Saturday, July 20, 2013

Ways to increase available transplant organs

Here's my OpEd from this weekend's Kingston Whig-Standard.

Ontarians die entirely preventable deaths every year because too many of us are simply too lazy to sign up as donors with our provincial transplant organ network. If Canada-wide statistics are anything to go by, about twice as many Ontarians are on a waiting list for transplant organs as there are suitable donor organs.
Reportedly, about 200 Canadians died last year while waiting for suitable organs. Most people on our waiting lists are desperate for kidneys. In Ontario alone, about 1,500 people wait today for suitable transplant organs. They could be a loved one, or it could be you. Some of those waiting today will die crude, premature deaths because the wait will be too long for them.
The current situation is not only unacceptable because people die preventable deaths when they could be looking forward to productive and happy lives. It is also unacceptable because of the unnecessarily high expenditure on kidney dialysis that is required to keep desperate patients alive while they are stuck on the system’s waiting lists. How can we close the gap between patients in need of transplant organs and the availability of suitable organs?
What we have in place at the moment is best described as an “opt-in” system. We need to opt-in pro-actively by registering as an organ donor. Typically, organs are removed from such donors after they have died.
In Ontario, living-donor donations are also possible, usually for kidney transplant purposes. Living-donor donation is feasible in the case of kidney donations because we can function perfectly with one healthy kidney. Unfortunately, unlike our – rightly so – highly paid transplant surgeons, and everyone else involved in the transplant process, the transplant source must not receive a financial reward for their decision to part with one of their organs.
Unlike in some other countries, we are unable to offer our spare kidneys for sale, despite the negligible health risk involved. No doubt this has a significant impact on the availability of transplant kidneys.
So, why should we not try and offer financial incentives to potential sources of transplant organs, i.e. people like you and me? Let me stay here with the kidney transplant business. We have reasonably persuasive data today suggesting that it is pretty safe for healthy people to donate kidneys. So, why should we, as the owners of our bodies, not be entitled to decide to put our spare kidney up for sale?
Clearly it isn’t the risk to the person who's the source of the kidney, given how very low that risk is, that could justify the current prohibition on organ sales. We are already permitted to undertake significantly higher-risk activities, including rock climbing, smoking ourselves to lung cancer, scuba diving in shark-infested waters, and the list goes on. So what’s morally reprehensible about accepting a small health risk for a handsome financial reward that would also help preserve a desperate Ontarian’s life?
For reasons I cannot comprehend, regulators expect donors to provide their organs for altruistic motives only. They are pretty much the only participant who isn’t handsomely rewarded for their participation in an organ-transplant procedure. Everyone else gets paid or receives a life-preserving organ. Isn’t it implausible, indeed, that patients should lose their precious lives because of an unreasonable societal squeamishness when it comes to paying people for their spare kidneys for transplantation purposes?
Desperate patients travel today overseas and obtain kidneys frequently under highly questionable circumstances, often exploiting vulnerable, impoverished people in developing countries. Surely one response to this challenge could be to develop a carefully regulated living-donor system that permits the sale of spare kidneys in Ontario.
We would, of course, ensure that vulnerable people are not subjected to the risk of exploitation or undue pressure. Benjamin Hippen, a U.S.-based transplant specialist, sums up what features a government-regulated market for transplant organs should have: It would prioritize the safety of both vendors and recipients; it would be fully transparent with regard to risks to vendors and recipients; it would safeguard institutional integrity regarding guidelines for co-operating with kidney vendors, and, last but not least, it would operate under a robust legal framework.
I suspect some people will find the idea of paying someone for their spare kidney unacceptable, and they will duly make noises about vulnerable people, as well as the wrongness of commodifying our bodies.
I do think that the first concern ought to be taken very seriously, but surely it is not beyond our capacity to legislate accordingly. As far as the commodification issue is concerned, my view would be that that decision is for the kidney owner to make, not for Tony Do-Good on her behalf.
Still, there is another way known to increase donor organs, and it is one that is being introduced in ever more countries. It is a proposition currently debated in Prince Edward Island. The idea is that we should switch from an “opt-in” to an “opt-out” system of consent.
This is based on a number of facts and a reasonable assumption: The facts are that many more of us would be happy to see our organs used for transplant (and even research) purposes after our death than there are people who actually opt-in to the current system. It is a fair assumption that people simply cannot be bothered to enrol themselves.
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.
Now, before you shout theft, socialism and whatnot, opt-out systems operate in a significant – and increasing – number of countries worldwide, including Spain, Austria, and most recently, Wales in the United Kingdom.
Truth be told, I would be comfortable with either system, or even with a mix of both, as long as we end up increasing the number of transplant organs available, and as long as the end result is that nobody in Ontario or Canada dies an unnecessarily early death due to a lack of transplant organs.
Udo Schuklenk is the Ontario Research Chair in Bioethics and Public Policy at Queen’s University. Follow him on Twitter @schuklenk


  1. More organs would be available if the system would actually take them. I know my organs are good, but I will not even consider donating them until sexually active healthy gay men can donate as well. If the organs of perfectly healthy donors go up in smoke, then that's where mine belong, and that's where they're going.

  2. I probably agree with your concerns on the discrimination against sexually active gay men, but it would seem to me that your stance has negative consequences affecting potential organ recipients. The latter truly have no power to change the current regulations re organ donations... no?