How black transplantology works in Ukraine. Jewish black transplantology Large federal centers

If you look at the development of medicine, you can note that often experiments that provide the opportunity to learn something new stand on the verge of ethics and morality, and sometimes violate the law in general. In addition, along with legal operations, clandestine operations are often carried out, which is also punishable by law. The most striking illustration is black transplantology, that is, the trade in human organs.

Black transplantology in Russia

The development of transplantology in Russia began not so long ago - in 1986. During this time, several laws were adopted defining the rules for transplanting donor organs to people in need.

According to the Federal Law “On Transplantation of Human Organs and (or) Tissues,” issued in 2007, the consent of the donor is required for transplantation of an organ or any tissue.

• There are two sources of organs:
• Relatives who agreed to become a donor;

Deceased people who agreed to donate their organs and tissues during their lifetime.

At the same time, it should be noted that donors do not receive money for donated organs, since the purchase and sale of organs is prohibited.

A person in need of some tissue or organ gets on the waiting list. Once a donor is available, an operation is scheduled, which can only be performed in Russia. The state pays for the transplant.

When a person is encouraged to become a donor, that is, forced transplantation takes place, a case is initiated under Article 120 of the Criminal Code of the Russian Federation.

Corpus delicti

• The article on transplantation, entitled “Forcing the removal of human organs or tissues for transplantation,” consists of two parts. In the first we're talking about
• about cases of coercion, through violence or the threat of its use.

The second part talks about the same acts, but committed against helpless citizens or persons financially dependent on the criminal.

• Thus, the object of this crime is human life and his health, since the removal of organs from deceased people (forcing relatives to give consent to this) is not discussed here. Also, cases in which the instrument of coercion is not violence or its threat, but bribery or persuasion, do not fall under this article.
• The crime classified under Article 120 is considered completed at the moment when the victim gave his consent to the removal of tissues or organs from him. Any sane person over 16 years of age bears responsibility for committing such a crime. His profession and type of activity are absolutely irrelevant.
• If the criminal, inciting the victim to make a seizure, realizes the danger of the operation for the life of the future donor, the crime is classified under Part 2 of Article 105 as complicity in murder.

Now let's find out what the law provides for illegal transplantation of human organs and tissues.

The following video contains useful information on the nuances of disclosing black transplantation in Russia:

Responsibility

The first part of Article 120 of the Criminal Code provides for such a type of punishment as imprisonment for a period not exceeding 4 years. In addition, the offender may be prohibited from engaging in specific activities and holding positions related to them.

A criminal who has committed an act falling within the definition of the second part of Article 120 may be imprisoned for five years, adding to this a ban on conducting specific activities.

Arbitrage practice

Find examples from judicial practice under Article 120 of the Criminal Code it is almost impossible. Two cases related to illegal organ transplants made headlines in the media. The first was about a group of doctors who were later acquitted, and the second was about a grandmother who wanted to sell her own grandson for organs. However, trafficking in persons for the purpose of removing tissues and organs from them is considered under the second part of Article 127.1.

The fact that there are no real cases under Article 120 makes it possible to assume that the black transplant market in Russia, according to 2015 data, is not developed to the same extent as noted in the West, which is understandable for a number of reasons:

• Transplantology began to develop in the post-Soviet space not so long ago, so there are not too many specialists in this field;
• Transplantologists working in Russia, due to their small number, earn decent money, so there is no point in risking them;
• To carry out operations to remove tissues and organs, in addition to transplantologists, a whole group of doctors is required, as well as special equipment;
• To store organs, it is necessary to create special conditions;
• It is necessary to remove organs from healthy adults, but it is too difficult to persuade such individuals to do this. And potential victims - homeless people, minors, mentally ill people - are not well suited for these purposes.

So, it becomes clear that this crime is too difficult to commit, hence its low prevalence. However, the spirit of the times itself requires the presence of a corresponding article of the Criminal Code.

Now let's talk about scientists' experiments on people.

Doctors' experiments on people

Often for further development or testing a theory, scientists need to test medicinal substances on humans. Realizing the need to develop science, the state, nevertheless, stands for the protection of the health and life of each individual person, and therefore prohibits conducting experiments on people without consent obtained from them or their legal representatives.

The Criminal Code of Russia does not deal with violation of this prohibition in a separate article. However, there are a number of legislative acts, both international, ratified in Russia, and domestic, which clearly stipulate the principles of work of specialists conducting such experiments.

One of the first, so to speak, fundamental documents on this issue is the Nuremberg Code of 1947, which prohibited conducting experiments on a person without his consent. But it should be noted that long before the adoption of this treaty in Russian Empire There have been cases of conviction of doctors who abused their powers.

Thus, in 1901, a doctor was convicted for the death of a patient on whom experiments were carried out, qualifying his act as causing death by a careless, but not prohibited, action. And although in the medical instructions of that time there was no direct prohibition on experiments without the patient’s consent, the Senate condemned the doctor’s act, regarding the fact that the test subject’s consent to the experiment was not obtained as negligence, which took on the nature of criminal negligence.

As for the Nuremberg Code, its main provisions are as follows:

• Obtaining consent from a person who has been thoroughly informed about the purpose and course of the experiment;
• The exclusively socially beneficial purpose of the experience;
• The impossibility of testing the theory in any way other than the experimental method;
• The validity of the provisions underlying the experience;
• Conducting the experiment by a qualified specialist;
• No risk to the health and life of the test subject, minimizing potential complications;
• The opportunity provided to the patient to stop the experience at any stage.

Note:

• All subsequent declarations and conventions were developed on the basis of these rules. In particular, the 1964 Declaration of Helsinki and its amendments (1975, 83, 89 and 2000), the Convention on Human Rights and Biomedicine (1996) and its additional protocols (1998, 2002 and 2005).
• Russian laws are based on these provisions. Thus, the prohibition of conducting experiments on a person without his voluntary consent is enshrined in Article 21 of the Constitution of the Russian Federation (1993).
• Of the number of documents devoted to the development of biomedicine, the Federal Law “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” (hereinafter referred to as the Fundamentals) stands out.

This document, which appeared in 1993, regulates the application of new methods of treatment and prevention, as well as various medications and drugs. As in international declarations, the main criteria here are the usefulness of the purpose of the experiment for the patient and consent to its conduct.

• In addition to the Fundamentals, there are a number of laws dedicated to individual issues development of medicine in its various fields (genetics, psychology, psychiatry, etc.).

Now let's find out how to avoid becoming a victim of experiments on patients or illegal removal of organs for transplantation.

