Transplants could bring a better life for more Ukrainians

By Jim Davis

Ask any Ukrainian citizen about the most important things in his or her life and invariably good health will be near the top of the list. However, Ukrainians who  suffer from major diseases such as kidney and liver impairments have an irrational fear of organ transplantation, widely recognized as one of the greatest health tools developed in the 20th century.

Although interest in the possibility of organ transplants for humans has appeared in medical literature for centuries, actual successful organ transplantation is dated only from 1954, with most of the world totally unfamiliar with the concept until the sensation that surrounded the first successful heart transplant on December 3, 1967 by South African Professor Christiaan Barnard.

Today, organ transplantations that were considered fantasy a century ago have in little more than half a century gone for headline-grabbing events to the commonplace. Yet, even in the most advanced medical settings, actual organ transplantations fill only a small part of the demand for such procedures. Based on Organ Procurement and Transplantation Network data, in the United States there were 16,679 organ transplantations in the first six months of 2009. Even with what appear to be relatively high organ transplant rates, the United States on Oct. 14, 2009 had a waiting list of those needing transplants that numbered 104,335.

In Europe, organ transplantation realities vary widely, based on a number of factors. This variation is observed by comparing three European countries of relatively equal size. In 2008, Spain accomplished 7,000+ transplants; Poland did about 1,400 while in Ukraine organ transplants totaled only 140. Ukraine's transplant numbers are extremely low for a country with over 46 million citizens. This is even more surprising when you take into account that the government many years ago embraced transplantation and took the lead by setting up transplant centers in major urban center hospitals in Kyiv, Donetsk, Zaporizhya and Odesa.

Dr. Krzysztof Siedlecki, formerly chief of surgery in a Polish hospital that did a lot of transplant surgery, and now country manager in Ukraine for Astellas, a Japanese pharmaceutical firm, pointed out that an essential element in developing a strong transplant program in any country must begin with a program of providing correct information that stimulates the donation of organs to be transplanted.

Siedlecki praised the work of Ukrainian specialists including Professor A. S. Niconenko, head of the Transplant Department in Zaporizhya, but added that there is a need for other physicians to become more involved.

"Developing a culture that encourages organ donation requires the involvement of a group of respected physicians that must lead the process," Siedlecki said.

 He added that attitudes toward transplantation are often family decisions.

"Transplantation is nothing more than an advanced form of therapy. However, something about taking the organ of one person and giving it to another sparks very intense family discussions, and that must be taken into account," Siedlecki said.

Family concerns, economic costs, and quality of life concerns are all part of the transplant picture, Siedlecki said. He pointed to a study by Prof. Niconenko that clearly demonstrates the economic advantages the country would achieve by increasing transplantation over dialysis. A patient on kidney dialysis requires medicines and disposable hospital supplies that cost about UAH 350,000 over a five-year period. The same patient, after a kidney transplant, requires therapy that over the same period that costs UAH 78,000, a savings of UAH 278,000 for each patient over a five year period.

There is, however, another very important factor that must be considered, Siedlecki believes.

"Once a patient begins dialysis, their life becomes very restricted. They must visit a dialysis center two or three times per week, where they are attached to a dialysis machine for several hours. This is time-consuming and for some requires travel over long distances to the nearest dialysis center," he said. "Once a patient has completed a successful transplant, they lead a much more normal life, are able to travel and just in general have a much more enjoyable life."

Plus, every person who receives a transplant frees up space for another patient at a dialysis center, he says, adding that half the people who need dialysis treatment cannot be accommodated by the nation's existing dialysis centers.