Globally, the number of patients requiring organ transplants increases every year. This is because transplantation has enabled doctors to treat a wider range of conditions. This GxP News article examines the development of transplant programs in Russia, the potential use of animal organs, and the prospects for deceased organ donation.
Today, kidney, heart, liver, and lung transplants no longer cause surprise. Providing high-tech medical care has become the norm. The success of transplantology is linked to the development of two independent spheres: the improvement of surgical techniques and anesthesia methods, and advances in immunology and pharmacology. While the former ensures the successful performance of operations, the latter guarantees a favorable postoperative course.
Kidney Transplantation Becomes Accessible
Modern transplantology began with kidney transplantation, and today it is one of the most common operations in this field. Sergey Gautier, Director of the V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs and Chief Freelance Transplant Specialist of the Russian Ministry of Health, spoke at a press conference about the significant progress Russian medicine achieved in kidney transplantation in 2025.
According to him, last year the number of operations performed reached 2,188.
“From 2026, kidney transplantation becomes part of the fundamental state guarantees program and will be included in the compulsory medical insurance (CMI). This means that if a region performing kidney transplantation has a specific group of patients in need of this treatment, it is no longer obligated to limit the number of transplants as before. Previously, kidney transplantation was part of the state assignment, which constrained the region’s capabilities,” he noted.
Although the number of these operations increases every year, it does not cover all those in need because the number of patients on renal replacement therapy (the main indication for kidney transplantation) is constantly growing. Today, 60,000 adult patients are on dialysis in Russia. However, transplantologists can only help those without contraindications for surgery, and this group includes about one-third, or approximately 15,000 patients.
“I don’t think we will cope with this huge flow in the near future,” says Gautier.
In the Russian Federation, only state medical institutions with the necessary license, included in the list approved by the Ministry of Health and the Russian Academy of Sciences, can perform transplants. There are 68 such centers in 38 regions across the country. One of the current tasks is to increase their number to bring vital treatments closer to the population in the regions, rather than forcing seriously ill people to travel to federal centers for help.
Meanwhile, issues with kidney transplantation for children in Russia are practically solved. Specialists identify children approaching the phase of renal replacement therapy (transition to dialysis), then conduct numerous tests and examinations, after which the child is taken off dialysis and a transplant from a deceased donor is arranged if no living related donor is available.
“Our hospital has performed more transplants from incompatible donors than any other center globally. This includes many children—about one in five cases—who receive an organ from a parent or relative with a mismatched blood type. Even so, their results are just as good as patients who receive perfectly matched organs,” says Sergey Gautier.
However, donation remains a pressing issue. In 90% of cases, deceased donor kidneys are transplanted; there is no shortage in Moscow or St. Petersburg today, and regional centers are also expanding deceased donor opportunities each year.
“But we would like clinics to make greater use of transplants from living related donars, yet only a few institutions in the country practice it,” says Sergey Gautier.
Global leadership of Russian physicians
In 2025 alone, the National Medical Research Center of Transplantology performed 1,081 liver transplants. The surgical technique has also been mastered in many regions. Therefore, according to Academician Gautier, the national need, which is about 1,500 transplants per year, will be met in the near future for both adults and children.
As the expert noted, Russian transplantologists continue to maintain global leadership in heart transplantation for children. Last year, the National Medical Research Center of Transplantology performed 24 such operations. The use of artificial left ventricular assist devices has become a life-saving option for children with end-stage chronic heart failure.
More than just a machine, this pump is a bridge to survival. It grants precious time for children to grow, making the lifesaving gift of an adult heart transplant a future possibility. Today, the minimum weight of a child who has undergone such a transplant is only 28 kg.
The number of heart transplants for adults last year reached 340 operations. “For such a number of transplants, we have to deal with extremely severe patients at the terminal stages of heart failure; in some cases, these patients are on mechanical circulatory support and require emergency transplants. I must note the capabilities of Moscow’s donor system, it fully meets international criteria and helps us,” Academician S.V. Gautier says.
Significant progress has also been achieved in lung transplantation, with 40 operations performed at the center last year. The main reason for the increase in their number was a change in approaches to patient selection. Thus, the focus now includes severely ill patients with comorbidities, and the possibility of correcting the organs themselves during preparation for implantation using perfusion technologies.
“2025 was essentially the year of demonstrating the capabilities of these technologies concerning deceased donor organs when the quality of a human organ does not fully meet selection criteria. In many transplant centers, both foreign and domestic, these organs are deemed unsuitable for transplantation, although this is far from the case. And various types of perfusion techniques developed worldwide and refined in our center allow us to recognize a quarter of rejected organs as suitable, thereby increasing the number of operations,” says Gautier.
Transplantation helps diabetes patients
Another area developing in Russia is the transplantation of islets of Langerhans—cells responsible for insulin production. Today, doctors can transplant a pancreas to a patient with type I diabetes, but in Sergey Gautier’s opinion, a less traumatic and more promising option is the introduction of islets of Langerhans as a suspension, which is followed by their implantation into the hepatic portal system.
It was at the National Medical Research Center of Transplantology that a method was developed, which allows for more efficient and larger-scale isolation of islets of Langerhans compared to other existing methods in the world.
“I would not say this method cures diabetes. It does not. The method is intended for a specific group of patients who are already receiving immunosuppression because they have a transplanted kidney. Adding these insulin-producing islet cells to the treatment plan can help slow down diabetes-related complications that often damage transplanted organs. This full, combined treatment is now available. We are starting by offering it to about 100 patients a year to carefully study how well it works in the long run,” says Gautier about the center’s plans.
Animal to human transplants
Transplantologists worldwide are turning towards using organs obtained from animals for human transplantation. But at this stage, there are no possibilities to fully control the rejection reaction. There is also a moral and ethical aspect involved.
“A human should not be used as a model for developing this technique. As we know, both transplantations of a pig heart to a human performed in the USA ended in patient death. The reasons were severe immunosuppression and viral infections typical for pigs,” says Gautier.
It was after these failures that Thomas Earl Starzl, MD, the father of liver transplantation, is reported to have said, “Xenotransplantation (transplantation of non-human organs – ed.) is the future of transplantation…and always will be.”