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. Last Updated: 07/27/2016

Court Holds Key to Kidney Transplants

MTTatyana Karelina helping her daughter Masha walk down steps outside the Republican Children's Clinical Hospital.
Nine-year-old Masha Karelina has difficulties walking and suffers from stunted growth due to a diet that is without any protein and allows her to drink only 150 grams of water per day. Her home for the last eight months has been a ward in a Moscow hospital.

Born with a kidney defect, she suffered kidney failure after catching the flu three years ago. Since then she has lived on dialysis, and for the last eight months she has been on a waiting list for a kidney transplant.

Masha's mother, Tatyana, fears that her daughter may not live long enough for a kidney to be found, as she is aware that it can take several months or even years to find a suitable donor, given an unprecedented shortage of donated kidneys.

In large part, the fate of Masha Karelina and thousands of other patients waiting for kidney transplants could depend on the outcome of a trial of four doctors starting Wednesday in the Moscow City Court.

The doctors are accused of attempting to murder a patient by removing his kidney for a transplant. The same court acquitted them of the charge in March, but following an appeal by prosecutors, the Supreme Court overturned the verdict and ordered a new trial.

The high-profile case, and the fear it has generated among surgeons involved in organ transplants, has paralyzed the process of securing and delivering donor organs in the country over the last two years. Doctors say they now only perform kidney transplants when the donor is a sibling or other relative.

As a result of this de facto moratorium on organ donation, the survival chances are slim for patients who, like Masha, have no sibling or other potential donor within their families.

To fight for her daughter to receive a healthy kidney and live a normal life, Tatyana Karelina joined about 100 patients, doctors and parents outside the Health and Social Development Ministry on May 31 to rally in support of transplant surgery. The rally was silent. Protesters held photographs of their children and signs reading, "Bureaucrats, Hands Off Transplant Surgery!" and "Give Us a Chance to Live!"

"In the last six months our clinic has not received a single donor kidney," Karelina said in a recent interview at the Republican Children's Clinical Hospital, where she is staying with Masha, along with 35 other mothers awaiting donor kidneys for their children. "We have highly qualified surgeons, but without donated kidneys they cannot help our children," Karelina said.

Transplant operations first came under fire in April 2003 when prosecutors opened a criminal case against the four Moscow doctors who were accused of attempting to remove a kidney for transplant from a car-crash victim while he was still alive.

This March, the Moscow City Court cleared doctors Irina Lirtsman and Lyubov Pravdenko of City Hospital No. 20 and Bairma Shagdurova and Pyotr Pyatnichuk of the Moscow Organ Donation Coordination Center of the attempted murder of Anatoly Orekhov, 50. Police said the doctors were trying to remove Orekhov's kidney when he was still alive, while the doctors said Orekhov was already dead.

On April 19, the Supreme Court overturned the verdict and ordered a new trial in the same court but with a different judge.

Apart from Lirtsman, the other doctors have changed jobs in order not to deal with organ donation anymore. Meanwhile, the city's most prominent transplant surgeons have been keeping a low profile, avoiding making any public comments on the issue.

The climate surrounding transplant surgery received a further blow last year, when Rossia state television twice aired a documentary accusing the Organ Donation Coordination Center of being at the center of a lucrative market in donor organs in the city.

There are about 3,500 patients currently waiting for kidney transplants, the Health and Social Development Ministry said. Last year, only 390 transplants took place.

By comparison, an average of 20,000 kidney transplants are carried out annually in the United States, said Nikolai Kitayev of Nefron, a group assisting patients awaiting kidney transplants.

"The doctors' hands are tied, no one wants to risk their jobs and end up in jail after approving an organ donation, even if patients' lives are at stake," said Valery Shilo, director of the Moscow Dialysis Center.

Valery Shumakov, director of the country's main transplant operation center, the Research Institute of Transplantology and Artificial Human Organs, said that operations at his clinic have dropped by 85 percent to 90 percent since charges were filed against the four doctors in 2003.

"Fear is a natural human reaction and I cannot blame medical personnel for their reluctance or refusal to deal with organ donation," Shumakov said, adding that as a result dozens of patients have died unnecessarily and dozens of others will likely not live long enough to undergo a transplant operation.

While the total number of transplants has dropped, the number of cases of a father or mother, often elderly and not in good health, donating a kidney to his or her child has tripled since 2003, he said.

Shilo, who was one of the doctors who attended the May 31 rally with their patients, emphasized that dialysis was only a temporary alternative.

"Without the prospect of a transplant our patients do not have a glimmer of hope for recovery, and we have to operate like a hospice rather than treating them. It is extremely depressing and deeply upsetting that patients have no access to technologically advanced medical treatment," he said.

Deputy Health and Social Development Minister Vladimir Starodubov said that in the last 10 years his office had not issued a single new regulation restricting organ donation and transplant.

"What happened over the past 18 months? The answer is the doctors' case," Starodubov told TV Center television after he met with rally participants in his office.

Shumakov said that the prosecutors were likely appealing the acquittal of the four Moscow doctors to save their own professional reputations.

A pioneer of transplant surgery and the first Russian surgeon to carry out successful heart, liver and pancreas transplants, Shumakov denied any knowledge of a market in donor organs, and called such claims "nonsense."

About a year ago, the fence around his clinic was dotted with makeshift ads in which a kidney was offered in exchange for a car or apartment.

Shumakov said it was true that would-be donors telephoned or showed up in his office from time to time to offer organs for transplants.

"When it happens, we explain to them that there is a law in this country according to which human organs cannot be put up for sale," Shumakov said.

Meanwhile, Karelina is hoping the Moscow City Court will acquit the doctors a second time and lift the atmosphere of fear surrounding transplants. "This will be a sign that will either give us back hope or will bury it," she said.

Though the doctors' case severely hit organ donations, many Russians were already suspicious, Shumakov said.

"Things will change for the better when the criminal case is finally closed, the doctors are cleared of all charges and people in general stop regarding organ donation as some barbaric act performed by evil doctors on their loved ones," he said, adding that a spirited campaign would be required to change public opinion.

"Until then, dozens of patients will continue to die unnecessarily and no advanced technologies will be of any use," Shumakov said.