"To Save Lives Without Limitation"
At the recent World Transplant Congress 2006. pediatric nephrologist Richard N. Fine, MD, the outgoing president of the American Society of Transplantation, called on his medical colleagues "to challenge prior prohibitions and enhance approaches that have heretofore been taboo to the transplant professional."
Both the Talmud and Koran extol us to save lives without limitations. At present, transplant professionals are not enthralled with solicitation of a donor for individual specific recipients. Such solicitation, whether on the Internet or billboards or by utilization of the media is an anathema to the transplant professional. The primary reason that such methodologies are offensive is because they circumvent "equity". The playing field is not level because individuals with means or brashness have a potential distinct advantage. However, no one is actually harmed by such events and everyone potentially benefits because the waiting list shrinks as more individuals receive the gift of life.
It is time that we cease to be pious about "equity" in the acquisition of solid organs for transplantation? Equity is in the eyes of the beholder: Is it equitable that a child with AIDS living in the United States is provided drugs that can sustain life whereas a similar child born in Africa or parts of Asia will die because the world economies do not deem provision of such drugs a priority; Is it equitable that children in many areas of the world go to bed hungry every night yet the silos in the Midwest of the United States are overflowing and the harvest is stockpiled in the open fields; Is it equitable that a child born in Ethiopia or Sierra Leone has a life expectancy of fewer than 33 years whereas one born in the U.S. can expect to live an average of 78?
It is time that we enhance all approaches to increase the availability of solid organs without the prejudice of the taboos of the past. We should not arbitrarily dismiss such extraordinary solicitations but should strive to incorporate any legitimate methodology that results in a "life" being saved.
Since 1984, it has been a felony in the United States to pay for an organ for transplantation. Why is paying for a body part so repugnant? I believe the major impetus for such prohibition is fear. Fear that impoverished individuals will be exploited and/or coerced to donate part of their body. Fear that unscrupulous individuals will monopolize the donation efforts for financial gain. Fear that potential donors will not be appropriately evaluated and that follow-up care will not be provided thereby jeopardizing their health.
Parenthetically, in the United States there is no statute that mandates lifelong follow-up and medical care for live donors and no registry that categorizes the long-term potential adverse consequences of solid organ donation.
Is it wrong for an individual, who because of the fate of circumstances is impoverished and relegated to a life of poverty and who wishes to utilize part of his/her body for the benefit of another and in return will be provided with financial compensation that could obliterate a life of destitution for the individual and his/her family? If we can put a man on the moon we can surely devise a system that guarantees the short and long-term safety of potential donors, guarantees that the financial reward is not subverted and assures that availability is not limited to the wealthy. I realize that there are substantive risks to financially incentizing organ donation. In addition to potential exploitation and coercion of potential donors and manipulation of the process by unscrupulous individuals, a deleterious impact on altruistic donation could result.
I realize that this approach is iconoclastic; however, our current efforts have fallen far short of providing an adequate number of solid organs. If we, as Transplant Professionals, do not seize the opportunity of exerting a leadership role in expanding potential sources of organs we risk that less dedicated and committed individuals will potentially control the process. I also realize that the recent IOM report on organ donation was unenthusiastic about the concept of incentivization.
Therefore, I challenge the Transplant Community to reassess attitudes that potentially limit availability of organs for transplantation and suggest pursuing the following:
(1) SLIDE 11: Support the Collaborative to ensure that an increasing number of centers are involved in this innovative approach to increasing availability of deceased donor solid organs. Lobby the Federal Government to increase rather than decrease funding for the Department of Transplantation to enhance this effective effort.
(2) SLIDE 12: Partner with alternative approaches to solicit organ donation --Internet, billboards, media--to assure that potential donors receive optimal information and counseling and that the maximal number of potential recipients have access to these approaches.
(3) SLIDE 13: Re-evaluate the prohibition of financial incentives for both live and deceased donor organ donation. Initiate serious discussions to develop a system that assures optimal surveillance of the entire process and prevents exploitation and coercion of both donor and recipient.
(4) SLIDE 14: Actively advocate for a long-term live-donor registry and pursue the assurance that all live donors receive lifetime insurance coverage for any medical issue linked to the donation of a solid organ.
I've put the full text of Dr. Fine's speech online here.