This autumn Ukrainian government may consider the massive moral and ethical issue, on which the lives of thousands of people depends every year: whether to allow presumed consent to the donation of human internal organs in case of death.

Currently, in Ukraine, such operations, called “сadaveric transplantation”, aren’t almost made and one of the reasons of it is outdated legislation. In July, to get things moving, MPs suggested the Government a new bill on organ donation, stating the so-called presumed consent.

However, other MPs of majority, such as Olga Bogomolets and Oksana Korchynska didn’t like the idea.. A few weeks later after the appearance of the bill they have registered a counter document, which by contrast, proposes a presumption of dissent. In other words, taking the organ of the deceased will be possible only if the donor has agreed to it for the life .

Representatives of Department Of Health claimed that their bill is necessary to adopt as it will save lots of lives. In contrast, Mrs. Korchynska is convinced that society, especially during the war, isn’t ready for such innovations.

Both bills imply strengthening the criminal responsibility for the illegal transplantation and implementing ethical committees at transplant centers, which would supervise their work from the public side.

Nowadays, so-called informed consent is valid in Ukraine, when the relatives of the deceased can give the permission to transplantation.

Donor themself can sign an application of their agreement or disagreement to use their organs after death for the life, but the law of 1999 didn’t even explain where this statement serve. In practice, it is extremely rare case, say doctors.

Relatives disagree

There are no reliable statistics on organ transplants in Ukraine. According to rough estimates of physicians, only about a hundred such operations are held every year, and almost all of them are from living donors. The number of patients who need a kidney, liver, heart or other organ transplant includes thousands. These patients have only two ways. The first one is to go to foreign clinics.

Acting Head of the Organ, tissues and cells Transplantation Coordination Center , Serhiy Palianytsia told, that during last year Ukrainian doctors have conducted no more than ten transplantations of organs, taken from deceased people. The reason is the fact that relatives of the victims usually refuse to give a permission.

“Given their emotional state, to give consent to the organs taking is extremely difficult for them”, says Mr. Palyanytsya.

Belarus as a guide

Supporters of ministerial bill, which was brought in to the Council by former Health Minister Oleg Musiy and other MPs, bring two main reasons why they are in favor of presumed consent, namely more lives saved and saving money for operations abroad.

Slogans in support of transplantation are popular even in Catholic countries: “Don’t take away organs to heaven, leave them on the ground” Alexander Pavlenko, DOH

“In Ukraine cadaveric transplantation is developed poorly, although it is considered more progressive”, says Alexander Pavlenko, Deputy Minister of Health. “Slogans in support of transplantation are popular even in Catholic countries: “Don’t take away organs to heaven, leave them on the ground. We, on the contrary, didn’t even have such term in legislation till recently”.

Almost all officials and doctors, with whom BBC Ukraine talked on the subject, are telling not only about Catholic country, but Belarus, as a successful example of the state where a presumption of consent to donation is valid since 2007. “Since that time the number of organ transplantations there has grown exponentially”, adds Mr Palianytsia.

According to him, the cost of kidney transplantation in Ukraine is 150-200 thousand UAH., while in Belarus for the same operation you need to pay 65 thousand $, which is nearly nine times more expensive.

“They take one foreign patient, including Ukrainian, who come there, and then get money to make at least five free transplants to citizens of their country”, says head of the Transplantation Coordination Center.

“Ukraine,basing on the Belarus experience, can also make a “significant breakthrough” in this area, which will contribute not only to the health of most Ukrainian, but also the development of medical tourism”, says Alexandra Pavlenko.

War and religion

Oksana Korchynska, another co-author of the bill on the presumption of dissent, also praises the experience of Belarus and says that she understands the motives of the opponents.

Mrs. Korchynska, who heads the board of trustees of OKHMADYT and is the first Deputy Head of Committee of Health, says she knows about problems of those, whose life can be saved only by organ transplantation.

“I am Christian and deeply religious person … Human sacrifice manifests when they give their organs consciously”, says Oksana Korchynska, MP.

However, she continues to be an opponent of presumption of consent and explains it by the fact that Ukrainian, especially militaries’ relatives, aren’t morally ready for such rules yet.

“As a person who works in Government and understands the transplantation nuances, I have no doubt that even with the presumption of consent everything will be fine”, she told BBC Ukraine. “But for people, who have been hearing of some sort of black transplant for years, especially for the relatives of our guys (in the ATO zone. – Ed.), it will be scary. They will always feel that our guys disappear with a reason, that they were captured or killed to get their organs used. Although I personally understand that it’s not true. “

The fact that there are no illegal transplants conducted in Ukraine, notes Sergey Palianytsia. He explains that in the operation of liver transplantation are involved about 20 doctors, from surgeons to urses and anesthesiologists. “Tell me, how you can to do it so, that you can avoid leakage about illegal transplants? They will be caught at the second operation top” – he said.

Mrs. Korchynska has another argument against the idea DOH – religious values.

“I am Christian and deeply religious person. I spoke on this topic with my clerics, bishops, and with Mufti Saeed (Ismagilov. -Red.). Religious people still say that human sacrifice manifests when they give their organs conciously”.

As explaned the MP, along with her colleague Olga Bogomolets she is willing to give their consent to the using of the organs in case of death and will agitate other MPs to do it. However, according to Mrs. Korchynska, this consent must be conscious and voluntary.

“From the rational, medical point of view, if the bill on the presumption of consent is adopted, it will be easier for doctors to work. But I think, taking into account the situation in Ukraine, our joint bill with Olga is more real,” she said.

“Sold for organs”

However, the answer to the question of what Ukrainian society is ready or not ready for depends on who is answering it.

Sergey Palianytsia, who supports the DOH’s idea, said that many Ukrainian, on the contrary, aren’t ready to give voluntarily consent to use their organs in case of premature death.

He told a story from his practice of a woman, a worker of medical institution, whose husband died in a car accident. Seeing suffering of patients who died, haven’t waiting enough for donor organs, she decided to make a good thing and allowed to take organs from her husband before bury him.

“And she agreed, – says Mr. Palyanytsya. – After that she had to move to another area, because the whole village bullied her for selling husband for organs.”

What about the West?

Similar debate about which system to use – presumed consent or dissent – were held or is still held in many other countries.

In most EU countries one or another form of presumption of consent is valid. It is consistently followed in Poland, Spain, Italy, France and Austria.

In Austria, for example, the level of consent for cadaveric donation reaches almost 100% of people. In Germany, where presumption of dissent is valid, there are only 12% of such people.

Presumption of dissent is also valid in the United Kingdom and the United States, but in these countries the public encourage to sign permission for the usage of their organs after death. In Britain, for example, people can give such consent during getting of a driver’s license.