Development of transplantology in Russia

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One of the most promising and developing branches of medicine is transplantology. In 2022, Russia performed 2,551 organ donation surgeries, 235 more than in 2021 and 591 more than in 2020. Sergei Gauthier, chief transplantologist of the Ministry of Health, who presented the data, noted that the growth was due to the increase in transplantation capacity in the regions, among other reasons. Today 66 medical centers in 36 regions perform this type of operations, whereas in 2007 there were only 31 such clinics.

From 2007 to 2022, the number of heart transplants increased 16-fold. Now there are 2,000 patients with a transplanted heart under medical supervision in the country. During the same period, the number of liver transplants increased 5.6 times, kidney transplants - 2.2 times. In Russia there are the largest number of medical centers performing kidney transplants - 57 centers in 30 regions, a bit fewer medical institutions with departments for liver transplantation - 30 clinics in 20 territories [4].

Inhabitants of Russia are still wary and wary of transplantation. Relatives of people who could become donors make scandals and prohibit organ harvesting, although Russian laws allow organ harvesting after the death of a person. But the lack of information, illiteracy and fear of transplantation are stronger than the desire and possibility to save someone else's life.
All the questions which people have are answered by the Law of Russian Federation from December 22, 1992 N 4180-I (ed. from 08.12.2020) "On transplantation of human organs and/or tissues". It describes the conditions and procedure for the removal of organs and tissues, and spells out the provisions of liability on both sides.[2]

In accordance with the Law of the Russian Federation of 22.12.92 N 4180-1, transplantation means the transplantation of organs and (or) tissues to save life and restore health. A transplant is those organs and tissues which are used for transplantation. The exhaustive list of the human organs which are objects of transplantation is confirmed by the joint Order of the Ministry of Health of the Russian Federation ¹ 448 and the Russian Academy of Medical Sciences ¹ 106 from 13.12.2001 (with amendments from 09.04.2007).
We were interested in the question how people came to this way of saving or prolonging of life, which scientists laid the foundation of such branch of medicine in our country and whether they all received the desired result and recognition of ordinary people - patients.

The birth of Russian transplantology as a scientific discipline is connected with the name of the great Russian surgeon Nikolay Pirogov. On December 9, 1835 at the Saint-Petersburg Academy of Sciences Doctor of Medicine he delivered a lecture "On plastic operations in general, on rhinoplasty in particular", where based on his own experience for the first time he deeply and thoroughly analyzed the problem of transplantation and expressed his advanced thoughts on its further development. In this lecture the surgeon paid special attention to the "fusion" of tissues. This work is a classic example of an important scientific and practical work, with which Nikolay Pirogov actually laid scientific foundations of a new branch of medicine - transplantology.

Interestingly, at the University of Dorpat Nikolay Pirogov performed various experiments in transplantology, for example, heterotransplantations - he transplanted gallbladders and swim bladders of fish into the abdominal cavity of experimental animals. These experiments proving the impossibility of heterotransplantation were of great scientific value[5].

In Soviet times, scientists began to consider the possibility of blood transfusions. The most striking examples are the experiments of Alexander Bogdanov, Vladimir Shamov and Sergey Sergeevich Yudin.

In 1908, A. Bogdanov published his scientifically utopian novel "The Red Star". There he described in detail the important biological significance of blood in human life, suggested the method of blood exchange and pointed out the medical significance of blood transfusions. Having received the support of other doctors, the scientist began to carry out experiments on himself and his loved ones. In 1926 the first in the world Institute of blood transfusion was opened in Moscow under Bogdanov's guidance. The doctor himself became its first director. The practice of blood transfusion was actively developing, but the fate of the founder of this medical procedure is tragic. Alexander Bogdanov died as a result of the twelfth blood transfusion. He had a transfusion reaction. Until his death, he recorded the symptoms of the disease, refusing medical care[1].
Experiments with blood transfusions continued. The idea of dead blood transfusion first appeared. It belonged to Vladimir Shamov. He conducted an experiment on a dog, transfusing it with the blood of a dog that had already been dead for 11 hours. The operation was successful, the experience proved the possibility of such a practice. Shamov told about his discovery at the III All-Ukrainian Congress of Surgeons. The doctor and his colleagues did not want to repeat the experiment on a human being for ethical reasons and the difficult epidemic situation in the country (at that time, there was a syphilis epidemic).

