How the transplantation system has changed since the beginning of the full-scale war

Since August 2021, a pilot project of the Ministry of Health on aeromedical evacuation has been operating to quickly transport seriously ill patients and donor organs.

“For example, we could transport a heart from Vinnytsia to Kyiv in less than an hour. The helicopter landed directly on the roof of the Heart Institute. It was quick and convenient,” says Vasyl Strilka, director of the Ministry of Health’s Directorate of High-Tech Medical Care and Innovation.

Since the beginning of russia’s full-scale war against Ukraine, the skies over the country have been closed, and the Ministry of Health’s pilot project on aeromedical evacuation has been suspended. Helicopters, if used, are mostly used by security and defense forces, in particular, to transport the wounded.

Only on 06.06.2023, in cooperation with the Ministry of Internal Affairs of Ukraine, a 15-year-old recipient from the Heart Institute was able to receive a heart transplant by air for the first time since the beginning of the war. However, this is a unique, isolated case – an exception to the rule, aimed at promptly saving a child in critical condition. 

In the vast majority of cases, aeromedical evacuation for organ delivery is not available. And this is a large-scale and non-trivial challenge for both the medical system in general and the transplantation industry in particular. For example, it takes less than 2 hours to deliver a heart. Otherwise, organ transplantation is impossible.

Without a radical change in logistics, given the scale of the challenges and the inability to use aviation regularly, the number of heart transplants and other organs with a limited shelf life could have been significantly reduced.  However, a solution was found.

Restructuring the industry and creating mobile transplant teams

On 29 July 2022, the Verkhovna Rada of Ukraine adopted the Law “On Amendments to Certain Legislative Acts of Ukraine on Increasing the Availability of Medical and Rehabilitation Care during the Period of Martial Law”. This initiative of the lawmakers allowed the entire medical industry, including transplantation, to continue its active development. 

In fact, the deputies allowed hospitals licensed for a particular type of medical activity, such as transplantation, to provide it outside their medical institution. This opened the door for transplant centers to create mobile organ transplant teams.

From now on, organs with a limited life outside the body of a deceased person that can not be delivered in time by road to a hospital with the appropriate license. They are not delivered to transplant centers to which recipients are assigned. On the contrary, a person in need of a transplant, together with the relevant doctors, travels to the organ. This approach allowed saving additional time for the logistics that had been complicated and slowed down by the war.

How do mobile transplant teams work?

The hospital where the brain death was diagnosed, if there is consent for posthumous donation, enters the donor's data into the Unified Transplantation System. A digital algorithm selects a match based on a number of criteria, including laboratory tests. Then doctors from the transplant center, which has the appropriate license, collect several pieces of equipment and go with the recipient to the hospital where the donor is.

Meanwhile, the deceased person, who was diagnosed with brain death, is on life support. This makes it possible to store certain types of organs for up to two days instead of a few hours. This is enough time to transport the recipient to any corner of the country, deploy the equipment and perform the transplant.

The team from the transplant center can perform the transplant even in the simplest operating room. The team of specialists from a licensed institution brings all the necessary equipment with them.

First and foremost, this procedure is used for patients who need a heart transplant, as its shelf life outside the body of a cadaveric donor is the shortest. Lung transplants are also considered an exception. Given the complexity of such surgical interventions, they are performed exclusively in transplant centers. In these cases, it is not the recipient who travels to the organ, but the organ that travels to the recipient.

Thus, legislative changes, flexibly adjusted to the realities of war, in cooperation with the professionalism of Ukrainian transplantologists and rebuilt logistics, have already saved dozens of lives.