Long waits for organ transplants have more pondering payments to donors

ORGAN TRANSPLANTS
Long waits for organ transplants have more pondering payments to donors
By Michael Booth
The Denver Post
POSTED: 06/05/2011 01:00:00 AM MDT
UPDATED: 06/05/2011 01:42:57 AM MDT

For tens of thousands of kidney-failure patients like Andrew Aninye, joining a waiting list for a transplant adds a mounting sense of futility to the daily drudgery of dialysis and ill health.

The list of transplant hopefuls in medical purgatory, already at five years' wait and moving toward 10 in some states, is pushing more and more donation advocates into previously taboo territory: removing longtime prohibitions on paying donors for their healthy organs.

Aninye, a Nigerian immigrant to Denver, is a fan of the idea even as he admits selfish interest and the potential for abusing such a system.

But his street-level view is backed by top transplant surgeons and patient groups who say allowing payment for organs would increase supply, prevent deaths and save the government hundreds of thousands of dollars per patient.

Promoters, though, can't move the concept past the perceived taint of precious body parts on sale.

"It's time to loosen these restrictions in order to save lives," said Dr. Arthur Matas, a leading transplant surgeon in Minnesota and advocate of an organ compensation system. Such arrangements are illegal under federal law.

Organs to highest bidder?

Nonsense, responds UCLA transplant surgeon Gabriel Danovitch. Organ-selling is as horrible as it sounds, sanctioned or not, with the rich exploiting the poor.

"Donors are people. It's our job to improve people's lives," Danovitch said. "We are not in the business of human sacrifice. People are not made of Lego pieces that you can give out."

The debate likely won't be solved in time to help Denver patients like Aninye, who faces another five years on the Colorado regional waiting list before he might come up for a kidney transplant.

Aninye, a 24-year-old pre-med student at Metropolitan State College of Denver, has a rare chance at a live donation. His brother in Nigeria is willing to come here and give up a kidney — people can function with one remaining — jumping Aninye past the waiting list for donations from the deceased.

The family and their doctor are only beginning the visa process, and the U.S. often denies immigration even for humanitarian medical missions. Aninye's doctor, Melissa Yanover, says her patient's holding pattern is a perfect illustration of the need for a compensated-donor system.

Transplants cost between $90,000 and $200,000, depending on the organ and complications; government insurance has already spent far more than that for Aninye's dialysis, with years to go on the waiting list.

"And there are a lot of people like him," Yanover said. About 94,000 Americans currently wait for a kidney, 17,000 more for liver transplants.

Aninye, tall and soft-spoken, knows the diplomatic system is not kind to Nigerians seeking emigration. He worked on his own visa for three years with the U.S. Embassy in Nigeria, in order to join his mother here and to address his medical problems.

"Most of the time, they don't believe you," Aninye said. He's trying not to put too much hope in his brother's success. "It's more like a gamble."

Wait grows; patients die

Frustration with the lists, and growing reports of wealthy Americans buying kidneys from poor overseas donors, has risen to an ethical turning point for doctors like Igal Kam, chief of University of Colorado Hospital's transplant surgery.

Kam supports compensation and hopes enough medical professionals will sign on to give the idea momentum for the necessary act of Congress.

"It's our job to maximize donors," Kam said. "So we as a society need to look at how to create compensation for the donor families."

Kam favors starting a system for the families of deceased donors, using government money to provide a choice of an education fund, or health insurance, or a retirement plan. The system could later be expanded to the more sensitive question of paying live donors.

For Kam and other advocates, the numbers make the argument: Despite tweaks in the matching system and widespread education efforts for more donations, the waiting lists get worse. More than 1,500 Coloradans are waiting for a kidney, and more than 500 for a liver. Yet the overall total of kidney and liver transplant surgeries in Colorado is just over 400 a year.

While Colorado and Midwest waiting lists are about five years, the wait approaches 10 years now on the coasts, doctors said. Meanwhile, 40 percent on those lists will die before an organ is available for them, Matas said.

Twenty-five years ago, the wait was about one year in the U.S. The national waiting list at the end of 1999 was under 50,000 people.

Inequities increase the frustration. Those with resources to travel and confirm their diagnoses with local doctors can join more than one regional waiting list to try to move up faster.

Some ethicists question why the current priority system allows a 10-year-old's kidney to be given to an 80-year-old patient, effectively shortening the life of the valuable donated kidney.

And only 5 percent of U.S. transplants can go to foreign nationals before triggering audits by the U.S. organ donation governing body, Kam said.

Aninye had another slim chance pass him by. Metro State put out word he needed a donor, and a student stepped forward to offer a live donation, bypassing the list.

But then a liver donor at University died in August after giving part of his organ to his brother. (State investigators found nothing wrong with the procedure or care.)

That scared off the live kidney donor for Aninye even though the University death was the first in 141 live-donor liver transplants there since 1997.

Doctors divided in views

"We need to think of some radical solutions," argues Matas, who has written numerous high-profile papers on the subject. He cites polls showing a large majority of the public is open to a compensation system — the roadblock is inertia in Congress against changing the 1984 transplant act prohibiting any "selling" of organs.

"Legislators do not want to hear a mixed opinion from the medical community," Matas said. "They want one voice."

And outspoken opponents like Danovitch divide that voice.

People willing to buy and sell organs are much more likely to lie about their health and have infections or other problems, Danovitch said. As for the proposed list of "incentives," he said, "Do you want to live in a country where a poor person who wants health insurance has to give up a kidney?"

Other medical voices believe smaller, pilot programs might help sort out the debate. Under the current system, they note, living donors face medical expenses and families of deceased donors have funeral expenses that aren't paid for during the transplant proceedings. The least the transplant system could do is cover those direct costs for families, said Dr. Bryan Becker of Chicago, immediate past president of the National Kidney Foundation.

Aninye, for his part, knows a compensation system "could be abused." He also knows, though, that he has an unhealthy chance of dying before his brother can travel, or before he qualifies for another donation.

"I really get nervous when I hear the numbers on the waiting list," Aninye said.

Michael Booth: 303-954-1686 or mbooth@denverpost.com

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