On June 14, the world celebrates World Blood Donor Day. Moscow, as a huge metropolis, requires donor blood for transfusion every day. Victims of serious accidents, people with blood diseases, and women in labor need it. The donor donates 450 milliliters of blood at a time. This seemingly small volume can save the life of not just one, but three people.
Today, when the incidence of coronavirus infection in the capital is decreasing and hospitals are returning to their previous operating hours, the need for donor blood is increasing again.
The mos.ru portal learned from those who regularly donate blood what motivates them to help complete strangers and how to encourage friends to become donors.
No top bar
Only a healthy person can be a donor. Those who are sick with HIV or hepatitis, or suffer from chronic diseases - for example, gastric ulcers, inflammatory diseases such as acne or severe caries, as well as varicose veins - may be refused to donate blood. Such people may have bacteria in their blood, making it unsuitable for transfusion. The decision on withdrawal, temporary or lifelong, is made by transfusiologists.
“This is exactly why there is a consultation with a doctor before donation. Not a nurse, as in many countries, but a full medical examination and survey. If a potential donor is assigned to a Moscow clinic, we look at his health data in the EMIAS system,” says the chief physician of the O.K. Blood Center. Gavrilova Olga Mayorova.
The optimal age to become a donor is 18–20 years old. (By law, Russian citizens cannot be donors under the age of 18.) Those starting later should be prepared to receive a temporary allotment. If a person has a chronic disease and has not seen a doctor for a long time, he may be referred for additional consultation.
“A primary age donor rarely becomes one the first time. You may need a doctor's report on your state of health and the presence of chronic diseases; we provide a referral to the appropriate clinic with a clear list of questions that interest us. And then, based on the results, a decision is made as to whether a person can be a donor,” says Olga Mayorova.
However, there is no upper limit—up to what age you can be a blood donor . If a person is healthy and feels well, he will be allowed to donate.
“We have donors who have crossed the 60- and even 70-year-old mark. But these are, as a rule, those who started donating blood or its components in their youth. The overwhelming number of donors are people under the age of 45–50 years. Later, many people accumulate a burden of diseases that does not allow them to become a donor,” explains Olga Mayorova.
Who can become a donor
Only people who meet the following criteria have the right to bequeath their hearts:
- do not suffer from cardiovascular pathologies, this system must be completely healthy;
- under the age of 60;
- did not suffer from HIV, hepatitis B and C;
- They were diagnosed with brain death.
Most often, donors become people who died in road accidents after receiving fatal injuries at work. They end up in emergency clinics, where transplant specialists send requests. If a person has not expressed a desire to become a donor during his lifetime, then relatives of patients on the waiting list for a heart transplant turn to the loved ones of the deceased. It is in this case that we can talk about the “sale” of an organ; a reward is paid for permission to transplant a human heart.
In Russia, at the legislative level, the provision is enshrined that a person who has not expressed a desire to become a donor during life can become one after death. Doctors have the right to remove his organs for patients who need them. The relatives of the deceased have grounds to prohibit this from happening, so that they withdraw their veto and money is paid. The reason for the sale is often a difficult life situation, the loss of a breadwinner. But you can only pay for a heart if you know that a particular human heart muscle was intended for a patient who has the opportunity to buy it. Organs are distributed according to donor lists; commercial sales are prohibited.
Approximate cost of transplantation
Prices for purchasing a human heart vary greatly. The fact is that the cost of the heart muscle itself can be about 13,000,000 rubles . This amount, in addition to the organ itself, also includes the services of specialists for the professional transportation of the heart from the donor to the patient, as well as the use of high-quality materials and equipment in the transplantation process.
The possibility of purchasing heart muscle on the “black market” is quite rare. However, subject to its availability, the cost will be approximately from 3,000,000 to 4,000,000 rubles .
Sometimes, for a successful operation, it is necessary to transplant not only the heart, but also both lungs. In this case, the cost increases to 50,000,000 rubles .
Organ transplantation is an unusually complex process in which a large number of specialists are involved. The average cost of a heart muscle transplant surgery reaches 60,000,000 rubles .
In cases where surgical intervention by doctors is necessary for the purpose of immediate transplantation of healthy organs to a patient, the amount increases to 100,000,000 rubles , depending on the presence of additional burdensome factors: the age of the recipient, the presence of serious diseases that can affect the course and success of the operation and etc.
