Should human organs be for sale?

  1. Posted on Sat, Sep. 21, 2002 Miami Herald

    BY JOHN DORSCHNER
    jdorschner@herald.com
    http://www.miami.com/mld/miamiherald/4125034.htm

    Michael Ritchie, 45, has spent two months ''hooked to a lot of machines'' in a Jackson Memorial Hospital bed, waiting for a new heart. ''I have faith in the Lord,'' he says, ``and I have faith in my doctors.''

    The problem is that no one has faith that enough people will donate their organs to keep people like Ritchie alive.

    The shortage of available organs is so severe that some experts are proposing a radical solution: paying for organs -- giving money to the relatives of the recently deceased.

    The hope is that the move would help the 80,000 people waiting for transplants. That's up from 20,000 in 1990. Last year, 6,238 Americans died while on the transplant waiting list, and many more became so sick that they were removed from the list before they died.

    At present, paying anything for organs is illegal, and many transplant surgeons think payment is morally wrong. But as the waiting list has lengthened, a growing segment of the medical establishment is willing to at least explore the idea.

    This summer, delegates of the American Medical Association voted to support a study to see whether payments would ease the shortage. Several bills in Congress propose changing the 1984 law that forbids payments for organs. ''The organ shortage we are experiencing is not mandated by nature,'' writes David L. Kaserman, an economist at Auburn University and the recipient of two kidney transplants. ``Rather, it is the outcome of a myopic public policy.''

    UNMET NEED

    While many disagree with him, the United Network for Organ Sharing, which keeps the waiting list for transplants, says it is an ``undeniable fact that the current system, despite 30 years of experience based on altruistic donation, has yet to meet this need.''

    Kaserman wants to know what is un-American about paying for a heart the way one would pay for a car. If there is a shortage of cars, you give an incentive to manufacturers to produce more by raising the price.

    ''I don't tell a surgeon how to operate,'' says Kaserman, who this summer co-authored a book, The U.S. Organ Procurement System: A Prescription for Reform. ``I don't know why a doctor would tell an economist what's right. A shortage is by definition an economic demand that's not being met -- a difference between supply and demand.''

    Kaserman's book, published by the conservative American Enterprise Institute, has a two-tiered proposal. The more radical would be a pure free-market system, in which families could auction organs to the highest bidder and brokers could then resell them to whoever paid the most -- similar to the black-market system that now operates quietly around the world.

    ''The medical community is still very much opposed to that,'' Kaserman says. It's also opposed to paying live donors for a kidney. The implications of a poor person endangering his health for a few thousand dollars are too distasteful.

    What is gaining support is Kaserman's second proposal: paying a small fee to the family, with the organs then going to one of the several dozen nonprofit procurement organizations around the United States.

    The nonprofits are tied to the United Network for Organ Sharing, which would continue to maintain the waiting list based on medical criteria, not wealth or fame.

    Others think it's not that simple.

    ''The downside is it opens the process to undue influence, if not downright corruption,'' says Ken Goodman, director of the bioethics program at the University of Miami.

    Selling organs to the highest bidder could lead to the rich living by buying up all the available kidneys, livers, hearts and lungs while others die. It could also lead to the poor being persuaded to risk their health by parting with a kidney or a slice of their liver -- the two organs that live donors can part with.

    ''I can see the slippery slope,'' says Sister Kathleenjoy Cooper, 61, of St. Raphaela's convent in North Miami-Dade. She has been waiting for a kidney for four years, but she is opposed to buying organs. ``I don't want the United States doing what they're already doing in other countries.

    ''That could lead to the poor being exploited for their bodies. Or it could lead to that murky line about being brain-dead'' -- speeding a declaration of death in order to harvest organs.

    THIRD WORLD SALES

    In fact, in poor countries around the world, including Iraq and India, sales of organs are already occurring -- generally by poor men willing to give up a kidney for as little as $1,000. Kidneys are the main black-market organ because they are needed by more than half the people on the waiting list, and because most patients don't trust the quality of organs taken from cadavers.

    The shortage exists because transplants have become much safer -- and therefore possible for more people -- since the first successful transplant in 1954.

    Much of the success is due to improved drugs that stop the body from rejecting another person's organ. More than 85 percent of patients now survive the first year. For kidney and pancreas patients, it's 95 percent.

    Last year, 24,000 transplants were performed in the United States, and while the number waiting for transplants has increased 400 percent since 1990, donations from cadavers have increased only 32 percent, according to the United Network for Organ Sharing.

    The problem is that only 1 percent of the dead are potential donors.

    Those whose bodies have wasted away slowly with disease can't be used. Surgeons need people who die suddenly, as in an accident, and have healthy organs.

    It used to be that cadaveric donors had to be younger than 50. Then the limit was raised to 55, and finally removed. ''There's no cutoff in age,'' says Andreas Tzakis, director of liver and gastrointestinal transplants for the University of Miami. ``We've used the liver of an 87-year-old.''

