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More than Just a Six-Inch Scar: The Debate over Organ Sales

By Stephanie Smith • Apr 28th, 2008 • Category: Public Affairs

Once a medical miracle, kidney transplantation has become routine. Besides mastering the operation, doctors have new drugs that keep the body from rejecting the organ. As a result, the demand for kidneys has hit an all-time high with waits of around five years, according to the National Kidney Foundation.

That delay can be fatal.

According to a 1988 survey, fewer than 14,000 patients were awaiting kidney transplant with about 7,000 kidneys donated. Today, the waiting list has grown more than fivefold. In 2006 alone, 4,400 people died while waiting. Fewer than 20 percent of patients on a waiting list can receive a transplant each year.

So, wouldn’t it make sense to let people sell a kidney to help meet this demand? Not in the U.S.

Here living people can legally donate organs and people can volunteer to donate organs after they are dead. But selling organs is illegal.

That is not true everywhere in the world. In Iran, for instance, organ sales are legal and regulated. Government offices match recipients and donors and tests for compatibility.

In countries such as China, India, and South Africa there is a black market in organs, despite government efforts to shut it down. Sometimes legal loopholes aid the process. For instance, the Indian government’s 1994 law that criminalized organ sales still allowed for “unrelated kidney sales” so that nonprofit organizations say that the trade has spread further since going underground.

With prime locations for transplant tourism popping up in countries such as China, Pakistan, and Turkey, organs purchased from the destitute or harvested from executed prisoners go for just a few thousand dollars. Illegal and dangerous, operations performed under unsanitary conditions often leave “donors” susceptible to infection, sickness and, in some cases, even death.

While opinions on how to handle the growing organ shortage vary, many agree that the federal ban on organ sales adds to the problem.

The organ sale ban cropped up in 1983, to stifle a proposal to legalize organ sales.

This came from Virginia physician Dr. H. Barry Jacobs, who proposed buying and selling kidneys to the highest bidder. Jacobs wanted to match r healthy recipients from the United States with donors from third-world countries, who would be flown to the U.S. and after surgery flown back, having collected a sum for their organs which, according to newspaper the West Australian, ranged from $6,550- $8,700.

Jacob’s plan, however, was criticized and deemed “immoral and unethical” by the National Kidney Foundation. Also outraged was Al Gore, who introduced legislation banning the sale of organs. And organ sales became illegal in 1984.

But the issue refuses to go away.

Dr. Arthur Matas, former president of the American Society of Transplant Surgeons, recently proposed legalizing organ sales to lift the death sentence that awaits too many people waiting for organ donations.

“The obvious solution to this dilemma is to increase the number of available kidneys, which might include legalizing sales,” Matas wrote in “The Case for Living Sales: Rationale, Objections, and Concerns,” a case study that promotes his views.

Under Matas’s plan safeguards would ensure that kidneys did not go to the highest bidder but instead to the most compatible candidate. The system would be regulated, meaning that a fixed price would be paid to the vendor (by the government or a government approved agency), the kidney would be matched to the recipient through a predefined algorithm similar to that used for deceased donors, Matas would also set standards for vendor evaluation, acceptance, and follow-up, as well as safeguards for vendor protection.

Legalizing sales, he says, would increase the number of available kidneys, shorten the waiting time, and improve patient survival rates.

“After four decades of trying to increase the number of kidneys, we are still left with an ever-increasing organ shortage,” Matas said in his paper. “It is time to discuss the potential merits and adverse consequences of sales.”

Matas continues to face strong opposition from such notable organizations as the World Medical Association, the World Health Organization, and the Transplant Society. K. Raghuram, Chief Executive Officer of the Mohan Foundation, a multi-organ harvesting aid network raised doubts about whether poor people from third-world countries would really benefit.

“Commercializing organ sales would leave donors back in the slums of poverty shortly after, begging again,” he said. The payments of a few thousand dollars last only a short while. The cycle of poverty rolls on.

