Why Not Sell Your Kidney for Personal Gain?

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.

Kidney Transplant TV Show Is a Hoax

Nice story came via Associated Press last night. It's to do with a Dutch TV show (designed by the infamous Endemol production company (creator of Big Brother among other programmes). The idea was that several contestants in need of a donor organ would compete (on air) for the kidney of a dying woman. The winner would receive the kidney and thereby be spared infinite dialysis (and likely premature death). There has been a huge outcry over this internationally. - It turns out, the story (and show) was a hoax. Here's the AP item:

Saturday June 2, 2007 12:46 AM


By TOBY STERLING
Associated Press Writer

AMSTERDAM, Netherlands (AP) - A television show in which a woman would
donate a kidney to a contestants was revealed as a hoax Friday, with
presenters saying they were trying to pressure the government into reforming
organ donation laws.

Shortly before the controversial program was to air, Patrick Lodiers of the
``Big Donor Show'' said the woman was not actually dying of a brain tumor
and the entire exercise was intended to put pressure on the government and
raise awareness of the need for organs.

The three prospective recipients were real patients in need of transplants
and had been in on the hoax, the show said.

The program concept had received widespread criticism for being tasteless
and unethical.

But Lodiers said that it was ``reality that was shocking'' because around
200 people die annually in the Netherlands while waiting for a kidney, and
the average waiting time is more than four years. Under Dutch rules, donors
must be friends, or preferably, family of the recipient. Meeting on a TV
show wouldn't qualify.

``I thought it was brilliant, really,'' said Caroline Klingers, a kidney
patient who was watching the show at a kidney treatment center in Bussum,
Netherlands.

``I know these transplant doctors, and I thought they'll never go and
actually do it. But it's good for the publicity and there are no losers.''

During the show, 25 kidney patients were vetted by ``Lisa,'' and most were
quickly dismissed for being too old, too young, smokers, ex-smokers or
unemployed. Contestants gave moving pleas for why they should receive the
organ.

``It really hurt watching that,'' said Tim Duyst, whose wife is awaiting a
transplant and cannot work. ``You're dismissed in a wave of the hand.''

Viewers were called on to express an opinion or vote for their favorite
candidate by SMS text message for 47 cents.

The show was produced by Endemol, which created ``Big Brother'' in 1999.

The Royal Netherlands Medical Association, known by its Dutch acronym KNM,
had urged its members not to participate and questioned whether the program
might just be a publicity stunt.

``Given the large medical, psychological, and legal uncertainties around
this case, the KNMG considers the chance extremely small that it will ever
come to an organ transplant,'' it said.

All seven of the country's transplant centers had said they not cooperating
with the program, KNMG spokeswoman Saskia van der Ree.

Earlier in the week, the Cabinet declined suggestions from lawmakers to ban
the program, saying that would amount to censorship.