The Peace and Development Foundation initiated a conversation with Minister of Health Viktor LIASHKO, in particular on the subject of biotechnology.

The main topics of our conversation with the Minister of Health of Ukraine Viktor Liashko were two: transplantology, which began to develop massively in the country some incomplete two years ago (before that, Ukrainians operated abroad) and support for biotechnologies designed to respond to the challenges of the time (the same vaccines against COVID-19, for example). In this regard, we also invited Volodymyr Zhovnir, Director General of the Okhmatdet National Children's Specialized Hospital, and Alexander Lysytsia, Head of the Bone Marrow Transplantation Department of this hospital, to talk.

- Mr. Minister, we are a developing country, in which, besides, the war has been going on for eight years, and meager funds are allocated for science. And yet, over the past year and a half, the Ministry of Health has “promoted”, including at the legislative level, the topic of transplantation, thereby saving the lives of Ukrainians. What are the prospects for Ukrainian transplantology? What has changed for doctors, patients?

Viktor Liashko: - Over the past two years, domestic transplantation has moved off the dead center, in which it has been for about three decades. Now we have 43 institutions where the Ministry of Health guarantees payment for transplant operations, of which 22 institutions have already begun to perform such operations. They are completely free for the patient.

Ukrainians must be sure that, if necessary, they will receive medical care by transplantation in their own country in a timely manner. They do not need to collect large funds for a trip to a foreign clinic, because such treatment is available with us. Each state prefers the treatment of its citizen. This is how it should be in Ukraine.

- Whose experience are you referring to?

Volodymyr Zhovnir: - Olexander Lysytsia studied the experience of many countries: from Belarus to the USA. He won a grant for an internship at the world-famous American clinic - St. Jude Children's Reseach Hospital in Memphis, Tennessee. Several of his students also received grants to study at leading Western clinics.

– In other words, are our doctors competitive?

Volodymyr Zhovnir: -Yes! Sorry, but if the state does not take care of our doctors, they will not come back after going to study/training.

- The struggle is now being waged not so much for territories as for human resources.

Viktor Liashko: Now we are working to fulfill the decree of the President of Ukraine, which guarantees salaries throughout the country: UAH 13,500 for paramedical workers and UAH 20,000 for doctors. They will be proportionally increased depending on qualifications.
If we talk about transplant doctors, already in the summer we significantly increased the tariffs for kidney, liver and bone marrow transplants so that the heads of institutions could pay for the competitive work of the team performing the operations. Raising salaries, we are now looking for legal mechanisms - how to ensure the complexity factor for conducting surgical interventions.

- Actually, what are the prices for transplantation? By the way, Ukrinform published an interview with Oleh Zhurba, head of the Department of Cardiovascular Surgery at the Cherkasy Cardiology Center, where a 59-year-old recipient underwent a heart transplant for the first time in the Cherkasy region. So, he says that in Belarus such an operation costs 100,000 dollars, and in Cherkassy, with all the associated costs, it is five times cheaper, 613,000 hryvnias.

Viktor Liashko: It's not a secret, now I'll tell you everything. So:
● liver transplantation from a living donor - UAH 1,579,165 (UAH 971,169 in 2020);
● liver transplantation from a deceased donor - UAH 1,428,734 (in 2020 - UAH 929,125);
● kidney transplantation from a deceased donor - UAH 801,071 (last year - UAH 397,884);
● kidney transplantation from a living donor - UAH 788,314 (last year - UAH 357,359);
● bone marrow transplantation (BMT) from a non-family donor - UAH 2,484,470 (2020 - UAH 1,360,141.36);
● BMT from a family donor - UAH 1,874,969.08 (2020 - UAH 1,360,141.36).

As for the change in tariffs for heart transplantation, here the centers themselves develop calculations, analyzing the experience of the operations performed, the tariffs will increase.
We have competitive prices, but cheaper than in neighboring Belarus. Not to mention the countries of Europe, where the priority in the queue is given to their citizens.

In addition, tariffs in Ukraine allow the development of the medical field itself - transplantation, since they include, as was said, the salary of medical workers, equipment renewal, the possibility of laboratory support ...

Oleksandr Lysytsia: - Allogeneic bone marrow transplantation from an unrelated donor costs somewhere more than UAH 2,400,000, that is, it is 90 thousand dollars. This price is still in Turkey. However, we have a period of observation of the patient - a year, there - 60 days. You can still get into intensive care, and this is at least $ 1,500 a day. Four years ago, Turkey began to develop medical tourism for transplants, making the following marketing move: they say that the real price is $140,000, but there is a discount - up to $90,000. Further, there are a lot of additional options that are mandatory for payment. So Ukrainians become hostages, being treated there. This is a tough medical business where there is no place for empathy and emotions.

