Today, every new day in Ukraine is a struggle for survival. War takes lives, destroys cities, leaves behind broken destinies. But have you thought that at this very time, when death is so close, a new front of struggle is being formed in the country – for life? Organ transplantation and donation have become the only possible options to give a person a second chance at life. However, it should not be forgotten that in a country that is fighting for its survival, this chance is quite shaky.
A new medical achievement in numbers
The medical system in Ukraine works in extremely difficult conditions. By data Ministry of Health, as a result of a full-scale war, unleashed by the Russian Federation against Ukraine, 1,887 medical institutions were damaged, and 216 were completely destroyed. The war has already claimed the lives of more than 100 health workers, and 2,273 highly skilled professionals have been forced to leave the country, fleeing danger and seeking livelihoods.
Currently, Ukraine stands on the threshold of a huge challenge: will it be able to make transplantation affordable and effective in such difficult conditions? While some countries have turned transplantation into a routine procedure, in our country people die without waiting for their only chance to be saved. So let’s try to figure out whether transplantology will become a symbol of life in a country struggling for its existence.
Organ transplantation is one of the most important achievements of modern medicine, saving thousands of lives every year. In the world, 150,000 organ transplant operations are performed annually, saving someone’s life every three minutes. Ukraine is one of the 50 countries in the world where doctors perform one of the most complex lung transplants. And Ukrainian doctors do it in difficult conditions caused by the war. However, in Ukraine, even before the war, this sphere remained under the shadow of bureaucracy, mistrust and financial barriers.
At the same time, treatment abroad costs an average of $60,000–100,000, which is beyond the reach of most citizens. At the same time, more than 5,000 patients die every year without waiting for their chance. And this is at a time when transplantation has become a routine practice in the world. For example, in the USA, up to 100 such operations are performed every day, and in Spain, thanks to the system of presumption of consent, several recipients are waiting for one donor.
However, despite all the difficulties, transplantology is developing in Ukraine. In 2023, the first heart and liver transplant operations were performed in military hospitals. The state is taking steps to create a single register of donors and recipients, which is an important step towards transparency. However, this is not enough.
For data Ministry of Health, in 9 months of 2024, 373 organ transplants were performed in Ukraine: 250 kidneys, 73 livers, and 50 hearts were transplanted.
The most organ transplantation operations were performed:
- The first medical association of Lviv (106),
- National Scientific Center of Surgery and Transplantology named after O.O. Shalimov (62);
- Heart Institute of the Ministry of Health of Ukraine (37).
290 stem cell transplants were carried out, 48 of them to children, which is 15 percent more than in 2023.
The top three institutions that perform the largest number of stem cell transplants include:
- NDSL “Okhmatdit” (54);
- Cherkasy Clinical Oncology Center (53);
- Kyiv City Center of Nephrology and Dialysis (52).
An important indicator indicating culture and awareness in the field of transplantation in the country was the number of posthumous donors. Thus, in 2024, the most cases of brain death, which made it possible to carry out organ transplants, were recorded in medical institutions of Kyiv (22), Lviv (13) and Ivano-Frankivsk (7).
Problems of transplantation in Ukraine
Despite all the successes and achievements of the country in the field of transplantology, there are figures that cause alarm. As of September 2024, 3,438 patients are registered on the National Waiting List. 2,021 patients are waiting for a kidney transplant, 564 need a liver transplant, 550 need a heart transplant, 51 need a lung transplant, 27 need a whole kidney-pancreas complex, 8 need a liver-split, another 37 patients need a heart-lung complex transplant.
Every year, thousands of people in Ukraine learn that their lives are literally counting down the hours. The kidneys have failed, the heart can’t take it, the lungs can’t breathe. In other countries, these diagnoses would mean only one thing — an urgent transplant. But in Ukraine it is a sentence. And the matter is not only the lack of a sufficient number of medical institutions with modern technologies. The problem is in the system itself, which works not for salvation, but against it. Ukrainian transplantology is a paradox. On the one hand, our country has modern equipment, trained specialists and even a legal framework. On the other hand, the statistics are shocking: more than 5,000 people die every year from the lack of donor organs. Most of them don’t even make it to the waiting lists. According to the Ministry of Health, in 2024, 598 patients died without waiting for an organ to be transplanted. As experts explain, the problem is histocompatibility, when the donor organ is not suitable. But if there were more donors, the need would be filled faster. All health care facilities need to implement a brain death diagnosis procedure. And this should become a regular procedure, not some kind of miracle.
Nevertheless, the main reason is the low level of culture of donation. Ukrainians are not ready to agree to organ donation of their loved ones after death. Fear, prejudice, and often a lack of trust in the medical system turn potential donors into illusory hope.
However, it is worth knowing that only a person who has given his consent can become a donor. During her lifetime, she can leave a statement of consent or non-consent to donate organs. This issue is settled Cabinet Resolution No. 1211 on “The procedure for giving consent for donation”. If the person consents for posthumous donation, then in this statement she herself determines the list of organs that can be removed, and for what purpose – for transplantation, production of bio-implants or for scientific research. If there is no such statement, then the decision on the donation can be made by her close relatives. There are still no donations for transplantation after cardiac death in Ukraine. Therefore, no one has the right to remove organs immediately after a person’s death without a corresponding diagnosis of brain death.
Another problem is that there are only a few transplant centers operating in the country, and their capabilities are catastrophically lacking. It is also worth noting that such operations are not cheap. The transplant fee depends on the organ:
- lungs – over UAH 2.6 million;
- heart – more than UAH 2 million;
- liver – about 1.4 million hryvnias;
- kidneys – UAH 800,000.