The doctor told how the Russians became kidney incubators for the Turks
The specialist frankly voiced all the nuances of the black market for transplantation in Russia.
5:03, April 23, 2016 19252
organ transplantation
Exclusive
Andrey Zvonkov, an emergency physician at one of the capital’s clinics, in an exclusive interview with REN TV, spoke about how the black market for human organ transplantation developed in Russia.
According to him, at some point the capital of Russia turned into a donor appendage. Those wishing to receive, for example, a donor kidney, traveled to Moscow weekly.
The heyday of the criminal business came in the dashing 90s, when the hospital where Andrei worked began to offer kidney transplants to Turks.
"I finished medical school in 1991 and immediately went to an internship. Internship in anesthesiology and resuscitation. I worked in one of the Moscow clinics and saw myself as a resuscitator in the cardiac intensive care unit. So, large quantities of auto injuries were brought to the intensive care unit, since this hospital was associated with neurosurgery. Including auto injuries incompatible with life. These are severe traumatic brain injuries, when the patient is still formally alive, his heart is beating, he seems to be even trying to breathe, but his brain is no longer there. And in this case, the head of the department simply dialed the telephone number of the transplantologists, the team-team that left and arrived. In fact, they diagnosed biological death and registered it as a corpse. And they carried out the so-called first stage of the autopsy, taking away everything that could be taken,” says Zvonkov.
According to him, no one asked for any permission, naturally.
“The carcass was then sent to the morgue, already partially opened, partially freed from the organs that burdened it,” he adds. “As a matter of fact, I didn’t interfere in this. I’m an intern, bribes are fine with me. I minded my own business. And so Our doctors earned a little extra money. To be honest, I don’t know. Somebody was paid something. But I won’t tell you how much. I won’t lie.”
Andrei learned the prices, at least partially, when he moved to work in another clinic in 1992, during the most difficult time for Russia.
“The earnings were minimal, minimal. Naturally, for a doctor with no experience. What is an intern? This is a zero-level doctor, zero level. The salary was very small, 900 rubles, less than 1000 at the prices of that time. You could somehow live on 2000, enough. But at 900 it’s very difficult... I switched to private company"Russian Hospital" in one of the Moscow clinics, where we organized paid medical care on the basis of a regular department. We had a completely normal office in this sense, absolutely law-abiding. But we all know each other. The department is on the second (floor)... I know that one of the departments dealt with kidney transplants,” says the doctor. “And for some reason, Turks came to them and had these kidneys transplanted to them. I don’t know where these kidneys came from. The living or the dead. Well, in general, there was a company that organized such medical tours for Turks who came, paid for the tour itself, treatment, transplantation, organs. I know that a sum was given to the department; the cost of this transplant was about $2,000. Whether for the operation, or for the kidney, I don’t know. But this figure sounded."
Andrey Zvonkov
“Technically, transplanting a kidney is not as difficult as any other organ; primary rehabilitation after the operation took a week for the patient even then, after which the operated person could be returned to their homeland,” explains Zvonkov.
“I started working there somewhere in the spring of 1992. And in the spring of 1993, we already moved to a different address, and I no longer dealt with them,” says the doctor. “Mechanics itself can still exist. There is nothing complicated about it, and in general, it’s illegal too, because everything was formalized as such. tourist trip. And since in those years there was no compulsory health insurance, any person located on the territory of the Russian Federation or the Soviet Union received medical care in full, regardless of their citizenship. That’s what they actually used.”
Why exactly Turkish citizens have mastered the so-called transplant tourism, Zvonkov can only speculate: “Whether they were from other countries, I don’t know. Maybe. You see, there is one more nuance here. Europe would not go for this. They have their own characteristics. They do.” their own rules, their own zealots. The doctors there are very sensitive to the fact that someone should leave and be treated somewhere other than them. The Turks, apparently, have no problems with this.”
In the clinic where Andrei Zvonkov worked, according to him, kidney transplant operations were performed once or twice a week:
"I talked to the guys there. They said that they (the patients) are waiting. They are waiting there at home. As soon as they are told that there is material, they arrive within 24 hours, and they are immediately put into surgery. Moreover, the operation was carried out even in the middle of the night. That is, he arrived, he was immediately taken from the plane to the clinic, and a team immediately appeared, I believe that this was still the result of an accident. In the 90s we also had a lot of shootings... So, in general, we had the materials.”

Such a business would not be possible without connections on the “customer” side.
"There is definitely a partner on the other side. Someone is sitting in Turkey. The partner on this side is a coordinator who holds the information field in his hands. An agreement with the department and team, who are always ready to receive here. And with the specialists who are involved in organ procurement . There were channels for hospitalization. What are our main channels for hospitalization? Ambulance“The so-called RGV is the order of the chief physician,” explains Zvonkov. – I don’t know if it exists now or not. Then there was. You could write a statement “please hospitalize me,” and chief physician I signed “put in such and such department if there are places available,” but there were places in advance. Somehow they worked through these channels. Well, we settled accounts with all the interested people. And the brigade got what it deserved, and the chief, apparently, had something too. Without this, it would not be interesting for this to be carried out in his clinic, and he would be left behind."
In previous publications, we talked about how REN TV journalists managed to find an intermediary who is ready to send anyone to carry out such an operation in Pakistan. The film crew was also lucky to communicate with the happy owner of a donor kidney purchased in this country. Just recently, a scandal erupted in Moscow over a kidney transplant in one of the capital’s clinics, which a woman was forced to sell due to mortgage debts. According to Andrei Zvonkov, the black market for transplantology is thriving.
“With kidneys - yes, now they are reaching the same level. Only the price is in millions. I think the scheme will be exactly the same,” he says. “The black market develops when the white market cannot cope. If the white market is not able to fulfill certain tasks, a black market always arises in parallel. This is the law of the market. You see, if we cannot do something legally, the opportunity immediately arises to do it illegally. The question is: who is to blame? In this case, the person went and ratted out. He says, I want to give it away, but I don’t want to give it away for free. Why am I... On the other hand, being left with one kidney, I am disabled, and he cannot go to register for disability. where did his kidney go, why was he left with one, we need to falsify the problem and justify the removal of the kidney by some kind of disease. Now this is the edge of the law. Now some kind of fraud is beginning, and we are making him sick. How else? On what basis would an organ be taken from him? On the other hand, this organ must be healthy in order to be transplanted. Again, somehow justify that good organ appeared, found somewhere on the street. We were walking past and suddenly saw it lying around. So how? So it's not his organ. Whose? Someone was found dead and it was seized. All. Done. It's not his kidney anymore. And so on. The one who organizes this case turns out to be guilty. And who is doing the seizure? At this point we can say: you are guilty of breaking the law. Because here is the issuance of forged documents and falsification of data. Otherwise everything is legal. These are waiting for an organ, the organ arrives, the organ is transplanted. And people say - we don’t know anything. The donor himself says he’s also happy, he got what he deserved. The main thing is not to be deceived. All. But those who took this organ are under attack and are to blame."
Watch a special investigation about black transplant surgeons on REN TV on Sunday, April 23 at 23:00 in the “Dobrov on Air” program.

