What one needs to know about organ transplantation?
Organ transplantation is transplantation of organs (part of an organ) and (or) tissues (part of a tissue) to another place in the body or into another organism.
Any person, both an adult and a child, may need organ transplantation, no one is immune from loss of health.
Many diseases can result in a situation where a human organ ceases to function and there is a need for its transplantation.
Today, more than 3 thousand Kazakhstani citizens are in desperate need for organ transplantation, including 113 children. For some patients, the time counts not in days, but in hours. Usually, Kazakhstani citizens need kidney transplantation - 91.5%, then heart - 4.4%, liver - 4% and lungs, including cardiopulmonary complex - 0.1%.
Heart, lungs, liver, kidneys, and pancreas transplantation is carried out in Kazakhstan. Since 2012, 1892 transplantations have been carried out, of which 80% of patients received organs from live donors and 20% from postmortem donors.
Currently, according to the transplantation centers data, 86.2% of citizens operated during these years live in the Republic of Kazakhstan.
Who can be a donor?
Pursuant to the Article 210 and clauses 1 and 3 of Article 212 of the Code of the Republic of Kazakhstan as of July 7, 2020 "On People's Health and Healthcare System" (hereinafter: Code), a living person (live donor) and a deceased (postmortem donor) can be donors.
Live donor of an organ and tissues can be a person:
- aged 18 and older,
- legally capable,
- being in a genetic relation with a potential recipient (a patient in need for an organ transplantation) or having histocompatibility with him/her (an immunological property of organic tissues that promotes their engraftment in the tissues of another organism),
- who have expressed written notarized consent for the withdrawal of one of the paired organs (kidney) or part of the organ (liver),
- who have undergone a complete medical examination, confirming that the withdrawal of an organ (part of an organ) will not entail an irreversible disorder of health.
In Kazakhstan, the decision to transplant an organ (part of an organ) from a live donor is made by the Ethics Commission, which, in order to exclude abuse and promote safety, considers all the confirming documents stated above and establishes a genetic relation between a potential recipient and a live donor.
Postmortem donor is a person aged 18 and older who has been diagnosed with irreversible brain death, whose organs or tissues can be used for transplantation to a recipient. One postmortem donor can give life to 7 people. Such a donor gives two kidneys, a liver, a heart and lungs, as well as a cornea (there are two of them and, as a rule, one is transplanted to one recipient).
Кому нельзя быть донорами органов?
Who cannot be a donor?
Pursuant to clauses 4 and 5 of Article 209 of the Code, the following people cannot be organ donors or it is prohibited:
- withdrawal of organs (part of an organ) and (or) tissues (part of a tissue) from an infected live donor or postmortem donor for transplantation to a recipient is prohibited, in particular:
- from those having acute infectious and contagious diseases;
- from those having uncontrolled bacterial sepsis;
- from those suffering from AIDS and HIV;
- from those having a positive marker for hepatitis B (HBsAg) or C (anti-HCV) virus;
- from those having malignant tumors with presence of established acute and decompensated chronic, focal and/or diffuse diseases of organs and systems.
At the same time, following the Order of the Acting Minister of Health of the Republic of Kazakhstan as of October 30, 2020 No. DSM-171/2020, a list of infectious diseases for which transplantation of organs (part of an organ) and (or) tissues (part of a tissue) from a donor is allowed was approved. It was registered in the Ministry of Justice of the Republic of Kazakhstan on November 2, 2020 under No. 21573.
Pursuant to paragraph 3 of Article 212 of the Code, withdrawal of organs (parts of an organ) and (or) tissues (parts of a tissue) from a postmortem donor for transplantation is not allowed if a medical organization at the time of withdrawal is informed that this person when being alive or other individuals, spouse or a close relative declared their disagreement with withdrawal of organs (part of an organ) and (or) tissues (part of a tissue).
Can one buy/sell an organ in Kazakhstan?
