TCS Daily


Kidney Central Planning

By Lawrence White - July 18, 2007 12:00 AM

I've been on hemodialysis for fourteen months now, seeking a kidney transplant. I'm on the official UNOS waiting list for a cadaveric organ (anticipated wait time: three to five years). I've had close relatives and friends (three so far) volunteer to be tested for donor compatibility only to be medically disqualified. Others are now stepping forward; the search and testing process continues.

So I noted with interest the announcement that a Dutch television network would air a "reality show" on which three dialysis patients would compete for a kidney to be donated by a terminally ill woman. Viewers could text-message the show to support their favorite patient.

As reported by the New York Times, "The Big Donor Show" turned out to have been an un-reality show, a stunt designed to raise awareness of the shortage of transplantable kidneys, with the "donor" being played by an actress. (The "contestants" were played by people who actually do need kidney transplants).

Televising a neediness competition among hard-luck contestants is tacky, of course. (Older readers may remember the NBC daytime TV show Queen for a Day.) But the Dutch broadcasters did have a point: there are indeed three or four people like me, seeking a transplant, for every kidney that becomes available. An increase in the number of donors, living or cadaveric, would literally save lives. At a zero price (payment for organs is illegal in the US) there is of course a severe shortage of kidneys from living donors. A little publicity, even if tacky, couldn't hurt and might help bring forth more donors.

What especially caught my eye in the New York Times report on the Dutch TV show was a comment on from an American bioethicist:

It's not all that different from what's happening on the Internet, on sites like MatchingDonors.com, where people looking for organs post their pictures and their stories, hoping a potential donor will choose them," said Jeffrey Kahn, director of the University of Minnesota's Center for Bioethics. ... "I think we'd reject as a matter of morality and equity that the prettiest people, the people with the best story, or the ones who can pay the most, should get access to this very scarce resource," Mr. Kahn said.

Actually, with all due respect to Mr. Kahn, some of us in need of a kidney would disagree. Allocating kidneys by "morality and equity" criteria presumably means that those in need of a kidney should wait their turn for an organ from a single common pool. This makes sense insofar as transplantable kidneys are supplied without restriction by recently deceased donors. But it makes no sense regarding kidneys from living donors. If we acknowledge the living donor's right over his own kidney - and we should - then we have to accept the donor's choice of a recipient even if we don't like the donor's criteria. Even a choice in bad taste should not be rejected as immoral or rendered illegal.

Mandating common-pool kidney allocation, over the wishes of live donors, can cost lives. Consider the case of Lisa Cunningham, who contacted her local newspaper in her search for a kidney donor. The Ashland, Massachusetts Daily News reports:

Cunningham's decision to go public triggered a national story when Beth Israel Deaconness Medical Center's transplant director said he would refuse to give Cunningham the potentially life-saving transplant if she found her donor through the media. Citing ethical concerns over donor or patient exploitation and fairness, Dr. Douglas Hanto said he thought it would be best that if an altruistic donor came forward, for that kidney to go to the next person most in need on the waiting list - not Cunningham.

Cunningham switched to another hospital but died of kidney failure after failing to find a donor. Dr. Hanto has reportedly since reversed his hospital's policy against directed donations from strangers.

If common-pool "equity" criteria were always to trump the donor's wishes, a live donor would not be allowed to direct his donation even to a blood relative. Surely Mr. Kahn and Dr. Hanto realize that most donors who come forward do so to donate to a relative. They would not come forward if their kidney would instead go to the anonymous person next on the waiting list.

Surely the same applies to potential donors who may have been moved by Lisa Cunningham's story: some who would donate to her would not come forward to donate to an anonymous recipient. MatchingDonors.com, the website Mr. Kahn cited, operates on the same principle: it moves donors to come forward by giving them access to the personal stories and photos of individuals in need of donor organs. Some of those moved are surely donors who would not - and have not - come forward to donate to an anonymous recipient.

This is why there is, in fact, no waiting list for live donations, only for cadaveric organs, as physician Dr. Sally Satel observed in an op-ed piece defending brokered transplants. Needing a kidney transplant herself, Satel joined MatchingDonors.com. She eventually received a kidney from a friend, author Virginia Postrel.

For the sake of those of us who need a kidney, deciding who should get access to the "very scarce resource" of a living-donor kidney should therefore be up to the donor, even if the donor wants to choose on the basis of the recipient's prettiness, narrative excellence, or willingness to pay. A directed live donation should not be turned away on spurious "equity" grounds.


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19 Comments

UK Organ donor change
I heard that a doctor in UK wants to change the organ donor program to one where people must OPT OUT instead of OPTING IN.

The immediate implication to me is that the doctor then believes the state owns us all unless we say "no".

If we can't own ourselves, then we can't own anyting.

how long before the option to opt out is removed?
...

Harvest organs form executions.
Why not? It is such a waste.

What's the waste, the execution?
I oppose killing prisoners for one simple reason, the 'justice' system is not perfect.

If they err, they are supposed to err on the side of letting the guilty go free. That only happens if you have lots of money, like OJ.

Too many people are in jail, even on death row, who have been eventually exonerated.

Which brings me back to the original issue of who owns your body, you or the state?

While You Live? You
The argument usually is that once you die, there is no more you to hold ownership.

As for organs from executees, I'm against. Not because we don't need the organs, and not because I think that any sizable percentage of death row inmates are innocent. Its because, if you take organs from executees, you create a strong incentive to hold more executions, *irrespective of factors like guilt and deterrence.*

I wouldn't be opposed to opt-out on organ donation, though.

