The Canadian Society of Transplantation tells
on its website a story that is a mirror image
of what is happening all over the world. More than two times as many Canadians
are on waiting lists for transplant organs than there are suitable donor
organs. Reportedly about 200 Canadians died last year while waiting for suitable
organs. Most people on the waiting list are desperate for transplant kidneys. South
of our border about 80,000 Americans are on waiting lists for kidney
transplants. The current situation is not only unacceptable because people die
preventable deaths when they could be looking forward to a productive and happy
life, it is also immensely wasteful as kidney dialysis is a hugely expensive
undertaking. How can we close the gap between the number of patients in need of transplant
organs and the availability of suitable organs?
Dead donors
A number of different policies aimed at
increasing the number of transplant organs in an ethical manner have been
discussed and implemented in various countries around the world. I am
personally in favor of an idea currently debated in PEI. The
proposal is on the table that we should switch from an opt-in to an opt-out
system of consent. The idea here is that for everyone who does not expressly
refuse to donate their organs after their demise the reasonable assumption is
made that they would be happy to see their organs utilized to preserve a
fellow-Canadian’s life. However, some don’t like this proposition. As far as
they are concerned, this is not just a question of solidarity but one of
ownership. After all, nobody is entitled to take my car after my demise either,
just because I have forgotten to stipulate that it should go to my loved-ones.
Living donors
Here is where an alternative idea comes into
play: perhaps we should consider incentivizing potential sources of transplant
organs, ie people like you and me. I am focusing here primarily on living donor
kidneys. We have reasonably persuasive data
today suggesting that it is perfectly safe for most healthy people to donate
kidneys. As the autonomous owners of our bodies we are entitled to make
decisions with regard to how we wish to use our bodies. There are lots of
things we are morally and legally entitled to do with our bodies, including
engaging in risky activities like playing rugby, scuba diving in shark infested
waters and many others. Strangely, when it comes to the use of our bodies for
medical research or transplantation purposes, the response we get frequently
from religious leaders, medical ethicists and others is that we should
contribute from the goodness of our hearts, rather than from a less altruistic
motive. Any sensible medical system would focus here on outcomes instead,
namely a maximization of the number of available suitable transplant organs, rather
then a second-guessing of vendors’ motives. Given that we already accept
altruistically motivated living donor kidney donations, it does not strike me
as particularly plausible that people should continue to lose their precious
lives because of an unreasonable societal squeamishness when it comes to paying
people for their spare kidneys for transplantation purposes.
It is important to recognize that our current
system is not working in many ways. Precious lives are unnecessarily lost year
after year. Desperate patients travel overseas and obtain kidneys frequently under
questionable circumstances, often exploiting vulnerable impoverished people in
developing countries. The list goes on. Suffice it to say: leaving things as
they are is not a cost neutral choice!
Let’s try it
What I am proposing is to run a pilot program
aimed at investigating whether strictly government regulated incentives for
living donor transplant kidneys would result in additional available transplant
organs with a resultant decrease or elimination of the current waiting lists. The objective of this pilot program would be
two-fold: 1) develop a system that would create successful incentives for organ
vendors to offer their spare kidneys while at the same time 2) ensure that
sufficient safeguards are put in place to guarantee that whatever incentives
are offered do not generate additional harms. Benjamin Hippen, a US based
transplant specialist sums
up what features a government regulated market
for transplant organs should have: It prioritizes the safety of both
vendors and recipients; it must be transparent with regard to risks to vendors
and recipients; it must safeguard institutional integrity regarding guidelines
for cooperating with kidney vendors, and last but not least it must operate under
a robust legal framework.