- Mr. Olexander, what do you feel when you save a life?

Olexander Lysytsia: -Last year I was at the christening of my patient's son. He held a baby in his arms, watching his mother's laughter, eyes filled with happiness, even her inner freedom from illness. And nine years ago, big frightened eyes looked at me.

My grandmother was a rural paramedic in the Chernihiv region. She healed the sick and knew how to talk to people. Treatment is communication as well. Unfortunately, this is not taught in domestic medical schools.

It is true that doctors often become cynics. But when you do not contact face to face with a patient, especially a seriously ill patient, and his relatives, then you need to move into management, administration.

– Obviously, medicine with a human face is the dream of Ukrainians. And also - the value of life in the country ... But let's get back to the topic of transplantation. As you know, a large number of organs are transplanted in the world. What is transplanted to Ukraine?

Viktor Liashko: - Mentioned kidneys, liver, heart. The biggest request is for a kidney transplant. Accordingly, the centers where such a surgery is performed are the most numerous. Liver transplants require about a thousand patients annually, heart and lung transplants - about three hundred. We are preparing for the introduction of high-tech and complex transplantations of the lungs, pancreas, and intestines.

As for meeting the needs, of course, we are confidently moving in this direction. However, we should not forget that the advanced countries have been moving towards modern indicators for decades - until now, by the way, they do not cover the entire request. On the other hand, we do not need to invent a "Ukrainian transplant bike" - we can introduce the best world experience, bypassing the mistakes of foreign colleagues who were corrected with the development of medical science.
So, I think, in 3-5 years it will be possible to say that transplantation has taken place in Ukraine.

Volodymyr Zhovnir: - I would like to say that a few months ago a cryobank appeared in Okhmatdyt (by the way, the first state bank). For example, neurosurgeons are forced to perform craniotomy. Previously, the trepanned bone was thrown away, now it is stored in a cryobank for reuse.

Now there is a scientific possibility of egg freezing, when a young-young patient has her ovaries removed, for example. So she can have children.
We freeze stem cells with their subsequent cultivation.
We also have a Prenatal Consultation, when we detect congenital malformations before childbirth and think about how to influence the situation.

Viktor Liashko: "Okhmatdet" is and will be the best clinic in the post-Soviet space and the Mecca of medical tourism for patients from Eastern Europe.

Now a large-scale initiative of the President of Ukraine is starting - "Great Construction" within the framework of the "Healthy Ukraine" project. We are planning to rebuild/reconstruct budget funds, to equip hospitals in every region of the country with technological equipment.

- When it comes to organ transplantation, the Ministry of Health is focusing its efforts on the development of a system of post-mortem donation (when most often in an accident or stroke, brain death is ascertained, but the heart is still beating). Do you think Ukrainians are morally ready for this?

Volodymyr Zhovnir: - Many do not know that they can be an organ donor. To do this, you need to talk with society. If after death I can save someone's life, why not? (This is me about myself).

– Does it have to be agreed in advance?

Volodymyr Zhovnir: - It depends on the country. Different countries have different laws. In ours - consent in advance.

Oleksandr Lysytsia: - There was a meeting with the All-Ukrainian Council of Churches on this topic. It just so happens that, for example, for residents of the regional towns and villages of Galicia, the word of His Beatitude Sviatoslav (Shevchuk) is often more important than what they say on television.

Viktor Liashko: – We are working with the Ministry of Digital Transformation to expand the citizen's account in the Action app. There should appear a section in which everyone who decides on the highest manifestation of sacrifice will be able to leave a statement during their lifetime about their consent to become a donor after death. This is a difficult job, because no one should see information about such a statement while the person is alive. Even doctors. At the same time, information should become available if this person is diagnosed with brain death, and the transplant coordinator forms a map of a potential donor in the Unified State Information System of Transplantation. When these works are completed, we will start an information campaign to promote organ donation.

In any society, there are always those who are “for” and who are “against”. The latter, as a rule, inflate more - they misinform the society. A "fresh" example is with anti-vaccinators.