The first rocket launch from the Vostochny Cosmodrome - 04/27/2016 was cancelled.
Automation canceled the launch of the Soyuz-2.1a space rocket from the VOSTOCHNY cosmodrome 1.5 minutes before launch. The reserve launch date, April 28, remains. The commission is studying the reasons for the launch cancellation. The commission's findings will be reported additionally.

A loud scandal is unfolding in Ukraine: in the Kiev morgue on Oranzhereynaya Street, some unidentified corpses were burned for a whole month, The Russian Times reports.

The bodies were destroyed by the 24th “hundred” of Maidan self-defense, not allowing outsiders into the premises. According to the investigation, about fifty people passed through the hands of Ukrainian “black transplantologists”. At the same time, there is information that the dead were previously “eviscerated” by removing their organs. They also say that organs are taken there not only from the dead, but also from people who are still alive. It is impossible to check, doctors and law enforcement officers are not allowed into the territory. And in general, it is not clear why the nationalists needed this crematorium - precisely now, when power was seized and the country returned to peaceful life, according to the Ukrainian authorities. The “revolution” has ended, but the flow of its victims has not yet? I remember that in Kosovo, local nationalists, having seized power, organized in morgues and maternity hospitals real fairs of human “spare parts” for foreigners - aren’t the Kyiv impostors repeating the sad experience of the Kosovars?

Advertisements for the purchase and sale of human organs appear on specialized websites and in relevant groups on social networks every day. At the same time, there is not a single criminal case about “black transplantologists” in the Russian legal field. “Snob” studied how the market for human organs works in Russia and the post-Soviet space

Photo: Romeo Ranoco/Reuters

Applicants

Asia I’m ready to sell a kidney or a liver, it doesn’t matter. She thought for a month before writing the ad. “I don’t drink, I don’t smoke, I need money.” I came up with the text quickly. Two years ago, she could not have imagined that she would have to think about this. “My husband and I lived in Almaty for ten years, without knowing grief, we raised two children. And then he was laid off from the car dealership where he worked,” says Asiam. My husband tried to get a job for several months, but was unsuccessful. “We had a loan for renovations we were doing on the house. We took another one to pay it off, but in the end we still didn’t have enough to live on. The husband decided to take a risk and started playing slot machines and cards. And he was sucked in. And after some time, he lost more than we owed - 9 thousand dollars. In general, I signed a mortgage on the house in which we lived,” says Aziyam. When bandits came to take away their house for debts, Asia managed to find intermediaries who took out another loan for her. Six months later she managed to pay off the debt. Around the same time, the husband again squandered the house at cards. “So I stayed on the street with two children. My husband disappeared when we were evicted.” Asiam doesn’t know where he is—maybe he found another family, or maybe he committed suicide. “I’m tired, I don’t have the strength,” says Asiam. -Can you help me find who needs a kidney or a liver? I understand that everyone has their own problems, and there are a million people like me. I do not know what to do. Probably hope for something good.”

Andrey ready to sell any organ, “the absence of which will not cause problems later if it is not there.” You can sell a lot of things: the cornea of ​​an eye, part of the bone marrow, a testicle, a kidney or a liver, and earn from 3 to 100 thousand dollars. Prices vary greatly. Andrey needs about 15 thousand dollars for an operation that his sick mother requires. Relatives are not aware of his attempts. “I can’t earn money any other way.”

Orhan looking for money to open own business— he was banned from entering Russia for three years, and in Baku, where he now lives, he cannot earn money. “The bank doesn’t give 15 million, but to win, you have to take a risk. There is no fear, we all die someday. I believe in Allah, everything will be as he wants. My victory is my paradise. And yet, I don’t have anyone. After I lost my brother, I was left alone.”

Sergey hopes to get an education. “Last year I entered a Moscow university. I studied for the first months, although it was difficult. Once, a blogger from Japan, whom I follow, came to Moscow to meet with subscribers,” says Sergei. At the meeting there were representatives of educational institutions from Japan, they told how everything works. Sergei was eager to go. “Of course, it cost a lot of money. I started filling my head with all sorts of ideas about making money, and before I knew it, the first semester was over, and I didn’t pass a single exam—or rather, I wasn’t even admitted to them,” says Sergei. “And recently I saw a headline on the Internet about organ donation and decided to sacrifice something to pay for my studies. Perhaps there may be health problems later, but I think this is the beginning, and then I will get better. Still, it depends on the person’s health. How many people live quite normally with one organ!”

Each author of advertisements posted on numerous “exchanges” has his own sad story. It is unlikely that most of these people will be able to sell their organ: even if they decide to go all the way, they will fall for scammers who will lure them out of money for mediation, but will not connect them with a buyer. These scammers contemptuously call them “dodiks.” Real buyers, who, however, also call them rather contemptuously - “spare parts”, are much more difficult to find.

Scammers

In March of this year, Asiam found buyers for her kidney - she was offered 4 million rubles. She contacted the customer via e-mail. “What you told about your problems and debts, sorry for the directness, interests me the least,” a person with the nickname vstranechudesaliska wrote to Asia. “You come to us in Irkutsk, yourself. At the same time, they shouldn’t lose you at home for about a week. There will be no communication with the outside world. We will meet you and take you to the right place. You take tests for four days, and if everything is normal, we’ll cut it out for you.”

Two months have passed since this conversation. Despite being tired of debts, Asiam still can’t decide whether to go to Irkutsk or not. Her interlocutor did not give any guarantees and refused to pay the advance. Aziyam is afraid to return back without money or not at all: friends say that she could be sold into sexual slavery. However, stories about kidnappings of people who want to sell their kidneys are from the realm of rumors; the leader of the “Alternative” movement, Oleg Melnikov, who rescues people with his own money, for example, from brick factories in Dagestan, told “Snob” that he had never encountered such cases in his long practice.

Konstantin from Bratsk tried to sell a kidney four times: he needed money to buy a computer powerful enough to work as a web designer; With the rest of the money, he wants to buy a tent in Irkutsk, which he will rent out. Konstantin is an orphan, visually disabled from childhood. On the Internet, he negotiated services with intermediaries. “For some reason I trusted the girls all four times, I don’t know why. They all turned out to be scammers. I even understand that, most likely, these are not photographs of them, maybe, in general, a guy is sitting at a computer. They explained that they were providing services—they were connecting me with a doctor. You need to pay money for this. In just six months I gave away 18 thousand. Every time after payment the person disappeared. I don't even know how I, such an idiot, did it so many times. However, I continue to look for opportunities, I didn’t have any money, and I still got into debt. Can you help me sell a kidney?”