Myths and legends about blood giving
In addition to objective reasons, potential donors are stopped by irrational fears.
“One of the persistent myths is that a donor at a blood service facility can become infected with any diseases that are transmitted by blood. This is absolutely impossible. Disposable consumables are used during the procedure. They simply physically cannot be reused. In addition, the staff regularly changes gloves and undergoes a medical examination,” says Olga Mayorova.
Another popular fear is the fear of going to the procedure early in the morning on an empty stomach. However, donors, on the contrary, must have breakfast before the procedure. The morning meal, however, should be very light, containing mainly carbohydrates. This could be porridge with water, fruit, tea with cookies. No dairy or fatty foods.
The popular fear of fainting is certainly justified. However, with proper actions, the risks are minimal.
“If you feel the slightest discomfort, you should immediately contact medical personnel. It is important to rest after donation. You don't have to rush to work right away. You need to sit quietly for 15–20 minutes, drink water, tea or juice, and only after that go about your business,” says Olga Mayorova.
Signed up or just passed by
According to Olga Mayorova, the entire blood donation procedure takes about two hours. This is how much time will be required for registration, initial blood test, medical examination, donation itself, obtaining all certificates and rest.
A typical donor spends about 15 minutes in the chair. During this time, he donates 450 milliliters of blood. Plasma collection lasts about 40 minutes, platelets - up to one and a half hours.
Donors can expect to be excused from work or school for two days. Those who came for the donation, but were not suitable for donation according to some parameters, receive a certificate indicating the time of their presence at the center. The employer does not have to deduct payment for these days or hours.
For convenience, on the website of the O.K. Blood Center. Gavrilov, a number of other blood services operate by pre-registration, just like in a regular clinic.
“If a person does not use the Internet or, in the end, was just passing by and today he wanted to accomplish a feat, we, of course, will accept him. He'll just spend more time. We are located next to the Botkin Hospital, there is a large flow of visitors whose relatives are being treated there. If a relative received a blood transfusion a few days ago, they may express a desire to become a donor and help someone else,” says Olga Mayorova.
Due to the spread of coronavirus and the postponement of some planned operations, the city’s need for donor blood has temporarily decreased . However, no one has canceled the treatment of hematological patients and traumatism. Donors continued to visit blood transfusion stations even during the period of restrictive measures. , a free taxi ride was provided
With the gradual exit of the capital from the regime of restrictive measures, the need for donor blood will grow, which means that the stations are waiting for new people willing to help.
By the way, on the eve of World Donor Day, the first to respond and take part in donating blood were Moscow volunteers - participants in the #WeAreTogether mutual aid marathon (from the resource). Volunteer doctors and students of the capital held the action “Follow me! #I'mAResponsibleDonor." Blood donation points have been set up at medical universities and healthcare institutions. More than 200 people took part in the donation. In addition, on the website wevmeste.mosvolonter.rf there is a page dedicated to donation. There everyone can learn about becoming a donor and how to prepare for it.
Donors by order
– Alexander Mikhailovich, what is the situation with heart transplants in the country?
– In the central regions, the problem of transplantology is being solved more successfully than in the Siberian Federal District and Far Eastern Federal District. Transplant coordination centers work well in Moscow and St. Petersburg; they are supported by the authorities. The industry received a certain impetus in Samara, Kazan, and Ufa. But on average in Russia the level of coverage by operations is low. This is due to the problem of donor organs and insufficient funding. Although many regions, the Altai Territory for example, recently announced that they would become “transplant centers.” It’s good when words are followed by actions: this was said a year ago, but there are no actions yet, and even kidney transplantation, which has been actively going on in the region over the past years, is losing volume.
– Are new regions joining the program?
– Yes, yes, two heart transplants have been performed in the Krasnoyarsk Territory over the past six months. I'm glad that this happened and we were involved in it. SFBMITs im. ak. E.N. Meshalkin together with FMBA developed a donor service in the region. We have successfully transplanted hearts from Krasnoyarsk to Novosibirsk, our developments - conditioning and management of an effective donor - are now used by local specialists. This is for the best, since it is impossible to transport a heart from Krasnoyarsk to Novosibirsk in the shortest possible time, the minimum time is above average. This always leads to a difficult postoperative period and cardiac weakness, which we have to combat with additional methods.
