To Sell Or Not To Sell - Your Kidneys

Editor's Choice
Main Category: Transplants / Organ Donations
Also Included In: Urology / Nephrology;  Public Health
Article Date: 17 Jun 2008 - 0:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

The growing shortage of kidneys to be used for transplantation has spurred a debate between two specialists that is published in two opinion articles in BMJ. Arthur Matas (Professor of Surgery at the University of Minnesota) argues that a solution to the supply problem lies in a regulated compensation system for living donors. On the other hand, Jeremy Chapman (Center for Transplant and Renal Research in Sydney) warns that a regulated market would result in a reduced supply of all organs.

Patients in the United States wait about five years, on average, for a transplant from a deceased donor. However, in some parts of the US people wait 10 years or more. This has resulted in a considerable increase in the annual death rate for suitable transplant candidates - 6.3% in 2001 to 8.1% in 2005.

Matas claims that in developing countries, the current unregulated systems are only beneficial for the rich. In addition, there are no provisions for long-term donor follow-up or protection for buyers and sellers. Matas believes that if the Western world had a regulated compensation system, there would be an increase in the number of organs available. His ideal system would allow each candidate a transplant if desired, full donor evaluation, informed consent, long-term health follow-up, government- or insurance company-managed payment, and the banning of other commercialization. A structure such as this, according to Matas, would offer strict control and reduce harm.

A regulated compensation system for organ sales is likened to the existing practice of compensating people for sperm, ova, surrogate motherhood, and even loss of body parts. Matas maintains that there is no loss of dignity or humanity for these customs. In order to determine if compensating for living donations can increase the number of kidneys while protecting the dignity and humanity of donors, Matas recommends that a trial should be conducted.

Chapman, contrary to Matas, is skeptical of the regulated market and believes that its introduction would lead to devastating consequences - especially in parts of Asia and Africa that are not easily regulated. People in India and Pakistan often sell kidneys to pay off debt. However, the practice rarely lifts people out of poverty, as they continue to live below the poverty line. A recent study showed 86% of sellers have deteriorating health after the organ is removed.

If governments are willing to buy a kidney from a live donor, Chapman remarks, a family would have to decide which of its members would provide the organ. He believes that most people would rather a stranger take the risk than a family member. His prediction is that placing value upon a kidney before death will lead families to demand payment for various organs after a family member dies. Chapman concludes that the end result is, "A reduction in kidney transplantations and destruction of heart, lung, liver, and pancreas transplantation."

Should we pay donors to increase the supply of organs for transplantation? Yes
Arthur J Matas
BMJ (2008), 336(7657): p. 1342.
doi:10.1136/bmj.a157
Click Here to View Abstract

Should we pay donors to increase the supply of organs for transplantation? No
Jeremy Chapman
BMJ (2008), 336(7657): p. 1343.
doi:10.1136/bmj.a179
Click Here to View Abstract

Written by: Peter M Crosta
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today