A survey of about 300 Pakistani people who had sold organs (often for only around $1,000) found many back in poverty within six years.

There were also ethical concerns.

“Human bodies should not be commodities that are bought and sold,” said Nicholas Freudenberg, distinguished professor of urban public health at Hunter College. “I oppose the selling of body parts anywhere. Letting poor people sell their children on E-Bay would also benefit poor people, but we’re clear that that conflicts with our basic human values. Black market organ sales are no different.”

While legal transplantation allows donors to be either living or dead, the living generally donate to family and friends, while decreased donors must consent to donate their organs post-mortem.

It is illegal in the United States to pay for an organ. The U.S. condemns the process in which donors receive money in exchange for organs- a process deemed by many to be a factor driving medical tourism.

“Payments eventually result in exploitation of the individual,” Dr. Francis Delmonico, a member of the Mohan Foundation and an avid opponent of Matas’s plan told The Wall Street Journal.

“It’s the poor person who sells,” Raghurman agrees, “Once selling organs becomes legal, the question quickly becomes ‘why shouldn’t we sell other organs?’”

As a possible solution Raghuram says the government should promote cadaver donations, organ retrieval from those who have passed on. The process is thought to possibly save man patients currently suffering from end-stage organ failure.

“The success rate in cadaver donations (in comparison to living donations) has improved a lot because of good immunosuppressant drugs,” Raghuram states. Others question the success programs such as Matas’s would have. Verena Huetteneder, public relations manager of the National Kidney Foundation, states that “While payment for organs has real potential to undermine the transplant system in this country (by making it a system run on capitalist values rather than human need), its ability to increase the supply of organs for transplantation is questionable.

In fact, a recent survey conducted by the foundation polled families who refused to donate organs of their loved ones who passed away. Weakening the foundation of Matas’s money for organ trade incentive, 92 percent said that payment would not have persuaded them to donate. “Public opinion polls and focus groups have disclosed that many Americans are not inclined to be organ donors because they distrust the U.S. healthcare system… they are concerned that the health case of potential donors might be compromised if their donor status were known.”

According to Ms. Huetteneder and the NKF, a program ensuring financial incentives isn’t likely to make more than a ripple in the pool of distrust.

Local and Grassroots Sources

The American Medical Association- Advocating on issues vital to the nation’s health, the AMA is the nation’s largest physicians group. With core values that include leadership, excellence, integrity and ethical behavior, the AMAs surveys have found that organ sales do not halt the constant cycle of poverty. http://www.ama-assn.org/

The World Medical Association- An international organization of physicians, the WMA was formally established in 1947.Their goal is to serve humanity by endeavoring to achieve the highest international standards in medical education, science, ethics, and health care for all peoples of the world. They are opposed to the legalization of organ sales. http://www.wma.net/e/

The World Health Association- The directing and coordinating authority for health within the United Nations system, WHO provides leadership on global health matters, shapes the health research agenda, sets norms and standards, articulates evidence-based policy options, and provides technical support to countries and monitoring and assessing health trends. They too oppose Matas’s plan of legalization. http://www.who.int/en/

The Mohan Foundation- A noncommercial group of medical professionals, the Multi Organ Harvesting Aid Network promotes the cause of organ donation. It aims to popularize organ donation, aiding the process by launching “Donor Cards” which express an individuals wish to become an organ donor. They too are opposed to Matas’s plan. http://www.mohanfoundation.org/aims.asp

The National Kidney Foundation- The National Kidney Foundation is a major voluntary health organization, that seeks to prevent kidney and urinary tract diseases, improve the health and well-being, and increase the availability of all organs for transplantation. They, however, are also against the legalization of organ sales. http://www.kidney.org/about/

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Stephanie Smith is a senior at Hunter College, majoring in english with a minor in media. She has recently been accepted to the Missouri School of Journalism, where she plans to focus on magazine writing.
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