    MULTIPLE BENEFITS

    Theoretically, a single body could save up to seven lives -- two kidneys, two lungs, one heart, one pancreas, one liver -- but the practical maximum is three or four.

    That makes organ donating a huge gift, and for years, the medical community has tried to drive that point home while urging people to put ''organ donor'' on their driver's license and explain their decision to relatives.

    Still, only two out of five eligible cadavers are used as donors.

    ''Americans don't want to think about dying,'' says Anne Paschke, spokeswoman for the organ sharing network, ``so they don't think in advance about donating.''

    ''It's not against the tenets of the major religions,'' says Goodman, the bioethicist. ``But a lot of family members think of it as yucky.''

    Kaserman thinks money would help focus families' attitudes. ''I've been preaching this sermon for 10 years now. . . . When I first started writing, the medical community was extremely opposed.'' But as the number of deaths of people on the waiting list has grown -- it's now 17 a day -- the medical community has become more receptive.

    `MENU OF OPTIONS'

    Offering money doesn't have to be crass, Kaserman says. 'You should do this in a sensitive way, with a menu of options. You say, `You are giving the gift of life. . . . As an additional inducement, we can make a contribution of $500 or $1,000 to your favorite charity, or help with funeral expenses, or as a cash payment.' So they can make a contribution or take a vacation.''

    The crucial issue is how big the payment should be. Kaserman thinks it doesn't need to be astronomical. He believes that families will be willing to donate for as little as $1,000, based on a poll he did of Auburn students. That's not much of a survey, he acknowledges, and that's why he supports better surveys.

    That's precisely the American Medical Association's position.

    Leonard Morse, a Massachusetts physician who chairs the AMA ethics council, says the group supports a limited study, involving only cadaveric donors, offering incentives of ''moderate value,'' such as partial payment of funeral expenses.

    The board of the organ sharing network also favors such a study examining the usefulness of ''small amounts paid directly to a funeral home, or a token thank you,'' Paschke says.

    So far, no group has launched a pilot project, at least partly because it might first have to seek a federal waiver from the 1984 law.

    `IMPLIED CONSENT'

    An alternative to payment is the ''implied consent'' system of several European countries, including Spain. Doctors there assume that a patient is willing to have his organs donated unless he is carrying a card that says he does not want to be a donor.

    Most U.S. experts doubt that such an attitude would work in this country. ''Americans have a suspicious nature about authorizing a government to do that,'' says Tzakis, the Miami surgeon. ``It's just a blank check.''

    Goodman, the bioethicist, would rather spend the money on education than funeral expenses. ``If a family thinks it's yucky to remove organs and desecrate a loved one, are you going to surrender the loved one for a few shekels? I think we're better off educating people about what a valuable gift they're giving.''

    Meanwhile, the waiting list grows.

    Bruce Modlin, 49, a former bar owner who lives in Weston, has been waiting for a liver for four years. ''It's an emotional roller coaster,'' he says.

    He has no opinion about how organs are obtained. He just knows he needs a liver. ``I'm getting progressively worse.''
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  2. 38 Comments

  3. by   jode
    OH BOY! This is ....well...it should keep the board busy for awhile.
    My personal feeling is NO. I will say that if someone has signed their licence and/or designated this in their living will, the family or spouse should NOT be able to over ride that decision. I am not unsympathetic to the needs of those waiting for organs, and its possible that my feelings would change if it was myself or a loved one in need. But as soon as money gets added into any equation...its bound to stretch ethics. I guess it just doesn't feel right.
    Interesting topic Karen.
  4. by   Just Angi
    Great write up! In my opinion, NO. I think it should be a gift from one person to another. If you were to pay for it, to me that is the only thing that would be "yucky" about an organ DONATION. Personally, I am a donor. However, if they were to offer to pay my family when the time came, I believe it would be humiliating for them as it would for me. It is downright untasteful.
  5. by   CMERN
    The Problem I forsee is as jode has already stated ...."its bound to stretch ethics". (aren't ethics stretched to the max as it is?) We definately do not need money to be added to the equation..and becoming someones motivation to donate an organ ..or procure an organ to be SOLD..
  6. by   RoadRunner
    That subject touches me because I work in an ICU where organ donation is well implanted within. We have a lot of donors because we (doctors, nurses, resources,...) are into the notion easily and well organized about it. It's even talked about in the orientation of newbies in the unit.

    I'm totally against buying organs thought. The line between the price one is willing to pay in hope of a better life (buy a kidney) and the price one is willing to pay in hope of a better life (sell a kidney) is a peculiar one... It goes down to what's the price a human being and is some lives worth more than others. Dangerous.

    Try looking on the net for "kidneys on sale". Amasing what you'll find: selling against the promise of citizenship, for money problems, etc... In some countries, half of the guys in some villages have "scars of givers" they call it. Freaks me out.

    And the horror stories of those willing to pay. Organ rejection in the first week because lack of compatibility testing, poor surgical environnement, no testing for deseases, etc... So legalize it for better control? It's coming... God help us!!!
  7. by   researchrabbit
    I don't believe in selling or buying organs.

