An Update on Transplant

An Update on Transplant

By Lawrence Henry
Published 7/27/2007 12:08:35 AM
The American Spectator

In an op-ed published July 16 in the Chicago Tribune, "Using the Internet to Donate Organs," Tom Simon argued the case for donating a kidney to a stranger via the website Matchingdonors.com.

When I made the choice to donate a kidney to a stranger, I began the process as a non-directed donor -- meaning I was prepared to let Northwestern Memorial Hospital choose my recipient for me. I immediately began to have misgivings about this approach.

What if my kidney wound up inside a registered sex offender or a violent ex-convict....I was less interested in saving the sickest person I could find and more interested in saving the life of someone who could make a difference in the world once his or her health was restored to normal.

...I found the posting of a Chicago woman named Brenda for whom I felt a great deal of empathy. She was young, aspired to have kids and worked as a domestic violence court victim advocate for the Cook County state's attorney's office.

TRANSLATION: I WANTED TO DONATE A KIDNEY TO A LIBERAL. Does this kind of sanctimony make you as nauseated as it makes me? I have been on the other side of this Internet tease. I did a one-week trial with Matchingdonors.com. I wrote to four people of my blood type who stated on the site that they were willing to donate to anyone. The site's internal messaging system confirmed that my messages had been read.

I heard from no one.

I don't know what Matchingdonors.com charges for the privilege of "playing God," as Mr. Simon so accurately puts it. But it costs about $700 for a "lifetime" membership for would-be recipients. I've been getting e-mail blandishments from the site ever since my trial membership. They have slick phone salespeople to try to persuade you to buy those "lifetime" memberships.

Here's the rub: If Mr. Simon and his like are "less interested in saving the sickest person I could find," that sickest person is left to die. Twenty percent of dialysis patients die every year. I've had one close call myself this year.

IN 1972, THE GOVERNMENT STRUCK A DEAL with private insurers. After three years of treatment, Medicare would take over insuring End Stage Renal Disease (ESRD) patients. That also qualifies most ESRD patients for Supplemental Security Income (SSI). Being in a weakened state, most of us take it.

As usual, the government had no idea what it was getting into. In its first full year of operation, the ESRD Medicare program was spending $229 million. By its tenth year, the program costs exceeded $2.5 billion. By 1997, that cost had ballooned to $15.64 billion. Most of this money goes toward maintaining dialysis patients. Transplant saves Medicare about 60 percent post-transplant, assuming a ten-year period, because, 36 months after getting a successful transplant, transplant recipients stop receiving Medicare payments. Transplant patients mostly return to normal lives (as I did for 20 years). Nearly two-thirds of dialysis patients, especially those with diabetes, find themselves unable to do any more than support their daily personal needs.

THIS IS A PUBLIC POLICY ISSUE, LIKE IT OR NOT. It makes sense for government to encourage transplant, as opposed to long-term dialysis, simply on the basis of cost outlay. But it also makes social sense, because transplant recipients lead transparently normal lives, working, paying taxes, raising families, contributing to the general welfare.

As always, faced with a system that doesn't work well, patients with the gumption have taken matters into their own hands -- and wallets. An old pal of mine, also going for his third kidney transplant, got in touch with me to urge me to solicit a kidney from my friends, church members, and associates. I did that, and ultimately found several willing donors. One survived the testing process, and was willing to donate to the swap program at my hospital. The database of potential paired transplant donations is being run now, and I should know within a couple of weeks whether or not I have a kidney.

The head doc of the transplant program here advised me to wait until the fall to see what the database turns up -- it changes regularly. If I don't have a kidney by that time, I will take a short trip to Tampa and register with a transplant center there. The waiting time for a cadaver transplant -- from accident victims, mostly -- is shorter in Florida than in the Northeast. I do not have to move to Tampa. I can simply be ready to hop a plane at a moment's notice. It's expensive, but lots cheaper than living the way I'm living now

PREFERABLY, TWO PROGRAMS OUGHT TO BE IMPLEMENTED. First, there ought to be a national program of reimbursal for "Good Samaritan" donors -- people willing to donate either to an individual or to a medical center's swap program. Put simply, you ought to be able to sell a kidney, or have yours heirs do so. Second, instead of asking people to designate themselves as organ donors through the driver's license programs of various states, it ought to flip over: People would be presumed donors unless they explicitly opt out.

This is called "presumed consent," and it exists in Portugal and Italy, where dialysis is minimal and transplant common. Unfortunately, an irreducible population of idiots in this country remains convinced that doctors wait, Frankenstein-like, scalpels at the ready, to turn an accident victim into a dugout canoe before he's really dead.

Ideally, both policies would work together. Presumed consent would tend to keep the otherwise-inflationary price for selling an organ down.

SO WHAT'S THE OBJECTION, IN THE MEANTIME, to Internet dating for organ donors? Several statistical realities.

Organ donations are matched up by blood type. As my doc told me, "The ABs cycle through very fast, because blood type is not an issue." An AB can receive a donation from anyone. Meantime, Bs, Os, and As wait, and are likely to be among the sickest cited by Tom Simon in his smarmy op-ed.

Internet matchups do little or nothing to even out regional inequities in waiting time. They do nothing much, at least intentionally, to alleviate the generalized, ill-distributed, suffering of the waiting population of transplant candidates. And they will tend to give kidneys, like Mr. Simon's, to those applicants who, naturally or by design, ring all the right Oprah-like bells to move Mr. Simon's and his cohort's questionable consciences.

Make no mistake, Good Samaritan donorship is in the wind these days. Transplant medical centers are filled with literature on the subject from the National Kidney Foundation, the very establishment of transplant.

It all helps. But it's still not enough.

Lawrence Henry writes every week from North Andover, Massachusetts.

http://www.spectator.org/dsp_article.asp?art_id=11790