Auditioning for a kidney

Commentary

Auditioning for a kidney

Transplant policy should be revised so organs go to those most in need, not those with the best appeal for help
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By Timothy F. Murphy, professor of philosophy in the biomedical sciences at the University of Illinois College of Medicine at Chicago

July 9, 2007
Chicago Tribune

Dutch television delivered a reality TV show like no other. Producers followed a dying woman as she chose which of three competitors would get one of her kidneys for transplant. The advance details were vague, if only because it was all a hoax: Nobody was dying, and everyone involved was an actor. By way of defense, the producers said they wanted to draw attention to organ shortages.

Finding organs for donation still is an uphill struggle in most countries. In the United States, people do not donate organs and tissues after death in numbers equal to the need. Surprisingly, living organ donors are not always so scarce. For example, since 2000, the number of living people who have given up a kidney for a family member or friend has exceeded the number of people who have been willing to donate kidneys after death.

This inclination to donate to a real, live person--instead of an unknown person on a waiting list somewhere--helps sustain an Internet site that matches living donors with people waiting for organs and tissues. At matchingdonors. com, people waiting for organs and tissues say a bit about themselves and what a transplant would mean to them. In fact, complete strangers do step forward to donate to people whose stories they find compelling. After these donors are screened, surgeons move organs from one body to another, relationships are forged and lives are saved.

Any transplant patient who receives an organ because a living stranger comes forward via the Internet wins the equivalent of a transplantation lottery. But people using the Internet to solicit donors represent only a tiny fraction of the nearly 100,000 people waiting for organs and tissues in this country. This kind of Internet publicity creates an express lane for some patients, to the disadvantage of others. Most people waiting for transplants are invisible to the public as they quietly wait for donations from the dead.

United States transplant policy must move to acknowledge the role the Internet has come to play in direct organ donation. Good-hearted people are using the Internet to search out people who need organs, but this approach does an end run around policies crafted to balance need and availability. To resolve this problem, the government could move to put people in need of a transplant on the Web, at least those willing to go public that way with a picture, a story, and some words of solicitation.

This way, strangers could search the entire catalog of people needing organs, with no one excluded. Yet this approach would ultimately pit transplant patients against one another, with advantages falling to the sympathetic and manipulative. Dubious motives--racism, sexism, ageism--could distort donation decisions as well.

In the name of protecting access for all, another option might be to bar the practice of stranger donation unless the donor surrenders the right to direct where the organs go. Some medical centers already accept stranger donations and treat organs obtained this way as donations from the deceased.

For example, a kidney donated by a stranger goes to the appropriate person at the top of the regional waiting list. This way, nobody jumps the line, and the accidents of fate--one's disease, one's skin color, one's age--don't stand in the way of hope for the organ one needs to stay alive. This option seems reasonable to me, but there may be other options out there that protect access and equity when it comes to sharing all-too-scarce organs. Let's get a discussion under way.

The Dutch public was cool to a television program that treated organ transplantation as reality-show fodder.

In the United States, we should learn from that lesson and reject the idea that one's media appeal ought to decide who gets a lifesaving organ and who does not.

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Timothy F. Murphy is a professor of philosophy in the biomedical sciences at the University of Illinois College of Medicine at Chicago.

Chicago Tribune
http://www.chicagotribune.com/news/nationworld/chi-oped0709organsjul09,1,4858076.story?coll=chi-newsnationworld-hed