    But money to offset the cost of the (sometimes huge) hospital bill the patient acquired to be AT the donation stage...or money for funeral expenses could also be considered a gift to the bereaved family. Perhaps more LIVING people would sign up to be organ donors if they thought their OWN family would be helped by it. Perhaps if the money were only made available to donors who had signed up while alive...? That way it could not be used as a way to trade money for organs, but more people, knowing their families might have a little extra to bury 'em with, might sign up NOW. And families might be more willing to honor their wishes LATER.

    BTW, I am a designated organ donor, and so are my parents, my 17-year-old, my brother and sister...and I would not hesitate to give any of ours away if we didn't need them anymore (quick prayer this will not be something I am called upon to do!).
  8. by   LasVegasRN
    Originally posted by NRSKarenRN
    ...Selling organs to the highest bidder could lead to the rich living by buying up all the available kidneys, livers, hearts and lungs while others die. It could also lead to the poor being persuaded to risk their health by parting with a kidney or a slice of their liver -- the two organs that live donors can part with...
    That says it all for me. This should NEVER occur.
  9. by   Lausana
    Very good article, Karen!

    No, I don't think selling organs is the answer. For many of the reasons already stated. How much would be too much, how would you "price" the organs? Just doesn't seem right...

    I wish there was a bigger drive to get more people to be donors. Seems that many people never think about it. I'm happily a donor, if I'm ever in the position to give-than I sure as heck won't be able to use them anymore. A close friend of mine lost her older sister (was hit by a car) and the family was able to donate to seven separate people with her organs. The loss was & still is huge, but it was really special to meet through letters those who received from her. I think money would've taken away the special "gift" of the donation to them, it wouldn't have made up their mind for them. But that's just me!

    Interesting!
  10. by   semstr
    Never ever should that happen for God's sake!!
    He, who has the money gets the kidney, he, who is poor dies.
    NO WAY!!
    I am glad we have a reverse law here, everybody is a donor, unless you write a codicil that you don't want to be one.
    This law is for anybody on Austrian soil, I know there are difficulties with tourists about this, but hey, when someone dies abroad it is to expensive to fly him home in a casket, balmed and everything, so they let the deceased cremate most of the time.
    I know this sounds very harsh and unemotional, but hubby is doing his job everyday, that's why I know this.
    PS: we've got a very high transplantation rate here.
  11. by   shannonRN
    tricky topic. i went to a bioethics seminar a while ago about organ donation. they had a doctor who talked about getting donors for live liver transplants. the md said that they do a lot with children who are found to have liver problems in utereo. they approach the parents to see if they would like to donate to their child or would like to place them on the list. they will not let them do both. so if the parents decide not to donate their liver and there isn't a donor found...the parent's cannot change their mind and donate. they said that it had to do with guilt and debt and you shouldn't donate for that reason.

    a little while ago my coworkers were debating this topic and one of them made a very interesting comment. they were talking about how many people say that organ transplants are wrong and they will not donate their organs. and then they mentioned what would happen if they got sick. would they change their opinion and want a transplant? so their "answer" was screening people every so many years to see if they would be donors and if they were donors then they could receive an organ if they became sick. and if they were not donors and they became sick, then they would be unable to receive an organ.

    i definately think that money for an organ is not the answer, but am unsure what could change the situation....educating the public would be a good start.
  12. by   RoadRunner
    There are still too much misconceptions about organ donation. Public awareness is improving but there is still much work to do. I sign my card and my family too but mostly they know MY position on the subject. I find that when it has been discusted amoung the family, the decision is somewhat easier to make when the question is brought, since it is always a very hard moment, far from good for decision making! But then, it is very very rare that the family refuse or go against the patient will. It happened only two or three times for my own patients in 10 years (and we do a lot of organ donations in my facility).

    I saw a TV report the other day stating that if all organs that could be transplanted were, this question of selling-buying organs would not even be an issue... It's always hard to ask thought...
  13. by   LasVegasRN
    I agree, the big hurdle is misconception. It is also religious-based notions. My parents do not believe in cremation and want to "leave this earth intact just like the way I came into it". I've said to them, why? You'll be maggot food! Then they run off saying "she's talking that gross nurse-stuff again" and ignore me. :chuckle This is common among their peers, which I find very interesting.

    I'd like the same law enacted in America (which will NEVER happen as the ACLU will not allow it) where you are automatically a donor unless you write a codicil saying you don't want to be one.
  14. by   OBNURSEHEATHER
    Originally posted by LasVegasRN
    I'd like the same law enacted in America (which will NEVER happen as the ACLU will not allow it) where you are automatically a donor unless you write a codicil saying you don't want to be one.
    Interesting thought Vegas. So many people aren't donors simply because they haven't taken the initiative to be a donor. The people that aren't are usually more adamant that they remain intact, and would be more likely to take the initiative not to be organ donors.

    Hmmmm.....

    Heather

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