Sarah was my first identified positive match for a donor (and hopefully will be my last.) I would like to send a huge thank you out to the over 30 people who agreed to be tested to donate a kidney to me. The response was actually so positive that it overwhelmed the system, which caused a great deal of frustration to my potential donors and to me. In addition to Sarah, I want to thank my cousin Amy and my previous physician who went through a large battery of tests to see if they were good matches. (And Bob who is on tap as a backup!)
I wanted to write for a minute on the ethics of organ donation. In the United States, and most countries in the world, it is illegal to purchase an organ (sorry Sarah.) That said the illicit purchase of organs is not uncommon. There are stories of folks who find strangers to donate to them on Craig’s list or Facebook. I hear rumors that money often changes hands in these transactions. There is also a large trade in organ trafficking, with Americans and other foreign nationals going to counties like India and Pakistan to buy a kidney from a poor local.
The ethics of selling organs is actually not as cut and dried as you may think – there are those in the transplant community who are in favor of a legalized, highly regulated and controlled market in organs. The reason is that in the United States, more than half a million people currently have end stage renal disease, and almost 84,000 are waiting for a kidney transplant (with another couple thousand waiting for a kidney/pancreas.) About 18,000 kidney transplants are performed every year. The chance of living 5 years on dialysis is only 33%, versus 80% after a deceased donor kidney and 90% after a living donor kidney (National Kidney and Urologic Diseases Information Clearinghouse.) There is a real urgency to find additional donors.
The idea of payment for organs is being seriously explored. Last year, Singapore legalized payment for organs. In a March issue of Annals of Internal Medicine, a group of University of Pennsylvania researchers and ethicists explored the theoretical construct of regulated payment for kidney donation. They concluded that “Theoretical concerns about paying persons for living kidney donation are not corroborated by empirical evidence. A real-world test of regulated payments for kidney donation is needed to definitively show whether payment provides a viable and ethical method to increase the supply of kidneys available for Transplantation.” (Halpern et al, Ann Intern Med. 2010;152:358-36).
I don’t know how I feel about this frankly. I was fortunate enough to have many people who were kind enough to be willing to donate on my behalf. The reality is that many of the folks that were in dialysis with me probably don’t have the resources to purchase an organ anyway, although I suppose that if those that could buy one did, the deceased donor list would be much shorter for those who did not have the resources. I certainly think it is worth considering and further investigation.
Something to think about – please feel free to comment on this post, I would really like to hear your opinions.