N.M. Kulayets
Abstract. The requirement for organ and tissue transplantation in our country is very high, but transplant operations are not numerous.
Those who need surgery are looking for treatment abroad. At the beginning of 2016, the Accounting Chamber issued a report in which they audited the expenditure of the state budget, aimed about treating Ukrainians abroad. The need for liver transplant in Ukraine is 800-1200 operations a year. In 2016, at the beginning of November, 100 transplants of organs were performed in Ukraine, 95 of which were kidney transplantations and 5 liver transplantations. At the same time, potentially it was possible to hold up to 70 liver transplantations per year, as well as about 300 heart transplantation operations. So now, the situation in transplantology is quite disturbing: there is a huge demand for such operations, but they are very few, and our country for some reason spends money on treating Ukrainians abroad, although in Ukraine it would be cheaper.
The main problem is the lack of donors, both alive and dead. Living donors are a huge problem in the legislative area, because our legislation restricts the list of people who can provide their tissues or organs for transplantation. This is husband or wife, and a list of relatives in the blood - from parents to nephews. There are no cousins in this list, there is no right to take organs from a donor who simply showed his desire to help. Often, this simply makes Ukrainian patients go for treatment abroad, where the law allows transplantation from a person who is not close relative.
Transplantation from a living donor can not only help to reduce the time in the waiting list, but also give a chance to patients with cancer that can be cured by liver transplantation. Regarding cadaveric transplantology, it has long been surrounded by heated discussions about the presumption of consent or disagreement with organ harvesting from the corpses for transplantation.
The presumption of consent is if, during a lifetime, a person did not refuse to have his organs and tissues to be used for transplantation, and they could be taken from the corpse for this purpose. The presumption of disagreement - on the contrary, proves that organs can be taken from a posthumous donor only if he, at the time of life, gave his consent.
At the time of the first reading in April 2016, the law No. 2386a-1 stated about the presumption of disagreement. In fact, both models are successful in the world. Another huge problem of transplantology is the lack of a registry.
Unified Register of donors and those who need a transplant, would add much necessary transparency to the transplantological field. "There are currently no donor registers or waiting lists. If there were registries - people would know how much time it would take to estimate their chances and the necessity to search alternatives abroad. According to the Association Agreement, in Ukraine, such "Institution of tissues" must be opened, they will be responsible for donor materials (tissues and cells, with the exception of blood and organs).
Commission Directive 2006/86 EU, which our country has to implement, defines detailed requirements as for their work: from the organization of work and keeping records and register - up to the quality and storage conditions of human tissues and cells during coding, processing, preservation, storage and distribution between healthcare establishments, where they will be applied to the human body.
The directive sets out what to do in cases of negative reactions to transplanted tissues and cells. Currently, this Directive has not been fully implemented in Ukrainian legislation yet.
Privacy is very important for transplantation. Indeed, its violation may entail grave consequences of moral, psychological and commercial nature.
Transplantology is a very delicate area, each aspect of which is triggered by heated discussion and where each decision involves a difficult moral choice. However, in the whole world, the development of this branch of medicine is a priority because it is the salvation of life in the most critical situations.
We have a good technical base and excellent specialists the only question is in legal and organizational aspects.
Full text: PDF (Rus)
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