Of the several dozen people posing as intermediaries on the Internet, Marina () is the only one who agreed to talk with “Snob”. Marina has several fake VK accounts - she bought them in bulk, about fifteen pieces at once, on one of the exchanges of hacked pages. “They are already shopping with friends. I fill out my profile so that it can be seen that I lead an active life. I repost all sorts of quotes. I choose photos that are cute, but not too cute - just a nice, pretty girl. So that both men and women can be led.” Marina says that people come to her with requests for help to sell a kidney several times every day. For meeting a doctor who performs such operations, she asks from three to five thousand rubles. “The majority refuse, but up to seven people are recruited per month. After transferring money, I either immediately block the person or feed him breakfast for a while. These Dodiks are so tired of life that, as a rule, they have no strength to complain. If they block it, don't worry. Accounts cost pennies, and there are too many people interested.” Marina lives in a small town in the Urals and is raising her alone. small child. The money he earns is enough to give him everything. “We have few options: either as a saleswoman or on the track. So I settled in okay,” she says. Marina does not feel any remorse: “People want easy money instead of working. I want it too, only I'm smarter. Everything is fair." In her opinion, it is impossible to find a real intermediary via the Internet. “I have never heard of anyone actually being able to sell. In my opinion, there is simply no such thing.”

According to transplant doctor Mogeli Khubutia, this business simply cannot exist. “This is all fiction, just stories, you know? The profession of transplantologist is so rare that doctors simply do not need it. After all, this is dangerous for your reputation. The professional world is a very narrow one, where everyone knows each other. This is the first thing. The conditions for the operation must be appropriate - this is the second thing. Qualification, again. Have you ever heard of this yourself? There were no criminal cases or anything like that. If someone did this, they would definitely get caught,” says Khubutia.

Photo: Keith Bedford/Reuters

Spare parts

Sergey from Ukhta found a real intermediary after giving money to two scammers. Sergei was not selling a kidney, he was looking for where to buy it for his wife, who really needed it.

“I would be happy to tell you, but you yourself must understand that all this is illegal. “I’m afraid,” Sergei begins the conversation. “I’ve already been burned several times by these intermediaries.” Then I saw one agency and decided to contact them. I don’t know why I made up my mind - it’s just that the situation was already becoming hopeless.”

“Snob” contacted several agencies offering similar services in Russia. The standard answer looks something like this: “The cost of the liver is from 4 million rubles. The cost of a kidney is from 6 million rubles. Our clinic provides electronic tickets for fast trains or planes, it all depends on your location. To cooperate, you must pay a registration fee of 12,300 rubles. This contribution is made by the potential donor for the preparation of documents and is a guarantee of the seriousness of your decision. Upon admission to the clinic, you will begin to undergo examination from the first day, after which, based on all indicators, a fee will be announced.”

Sergei was very worried whether he would be deceived again, since first of all he had to pay. “In general, there was no, I sent my wife’s data. I waited for a week, then they told me that they had found it. They offered two candidates - we chose the one who asks the least.” After that, Sergei paid half the amount - 15 thousand dollars. They told him the city and the date to arrive. “My wife and I arrived in the city of N, they met us there. Those who met did not hide their faces. We were put in a car and taken to the clinic, it was located within the city. They took tests and had surgery the next day. The doctors are intellectuals, wearing masks, I didn’t see their faces. After the operation I paid the balance, that's basically it. The kidney has taken root, everything is fine.”

Lyudmila Lazareva- one of the few who publicly spoke about having undergone such an operation in Russia. In 2014, in order to pay off her foreign currency mortgage, she took a desperate step and sold her kidney. Doctors I knew helped organize the operation in one of the clinics near Moscow, the name of which Lazareva did not specify in a conversation with journalists. According to her, they looked for a buyer for about two weeks, then she underwent an operation, after which she “lay in a regular ward with some kind of usual diagnosis.” A week later, Lazareva was discharged. She received only 150 thousand rubles for the organ, which was barely enough for the monthly mortgage payment.

“My health is the same as it was before. Only my hair stopped growing, and I lost a lot of teeth,” she said in an interview two years after the operation. After several TV shows that Lazareva attended in 2016, her traces are lost.

Torpedoes and donkeys

There are no references to criminal cases under Article 127.1 of the Criminal Code, paragraph “G” - trafficking in persons for the purpose of removing human organs - in any database of court sentences. Those who sell organs, as Snob found out, are not too afraid of prosecution by the law. “Snob” managed to find a real mediator who explained why. Arseny Potapov (fictitious name on VK. — Approx. ed.) lives in one of the neighboring countries. “You may have heard that a group of people who facilitated the donation were detained? Each person receives 35 thousand dollars, and we again work in a world where everything is bought and sold,” explains Potapov. — Let’s imagine that you decide to sell your kidney. There are very few intermediaries, I know about five other people, all of them do not live in Russia. So there is a 96% chance that you will be deceived. People are fooled by exorbitant sums; they are offered, for example, 400 thousand dollars in fees and half at once. This is how one woman recently got $500. There are a lot of scammers, however, I also did not immediately become an intermediary.”

Several years ago, Potapov urgently needed money, and he was offered to work as a “torpedo”. “This is a job that involves transporting drugs, most often in your own body; I hid it in other places. The pay was good, but six months later I was offered to go to a less dangerous job - as a mediator, or “donkey.” “Donkey” is the one who picks up the client from his city and takes him to the clinic. Now every month from two to four people pass through Potapov. He charges one and a half thousand dollars for his services. Potapov sends me the price list of one of the Moscow clinics. “In Russia, livers are not transplanted; for this operation we provide the opportunity to fly abroad. All other procedures: kidney, bone marrow and stem cell transplants are performed in our clinic. Stem cell transplant – 10 thousand dollars, bone marrow – 70 thousand dollars, liver – from 130 thousand to 300 thousand dollars (including flight), kidney – 200 thousand dollars.”

“Of course, even if you find a real intermediary, you will receive 30 thousand dollars for a liver or kidney. The rest goes to pay for the operation, part of the amount is taken by the intermediary, part goes to doctors and those who turn a blind eye to this matter. The donor himself will never find anyone without an intermediary, so the money goes away,” explains Potapov. In addition to donation, he is involved in several other “related” businesses. “I take young girls who have been abandoned by their boyfriends or are simply disappointed in life to India for egg donation. This is better than cutting out a kidney, and the fee is around 7 thousand dollars. Plus it's legal. There is one more know-how, you will laugh. Wealthy ladies are willing to pay for young guys with good looks. Now a woman from Estonia, 57 years old, asked to find young guy according to her criteria. Looking for a dandy - tall, weight no more than 90 kilograms, athletic build.”

At the end of the conversation, Potapov promises to send me a video in which there is a “real major intermediary.” This is a recording of a 2014 program for Ukrainian television. He will also advise how to reach him - introducing himself as a donor, write a letter to the administrator on a specialized website.

First thing Alexander G. tells me that most of what is said about him in the media is lies. “I got into this story like most people. At first I wanted to sell my kidney. In most cases, people are used to searching on the Internet, but I read an advertisement in an Israeli paper newspaper in Russian. We were looking for a kidney donor for a fee. I was young, graduated from the Faculty of Medicine at Tel Aviv University. There was no apartment, no car, I had to work as a doctor for more than 10 years to earn all this.”