Pursuant to subclauses 3) and 5) of clause 4 of Article 209 of the Code, the following is prohibited for the purpose of transplantation:
- buying/selling organs (part of an organ) and (or) tissues (part of a tissue);
- withdrawal of organs from a postmortem donor for transplantation to foreigners and stateless individuals.
How to refuse or grant consent to become a postmortem organ donor?
Kazakhstani citizens can register their will for postmortem donorship in two ways:
- when visiting an outpatient clinic at the place of registration, where an authorized person will verify the identity documents and registration status, and then provide an appropriate application form (consent or withdrawal of consent/refusal). The completed form is put into the Register, and within 1 working day an applicant will receive a certificate on registration of his/her will signed by a chairman and sealed by a PHC organization;
- or one can register his/her will for postmortem donorship online via e-Government Portal:
- to do this, an applicant needs to log in to the Portal and order the service "Registration of consent or withdrawal of consent for an intravital voluntary donation of tissues (tissue parts) and (or) organs (parts of organs) after death for the purpose of transplantation";
- then fill in all the required fields and sign an application using digital signature; after a few minutes a status will be updated and a certificate on registration of one`s will shall become available in two languages.
In an application, one can provide permission to use all the organs or some specific ones. Subsequently, one can change one`s decision an unlimited number of times. An application itself is termless, that is, it does not need to be updated or confirmed after some time. A decision is made based on a person's last registered application.
Information about people who registered their consent or refusal is restricted. Only three republican transplant coordinators have access to this database and only after the death of a person.
Personal data protection is carried out in accordance with the Code and Article 29 of the Law of the Republic of Kazakhstan as of May 21, 2013 "On Personal Data and its Protection".
Pursuant to paragraph 2 of Article 212 of the Code, a draft order was drawn up "On approval of the Rules for providing a person's will for postmortem donation of organs (part of an organ) and (or) tissue (part of a tissue) and notifying a spouse or one of close relatives about this", which is currently undergoing approval procedures in government agencies.
How to get into the list of people in need for transplantation?
A decision on the need for transplantation is made by a multidisciplinary group, i.e., a group of various specialists, which is formed depending on the nature of disruption of the functions and structures of a patient's body, severity of his/her clinical condition. If the group confirms the indications for transplantation, it sends the information to the transplant coordinators. A patient is put on the waiting list. He/she is in the list until an organ he/she needs from a postmortem donor appears.
There is a single waiting list for organ transplantation in Kazakhstan.
The waiting list includes people for whom a clear decision has already been made about the need for transplantation (protocol decision of the nephrological commission at the regional health department, or statement of the multidisciplinary group of the transplant center, an extract from a patient's medical record (027/y form) (indicating the blood group, Rh factor, patient's height and weight, lack of contraindications for transplantation), national ID, home address and contact numbers.
Queuing for transplantation of organs (parts of an organ) and (or) tissues (parts of a tissue) is carried out in accordance with the order of the Minister of Health and Social Development of the Republic of Kazakhstan as of October 9, 2020 No. KR DSM-120/2020 "Formation and maintenance of register of hematopoietic stem cells (bone marrow) donors in order to ensure hematopoietic stem cell transplantation".
Pursuant to clause 7 of Article 209 of the Code, a new draft order "On approval of the Rules for formation and maintenance of the register" has been developed, which is currently undergoing the procedure of approval in government agencies.
Groundings for inclusion into the waiting list are as follows:
2) statement of multidisciplinary group (multidisciplinary group of specialists of the transplant center).
In this connection, one should visit a district or family doctor at PHC organization at the place of registration to settle the issue of referral to an appropriate commission if there are indications for transplantation.
In the waiting list, potential recipients infected with viral hepatitis (B, C), tuberculosis of any localization, HIV infection, syphilis have the opportunity to receive an organ not only from a healthy, but also from a postmortem donor infected with the same diagnosis (order of the Acting Minister of Health of the Republic of Kazakhstan as of October 30, 2020 No. DSM-171/2020 "On approval of the list of infectious diseases for which transplantation of organs (part of an organ) and (or) tissues (part of a tissue) from a donor is allowed).
Last update: 24.02.2021