If the donors did not fall prey to misinformation

Academician Mykola Amosov was asked once what he thought made the difference between a backward and a civilized country. The noted cardiac surgeon instantly replied, “Practicing heart transplants is a good sign,” then added, “Ukrainian medicine is about thirty years behind Western medicine.”

Mykola Amosov discussed heart transplants at a time when no one in the Soviet Union could dream of such surgery. It is practiced in Ukraine today, starting at the Institute of Surgery and Transplantation of Kyiv, in 2000, although the first transplant could hardly be described as effective; the patient with the heart transplant lived for only ten days. The second operation was performed three years later, at a cardiology center in Zaporizhzhia. The third took place at the Kyiv institute. Eduard Sokolov, the patient at the cardiac surgery ward, signed out the next day after this photo had been taken.

The man was lucky. There were thirty other patients waiting for donor hearts. They did not receive them. Eduard feels sure that hope was what had helped him survive the nine months of painful waiting; he had not doubted the successful outcome, not for a moment, although the doctors had made it clear that he had only a slim chance. A donor heart is made available only after the brain is pronounced dead. The next of kin, as a rule, believes that heartbeat means there is still a chance. Under Ukrainian legislation, no organ can be extracted from the deceased without the knowledge and consent of the next of kin. In Eduard’s case, the parents of a 26-year-old fellow who passed away at a hospital allowed his heart to be transplanted.

Eduard suffered from an inborn neurosurgical pathology, and when they called the radiosurgery department to say that a heart was available he had only several days left, so the doctors were afraid they would not have the time to do the transplant surgery (it can be done within three hours after the donor’s death, within which time the heart must be extracted, observing dozens of parameters, comparing them to the recipient’s height, weight, and blood group). Some of the nurses involved would tell later that they had kept their eyes closed all the way to the hospital where they had to pick up the heart, the ambulance rushing through the city center contrary to all traffic rules, doing over 100 km/h.

Borys Todurov, who performed the heart transplant, says the operation lasted four and a half hours. Svitlana, Eduard Sokolov’s wife, was allowed to visit him three days later. She stepped inside and could not believe her eyes: “After spending nine months here, I know the way people look after complicated surgeries. But I saw my husband with a healthy complexion, enthusiastically conversing with fellow patients and personnel, saying the oxygen mask was a damn nuisance.” Eduard says he felt an upsurge of physical strength on the first days after the surgery. Nothing compared to his previous constant shortness of breath, cyanosis, asthenia, and so on.

In Ukraine, this kind of surgery could become standard procedure. Some 50,000 persons with heart transplants are registered all over the world. According to the Registry of the International Society for Heart & Lung Transplantation (ISHLT), a total of 4138 transplants were made from January 2000 to June 2001, with 73-91% survival. A 90% survival rate was recorded in Taiwan in 2001, when marking the tenth anniversary of the first heart transplant there.

In Ukraine, surprisingly, the problem is not only funding and personnel. There are heart transplant experts, some of them take on-the-job training in countries where this kind of surgery is nothing out of the ordinary. What meager number of transplants is performed in Ukraine (mostly kidney and liver surgeries) appears sufficiently provided for by the central budget. Here the problem consists in public opinion and legislative support. Polls made by the Social Monitoring Center indicate that 34% Ukrainians would agree to serve as transplant donors after demise. Moreover, no one would call any of the Healthy Ministry’s services to offer organs after one’s death. Just as few if any would do so anywhere in the West. Borys Todurov says all the developed countries have adopted their patterns of transplant donor support. Thus, every citizen of Poland is a potential donor. If one does not agree or is prevented doing so by one’s religious beliefs, calling the pertinent agency will suffice, whereupon one’s name will be entered in the database with donor names, indicating that such-and- such has refused to donate any organs after his/her passing. There is another option practiced on a broader scale. When being issued a passport or driver’s license, you are asked whether you would be willing to save someone’s life after your death. More often than not, the answer is in the affirmative, although you are always granted the final say in the matter, not your next of kin. Also, countries with advanced medical systems practice regular information and advertising campaigns producing quick and gratifying results. In Great Britain, after one such campaign, the number of potential and willing donors increased by 36%. Spain, which remains in the multi-organ transplant lead, owes this status to precisely such campaigns.

Borys Todurov believes that Article 16 of the Law of Ukraine “On the Transplantation of Organs and Tissues” should be amended. It reads that organs and tissues can be transplanted only with the knowledge and consent of the donor’s next of kin. And the latter are more often than not against it, and not only because they are disturbed with such requests on such mournful occasions. Physicians are convinced that the main reason is the relative’s distrust of our domestic medicine. Objective factors are enhanced by horror movies about monstrous doctors trading in human organs. “You can trust my word,” says Dr. Todurov, “that what we know as shadow transplants are actually impossible. Every transplant is a highly sophisticated procedure involving a team of at least ten specialists — surgeons, anesthesiologists, blood transfusion, resuscitation personnel, so doing it in a dark and damp basement is science fiction. Besides, the whole thing costs too much to make the game worth it.”

In the West, the surgical phase alone costs some $100,000. In Ukraine, they are trying to lower the prime cost, using domestic surrogates in lieu of genuine Western products, tampering with disposable implements, making them non-expendable, shocking foreign visitors. Likewise, the human factor is ignored — that is, the salaries due medical personnel. No one knows so far exactly how much saving Eduard Sokolov cost. Some mention $30,000. As for kidney transplants, even at this stage it is clear that such surgery can and does save budget money. The whole procedure amounts to some UAH 30,000, but on the other hand, such patients can become full-fledged members of the community, doctors say. Otherwise they have to undergo hemodialysis three times a week, which costs UAH 60,000 a year. Also, they must be issued disability allowances, have the local ambulance service on call, and be hospitalized on a more or less regular basis.

At present, operations like the one sustained by Eduard Sokolov, are described as elite in Ukraine. The international medical community will eventually discover that Ukraine has experts capable of effectively performing heart transplant, considering that at least two to three thousand Ukrainians have the indications. The institute’s cardiac surgeons say that no beds would be vacant anywhere on the premises if all those in need of treatment were hospitalized. Borys Todurov stresses, however, that he and his team are prepared to work practically around the clock, even on their current token pay, as long as there are donors, people willing to surrender parts of their bodies after their deaths for the benefit of others.