G. was born in Ukraine and is now about 30 years old. He is considered an ex-participant of the international criminal group Turkish doctor “Dr. Zis” is the main player in this business in the post-Soviet space and in Europe. G. himself admitted this in a conversation with “Snob”. In 2008, he called the number listed in the newspaper, where he was offered to meet. “I met with group member Boris Volfman, he said that there are people who need a transplant, and if I am ready, I can be a donor. They promised me 80 thousand dollars. I gave the go-ahead. They conducted an examination, they paid an advance.”

What saved Alexander from donating was that the buyer of his kidney died while he was applying for a Canadian visa - the operation was supposed to take place there. “Wolfman told me to wait and they would find another person. After some time, I assessed the situation, understood how these people make money, and persuaded Wolfman to take me into the business. At first I wanted to look for donors, but Boris said that there was no problem with this and that we needed to look for buyers. I know Hebrew, Russian, Ukrainian, English, and even before studying medicine, I worked part-time as an IT specialist. I found several American forums where people who needed a transplant gathered. I looked at the data of these people, sent them letters, told them that I knew about their problem and could help. 8 out of 10 agreed to the services. This is how I found my first clients. I was promised 10 thousand dollars from each. I figured it was great option earn money for an apartment in Tel Aviv.”

Photo: Pierre-Philippe Marcou/AFP

Doctors and bosses

Then Alexander came up with a more reliable scheme for finding clients - getting his doctors to work in hemodialysis departments in expensive private clinics in Europe. The plan was implemented. “It was very important to know who you were dealing with. Someone was charged 80 thousand dollars for a transplant, but if they understood that a person could pay 150 thousand, then they charged one hundred and fifty,” says G. “There were 25 people in our group. Some were looking for donors, others were doing analysis, and others were providing support. Everyone had their own responsibilities, but no one knew each other, so that if one was pulled, nothing would happen to the others. Some were parasites who did nothing but received money.”

At some point, according to Alexander, he began to be paid less and less, and his dissatisfaction with Wolfman’s work methods accumulated. “I didn’t know how much donors actually received. They were usually paid after the operation. Over time, I learned that donors were not paid the promised money; they received 10-15 thousand dollars in their hands, and sometimes they did not receive anything at all. People were afraid to go and complain; they thought they were breaking the law. I understood that this was wrong and sooner or later it would all crack. I decided to leave and went to talk to Wolfman. As a result, 10 people took me out into the desert and beat me for wrong thoughts. They said that I would not leave the case. Then I had to go to the police. Everyone was detained, there was a scandal.”

Alexander temporarily moved to Egypt and was thinking about what to do next. During his work, he understood well how the business works and decided to do it on his own. “There is a lower level - “donkeys” - the only people who risk being subject to criminal prosecution. They transport people across the border and get paid pennies for it. Next come various intermediaries - those who look for clients and work on organizing the process. The highest level is the doctor for whom we work. He personally operates or negotiates with other doctors. There are about six such doctors - Albania, Türkiye, Azerbaijan, Kosovo,” explains G.

About a month passes from the date of the meeting to the operation. “I need to find a buyer, negotiate with him, many want a personal meeting, I have to fly, this is an expense,” says G. “At this time, the donor leaves an advance, I give him a list of tests that need to be taken. Then I call the doctor and send the donor there at my own expense. Next, it is necessary to calculate before the operation, then the operation. This is where my services end."

To prevent the donor from running away, G. takes his passport and a receipt, where he indicates that he received money for the upcoming donation and understands that he is breaking the law ( V different countries The law varies, but sales are prohibited everywhere. — Approx. ed.). “It never came to the point where I applied somewhere with a receipt. But there are guys who, if anything happens, will break their legs.”

In this business, according to G., everyone is somehow connected with Wolfman or Zis. “There’s really no competition - just pay money, bring normal clients, and you’ll be welcome,” says G. “I know that Wolfman works in Albania. There is nothing stopping me from coming there and agreeing on the operation. He won’t say a word to me - the main thing is money.”

He himself does not feel any shame about being involved in this business. “I always warn people what this could mean for them. Moreover, I always make people sign a paper that describes the consequences. In the worst case scenario, a person may then look for a donor on his own, which he will not be able to pay for. But this is a business where everything cannot be clean. However, like anyone else. It's like having a store."

According to Kommersant, a decision by the European Court of Human Rights in the case of Alina Sablina, whose relatives complained that they were not notified of the posthumous removal of organs, is expected in the near future. In June, the Moscow City Court will consider a complaint in a similar case. Alexey Pinchuk, head of the scientific department of kidney and pancreas transplantation at the Sklifosovsky Research Institute of Emergency Medicine, told Kommersant correspondent Valeria Mishina how in Russia one can express consent or disagreement to posthumous donation, how the system of distribution of donor organs works and how long patients have to wait for an organ for transplantation .

Russian officials talk about a growing number of organ transplants. At the same time, the courts are receiving lawsuits from relatives of those killed in road accidents and who became posthumous donors: families complain about the removal of organs without notification. What is happening in Russian transplantology?

Fundamentally significant changes in our industry over the past ten years, unfortunately, we have not observed. There are some successes. For example, we began to more actively introduce those types of transplantations that were practically not performed in the country before: heart and liver transplants (in some centers they even became routine), lung transplants, pancreas transplants... 10–15 years ago these were rare , isolated cases. Now such operations, one might say, have been put on stream, but, unfortunately, not throughout the country, but only in the leading, largest transplant clinics.

- What kind of clinics are these? And what happened ten years ago that these operations became routine?

Nothing global has happened, we’ve probably just come to the point where we understand that without conforming to global trends, without keeping pace with global medicine, we find ourselves on the periphery. Therefore, we began to more actively master these methods and try to introduce them into everyday clinical practice. There are not many clinics in our country that work with all types of organ transplants; we can single out about five leading ones in this regard, no more. These are primarily the Shumakov National Transplant Center and the Sklifosovsky Institute, which is the largest urban transplant clinic in the capital. All the others are still inferior in scale - the regional hospital named after Ochapovsky in Krasnodar, MONIKI named after Vladimirsky in the Moscow region, regional transplantation centers in Rostov, Novosibirsk... But, unfortunately, in the country as a whole, the pace of development of the industry leaves much to be desired. Leading clinics are still primarily concentrated in Moscow.

If we look at the map of transplantations for the country as a whole, we will see that about half of all transplants are performed in just two institutes - Shumakov and Sklifosovsky.

There are more heart transplants at the Shumakov Institute, and until recently we performed more kidney transplants. In Sklif, more liver transplants are performed from cadaveric donors, and from relatives - in the Shumakov center. We annually perform almost 200 kidney transplants and 100 liver transplants, about 10 heart and lung transplants. In other clinics, transplants are performed an order of magnitude less. But these round figures do not entirely correctly reflect the current state of affairs, because from year to year the number of organ donors nationwide remains at a very low level.

- How many people need organ transplants in Russia?