Sergei Sergeevich Yudin was present at this congress, who thought about the idea of dead blood transfusions. He worked as the head of the surgical department of the Sklifosovsky Institute of Emergency Care.

The opportunity to try out a new method of treatment came soon. A man who was dying of blood loss after a suicide attempt was brought to the Sklifosovsky Institute. At the same time, an elderly man who had passed away was brought in. Yudin quickly found out that the patients' blood types matched and performed a blood transfusion.

The man survived. The experience was condemned abroad. The USSR had its doubts, but in 1962 it posthumously awarded Vladimir Shamov and Sergey Yudin the Lenin Prize for medical innovations.

Since 1938 the practice of blood transfusions from the dead to the living began to spread throughout the country. The bodies of men who died of heart attacks, strokes or death by hanging were taken. On the eve of death they were not supposed to receive drug injections. Bodies with abrasions, bruises and signs of illness were excluded.

Sergey Yudin believed that the blood of deceased people is a real panacea, saving patients from thrombosis, since after some time cadaver blood is freed from fibrinogen and liquefies, and therefore has special properties, including the fact that it can be stored without additional medication injections.

S.S. Yudin's experiments yielded their results, advanced medicine, especially transplantology in Russia, but still they were also frightening, so not all people sought to use this way of prolonging life. And it is not necessary to forget that Russia always was and still will be a very religious country, that is why these experiments did not find a great acceptance among common people[3].

But this was not the end of transplantology development in our country. Even more interesting and at the same time frightening experiments were continued.

In November 1930 at the IV All-Ukrainian surgeons' congress Yuriy Yurievich Voronoy demonstrated a dog with a kidney transplanted with the help of vascular sutures under the skin of the neck. The renal artery and vein and the common carotid artery and jugular vein were connected. The organ engrafted well and functioned properly. The time elapsed since the operation was 6 months.

Y.Y. Voronoy's decision to perform kidney transplantation under clinical conditions was based on a strictly scientific approach to the transplantation problem itself and numerous experiments on animals.

There was no suitable living donor, and Voronoy decided to take a kidney from a cadaver. The example of his teacher, Professor V.N. Shamov, who was the first in the world to successfully use cadaveric blood in a clinic, played an important role in this decision.

The world's first clinical kidney transplantation from a cadaver was performed on April 3, 1933. A 26-year-old girl was admitted with mercury poisoning and her kidneys did not function. The donor was a 40-year-old male cadaver six hours after death. Despite the mismatch of blood types, Voronoi decided to perform the operation.

The kidney was transplanted to the anterior-medial surface of the thigh, according to the course of the blood vessels. After vascular suturing, blood flow in the transplanted organ resumed, a slight ureteric overstimulation and excretion of small drops of urine was noticed. By the end of the first day, after several large blood transfusions, blood began to appear in the urine. On the evening of April 5, the transplanted kidney failed, and the girl died 48 hours after surgery. Voronoi reasonably believed that short-term graft engraftment by no means compromised kidney transplantation as a treatment method. Moreover, he believed that if the first transplanted kidney died (due to high mercury concentration), it should be recommended to replace it with a new, fresh kidney, i.e. to perform a repeated transplantation[7].

The idea of transplantology has been realized not only on people, experiments were actively carried out on animals.

In 1938, the Soviet scientist Vladimir Demikhov was able to keep a severed dog's head alive for three hours. It was able to respond to extraneous stimuli.

Six months later, the scientist transplanted a second heart into a dog's chest cavity for the first time in the world. Before that, the organ had been transplanted to the neck, side, groin, but the organ did not take root - it needed a pressure drop in the circulatory circles. The results of the experiments varied: dogs died during the operation, after two days, three, two weeks. The maximum life time was 32 days.
Since 1948, the experimenter began transplanting the liver into dogs. This became known in the United States, where such operations were quickly perfected and introduced into medical practice.

In 1950 Demikhov received the Burdenko Prize. Two years later he started to develop the methods of coronary bypass grafting: he sutured a vessel into the coronary artery bypassing the place of damage. During nine months of 1954-1955 he performed about 30 operations: four times he transplanted heart, five times - heart and lungs in dogs and rabbit, transplanted lobes of lungs. He implanted organs in puppies: kidneys, adrenal glands, segments of the spine with the spinal cord, parts of the aorta, liver, gastrointestinal tract, and even the entire "complex" of abdominal organs. And finally he got to the point of transplanting the puppy's head to the vessels of the dog's kidney and the lower half of the puppy's torso to the dog's neck.

