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Kidney for Sale

Despite campaıgns to promote organ donation, thousands of Minnesotans are awaiting kidney transplants. What would it take to convince you to part wıth one of your internal organs? How about $95,000?

Kidney for Sale
Photo by Darrell Eager

(page 1 of 3)

Full of nerves,that’s how Aaron Ziegler felt as he walked into the Fergus Falls McDonald’s that hot summer day. The Elk River man took his time ordering a bag of French fries before joining his wife at a table. Across from them sat a man with whom Ziegler had exchanged letters, but the two men had never met. They were perfect strangers, except for one surprisingly intimate link: A year and a half earlier, doctors at the University of Minnesota had transplanted one of Ziegler’s kidneys in the other man’s lower abdomen. ¶ “It’s an odd thing,” says Ziegler, 37. “We had shared so much.” But what was he supposed to say to the stranger whose life he had helped save? ¶ The beneficiary of Ziegler’s generosity, Brett Bodway, from Fargo, also felt awkward. “I just didn’t know how to act,” the 44-year-old says. “It’s nerve-wracking.” ¶ For maybe half an hour, the men talked about the day of the surgery, when they lay unconscious in adjacent hospital rooms, never laying eyes on each other. They chatted about music and movies and Bodway’s desire to write a children’s book. And then, they went their separate ways. “It sort of brought closure,” Ziegler says. “I met this person, and he’s okay.”

“It takes a pretty special person” to give an organ away, Bodway says. “I don’t know if I would be able to do it myself.”

It can be hard to imagine making such a sacrifice. But Ziegler is not the only one who’s done it: Over the past decade, dozens of others have donated kidneys to complete strangers through a pioneering program established by the U of M’s Transplant Center in 1999. The success of the U’s nondirected donor program, the first of its kind in the United States, has led many hospitals, including the Mayo Clinic in Rochester, to launch similar programs.

But the need for donors is quickly outstripping the supply. More than 75,000 individuals are awaiting transplants, according to the Organ Procurement and Transplantation Network (OPTN), which oversees all organ placements in the United States. Public campaigns to promote organ donation have had some success—surgeons performed more than 17,000 kidney transplants in 2006, the last year for which figures are available—but the average wait for a kidney still tops five years.

Sixty-two percent of transplants involve kidneys from deceased donors. The remaining 38 percent come from living donors. But if you can’t find a suitable match among friends or family, you’re probably out of luck: Nondirected donations accounted for less than 1 percent of all living donations in 2006.

That’s a huge problem, says Dr. Arthur Matas, director of the kidney-transplant program at the U of M and past president of the American Society of Transplant Surgeons. But it’s not without solutions. “There are lots of little steps you could take,” he explains. “My personal opinion is that we need to take a big step.”

His proposal? Let people to donate kidneys for money.

Sporting corduroys, loafers, small spectacles, and a salt-and-pepper beard, Matas looks and acts like an unassuming academic as he greets a visitor to his office. The Winnipeg native spends most of his days on the 11th floor of the Phillips-Wangensteen Building on the East Bank of the U’s Minneapolis campus. Piles of papers and journal articles spill across two desks, a table, and the floor, along with bottles of empty Diet Coke and a jar of aspirin. A dozen cactuses line the windowsill. A Led Zeppelin CD plays in the background.

Matas used to work primarily as a surgeon. Now, he mostly does research, writing papers that focus on the long-term health outcomes of organ-transplant donors and recipients. Since his arrival at the U, as a medical intern in 1972, Matas has witnessed dramatic changes in what physicians consider acceptable in transplantation. And he has championed many of those changes. “I tend to be a devil’s advocate,” he says with a smile. “I don’t know what my reputation is. I prefer to think of myself as a seeker of truth.”

The first kidney transplant was performed by surgeons on a Chicago woman in 1950. Ruth Tucker’s new kidney came from a cadaver, and the organ worked for roughly three months before her immune system rejected it. Astonishingly, however, one of her kidneys began functioning again during that interval, and she lived another five years before dying of an unrelated illness.

Over the next few years, doctors had more success with kidney transplants on identical twins: An exact biological match seemed the only way to ensure that the recipient’s immune system didn’t reject the transplant, attacking the organ as it might any other foreign object, like a tumor or virus. Later, doctors figured out how to test blood and tissue types for matches that, if not identical, were suitable enough for transplantation. Drugs became available that suppressed the immune response and prevented rejection. Doctors began transplanting kidneys not only from deceased donors and identical twins, but also from living, genetically related donors, including, siblings, parents, and adult children.

During the 1980s, immunosuppressants and tissue-testing improved considerably. Risks associated with surgery shrank, and doctors began recommending transplants for patients once considered too old or too sick to survive the operation. As a result, the waiting list for kidneys ballooned: People with kidney failure can live for years with the aid of dialysis machines, which remove waste and extra fluid from the blood—the kidney’s natural function. Dialysis is cumbersome and costly, says Matas, but it keeps people alive.

Still, even as the waiting list grew, the number of kidneys available from deceased and related donors remained limited. To meet the new demand for transplants, doctors expanded the donor pool, experimenting with kidneys taken from individuals who were suitable matches but genetically unrelated, such as spouses. “People said to us, ‘Goddammit, why are you making my loved one wait when I can be a donor?’” Matas says. “They pushed us to do it, and lo and behold, the results were as good as with living related donors.” By the 1990s, transplant centers were accepting living donations from recipients’ friends, coworkers, and even fellow church members.

For years, people had been calling the transplant center at the University of Minnesota–Fairview, offering to give kidneys anonymously to those on the waiting list. They had seen handmade requests for organs posted in parking ramps, church bulletins, and even a Perkins restaurant. The answer from the U’s transplant center, though, was always no. “You worry, ‘Why are these people offering to do this? Are they nuts?’” explains Catherine Garvey, a transplant coordinator at the center.

In 1997, however, the U’s transplant specialists got a note from a Texas man that led them to change their policy. The man, Roger, had received a letter from a Minnesotan named Bob, asking for a kidney. Both men were graduates of Boys Town, a Nebraska–based nonprofit that serves at-risk youth, and Bob had sent Christmas letters to every graduate whose address he could find. Even though Bob and Roger had never met, the Texan was moved by the other man’s appeal, and he wanted to help. Could he fly up for a donor evaluation?

Per policy, the center’s staff denied the request and, soon after, they got a livid phone call. “Who are you,” Roger demanded, “to tell me who my family is?”

Matas and his team decided to consider the idea. Reviewing the medical research on the subject, they could find only one published account of a nondirected kidney donation, done in the 1970s. In fact, the mere idea proved so controversial, that Matas and his peers assembled a panel of U surgeons, nurses, bioethicists, nephrologists, psychologists, and lawyers to examine the subject from every angle. The panel met every few weeks for nearly a year.

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