So many. We perform 200 kidney transplants a year - this is a decent figure for one clinic. Nevertheless, we always have about 500 people on the waiting list, and these are only Muscovites - residents of a region where, compared to others, this situation is not so acute.

On a national scale, the picture is sadder. We, as a Moscow healthcare structure, unfortunately, cannot provide assistance to regional patients. This is done in federal clinics - the Shumakov Center, the Russian Scientific Center for Surgery, and the Research Institute of Urology. All these institutions are also located in the capital. Therefore, those who were able to get to Moscow have some chance.

- How to get to Moscow for a transfer?

So far, through a system of federal quotas for the provision of high-tech medical care. They are distributed by the Ministry of Health. This year the quota system remains in place. But if financing is provided through the compulsory health insurance fund, then I don’t think that the situation can change dramatically. In the end, it doesn’t matter where exactly we get funding from, in any case, the available donor organs do not go to waste. All suitable ones that can save a life will be transplanted. In any region. Here the question is not about financing, but about the available quantity - we are able to perform not 200, but also 400 and 600 kidney transplants per year. This quantity corresponds to our level, both surgical and medical in general, but we do not yet have such a number of organs.

- Approximately how long do people wait for a suitable organ?

On average, in our clinic, if we talk about a kidney, then one and a half to two years. There are a number of patients who have to wait longer because they have certain medical difficulties with the selection of an organ.

“It is not an organ that is “searched for”, but the most suitable recipient from the waiting list that is selected for the organ.”

- How is an organ found for a patient?

It is very important to note: it is not an organ that is “looked for”, but an already existing, removed donor organ, with a certain set of medical characteristics, the most suitable recipient is selected from the entire list of those in need - from the so-called waiting list. The selection of a recipient, in addition to many medical indicators, is also made taking into account the waiting time. When in the intensive care unit, unfortunately, it is not possible to save a patient with a stroke or severe head injury, and if neither he himself nor his relatives actively spoke out against the possible removal of organs, after death is declared, they can be used for transplantation. Organ donor service specialists remove organs and a short time preserved. For an existing organ, recipients are selected from a waiting list for whom this organ the best way fits. And from this shortened list - the one who waits the longest for surgery.

- What should match, besides, for example, blood type?

There are about 20 factors that must be taken into account in order for a patient's donor kidney to work, work well, and last a long time. The most important are blood type, age, initial state of the organ, immunological compatibility.

Also, if the donor for a long time suffered from hypertension, it is very important that the recipient also has his own arterial pressure wasn't low. The kidney will work efficiently in the conditions to which it is “accustomed” and in which it worked during the last years of the donor’s life.

And, believe me, there are many such nuances in transplantation.

- How long will the organ work if all the parameters match?

Ideally, we strive for the patient to live happily to a ripe old age and die due to age with a normally functioning graft. Unfortunately, life makes its own adjustments, but there are survival rates that can be called record-breaking. Maximum time The lifespan of the transplanted kidney was 42 years. Heart transplant - 36 years old. There is no doubt that when correct selection organ and recipient, impeccable surgery and competent management of the patient after transplantation, the donor organ is able to work for several decades.

Organ transplant patients need to take immunosuppressants to prevent the organ from being rejected. How do they affect health?

The arsenal of immunosuppressive drugs is constantly expanding. In fact, the problem of rejection - something that our predecessors and teachers constantly faced - is not as relevant now as it used to be. That is, in principle, deceiving the body and making it “believe” that the donor organ is its own is possible in most cases. On the other hand, we must admit that even the most modern immunosuppressive drugs have a number of side effects, which still do not add health to the recipient. But these undesirable phenomena have been well studied, we know how to prevent them, how to prevent their development and how to deal with them if they have already appeared.

For example, we often have to deal with the development of diabetes mellitus. Or, against the background of immunosuppression, blood pressure may increase. Increased risk of developing infectious diseases, and not only the usual types of pneumonia and influenza, but also specific ones associated specifically with suppressed immunity. For example, cytomegalovirus and herpes. For ordinary person they are not dangerous. But in conditions of immunosuppression they can pose a threat to the health and even life of the patient.

- Some patients cannot have an organ transplant. What is the reason and what kind of patients are these?

There are fewer and fewer such patients every year. We now have a very liberal attitude, for example, to the age factor. Until relatively recently, patients over 60 years of age were practically not considered as candidates for transplantation. Today we successfully operate on patients much older than 70 years. If the patient can tolerate anesthesia and serious surgical intervention If he potentially lives after the transplant for at least five years, we are trying to help him. The same applies to patients with autoimmune pathology - when the body itself “devours” its organs. Previously, such patients were almost never operated on - after all, just as the immune system damaged its own kidneys, it also dealt with the transplanted one in the shortest possible time. And now we have the ability to successfully prevent such situations. For example, a patient with diabetes undergoes a kidney and pancreas transplant at the same time. Kidney failure is eliminated, and diabetes is virtually cured and does not further damage the transplanted kidney.

- Where in Russia are organs available for transplantation taken into account?

Separately in each organ donation center. So far, there is no full-fledged register, as well as a so-called organ bank. After all, donor organs acceptable for transplantation have a very short “life span.” It is impossible, for example, to freeze an organ and then take the one you need off the shelf, defrost it and transplant it.

A kidney transplant, for example, remains suitable for transplantation for a maximum of 24 hours. Subject to special preservation, of course. For other organs, this period is much shorter: heart up to 9–10 hours, liver up to 16 hours, pancreas up to 15 hours, lungs up to 7–9 hours.

Therefore, the selection of a recipient, his call and preparation are carried out in parallel with the work of the donor service. Both donor and transplant teams work around the clock, on holidays and weekends. This is a widespread, worldwide practice.

The entire process is organized by the coordinating donor center. Its functions include notifying teams, preliminary discussion of suitable recipients with the centers where they are awaiting transplantation. They try to take into account all the nuances at the initial stage, when they are just starting to seize.

Thus, the entire system of organ distribution is limited to the region or neighboring ones, since otherwise there are difficulties in successfully delivering the organ.

The kidney can be delivered to other regions in time, and in some cases to both the liver and the heart. But why? Each region should have an established organ donation process, and each region should have specialists and clinics that can transplant organs to patients living there. There is no need to organize organ delivery on an ongoing basis throughout our vast country - such a need can only arise in exceptional cases. Although we, for example, have experience in transplanting kidneys that were removed even in Krasnoyarsk. Our colleagues did not have a suitable recipient on the waiting list (he had a rare blood type), they contacted us, we calculated the delivery logistics and met it within an acceptable time frame, everything went well. But this is a rare, isolated case. Ideally, organ allocation should remain within the region, with potential recipients available within 1–2 hours. Again, I repeat, this is a widespread, worldwide practice.

- What are the chances that the transplanted organ will take root?

Organ survival rate is now very high for any organ and on average exceeds 95%: 98% for kidney transplantation, and above 90% for liver, heart and lung transplantation.

