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Sunday 16.12.2018 | Name days: Alvīne

Death can save a life – a conversation with a transplantologist

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Baltic news, News from Latvia, BNN.LV, BNN-NEWS.COM, BNN-NEWS.RUAfter walking through the doors of Stradins Clinical University Hospital, we are greeted by a hubbub, conversations all around and people – young and old. Walking further in through the wide corridor, we see people walking here and there. Looking at them, it is impossible to tell which illness brought them here. Once we make it to the doors of the Transplantology Wing, we are greeted by its head – Dr. Jānis Jušinskis. BNN came to him to talk about the field of transplantology, put to rest myths about and learn more about the ways someone’s death can save someone else’s life. Anyone can become an organ donor – an opportunity to save a life.

For the sake of clarity, it would be best to start off by saying that the percentage of people who permit or prohibit hospitals from using their body, tissues and organs after their death for transplantation is less than 1%, said the doctor, commenting on data provided by the Office of Citizenship and Migration Affairs.

The specialist says that the reason for that is simply the desire to not know. Jušinskis also mentioned that there is also an information deficiency problem.

«People do not want to learn more about the things that do not affect their day-to-day. Only when something happens do people usually looks up information,» says the transplantologist.

What if my child needs a donor?

It is also worth mentioning a survey posted on the internet. In it, ombudsman Juris Jansons concluded that the level of people’s knowledge of different forms of application for dead people’s organs and tissues in medicine is very low.

The survey revealed that 61.1% of respondents believe doctors in Latvia are not allowed to take people’s tissues or organs after their death if the Population Registry does not contain information about the person’s choice.

The ombudsman in concerned over the fact that 76.2% of respondents are not informed of their relatives’ and friends’ decision to donate their body to medicine after their death.

It is important to mention that unlike Jušinskis, who said that it’s not a problem of information deficit, the ombudsman mentioned that institutions, in this case Healthcare Ministry, have not made it their duty to keep society informed.

According to the transplantologist, the ombudsman started his survey with the wrong question. He says: «I believe if you start a question with a negative outlook, you can expect more negative responses.»

The question, said the specialist, should have sounded more like this – «If I or my child require transplantation would I allow using tissues or organs after death?»

«I believe around 90% of respondents would pick in favour of using donor organs. But this side of the matter was not touched upon,» said the transplantologist. 2,623 people participated in the ombudsman’s survey.

A small window for a donor to save someone else’s life

When asked about the most ‘popular’ organs used in transplantation operations, the specialist mentioned that in Latvia those are kidney, heart and liver. «Kidneys, I would say, are the most available organs,» said Jušinskis.

In order to use a dead person’s organs to save another, it is necessary to act quickly. «There is a very short window between a person’s death and the operation when the organ is still functional. If everything is legal and ethical, we do everything immediately. After the operation, I have to do everything to make sure the donor’s body is ready for burial – everything is sewn shut.»

The transplantologist mentions an example when a person’s heart stops. In such situations, there is a much lower chance of saving viable organs and using them for transplant operations. «Most often we transplant kidneys. The maximum amount of time organs remain usable after a heart stops functioning is two hours. This happens when it is not possible to bring a person back in intensive care. In such cases we diagnose biological death,» says Jušinskis.

In cases when death is sudden – when a person dies on the street and an eyewitness calls an ambulance – there is a short period of time (two hours) when specialists can check the Population Registry and see if a person was in favour or against using their organs after death. If no problems are found, specialists can prepare for an operation. The transplantologist explains this is defined as presumption of consent in the law. A person has to be identified – ‘unknowns’ are not organ donors.

Information available on the LV portal shows that any resident can allow or disallow the use of their organs after death. All data regarding use of the body, organs, tissues and cells after a person’s death are saved and stored in the database of the Population Registry.

When asked if paperwork takes up valuable time, the doctor said it is the opposite – the registry is one of the tools that helps specialists, because it is always accessible.

The only downside is that the hospital has only one stationary computer with access to the Population Registry. Nevertheless, talks are held with colleagues from the Population Registry about allowing remote access to data. «For example, if an ambulance team is away on a call, they do not have to drive back to Stradins hospital and then to a different hospital. But such cases are usually rare,» says the specialist.

Are organs paid for?

The transplantologist mentions that people sometimes ask if they can expect a compensation for providing organs. This question was far more topical in the past. Jušinskis recalls: «In 2008, when Latvia was struck by the crisis, there had been several cases in a row, when relatives requested money. This basically meant they were haggling with their dead relatives’ organs. Yes, we remember such cases.»

Section 18 of the Law on the Protection of the Body of Deceased Human Beings and the Use of Human Tissues and Organs in Medicine states that «any removal of tissues and organs from the body of a living and deceased human being shall take place upon strict observance of the expressed consent or non-consent, and the selection, sending and use of these tissues and organs as a commercial transaction is prohibited». It is a criminal offence.

A problem in Latvia – lack of personnel

The transplantologist mentions that any medical procedure in Latvia costs considerably less than it does elsewhere in the world. ‘No need to look around – even our countrymen return to their home country to fix up their health. It’s just life.’

When asked about the state of medical technologies needed for operations, the doctor mentions that equipment is sufficiently modern and works on a good enough level. A far more serious problem is the lack of personnel: «There is critical shortage of personnel. We lack nurses and anaesthetists. We have only four professional transplantologists in Latvia,» says Jušinskis.

He adds that a search for new specialists continues always. ‘Letting someone inexperienced and untrained here would mean the end for this sector. One wrong word with relatives often ends with a massive scandal in the media,’ says the specialist.

«Someone else’s death gave me life»

In the corridor of the Transplantology wing, BNN met a girl who agreed for a short conversation. Samanta, age 19, was happy, because it was the day when she was released from the hospital.

Samata told BNN that ever since childhood she has lived in two places – an orphanage and Children’s Hospital. Health problems for her started at an early age. It turned out that kidney problems were inherited from her parents. Everything started with angina, quickly followed up by often illnesses and life in one hospital or another. When Samanta turned 18, she had undergone a dialysis – artificial blood-cleaning process.

«Every day for a year I went to the hospital for procedures – conversations with the doctor and signing documents, because after three months it was necessary to get in queue for kidney transplantation. During one conversation, the doctor surprised me by saying that I could get a new kidney that day. This is how I remained in the hospital. I was ready for getting a kidney much later, at least three years later, but a miracle happened, and I had to wait only three months,» Samanta said.

Samanta said she feels very well now: «There was a person who saved my life. I feel better than ever. I have never been as healthy as I am now. I recovered very quickly. It does hurt a bit, but I can move and walk. I make 47 steps from my ward to the end of the corridor and back every day.»

Samata’s donor was some young man who died. Samanta does not know anything else about him because doctors are not allowed to disclose that information.

Samata said that it would be good to expand the existing law, by including a point for all people to automatically become organ donors upon death, so that it would be possible to save others.

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