Sunday, July 27, 2008

I WANT TO BELIEVE...In Altruistic Kidneys

*Spoiler Warning!*
(Photo courtesy of 20th Century Fox - Free download.)

By Emily Stephens

Okay, yeah, I admit it. I’m an X-Phile. So, after seeing The X-Files movie this weekend, I was delighted there were medical ethics raised within the film—just so I could blog about them.
The “freak of the week” themed storyline brought back my two favorite FBI agents…well, ex-FBI agents, whose lives are still so fascinating that Mulder and Scully could’ve picked their noses on the big screen for two hours and ten minutes and I’d still be riveted. The daring duo didn’t suffer from
Rhinotillexomania, however. They were plagued with a bad case of “I want to believe.”

The movie explores some interesting questions about the lengths we go to in order to keep ourselves alive. *There are two characters dying within the film: a Russian “mad scientist” willing to harvest organs and body parts from the living in order to prolong his life (he’s dying of lung cancer) and a young boy Scully goes to great lengths to save who suffers from a rare, almost incurable disease. Scully uses contentious “stem cells” to help the boy—an act made even more controversial by the fact that she works in a Catholic hospital. Scully was torn whether or not to try an experimental, extremely painful stem cell treatment on her patient. The other doctors at her hospital were convinced the boy’s health should be left to God’s will. Scully wanted to believe her will was aligned with God’s, but she couldn’t help wonder on the most basic level how her attempts to stall death were all that different from the mad scientist’s.*

Although disturbing, these storylines aren’t too far off base. People are living longer, there are less traffic fatalities, improved ER care keeps people alive who would’ve died’n’donored in the past, and not enough people are signed up as cadaver organ donors in the first place. Black market organs are a hot topic. Stem cell research stirs up heated debate.

Some organs are only available at the donor’s death, e.g. heart, eye balls, etc. Interestingly, kidneys don’t fall into this category. In fact, most of us could continue living absolutely normal lives without one of our kidneys.

Some current facts about
kidney organ donation:

· Over 95,000 U.S. patients are currently waiting for an organ transplant; nearly 4,000 new patients are added to the waiting list each month.

· Every day, 17 people die while waiting for a transplant of a vital organ, such as a heart, liver, kidney, pancreas, lung or bone marrow.

· Because of the lack of available donors in this country, 3,916 kidney patients, 1,570 liver patients, 356 heart patients and 245 lung patients died in 2006 while waiting for life-saving organ transplants.

· The organ graft survival rate for patients with organ grafts from live donors is greater than those who received grafts from a cadaveric donor.

Due to America’s alarming organ donor shortage, Al Roth of Harvard designed an online kidney exchange program. He proposed a place where potential donors and patients needing transplants could converse and negotiate costs, incentives, and other benefits such as lifetime health care, a college education, or pocketfuls of cash for the donors. The idea resulted in NEPKE, or the New England Program for Kidney Exchange, which formed a few years ago. NEPKE connects living kidney donors who are willing to donate but incompatible with their loved one, with other compatible recipients and donors in hopes that more people will benefit from a larger multi-compatible database. There have been
31 NEPKE transplants to date.

The black market for organs has created a violent surge in third world countries, where poorer people’s organs are valued more than their lives. What does this all mean? There is and will continue to be a growing market for organs. How should we handle this exchange? A New York Times article entitled ‘
Flesh Trade’ reads:

“If it's hard to get people to give up their organs upon death, consider how much harder it is to persuade a living person to donate a kidney. (From a medical perspective, a kidney from a living donor is far more valuable than a cadaver kidney.) Even though most people can live safely on one kidney, there is still a price to be paid in discomfort, risk, fear and lost wages. But the United States, like pretty much every other country in the world, forbids a donor to collect on that price, or any other.

It is hard to find an economist who agrees with this policy. Gary Becker and Julio Jorge Elias argued in a recent paper that ‘monetary incentives would increase the supply of organs for transplant sufficiently to eliminate the very large queues in organ markets, and the suffering and deaths of many of those waiting, without increasing the total cost of transplant surgery by more than 12 percent.’”

In Europe, organs are harvested after death. There’s no donor card. It is assumed all their citizens will give. If people are willing to sell their “living donations,” why are we stopping them? Would you donate a kidney to save a loved one’s life? What about donating one to someone you didn’t know? Would you altruistically donate an organ to someone in need? If not altruistically, would you do so for a price? Would you feel cheapened if a monetary price was affixed to your organ?

1 comment:

Cristy at Living Donor 101 said...

As the Washington Post, and this very blog, pointed out, 1/3 of those on the wait list are 'inactive', meaning they are ineligible for a transplant even if an organ were to become available. Secondly, the deaths on the wait list - that stat also includes inactives. Is there any evidence that a transplant would've helped any of those people, staved off their deaths?

Until the transplant industry can be trusted to give true Informed Consent, embark on comprehensive long-term research, and provide aftercare and support services for the depression, anger, anxiety and PTSD many living donors experience, any talk of compensation is inappropriate, unethical and premature.