Rozental R.L.1, D.A. Babarykin*2
(1 - Riga Stradins University, Riga, Latvia; 2 - University of Latvia, Riga, Latvia; dmitry.b@parks.lv)
In any field of transplantation recipient as well as donor should be protected against eventual ethical violation of rights, malice and non-justifying risks. Usually it is guaranteed by state legislation, which specifies all prohibited and permitted manipulations in patient’s therapy. This legislation is not universal all over the world - exist difference in the mentality, level of development, national resources, political system etc. of each country.
Law “Protection of person’s dead body and use of organs and/or tissues in medicine” in Latvia came into force in 1992. It specifies, that person’s body, organs and/or tissues are prohibited to use against living will of patient. Every inhabitant of the Republic of Latvia has the rights to prohibit or to permit to use organs and/or tissues after the death. About person’s decision Population Register of the Republic of Latvia must be informed in written form. Coordinator of the transplantation team have the rights in any time via internet to obtain the living will of dead person (his/her first name, family name and person’s identification code). In case of absent mentioned data of organs and/or tissues procure is prohibited. The rights of relatives also are regulated by the law - they can give information in written form to medical institution about the living will of dead person.
In that way, the presumption of understanding, which is on the basis of our legislation, provides successful action of National transplantation centre. Above mentioned principle is not relevant for persons younger than 18, when written agreement from parents/guardians is required.
In accordance with the requirements of the Law, 28-30 kidney transplantations/per million of population are carried out in Latvia every year. The number of heart transplantations also increases. The pancreas procurement during the multiorgan removal has been started in the last year. Now we have possibility for islets isolation, purification and cultivation for the transplantation to diabetic patients.
Above mentioned Law regulates also tissues removal for the further transplantation procedure (cornea, skin, bones, mitral valves). Very often it takes place in morgue, and therefore control of quality and security of all donor’s procedure is of special attention.
Procurement of kidneys and non-reproductive tissues from alive donors also is regulated by National legislation and is possible after informative agreement both donor and recipient.
At present at the P. Stradin’s clinical university Hospital, a new laboratory for cell transplantation is under construction. All practical work in it is planned in accordance with European Parlament and Commission Directives. The National legislation for the cells isolation will be the same - the presumption of understanding will be on the basis of dead adult donor, but informative agreement for alive donor.
Now at the Centre of haematology, for the treatment of blood diseases new technologies applying autologous bone marrow stem cells as well as allogenic stem cells of peripheral blood have been implemented. Investigations of rat bone marrow mesenchymal stem cells have been started in private company (MCS Ltd) in collaboration with the University of Latvia.
For time being more complicated is procedure of isolation of human embryonal stem cells. It is necessary to elaborate special legislation at the state level.
We are sure, that obtained experience in transplantation procedure in accordance with the strict legislation will help to us to adopt it for the stem cells isolation, preparation, preservation and transplantation, too.
См. также:
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