Donation needs to be developed in all regions. It is clear that if transplantation develops more actively in Krasnoyarsk, we will receive fewer organs from there. But the potential capabilities of donor bases have not been fully realized in the region - there is enough work for both us and them.
– How long does it take to deliver a donor heart from another city in Siberia to your clinic?
– The optimal travel time should be less than 4 hours. Staying at airports and traveling to the clinic takes the same amount of time as flying. The plane from Krasnoyarsk to Novosibirsk takes 1.5 hours, and the organ delivery time is 6 hours. Our cars also undergo checks and waits at airports... Under certain conditions, high-quality preservation of a donor heart is possible for up to 8 hours. We are trying to reduce this time as much as possible, it turns out to 5-6 hours. In such cases, restoring normal heart functions requires more time and financial costs.
– What is the cost of one heart transplant?
– The state pays about 800 thousand rubles under government orders. This may seem like a colossal amount of money. However, just one dose of the drug (and two are required per patient) to suppress organ rejection costs 80 thousand. If the transplantation went off without a hitch, the patient is discharged in 3-4 weeks, we fit into this money. But other tasks, in particular transportation of an organ from another city, are solved by medical institutions at their own expense.
– How many residents of Siberia are in need of a donor heart now?
– The population of the Siberian Federal District is 18 million people. If we consider that the average need for heart transplantation in the world is 6 patients per 1 million population, then we need to do about 100 transplants per year. Last year we performed 9 operations, one in Krasnoyarsk, five in Kemerovo - that’s how far behind we are. The state order for 2020 in our clinic is 11 heart transplants and 4 artificial heart transplants.
There is a current waiting list - these are patients who are being treated according to all the rules for preparing for transplantation. They undergo a full examination in the hospital twice a year, as they move from one status to another (first, second, third urgency, as well as A and B). 1 A - patients who walk with artificial hearts, they are in the first line, especially if there is a system failure (irregular operation of the mechanical support of the heart due to various reasons). 1B are patients who are in the hospital on medication support. Of course, we can create a waiting list of 100 or more people, but there is no point in that: we simply cannot cope with it. Therefore, there are now 35-40 patients on this list at the Meshalkin clinic.
Our average wait for a heart transplant exceeds two years. Every year we receive 3-4 artificial hearts, which we use to save the lives of patients in critical condition. This allows them to prolong their life for several months and wait for transplantation.
– What is the reason for the shortage of donor organs? Not enough funding?
– Since 2020, hospitals that engage in donation began to receive compensation. And this is a decent amount: for one multi-organ harvest, a hospital can receive 150-200 thousand rubles. In the Novosibirsk region, about 6 million rubles will be allocated for these purposes. There are five medical institutions in Novosibirsk, which should provide about 50 effective donors per year. Unfortunately, they give much less. In addition, there are regional bases... At the end of last year, the local Ministry of Health issued a resolution on transplantology, which talks about the priority of developing organ donation. But so far we have not seen the effectiveness of these orders.
There is already material stimulation, but no results. The human factor, inertia, and fear play a role. I believe that a serious administrative resource should be connected. How they solved this problem in Belarus: the president said that donation should be developed, and everyone who will not cope with this should not work as chief doctors of hospitals. And everything immediately fell into place. Our colleagues from the Krasnodar Territory followed the same path: at one time, Governor Alexander Tkachev ordered the development of transplantology in the region. And now they have no problems with donation. The Novosibirsk Transplant Coordination Center is not supported in any way administratively, only in words. The most productive hospitals in terms of organ donation are underperforming.
Another obstacle for the industry is the fear of criminal punishment. Thus, in Khabarovsk about 15 years ago, serious violations were found in the transplantation procedure. And although they concerned filling out documentation, the doctor was given a prison sentence. Since then, no one from the local medical community wants to hear about organ transplants. The Minister of Health ( Alexander Vitko ) has a desire to develop the industry, and this year we will discuss specific steps to revive it.
– How can you improve the situation?