The most expensive is the allogeneic transplantation of hematopoietic stem cells. 2.4 million hryvnias were allocated for it. Patients will be followed up for 180 days after such operations.
The tariff for the post-transplantation period also depends on the transplanted organ and can range from 185 to 193 thousand hryvnias.
When time is short, patients are forced to seek solutions abroad. Transplantation in India or Turkey costs from 50 to 150 thousand dollars. For most Ukrainians, this amount is unattainable. All that remains is to wait, but time plays against those who wait.
“Black transplantology” and its terrible consequences
Those with money and connections often find “wonderful” options. Behind the closed doors of hospitals, there is talk of “black transplantology” – illegal operations, when donor organs are obtained by unethical or even criminal means. The illegal organ market is estimated at millions of dollars. Black transplantation is the illegal removal of organs for sale on the black market, often without the consent of the donor. Anyone can fall victim to such schemes: from economically vulnerable people to migrants or even children. The cost of a human organ on the black market is staggering. As reported by the Polish publication Dziennik Gazeta Prawna, for a kidney you have to pay $150,000, skin – $15 per 10 square cm, liver – $100,000, heart – $119,000, lungs – $300,000, blood – from $44 to $590,000 per liter, cornea – $24,000.
Criminals easily find victims. As a rule, these are people in a difficult financial situation who agree to sell a kidney or other organ. They are often deceived by promises of much larger sums than they receive. To transport such organs across the border, criminals use forged documents, simulating legal transplants. Operations are carried out illegally in abandoned buildings, or even in ordinary apartments with minimal equipment. The black market for organs is fueled by demand from rich countries. Affluent patients who cannot wait in legal lines for transplants turn to shadow schemes. They are ready to pay any amount to get a “second chance” at life.
Black transplantation is a tragedy that highlights the dark side of humanity. It exists because of inequality, distrust of the system and the desire to survive at any cost. Ukraine can overcome this problem if it focuses on reforms of the transplant industry, restoring trust in medicine and strengthening the fight against corruption, because when the human body becomes a commodity, humanity is permanently lost.
State of transplantology in foreign countries: lessons for Ukraine
In the world, transplantation has long ceased to be experimental medicine – it is a full-fledged industry that saves millions of lives every year. Many countries have built efficient donation and transplantation systems that work transparently, quickly and in the interests of patients. At the same time, the experience of these countries can become a valuable example for Ukraine, which is just trying to overcome challenges in this area. After all, this field of medicine is still at the stage of development in Ukraine. While in European countries it has been developing for 30 years, in the USA – 40 years.
For example, Spain has been a world leader in transplantation for over 30 years. Its system is based on the principle of presumption of consent: every citizen automatically becomes a donor after death, if he did not object during his lifetime. The organization of the process is provided by the National Organization for Transplantation (ONT), which is responsible for coordination between hospitals, donors and recipients. This approach allowed Spain to achieve the world’s highest level of donation — more than 46 donors per million population.
In the USA, transplantation is based on the volunteer principle. People can register as donors through driver’s licenses or online platforms. Coordination is carried out by the Organization for Transplantation and Organ Donation (UNOS). The US has one of the largest databases of donors and recipients, which allows transplants to be carried out with minimal delays. At the same time, the country is actively implementing the latest technologies, including 3D printing of organs and xenotransplantation (using animal organs).
In Germany, the transplant system is strictly regulated. Donation is possible only with lifetime consent. To popularize this principle, the state actively informs the population, explaining the importance of donation. Special attention is paid to the support of donor families: they are provided with psychological assistance and financial support.
A unique approach is used by Israel, where donors and their families receive social bonuses: priority in the transplant queue, coverage of medical expenses and other benefits. This system encourages citizens to participate in donation without violating ethical standards.
Implementation of successful practices requires political will, financial investment and active participation of society. But the experience of Spain, the USA or Germany proves that an effective transplantation system is possible even in difficult conditions. Ukraine needs to take this step to restore hope to thousands of people who are waiting for their second chance at life.
As for illegal transplants, many countries have established effective mechanisms to combat the shadow organ market. China has passed laws that provide for severe penalties for illegal organ harvesting. However, the country is also criticized for violating human rights, in particular for suspicions of using the organs of those sentenced to death. In India, after several scandals with the black market of organs, in 1994 the “Law on Transplantation of Human Organs” was passed. It provides life imprisonment for persons involved in organ trafficking.
The World Health Organization (WHO) works with countries to develop transplant guidelines. Their goal is to make this field accessible and ethical. In 2008, the Istanbul Declaration was adopted, which condemned organ trafficking and called on governments to establish national transplant programs. At the same time, Israel has introduced a program that guarantees free transplants for its citizens abroad only on the condition that the procedure is carried out in legal clinics. This helps to track illegal transactions. In Pakistan, which used to be the center of the transplant black market, police and health authorities regularly raid illegal clinics.
Wide information campaigns are being conducted in Europe and the USA, which explain the importance of legal donation. This reduces the number of people willing to buy organs on the black market. In many countries, unified systems of registration of donors and recipients have been created, which allow efficient tracking of transplants. Some countries use genetic databases to verify the origin of organs, which helps expose illegal schemes. The times are not far off when the development of 3D printing of organs can completely eliminate the need for donation in the future.
In Ukraine, every day of waiting for a donor organ turns into a struggle against time, the system and despair. Thousands of lives are cut short every year not because of lack of opportunities, but because of indifference, fear and bureaucracy. And until the country breaks this vicious cycle, transplants will remain a privilege for a select few, not a right for everyone in need. Ukraine faces a choice: either to build a system that works transparently, honestly and in the interests of the people, or to finally lose the trust of its citizens, who are increasingly looking for a life-saving chance abroad or turning to illegal schemes.