As for transplantation, the most “working”, so to speak, stories like the one that Alexander told about the christening of a child. It is worth meeting with those who, due to transplantation, have been saved, life has been extended. Show them, talk about them, doctors. About people like Alexander, for example. This will also change this post-Soviet situation, and human life in the country will acquire meaning.

- In "Okhmatdyt" bone marrow transplantation from an unrelated donor has been performed for more than a year. Is it possible to use the experience and resources of the hospital to move the transplantation of adults from an unrelated donor in Ukraine and reduce dependence on treatment abroad?

Oleksandr Lysytsia: - I have plans to create the Ukrainian School of Bone Marrow Transplantation. In fact, it already exists. Not on paper. On practice. Right now, just on an internship, the young doctor will head the new department of bone marrow transplantation at the Lviv Emergency Hospital.

Volodymyr Zhovnir: Olexander spoke about communications with specialists. I would like to add that there is a powerful laboratory in Okhmatdyt that does a lot of analysis. A lot of hospitals, namely oncological and gynecological departments, cooperate with us.

There is also an interdisciplinary team that helps children with cancer from all over Ukraine find the right solution for diagnosis and treatment. That is, it acts as a council.

– This year, a pilot project on aeromedical evacuation is planned to be launched in Ukraine. So, in April and May, in the Lviv region, in April and May, in the “test mode”, the State Emergency Service and the Ministry of Health of Ukraine have already begun cooperation (the first was transported a 79-year-old resident of the town of Turky with suspected acute cerebrovascular accident). On a regular basis, the project should start working in Kyiv and Lviv. On whom and what does it depend for other regions to join it, Mr. Minister?

Viktor Liashko: - Helicopters for emergency medical services exist in one form or another in most developed countries of the world. We have long wanted to create a civilian alternative to the aeromedical evacuation of the Armed Forces of Ukraine, and in 2021 we finally succeeded. Not least because of the consolidated efforts of the Ministry of Health and the Ministry of Internal Affairs, because part of the aviation costs associated with the operation of equipment, and, in fact, the equipment itself is provided by structures coordinated by the Ministry of Internal Affairs (National Police, State Emergency Service). We hope that we will start systematic work with our colleagues from law enforcement agencies and, based on its results, in 2022 we will at least prolong, and at the maximum, expand the project to another additional region. Actually, the accession of other regions depends not least on the ability of local communities and emergency medical centers, as our experience proves, it is important that the motivation to implement something complex and innovative does not end at the threshold of the relevant ministry.

– Virologists say that pandemics like COVID-19 will become more frequent and the world needs to prepare for this. How can Ukraine be proactive here? (By the way, there is an interesting article by Viktor Conde, a researcher at the United Nations Economic Commission for Africa (UNECA), about the success of the biotechnology industry in developing countries, in particular, in Brazil, Cuba, and the state of affairs in some African countries. The article says that why some states manage to meet the challenges of the time, while others do not.

Viktor Liashko: - Yes, biological threats are one of the challenges to the civil health system in the world. Countries that do not have sites for their own production of diagnostics, medical devices and medicines are especially vulnerable, since a global shortage of them is created in a pandemic or emergency. We went through this last spring. Therefore, on August 18, the Cabinet of Ministers of Ukraine adopted a draft resolution “On Approval of the Procedure for Using the Funds Provided in the State Budget for the Creation of the Bio-Cluster “Biological Safety and Development of Biotechnological Technologies”, which significantly improved the situation. First of all, this will allow us to resume the production of test systems and immunobiological preparations.

UAH 100 million budgeted for this year will make it possible to launch the biocluster in 2021, as well as create conditions for its further development. The biocluster will start its work on the basis of the CSP of the Ministry of Health, which has the necessary human and resource potential. Further development will require the creation of a specialized state enterprise that manages the biocluster, uses the developments and manages the technology park. Such a state enterprise will be created already in the 4th quarter of 2021. I think that in the near future we will reach the forefront in this area.

We have already compiled a list of essentials that should be produced on the territory of Ukraine. And we have already met with leading pharmaceutical companies on this issue.

- Previously, Ukraine was often associated with a raw, agricultural country. After we became one of the IT centers in Eastern Europe, working for the whole world - from Kyiv, Lviv, Kharkiv and Odesa, this position has changed. Are breakthroughs possible in Ukrainian medicine for the country to become a leading biotech cluster, developing the technologies of the future?

Viktor Liashko: Why not? Read materials on the Internet about transplantation many years ago: they say, this is impossible in Ukraine ... Today, our doctors do it. So everything is real.

Source - Ukrinform