And the Organ Goes to...

Published: Tuesday, Feb 19, 2008
End-stage organ failure is a growing problem in the US, due in part to the fact that the number of available donor organs is lagging far behind the number of people (approximately 96,000) suffering from end-stage organ failure who are on the waiting list to receive organ transplants, leading to approximately 17 deaths per day. Roughly 70,000 of the people currently on the waiting list are in need of a kidney transplant.

The current system of organ allocation is not sufficiently addressing the inadequate supply of donated organs, or the concerns of patients who say they are unfairly restricted from procuring a transplant organ through alternate means. Various medical ethicists, economists, and patients’ rights advocates have proposed the controversial approach of creating a market-based system that treats donated organs as fungible goods, arguing that the financial incentives of such an approach would greatly increase the number of available organs and free patients from a growing medical bureaucracy. This concept, along with the idea of using the Internet to solicit donors and facilitate the buying and selling of organs, is at the center of a heated debate between the federal government, the healthcare industry, patients, and families. This is especially true when it involves voluntary donors who want to give an organ to someone in need.

Organ Registry

Many patients and families have turned to the Internet as a way to find a potential donor by creating personalized websites or joining an online organ registry such as Matching Donors, which was created “to give people in need of transplant surgery an active way to search for a live organ donor” and “to increase the number of transplant surgeries and improve awareness of live organ donation.” Patients who sign up with Matching Donors pay $295 a month to “advertise their stories on the Internet and anywhere else potential donors and families might learn about them and decide to donate an organ.”

With approximately 4,000 potential donors listed on the Matching Donors website, many happy endings have already occurred, including one for Robert Hickey, PhD, Corporate CEO of Innovative Strategies, Inc., who was one of the first candidates to receive a kidney transplant (October 2004) through the assistance of Matching Donors. “I read about [them] in the Denver Post… [and] initially I was convinced it was a scam,” Hickey told MDNG. “I hung up on the call when I was asked for a credit card number. After going through dialysis for another week, I took a chance for one month and was inundated with donation offers.” Although Hickey’s experience has made him a staunch supporter of permitting patients to use the Internet to locate a willing organ donor, the increasing popularity of organizations such as Matching Donors has raised questions as to whether online solicitation should be permitted.

Ethics 101

Douglas Hanto, MD, Chief, Division of Transplantation at Beth Israel Deaconess Medical Center, is against such solicitation. “I have all of the respect in the world for people who are willing to come forward, but there are so many people on the list that are needy,” he says. “I think where the kidneys need to be donated is to the person who needs it the most: the next person on that center’s waiting list.” Hanto wrote the article “Ethical Challenges Posed by the Solicitation of Deceased and Living Organ Donors,” published in the March 8, 2007 issue of the New England Journal of Medicine (NEJM). The article examines the potential ethical dilemmas surrounding a decision by living donors to choose a patient who is the same race or religion as they are, a decision that is highly opposed by the United Network for Organ Sharing (UNOS).

“The solicitation of organs from deceased donors bypasses the patient who is first on the waiting list; therefore, it violates the principles of utility and justice on which allocation policies are based,” wrote Hanto. Originally Beth Israel would turn away transplant patients who found a donor through the Internet or other media, but recently Hanto has changed his position. “We [Beth Israel] still feel the fairest way is for those donors to donate to the patients who need it the most—[those who are] at the top of the list,” he says. “However, for patients in our system, rather than have them leave the system, we’re trying to work with [them].”

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