The right to own property
Anyone has the right to dispose of his own assets, including his own body parts as he chooses. I agree that it the living donor wants to base his choice on the attractiveness of the person who needs a kidney, or their ethnic group, or their religion, that is his inalienable right as the owner of his body.

I do not know why governments are involving themselves in this transaction, save some socialist issue of "fairness".

If you can't direct disposal of your remains...
then why should you be able to dispose of any of your property, like your house?

When you die, the government can take it all?

Then no one would need a will and more lawyers could do something useful.

Easy question
Bidding wars. The government, and I would say probably a majority of the population, does not want a situation where only those with the income can afford a replacement organ.

However, a live donor who can donate, say a kidney, should be able to get whatever the market will pay. It is a quandry for many people. We want some type of equal access to life-saving proceedures but we don't want people to be denied the ability to set the worth of their own property, including their bodies.

Sell aborted fetuses for stem cell research!
Great way to make extra money!

I am glad you see the logic
Perhaps we can turn you into a liberal yet.

The line is how long?
There are about 100,00ish people on kidney waiting lists. To supply from live donors, we need 1 in 3,000 US citizens to step up each year. The price they get might be a few thousand dollars.

20 years out, expect we will be on our way to harvesting organs from cell cultures. Until then, we'll have all sorts of needless suffering in the name of equity.

Needless suffering?
Don't get your point.

You support payment for organ donations or you support laws to force people to 'donate' or...?

different issue entirely
But still does raise the same quandry in general discussion. If we are going to allow this research, then why not?!

Life is all relative?
Murdered babies should be sold for research so panicking baby boomers can avoid the grave for a few years?

I didn't say that
But if you aren't going to end abortion and stem cell research then Who owns those fetuses and their cells? Someone is making a profit off them guaranteed, as we speak.

Therefore the question, no matter how distastefull it migh be, is who owns the cells and who should be able to profit from them. The question is not whether or not anyone should profit, as someone already clearly is. The question is who should profit.

If you make all abortion illegal and all stem cell research illegal, then you are taking the legal profiteering out of the equation and no one can legally profit from this. That is not presently the case. Since that isn't the case, the law is arbitrary and the donor parent is being left out. They no only have to pay for the abortion, they are not allowed to profit from any exchanges of the product of the proceedure.

This is not an issue ofr "right or wrong" but of "who benefits", kind of like welfare and taxes.

No Subject
Lawrence White wrote 'For the sake of those of us who need a kidney, deciding who should get access to the "very scarce resource" of a living-donor kidney should therefore be up to the donor...'

The same is true for kidneys (and other organs) from deceased donors. Federal and state law allow organ donors to select their recipients. It's called directed donation.

Anyone who would like to donate their organs to other registered organ donors can join LifeSharers. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

LifeSharers members agree to offer their organs first to other LifeSharers members, if any member is a suitable match, before making them available to non-members. If you join LifeSharers you accomplish three things:
(1) You create an incentive for non-donors to become donors, because signing up to be a donor is the only way to get preferred access to the organs of LifeSharers members.
(2) You make the organ transplant system fairer. About 50% of the organs transplanted in the United States go to people who have not agreed to donate their own organs when they die.
(3) You increase your own chances of getting a transplant should you ever need one, because you get preferred access to the organs of other LifeSharers members.

Give organs first to organ donors
Lawrence White wrote 'For the sake of those of us who need a kidney, deciding who should get access to the "very scarce resource" of a living-donor kidney should therefore be up to the donor...'

The same is true for kidneys (and other organs) from deceased donors. Federal and state law allow organ donors to select their recipients. It's called directed donation.

Anyone who would like to donate their organs to other registered organ donors can join LifeSharers. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

LifeSharers members agree to offer their organs first to other LifeSharers members, if any member is a suitable match, before making them available to non-members. If you join LifeSharers you accomplish three things:
(1) You create an incentive for non-donors to become donors, because signing up to be a donor is the only way to get preferred access to the organs of LifeSharers members.
(2) You make the organ transplant system fairer. About 50% of the organs transplanted in the United States go to people who have not agreed to donate their own organs when they die.
(3) You increase your own chances of getting a transplant should you ever need one, because you get preferred access to the organs of other LifeSharers members.

A better idea
How about just letting people sell their organs? Or their heirs to sell/donate as instructed by a will? You don't even need a silly trademarked word with a capital letter in the middle.

Kidney Central Planning; THE FREEDOM OF CHOICE
I LOST A SON DUE TO AN VERY HORRIBLE TWO VEHICLE MANSLAUGHTER OF MY SON. ALL YOU HAD TO DO WAS TO READ THE WITNESS REPORTS AND TELL THAT THE TWO THAT HIT HIM ON THE STREET HAD TIME TO BRAKE AND OF STOP OR SWIRVE WHILE HE WAS STOPPED AT A RED LIGHT BEING RED.....
ANYWAY, MY SON TWO YEARS PRIOR HAD MADE THE CHOICE TO GIVE ONE OF HIS KIDNEYS TO HIS SISTERS MOTHERINLAW.
SO, THE ONLY REASON that I signed the legal organ share paper work for all of him that could be used was that they said, I quote: "As long as there is two-2 usuable organs, then one of them can be designated to person of your choice."; "If there is only one organ then the organ must go on the first come first serve list that is a match."

If the doctors had said, no to that statement of freedom of choice of recipient. I would of decided differently...for a fact.

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