- In kidney and liver transplants, how much is cadaveric donation, and how much is related?

Up to 20% may come from related donations in different clinics. In other cases, patients await transplantation from a posthumous donor. Related transplantation of a kidney or part of a liver, primarily for organ deficiency. At sufficient level development of organ donation, related transplantation will move into the realm of rare, difficult in terms of medical selection of cases. AND active development related donation programs occurs due to unresolved problems and difficulties in organizing posthumous donation.

“Donors can be those dead people who could not be helped"

- If we compare with other countries, what level are we at in terms of posthumous donation?

Unfortunately, we are among the laggards. We are somewhere in the third ten in the world.

- In other countries, the system is built specifically on cadaveric donation?

This largely depends on the length of wait for an organ transplant from a posthumous donor. For example, our colleagues in Belarus have virtually no waiting period for a transplant, because based on the level of development of organ donation, they provide the required number of transplants for all citizens of the country. That is, if a patient appears who needs a kidney, heart, or liver transplant, the operation is performed within a month, maximum two. Because the level of organization of the organ donation system, the level of administration, made it possible to build a system in which all possible patients whom doctors could not save will be considered as organ donors.

- How then is the situation in Russia different? We have the same presumption of consent.

Our weak point is in the system of administrative decisions, in the interaction of the donor service with those hospitals where they try to save the lives of patients, but this is not always possible. For example, in case of a head injury incompatible with life or severe brain damage as a result of a stroke or circulatory disorders. When all such cases are brought to the attention of the donor service, believe me, our level of organ donation will increase significantly. Again, Moscow is a vivid example of this. Average level organ donation in Moscow also leaves much to be desired, but at least this local example shows that with the proper approach, primarily through administrative and organizational efforts, it is possible to achieve a level five times higher than in the country as a whole.

Currently, the overall donation rate does not exceed 4 organ donors per 1 million population. And in the capital it is above 17. The acceptable level to strive for is 28–32 donors per 1 million people.

And it is quite achievable when the entire pool of potential donors is covered by the donor service.

But Moscow now cannot provide for everyone in need throughout the country; this requires the development of donor services in the regions. And we see that there are areas in which this development is happening very successfully: Novosibirsk, Krasnodar, Rostov, Yekaterinburg, Tyumen.

- Large federal centers?

In principle, this is a worldwide trend. It is inappropriate to develop a service such as organ donation and organ transplantation at the level of central district hospitals. It requires flow. In a small hospital, even at the highest coverage, 5–10 transplants per year will be performed. And the specialists there will never accumulate the necessary experience and level so that all these operations end well for them, without problems and complications. It is better to assign patients to federal and large regional centers. But nevertheless, taking into account the scale of our country, in every region, in large cities with a serious level of medicine and surgery, this is also possible. But not all regions have this yet.

- Are the indicators you mentioned, 28–32 donors per 1 million people, possible now?

Possible even now. These are the dead people who, despite the titanic efforts of doctors (who are actually trying to save patients, but doctors are not gods), could not be helped.

“As a rule, we have the opinion that doctors killed”

In Russia, there is a presumption of consent to the removal of organs - if the patient and his relatives have not indicated that they do not want the removal, according to the law they have the right to take the organs. Doctors are not obliged to ask the opinions of relatives. How ethical do you think this is?

Two systems have developed and are developing in parallel in the world. The first is when the default is that if a refusal has not been declared, then in the event of the patient's death, if his organs can be removed, they will be removed for transplantation. This is the so-called presumption of consent, which is practiced in our country. The presumption of disagreement, or presumption of consent sought, on the contrary, states that if the will of a person is not known, then by default it is assumed that the person was categorically against it. And in this case, you need to either find out the patient’s opinion while this is still possible, or enter some documents that, during life and full health, will register his consent. And here we can still talk about registers... Or we need to ask for the consent of relatives if the patient, due to the severity of his condition, can no longer say this. In fact, both models have pros and cons. And there are ethical disputes between their supporters.

- Where do which models operate?

IN North America In Canada and the USA, consent is sought, in Europe it is 50/50: for example, Spain is consent sought, Great Britain is a presumption of consent. In some countries, these models smoothly flow into one another: at first they worked according to one model, then reoriented to another. It seems to me that if we choose the model of requested consent, when we require people to record their opinion in a register, to put a mark on their rights, then in this case success comes only to those countries that have a high degree of public trust in medicine in general. Unfortunately, we in Russia cannot boast of such a situation. As a rule, we have the opinion that “the doctors killed you, the doctors treated you negligently, you didn’t pay the doctors any money - that’s why no one will come to you.” This is regularly heard in the media, from the pages of newspapers, from the TV screen, the Internet is full of similar reviews, regardless of whether we are talking about transplantation or treatment of a runny nose. And this all speaks about the degree of public trust in doctors and in medicine as a system as a whole. Of course, when people hear all this, even if they do not have a clearly formed negative opinion, then under the influence of all this information noise, if they are presented with a choice for or against, the person will say “no” just in case, without bothering to understand the issue in detail . Available the legislative framework in our country is absolutely adequate to the social situation. But at the same time, any person has the absolute right and opportunity to register in advance their disagreement with posthumous organ removal.

- How to fix it?

In practice, this is not applied, but according to the law, when hospitalized in a hospital for any reason, a person can tell the attending physician that in the event of death, sudden, accidental, unpredictable or expected, he categorically refuses to be an organ donor. The donor service will not work with this patient by default, due to the refusal of the patient himself. The same applies to relatives: when the patient was brought to the hospital already in a severe agonal state, or something happened and he ends up in intensive care unit and cannot express his will, it is enough for the relatives to tell the attending physician that they are categorically against it: “If you cannot save him, we ask, we demand that you do not consider him for the possibility of posthumous donation.” All. The organ donation service will not be called to this patient, and even if they have already arrived and the condition leaves no doubt that death is inevitable, the team will simply turn around and leave. Believe me, you don’t need to fill out any paperwork for this, you don’t need any signatures, you don’t need petitions, you just need to tell the attending physician, the head of the intensive care unit. This will be quite enough.

“No one will come to him, sit, rub their hands and think about what is about to be cut out...”

- When do doctors begin to realize that there is a potential donor in front of them?

Based on forecasts. If there is any significant percentage of probability that we will not be able to save the patient in his current condition. An experienced resuscitator can assess the situation and say that a fatal outcome is probably expected in a day or two, and call the organ donation service for a preliminary assessment so that they can take a look at it. If they arrive or ask over the phone how this patient is doing, and they are told that he is on the mend, there is a positive trend, the patient is removed from observation. No one will come to him, sit, rub their hands and think about what they are about to cut out... This will not happen. Doctors work here. Some more, some less, but they are all very highly moral people.

But a doctor who is treating a patient and, unfortunately, cannot cure him, has two options - either inform the organ donation center, or not inform. He understands that in one case one of the relatives can then file a claim with the prosecutor's office, and in another he will sleep peacefully.

