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?
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Some of the panel’s concerns were medical. Although donating a kidney is relatively safe—each year, just 3 in 10,000 people die from the procedure, Matas says, and donors aren’t more likely than nondonors to experience kidney failure later in life—it does involve major surgery and the attendant risks, including excessive bleeding, blood clots, bowel obstruction, pneumonia, and bladder infection. For up to two days following the surgery, donors can’t eat or drink on their own. They can’t drive or lift more than 10 pounds for up to six weeks afterward. It can take more than month before a person is ready to return to work and several months for a donor to feel normal again.
“You don’t realize how much you use your abdomen until you go through something like that,” says Audrey Bergengren, a 26-year-old marketing and communications manager, who donated a kidney to an unknown recipient through the U’s program two years ago. “It’s very, very, very painful.”
The panel’s other concerns were ethical—and vexing. Normally, the value of surgery is based on its potential outcome: Will the patient be healthier or happier—through the reduction of pain, removal of a tumor, delivery of a baby in distress, or unblocking of an artery? “Medicine has tried forever to avoid exposing one person to risk for a benefit to someone else,” says Jeffrey Kahn, director of the Center for Bioethics at the U. “When we do surgery on you to save someone else’s life, the argument falls apart.”
Doctors had reasoned that, for a living donor who knows or is related to the recipient, the risks associated with surgery are outweighed by the emotional payoff of helping a relative, spouse, or friend live a better, longer life. But they couldn’t grasp the idea that some individuals—for personal, religious, or other reasons—could derive the same kind of emotional benefit from donating an organ to a person they did not know. Given the risks, why would any sane, unrelated person volunteer?
Matas and colleagues realized they would need to question their basic assumption: I would never do it, so why would anyone else? Eventually, through interviews, they came to accept that some people are altruistic by nature. “Some are so altruistic, they do things the rest of us think are crazy,” Kahn says. “But that doesn’t make them crazy. We call people like them heroes.”
IF the U was going to let people give organs away to strangers, Matas and the panel decided, there were going to have to be some ground rules. And, as with family members or friends, anonymous donors would have to undergo an extensive battery of medical and psychological tests. Additionally, the program would be completely anonymous. Nondirected organs would go to the first person that was a match on the U’s waiting list. This would prevent discrimination among donors. Additionally, it would safeguard against under-the-table, organs-for-cash exchanges, as outlawed by the National Organ Transplant Act of 1984. The only information given to a donor about the recipient would be age and gender. Even during surgery, every precaution would be taken to prevent donors and recipients from crossing paths: They would check in at different times, be assigned to different wings of the hospital, and their families would wait in different rooms.
With a protocol in place, the team decided to go ahead and bring Roger the Texan in for tests. “This was a major psychological breakthrough,” Matas says. Instead of asking Why? he says, “We were saying Why not?” Adds Cheryl Jacobs, a clinical social worker for the U’s living-donor program, “We knew what we were about to do would raise questions in the whole world of transplant surgery. But we couldn’t find a reason not to do it.”
Roger, the Texan who started the whole debate, was eventually ruled out as a donor for medical reasons. But Matas and the crew had been through a long discussion and had turned a corner. When the next letter came—from a woman in Alaska who wanted to donate a kidney to anyone in need but had been told she was ineligible by 30 other centers because she didn’t have a recipient in mind—the team was ready to act. The surgery, in 1999 at the University of Minnesota Medical Center–Fairview, was a success. Since then, more than 500 people have called to ask about the program and more than 100 have come in for evaluations. Forty-four individuals have made it through the screening and donated a kidney.
A year after its first nondirected donation, Matas published a paper about the procedure in the New England Journal of Medicine. Some experts criticized the article, claiming it was essentially a promotion for an unorthodox practice. But hospitals around the country soon followed the U’s lead in accepting nondirected kidney donations.
Today, there are dozens of places you can go if you want to give a kidney—and some allow you to stipulate, for example, the age of the donor. On the website Matchingdonors.com, people who need organs can post pictures and stories for a fee that ranges from $49 for a week to $595 for life. Potential donors can pick the story that moves them most, from “Just married…Need your kidney,” to “I Love Life! Please help me.” As of January, postings on the website indicated that more than 64 successful matches had been made since its launch in 2004, and more than 40 surgeries were planned for the next few months.
Services like these make many transplant experts uncomfortable. Kahn says they open up the possibility that recipients will secretly pay their donors. Such programs also favor kidney seekers who can pay to advertise, rather than those most in need. A survey of 132 kidney-transplant programs, published last year in the American Journal of Transplantation, found that roughly 30 percent of programs would consider donors who had found potential recipients online or in other public forums.
Theoretically, nondirected donorship expands the pool of kidney donors. In practice, it has done little to increase donations. Of the more than 6,400 kidneys taken from living donors in 2006, just 68 came from nondirected donors. Matas believes that number would increase dramatically if organ donors were compensated for their donations. Would you trade a kidney for, say, $90,000?
Critics decry the idea. Black markets for human organs already exist in such countries as Pakistan, Turkey, and the Philippines, they note, and only the most desperate step up to sell. “Poor people are more likely to donate because they need the money more than rich people,” says Mark D. Stegall, chair of transplant surgery at the Mayo Clinic in Rochester, summarizing the debate. “That’s the biggest concern.”
Middlemen pay as little as they can for organs that sell at high prices. And donors often end up worse off. In a study of more than 300 people who had sold a kidney in Chennai, India, for instance, researchers found that kidneys went for an average of $1,070. Ninety-six percent of sellers gave up their kidneys to pay off debts, researchers reported in the Journal of the American Medical Association in 2002. But most were still in debt six years later, and nearly 80 percent said they wouldn’t recommend that other people sell their kidneys.