Organ Donation Must Remain a Gift

Organ Donation Must Remain a Gift

By WALTER GRAHAM
Published: February 06, 2011

Organ transplantation is unique among all forms of medical treatment. Certainly the skill of the medical team and the support of medical technology are essential to its success. But the ultimate implement of healing is a human gift, freely given from one person so that someone else may live and thrive.

More than 110,000 people nationwide need a transplant to save or enhance their lives; of those, more than 87,000 need a kidney. Kidney transplantation is highly successful, and it is possible to meet some of the need with living donation as well as deceased donation. In the case of living organ donation, the donor has made a conscious choice to face the risks associated with any surgery, including death or injury, for an operation that can only benefit someone else.

There has been considerable ethical discussion about whether and how people in prison can truly give consent for organ donation. Prison is, by design, a coercive environment. Prisoners are given very few choices about what they can do, and most of their freedom to act is contingent upon their compliance with established rules. Within this environment, it is difficult — if not impossible — to know whether someone is truly volunteering to be a donor of his or her own free will, understanding the risks involved, or he or she is acting only to gain an extra reward or avoid additional punishment.

Why does it matter what the motivation is? First of all, living donors, in consultation with their transplant team, must freely acknowledge and accept the risks of the procedure. If a person is coerced, by being pressured or persuaded with a promise of either reward or less punishment, he or she may make a decision that seems right at that moment but does not make up for life-limiting complications that may result.

Transplant professionals who would perform surgery on a living donor are aware has been coerced may well be in violation of medical ethical standards and subject to the consequences that come with it. A program offering rewards to prisoners for organ donation could therefore subject professionals to an ethical dilemma.

The potential donor may also conceal from the transplant team important medical information that may lead to an improper decision to accept a risky donor. Perhaps the donor's medical history may make it more likely he or she will suffer complications; perhaps the donor is at risk of having a disease that may be transmitted to the recipient. The risk of contracting diseases such as hepatitis and tuberculosis is often higher in a prison environment than in the general population.

In general, the transplant community believes that prisoners might be able to make informed and valid choices if, without any coercion, they wish to be a living donor to benefit a relative or someone with whom they have a defined and long-standing personal relationship. Under any other circumstances, it would be unlikely for a potential living donor in a correctional environment to be a donor.

In regard to the issue of offering payment in return for organ donation, the National Organ Transplant Act of 1984 made it a federal felony for any person to give or receive any "valuable consideration" (not just money but anything of value, including the promise of a future action) in return for an organ donation. Among several key principles that guided the law was that irreplaceable parts of the human body should not be commodities to be bought and sold.

Faced with desperate personal straits or hard economic times, people may risk — and potentially lose — everything they have that is of value. It is tragic when people lose retirement savings, nest eggs, even the family home. To place a value on a kidney, or part of one's lung or liver, is to invite some to risk not only their possessions for personal gain, but organ function they cannot get back if they regret their decision later.

Organ donation, particularly from living donors, is the most selfless of human gifts. Many people await these gifts, and it is fair to consider new and different means to boost donation to meet the need. But we owe it to all who would put themselves at risk for the sake of others to make sure everything possible is done to respect their right to choose and limit the harm they may endure.

Walter Graham is executive director of the United Network for Organ Sharing. Contact him at grahamwk@unos.org.

http://www2.timesdispatch.com/news/2011/feb/06/TDOPIN02-graham-organ-donation-must-remain-a-gift-ar-822040/