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.

Pay?

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.

Opt-out?

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

Medical professionalism African style - more on Manto Tshabalala-Msimang

Hey, what a tendentious headline this is... I don't mean to write about medical professionalism African style, but about the disgraceful conduct of the (current, and would you believe it, still in office) South African Minister for Health Prevention, Dr Manto Tshabalala-Msimang. Manto has succeeded for several years to aid and abet the line of her boss, Thabo Mbeki, on HIV/AIDS. Hundreds of thousands of South African people with HIV/AIDS died preventable deaths because those two shady characters colluded in slowing down the roll-out of effective life-preserving AIDS treatments for as long as was/is feasible. She instead continued to promote various vegetables as a serious alternative to proper AIDS treatments.

Of course, as is usually the case when it comes to such people, there's one rule for the people and another for the rulers. All the politically correct rhetoric of the ANC is not going to change that. It has since transpired that Manto,a card carrying member of the League of Continuing Alcoholics (LCA), jumped the queue in order to access a fresh liver. It would have been very difficult for her to continue drinking otherwise. Other people of her age who happen to continue to enjoy large quantities of alcohol (as she does) tend not to get access to life-preserving new organs. These scarce resources are usually preserved for people younger than Manto, and people who, unlike Manto, stopped drinking. Well, despite much by way of denials (attending doctors were seemingly pressured into claiming that her alcohol induced liver disease wasn't alcohol induced...), it's clear now that the country's health prevention minister is not only incompetent but also otherwise unfit to run the Department of Health. She doesn't seem to mind bending the rules that have been put in place to allocate scarce transplant organs justly in the country.

Since these facts came to light it was also discovered by an investigation published last weekend by the country's SUNDAY TIMES that Manto was fired a couple of years ago from her day job as a superintendent at a hospital in Botswana because she stole plenty of hospital property and even a watch from a patient who was undergoing surgery under full anaesthesia.

Here's a revealing excerpt from yesterday's SUNDAY TIMES:

This week some of the key witnesses who testified during her trial and who had worked with Tshabalala-Msimang at the time, told the Sunday Times that jewellery, hats, handbags and even shoes had disappeared from the hospital over several months.

They had not suspected Tshabalala-Msimang and had were shocked when she was arrested for the thefts.

“It was unbelievable that a superintendent of the hospital would do something like that,” said a retired nurse who worked at the hospital at the time. Tshabalala-Msimang was arrested after an oval-shaped watch belonging to a female patient disappeared while she was under anaesthetic. The theft was reported to the police. Tshabalala-Msimang was arrested when she arrived at work three weeks later, wearing the watch. Staff contacted the investigating officer and Tshabalala-Msimang was arrested in front of her employees. A warrant was obtained to search Tshabalala-Msimang’s home and police found, among other things, linen, blankets and heaters that belonged to the hospital.'

So, an incompetent, drinking crook that is how one could best describe South Africa's Minister for Health Prevention, Dr Manto Tshabalala-Msimang. No wonder the ANC leadership has promoted her straight into the health department. There are only few senior people in the ANC that haven't managed to get their hands in one till or another, so Manto probably had the perfect character profile for the job.

Mind you, there's still people left in South African medical schools seriously trying to teach ethics.

... to be continued