And this is the peculiarity Belarusian model: for them, failure to report such a case, about a potential donor, is equivalent to failure to provide medical care. Those patients whom this doctor does not see, who are in transplant waiting centers and for whom the organs of this deceased (or currently dying) person can help. We died - the doctor will not be punished for this (if there was no serious mistakes in treatment), and many colleagues will also approve: “Well done, otherwise, God forbid, in six months a lawsuit will come and you will be dragged through the prosecutor’s office and investigative committees" I know from the inside how the system works, I am absolutely sure that when organs are removed, everything is done ethically and within the law. Neither transplantologists nor donor service specialists are involved in any way in ascertaining death. But in the event of a claim from relatives, both the resuscitator and the head of the intensive care unit will be put under pressure, they will be put under pressure, they will face many sleepless nights, thoughts about the family, all this moral burden. And then the person will say: “Why do I need all this? Yes, it would be better if I didn’t tell anyone, I would sleep peacefully and with clear conscience. As for other people - those who need organs - I haven’t seen them, I don’t know them, I can’t help everyone in the world.”

In the USA, as in Belarus, if a resuscitator does not inform the donor center about a potential donor with minimal chances or about a patient in the process of ascertaining death, or it has already been confirmed, he faces penalties (up to and including deprivation of his license), censure from colleagues, administrative collections and so on. We have neither carrot nor stick for this. Not all doctors, unfortunately, and perhaps fortunately, can work for this idea. It’s one thing to make every effort to save a patient who is in your hands, for whom you are responsible, and another thing is that somewhere there is someone in a transplant center, and this is even another hospital...

- That is, propaganda is needed not only among the population, but also among doctors?

Among doctors too. And not just among doctors, but from school, from student days. Departments of transplantology are slowly beginning to appear in the regions. There are two operating in Moscow now. And for any medical student, it is necessary to make sure that transplantation and organ donation are a normal, civilized part of the work, especially for a doctor who works at the intersection of life and death, in intensive care, in emergency medicine. Everyone should have an understanding.

“In moments like these, every minute counts.”

Currently, the government is still working on a bill on organ transplantation, which has been in preparation for several years. It effectively provides for the consent sought. What is happening to the document now? And what are the positive or negative aspects of it, in your opinion?

The only positive thing I see in it is that it proposes the same mechanism that exists now, but in practice no one knows how to implement it. This is when a person is concerned with the problem of how to make sure that in the event of death, his organs are under no circumstances removed and used for transplantation. Now, hypothetically, a person can go to any medical institution, say that he is against it, even write it by hand, but there is no official form. Put the stamp of the institution on the piece of paper, fold it, put it in your passport and walk around with this piece of paper. And the bill introduces the possibility electronic registration of his will. The path is clearly laid out on how you can get into a single register for the whole country and express your will. The law proposes to create such a register, and this is perhaps the only thing we lack in the current situation from a legislative point of view. After all, if we simply, without changing the law, create a register of people who are categorically against the use of their organs in the event of death, this will solve a maximum of problems: a patient dies, he is checked against this database. If they do not find it, it is automatically considered that he agrees. Or they see that he is against it. And this removes the ethical point we are talking about.

On the other hand, given the peculiarities of our mentality, I doubt that more than 5% of the country’s adult population will register in this registry. By the way, both against and for. There is always a superstition: “I’m alive and well, I’ll go register a posthumous disagreement, what if higher powers do something to push me towards this. It’s better to let everything go as it goes.”

The law, in addition to creating registers of those for and against, proposes to give relatives after the death of a person who has not decided, two hours so that they remember that organs can be removed, call or come to the department and say that they are against . But even according to this law, doctors are not obliged to actively find out the opinions of relatives.

- Is two hours a long time?

Of course. In fact, at such moments, every minute counts - not all donors manage to maintain blood circulation, lung ventilation, that is, gas exchange, after death, in a state sufficient to prevent critical organ damage. Therefore, I advocate simplifying this point as much as possible: let there be only two registers - for those who do not mind, and for those who cannot “neither eat nor sleep” because their disagreement is not registered anywhere. Please, here is an online mechanism for expressing your will, refuse - no problem.

When I came to the transplant, with representatives of the funds mass media we talked about the fact that our society is not ready to accept the requested consent for posthumous donation. 20 years have passed since then, the situation has changed significantly, but we continue to say that society is not ready. So when will our society finally be ready? And what have we done during this time to ensure that it is ready? But we, doctors, and specifically transplantologists, have always been a closed community and remain so. Until we ourselves take a step forward, until we open up, until we show people, the security forces that supervise the rule of law in this country, it will be difficult to convince people that we have no abuses, no corruption, no organ market, no black transplantologists. Although believe me, they actually don’t exist.

- How can this be proven?

We need to open up, take the first step towards society in this regard. Firstly, there are no random people in transplantation: only enthusiastic doctors get there and survive. Those who went into medical practice, the art of medicine, with a highly moral position - and as a result of their development reached transplantation, which is now an advanced field of medicine. I personally know most of them - they are ambitious, they protect the “honor of the uniform”, and it is impossible to shut their mouths if they saw any serious abuses in this industry.

- Besides ethical aspects, what else says about the impossibility of black transplantation?

Second: the number of people involved in the process of organ donation, organ distribution, and transplantation is very large.

It is impossible to perform a transplant in some semi-underground organization, because this requires a developed donor service and an immunological laboratory to determine compatibility.

An operating room where highly qualified surgeons and nurses and anesthesiologists must work. Transplantation is the result of work large quantity people, each of whom must be a professional who has reached the top of his profession. And they don’t work at the same time in the same place: surgeons can’t just agree to sew something on someone. The donor service does one thing, the immunological laboratory does another.

After a transplant has been performed, high-quality intensive care is needed for a long time. And it can’t just be any one resuscitator, even a brilliant one. Depending on the situation after the transplant, intensive care is needed for 6, 8, 12 hours, and sometimes it takes a week, 10 days... And all this time the patient receives a huge amount of intensive therapy, correction of all organs and systems. Doctors must change, resuscitation nurses must change, the resuscitator on duty must change. Often large quantities of blood transfusions, certain specific drugs, and determination of the concentration of these drugs in the blood are required - that is, another laboratory, no longer immunological. We need a transfusiology center that prepares and distributes blood and plasma for this patient. We need specialists in hemocorrection, hemodialysis, and oxygenation. We need drivers who transport organs in special vehicles; We need nurses who prepare operating rooms. A lot of people work in the system - they see everything, know everything and will not remain silent when there are violations. To achieve this in a handicraft way somewhere “in garages”, to rent premises from veterinarians - it’s so funny for us to hear. We, the doctors, sometimes get unsatisfactory results, despite the concerted efforts of a large number of people caring for each patient around the clock. Therefore, for anyone who has worked at least a little in practical transplantology, fairy tales about black transplantologists bring a sad smile.