Demikhov began to develop ways to preserve donor organs for transplantation. He placed them in thermostatic vessels and connected them to the animals' circulatory system. One dog saved up to four cardiopulmonary "complexes", and they worked for a week. The scientist conducted experiments on replacing animal blood with human cadaver blood, and then connected a human heart to them and revived them for 2.5-6 hours.

Together with his student Mikhail Razgulov, Demikhov invented a method of preserving organs inside animals. Biologists placed human hearts in sealed polyethylene bags and sewed them into the abdominal cavity of pigs, connecting them to the blood system. One animal could keep 3-4 donor hearts for up to seven days[6].

The ideas of transplantology found their development, and this method of treatment began to be used more and more often.

In 1965 the first successful clinical kidney transplantation in the USSR was performed by B.V. Petrovsky. The following year he also performed a successful kidney transplantation from a cadaver.

1967 - Research Institute for Transplantation of Organs and Tissues of the USSR Academy of Medical Science was established (the first director - G. Solovyov).

On March 12, 1987 the first successful heart transplantation in the USSR was performed. The transplant was conducted by Valery Shumakov, a distinguished surgeon and member of the Russian Academy of Sciences. Alexandra Shalkova is our first countrywoman, to whom a vital organ was transplanted, after which she lived for eight and a half years.

On February 14, 1990 the first liver transplant in the USSR was performed by surgeons Alexander Konstantinovich Yeramishantsev and Sergey Vladimirovich Gotye. That was the beginning of a new era in the national transplantology. The operation allowed patients not only not to die from such a disease as "cirrhosis of the liver", but also to live a full life and have a family.

In April 2019, doctors at the Academician V.I. Shumakov Scientific Medical Research Center (SMRRC) performed the world's first successful lung and liver transplant surgery on a nine-year-old child with cystic fibrosis.

For the first time in Russia in 2019, doctors in St. Petersburg performed a face transplant. A serviceman who had received an electric burn was transplanted with a complex complex complex of facial tissues, including a total nose transplant along with mucosa, with cartilage, bone bases and muscles. Preparations for the surgery took two years. Such an operation was the 32nd in the world.

In our opinion, blood transfusion has given a huge step forward for our country in the field of medicine. Thanks to this discovery, various kinds of organ and tissue transplants are now possible in our country.

But today transplantation is not possible for all organs. The retina is a very thin structure with many small blood vessels. It is impossible to connect them during transplantation, and the transplanted retina will not take root. The same goes for the eye - it is impossible to connect the nerve in the eye to the transplant, and the new organ will not function.

Transplantation of the stomach, spleen, gallbladder, appendix makes no sense. Surgery is complicated, a suitable donor must be found, lifelong immunosuppressive therapy must be administered, and the functional value of these organs is not so great as to take risks. For example, the loss of the appendix goes completely without a trace, it is possible to live without a gallbladder and spleen.

Due to the fact that transplantology as a branch of medicine borders on bioethical and religious problems, its development is slow all over the world. We would like to thank the Soviet scientists, who laid the foundation for the development of this field in our country. Some experiments may be frightening, intimidating, and not understandable from the point of view of morality, religion, or one's own beliefs, but thanks to these experiments our country is now able to cure many diseases or at least prolong life.

We believe that the population should be informed about the results of the operations, because people do not get enough information. We need to educate people through the media, hold events with leading doctors in the field. We have to do everything we can so that people don't dislike this method of treatment and are convinced of all its aspects.

There is still the problem of organ shortages, which causes many patients to die before a suitable transplant is available. Scientists are actively working on this issue and are already developing 3D models of organs, as well as researching the possibility of using stem cells to regenerate lesions.

About the authors

Varvara Alexeevna Gayduk

Smolensk State Medical University of the Ministry of Health

Author for correspondence.
Email: varya.gajduk@mail.ru
ORCID iD: 0009-0009-6310-6447
Russian Federation, 28, Krupskaya str., Smolensk, 214019, Russia

Ulyana Konstantinovna Efimova

Smolensk State Medical University of the Ministry of Health

Email: marshell2020@yandex.ru
ORCID iD: 0009-0009-4273-4663
Russian Federation, 28, Krupskaya str., Smolensk, 214019, Russia

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