– We are now making a proposal to the Government of the Russian Federation for assistance from the Ministry of Emergency Situations. Remote areas are joining the organ donation program, for example, Khakassia and the south of the Krasnoyarsk Territory. Hospitals are beginning to be certified as donor sites. We have prepared a letter to the Presidential Plenipotentiary Representative in the Siberian Federal District, Sergei Menyailo , in which we ask you to consider the issue of improving the transportation of donor organs from remote regions. We would like to follow the path of Belarus, where the average time for delivering a heart from Brest to Minsk (700 km) is 3.5 hours. Transportation of the organ is provided by air transport of the Ministry of Emergency Situations. In our country, delivery is carried out on civil aviation planes, on regular flights; doctors just adapt to the planes, but all over the world it’s the other way around.
– Alexander Mikhailovich, how long do patients with donor hearts live?
– The numbers around the world are approximately the same: we discharge 90% of patients from the hospital after transplantation. Extremely seriously ill patients die when transplantation is a step of despair. Within a year, survival rate is 75-78%. The 10-year survival rate approaches 50%. Unfortunately, many patients die due to medical ignorance, due to viral pneumonia or other pathologies that need to be treated in a person with a donor heart according to a special protocol. There have been such cases in recent years in Kamchatka and Magadan.
“I want to become an honorary donor”
Elizaveta Chervyakova is a third-year student at the Moscow State Medical and Dental University named after A.I. Evdokimova, future general practitioner. In less than three years, she has already donated blood six times. Even earlier, the girl became a university activist and organizer of similar events.
“I found out that we have a donor movement at our university, I joined it, was an organizer, waited until I was allowed to donate blood according to all indications, and became a donor. I was really, really looking forward to this day,” says Elizaveta.
The girl plans to become an honorary donor in Moscow, and then in Russia. To do this, you need to donate blood 20 and then 40 times, respectively. University events take place every six months, so Elizaveta goes to the blood station at the N.V. Research Institute of Emergency Medicine. Sklifosovsky.
“For those who regularly donate blood, it recovers and regenerates faster. When donating, the body gets used to the fact that it can continue to function during blood loss. I initially chose a profession that would save lives. Since I don't have any qualifications yet, I'm looking for some other ways to help people. And donating blood is one of these measures,” says Elizaveta Chervyakova.
"No one is safe"
Murad Ibragimov is a future dentist. He is finishing his fifth year and preparing to enter residency.
“The first time I donated blood was in my first year. At first I joined the Nadezhda donor squad as a volunteer. I liked the movement and became interested. Since then, I have been donating blood during every campaign for four years now,” says Murad.
The young man actively encourages his acquaintances and friends to become donors.
“Life is such a thing that no one is immune from the fact that an accident will happen to their relatives or loved ones when they need a blood transfusion. This needs to be realized. Almost all of my classmates and acquaintances were donors or tried to become one. Sometimes there are exceptions - low hemoglobin or other indications. But everyone tried, and everyone wanted. And many succeeded,” says Murad Ibragimov.
Why do you get tested for hypertension?
You cannot become a donor if you have hypertension, except in special cases, and even then, only under the supervision of specialists. But to monitor your health, you must donate blood for testing. Biochemical and general blood tests allow you to determine the severity of the disease, and also serve the following purposes:
- monitor the patient's condition;
- choose the optimal treatment tactics;
- identify the development of complications before they cause significant harm.
For hypertensive patients, it is recommended to donate blood from a fingertip, as this is safer for the patient. If venous is needed, then blood pressure is measured before and after the procedure. Only if the pressure is within normal limits or slightly increased, a blood sample is taken.
An important indicator for a hypertensive patient is a value such as hematocrit; attention is paid to it first of all. This indicator reflects the ratio of red blood cells to the total amount of blood. If there are few of them, even a slight loss is already dangerous.
Hypertension, especially that which has been tormenting for several years, negatively affects the functioning of all internal systems. Most of all, it puts pressure on the heart, and these deviations in the functioning of the organ are observed on the ECG. Next come the kidneys, so it is important to do kidney tests during a detailed analysis. Indicators such as creatinine and urea allow you to determine how much worse these organs have become.
Electrolytes and glucose levels are also equally important. Often, hypertensive patients experience an imbalance of potassium and sodium or develop diabetes mellitus. High blood pressure affects the condition of blood vessels and causes the development of atherosclerosis, so it is important to monitor lipid metabolism and cholesterol concentrations regularly. Your doctor will tell you what tests you need to take. Having received the results, he will determine whether tests can be ordered for high blood pressure.
