But, alas – pediatric transplantation has been and remains one of the most difficult subjects in medicine. Not only in our country but throughout the world. For example, infant mortality in the waiting list for a heart 10 times higher than among adults, and this is a global statistic. What is needed for the development of children’s organ donation? We discussed with experts.
As told “MK” the chief transplant surgeon of the Ministry of health and the Director of NNECTIO them. Shumakov, academician of the RAS Sergey Gaultier, worldwide transplantation of children is mainly carried out with the use of organs from adult donors. This is due to the shortage of pediatric donor organs.
We would never be able to say that the demand for organ transplants in children completely satisfied, even in countries where transplantation is developing more actively than we have in Europe, United States, – says Sergey Gaultier. – Nevertheless, our laws today do not restrict the removal of organs from dead children. Although for many years the lack of posthumous donation of children was due to the fact that until 2016 our country was not approved instructions for the statement of brain death of the child. In addition, the bases about health protection of citizens in 2011 is the norm that children’s post-mortem donation (harvesting the organs of children) may be exercised only if there is informed voluntary consent of one parent, while living donation of organs from children are excluded, as elsewhere, for it is a crime.
Russian transplantologists do everything possible to help children who need donor organs. “We actively use the possibilities of intravital donorship. That is, you can get an organ or part organ from an adult donor. In addition, children used organs from deceased adult donors”, continues academician Gauthier.
Most children in this category are in need of transplantation of liver and kidneys – mostly young patients with chronic renal failure (CRF) and congenital liver diseases. “The issue of liver transplantation in children during the first months of life in our country is virtually closed. All children who need this transplantation will be referred to appropriate hospitals and always get the help they need. This is a great achievement, before such children were forced to go abroad. Now the flow is terminated, and everything is done in our country. This is approximately 90 cases of liver transplantation per year.”
The situation of renal transplantation to children with CKD not yet fully resolved. “At this stage we cannot say that we have this issue resolved completely. However, children have an absolute advantage in obtaining kidneys from post-mortem donors. However, almost all centres performing renal transplantation to children located in Moscow. And here there is a lot of work. In addition, kidney transplantation children from living-related donors – daily practice, we have gained in this direction a great experience,” continues Sergey Gaultier.
And yet, experts say, in pediatric transplantation we have a catastrophic situation with any body except the heart. “If, say, a ten-year child weighing 30 kg and with chronic heart disease we can transplant the heart of an adult donor, and we do, then, for example, to transplant the heart of an adult 3-4-year-old child we can’t yet. We have a law, and the instruction that enables the withdrawal of donor on the child, who was pronounced brain-dead. But in our practice there have been cases of proposals for organ donation in children. There was no attempt to implement children’s donorship in practice. The problem is of a purely organizational nature, medical professionals do not have relevant work experience in the field of post-mortem donation of children. I understand their scruples. Therefore, we are forced to send little children in need of heart transplant, abroad, hoping to receive a donor heart from a deceased child in another country where organ donation is a noble act of giving,” says our expert.
Sergey Gaultier hopes for a speedy adoption of a new law on organ transplantation, which will contribute to the solution of problems.