Should Kidneys Be for Sale?

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Please welcome Ankur Thakkar, who works in our Publications Department, with this fine post on the controversy over paid compensation for organ donation.

The economic crisis over the last three years caused many Americans to change their lifestyles to make ends meet. They turned to second jobs, second mortgages and tighter budgets. They sold the possessions they could live without. What else could they part with to make money? What if they could sell their organs?

Organ selling has polarized physicians and bioethicists since the beginning of clinical transplantation, but year after year it gains steam. This makes sense when there are 80,000 people in the United States waiting for a kidney and more than 5,000 of them will die this year, according to the Organ Procurement and Transplantation Network. Most people who need organs have to wait for donors they’ve never met to pass away, with the chances for a successful outcome deteriorating the longer they have to wait. There aren’t enough kidneys to go around.

“One reason for this is that modern medicine can now keep people alive long enough for their kidneys to fail,” said medical ethicist Lainie Ross, MD, PhD, associate director of the MacLean Center for Clinical Medical Ethics. “This means the waiting list for organs grows, while the number of usable organs from deceased donors is reduced.”

A 2010 study by researchers from the University of Pennsylvania and the Pennsylvania Veterans Affairs Medical Center found that when people were offered money for their organs, it made them more willing to donate. The researchers concluded that creating a financial incentive would increase the national supply of organs, resulting in saved lives.

Ross isn’t convinced. An outspoken opponent of opening the organ market, she believes it is socially irresponsible to allow people to make money from their organs. Far too many donors will assume that selling their organs will lift them out of poverty, without understanding the risks to their health.

The Pennsylvania study, conducted on Philadelphia commuters, found the opposite. The participants rated their willingness to donate their organs with and without payment. The responses were similar despite the participants’ incomes, suggesting that offering money for organs did not disproportionately change the minds of poorer people.

Ross points out that the study was conducted on people waiting for commuter trains, hardly representative of the nation’s poorest. She said it is difficult to take a poll like that seriously, given how unrealistic the responses were. For example, out of the 342 people that were polled, more than 100 said they would donate their organs to strangers without payment. Last year, less than 100 people actually did so, throughout the entire country.

Paying for organs was declared illegal in the United States in 1984. The idea also had been criticized by transplant societies, the National Kidney Foundation and the World Health Organization. A notable exception is Iran, which set up an organ market in 1988. According to several studies, Iran’s waiting list for kidneys has since been reduced to a single digit, zero.

Iran’s success, which still holds true today, has only ignited the debate. A number of American physicians have supported selling organs in the United States as a pilot program. Ross believes it is odd that proponents cite Iran’s program since an overwhelming majority of the organ donors in Iran are among that nation’s poorest and the data show that their economic situation is not improved five years later.

Ross just completed a study with Medical Center colleagues Andrew Aronsohn, MD, clinical instructor of medicine, and J. Richard Thistlethwaite, MD, PhD, professor in the Department of Surgery. They surveyed 800 United States physicians and surgeons in transplant societies about their views on the organ market debate. An overwhelming 80 percent of respondents were against an organ market for kidneys. Those who objected cited the “potential exploitation of the poor” as the strongest reason.

“The important thing to remember is that a donor becomes a patient as well,” Ross said. “It is one thing for a surgeon to agree to operate on a healthy person to voluntarily help a loved one. It is another thing entirely for the medical community to pay someone to become a patient.”

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