In their article, (Open Page, June 10, 2012), Dr. Shroff and Dr. Navin have argued that cadaver transplant is the only answer to the demand for organs. I agree that cadaver transplants and the role played by MOHAN in recruiting potential organ donors in the event of their death are a meaningful exercise. I do not, however, understand how they can rubbish the possibility of volunteer organ donation by individuals who are poor.
The argument embraces the flawed ethical notion that volunteer organ donation can only be made only out of ‘love and affection' or on consideration of ‘blood relationship' but never for economic relief. There is a space and need for paid volunteers too, because cadaver transplants will not meet even a fraction of the needs as the authors have gracefully conceded.
The Iranian model of government-sponsored paid donations has been criticised in their article as being ‘unethical' because there is a financial transaction. Voluntary donors can donate only kidneys, liver and stem cells, but these are also the most required organs for transplants. There are a million people waiting for kidneys. In the absence of donor kidneys, their only hope is repeated dialysis, which is expensive. I wonder if anyone has questioned the ethics of autonomy. The corporeal owner of the kidney is obviously the person who wishes to donate.
Adult voluntary donors should have the choice to donate kidney or any other organ which will not compromise their own lives. If this is legitimised, it will eliminate the criminal middlemen and other elements in our system. Malek, who teaches economics at San Jose State University, in an Internet post, questions the noise being made about paid transplants. He says: “If money is the catalyst that relieves shortage, and if the money/organ exchange is voluntary, then why prevent this transaction? Obviously, I want the money more than an (extra) kidney, and the sick person wants the kidney more than the money. This is a mutually beneficial exchange.”
Frank Adam et al., in Contemporary Economic Policy, April 1999 and William Barnett et al., in the Independent Winter Review 2001, ask the same rhetorical question: “Who owns my body?”.......I hope it is clear that the answer is not, and should not be the government! The argument that the poor are incapable of taking decisions is a specious one.” There is a misplaced notion about organ transplantations, specifically kidney transplants.
Gweyn Meyers in his article “Recent Changes in the Status of Live Kidney Donation” says: “Live donors, by most studies, have long-term mortality rates equal to or better than those who do not donate. The largest follow-up study, maintained in Sweden, has tracked over 400 donors through a lifetime and concluded that overall mortality was less than expected in the general population.”
The most common indication for transplants is end stage renal disease. This occurs in both kidneys and therefore the risks of the donor requiring a transplant later are the same whether he has one or both kidneys. Dr. Connie Davis believes that in the worst-case scenario only 0.15% of people who donate kidneys will develop kidney failure. This is not related to the donation itself.
Malek questions governmental concerns: “ — but should Government legislate risk taking? Would driving a car be illegal? What about flying? Bungee Jumping? Roller Coasters? Where would it stop?” People may argue that health is all about welfare and ethics, but it is impossible to leave out economics.
Nancy Scheper-Hughes of Berkeley, California, makes out a good case for open markets. She has personally visited and worked in 12 countries and collaborated with national governments to end trafficking in human organs. She argues that “everyone under the current system benefits, except the donor.” The patient gets a new kidney. The hospital and physicians are paid. The drug companies get to sell lifelong drugs. Why should only the donor be governed by altruism?”
The answer to the supply-demand question is to de-regulate organ transplantation. A good example is the requirement that organs can be donated on the basis of ‘love and affection'. The job of the authorisation committee is not enviable. The main problem is that the brokers, as always, are one step ahead of everyone else. The statement of one authorisation committee member is emblematic of the frustration that they undergo. On being asked, how he could permit a transaction which was patently commercial, he replied: “He tells me he loves the recipient. Who am I to say he does not?”
The Organ Transplantation Act needs a major overhaul if it is to be meaningful. Voluntary donations of select organs with clear informed consent may be the answer.
(The writer is a maxillofacial surgeon and lawyer specialised in Medical Law and Ethics. maxfaxgp@gmail. com)