Wednesday, October 20, 2004

Free markets and Organ Transplantation.....
From ABC: Man Undergoes Web-Arranged Transplant:
A Colorado man underwent surgery for a new kidney Wednesday in what was believed to be the first transplant brokered through a commercial Web site a transaction that has raised a host of ethical and legal questions.

Presbyterian/St. Luke's Medical Center spokeswoman Stephanie Lewis said the operation on both the donor and recipient was going well.

Bob Hickey, who lives in a mountain town near Vail, has needed a transplant since 1999 because of a kidney disease. He met donor Rob Smitty of Chattanooga, Tenn., through MatchingDonors.com, for-profit Web site created in January to match donors and patients for a fee.
The surgery was delayed because of some concerns that Mr. Smitty was receiving some sort of compensation for his transplant from Mr. Hickey. That appears to be have been resolved since the operation went on. Apparently UNOS can't control the "market" in living-related donors.
There are no laws against soliciting an organ donation, but by using the Internet, Hickey bypassed the United Network for Organ Sharing, the nonprofit group that works under government contract to allocate all organs donated from the dead. It doles out organs, in part, according to which patients need them the most.

The network does not oversee the increasing number of live donors, such as Smitty. Last year, there were 6,920 living donors compared with 6,457 dead ones.
And they are none too pleased:
UNOS came out against MatchingDonors.com in June, saying it "exploits vulnerable populations and subverts the equitable allocation of organs for transplantation." UNOS spokesman Joel Newman said the network is concerned when anyone puts his or her need for an organ above others.

"An organ that becomes available with certain medical characteristics should be offered equally to the people that could benefit from it," he said.
The site may be found here. The rates range anywhere from a "trial membership" of $19.00 for seven days, 30 days for $249, three months for $441, and $582 for six months. There is also some hand-wringing from the ethics crowd:
University of Pennsylvania bioethicist Arthur Caplan said the first ethical issue raised by Internet donations is financial: Not everyone can afford to pay MatchingDonors.com's fees or donor expenses.

"Those who are better off are going to have access to people as potential donors that the poor or the shy won't have," he said.
Shy? Since when did social awkwardness become equated with poverty? One complaint is that the site minimizes the risk to living donors. The risk is easier to take when it is a living-related situation when it is your brother, sister, child, or parent who will be receiving your "gift of life".
Back in August there was the controversy surrounding the solicitation of a liver by Todd Krampitz. The medical blogosphere was divided with Mr. Genes took the position that the current system was flawed, the Grunt Doc takes a position similar to my own, and the Bronch Blogger feels that while it may increase awareness of the need for transplantation, but bad for the organized structure of organ allocation. Dr Rangel came out four-square against the idea:
Todd Krampitz essentially bought his liver and screwed who knows which patient likely to be far sicker than Todd out of a chance for a cure of their liver disease and the addition of many years of life. Organ donations that specify the recipient are rare (only about 50 out of thousands of transplants each year) because cadaver organ donation is almost always an anonymous process. Unlike most transplant patients and their families, Todd Krampitz (who owns his own digital photography company) had enough money to pay thousands of dollars for billboard and other ads.
Dr. Rangel points out that while Mr. Krampitz may have "screwed" somebody out of a liver, but he was within the rules. Don't hate the player, hate the game.
As for me, I would move heaven and earth, buy all the billboards I could, put it out all over the internet if one of my loved ones needed a transplant. I cannot fault Mr. Krampitz, Mr. Smitty, or Mr. Hickey. While I can't bring myself to support the open market trade of organs for transplant, if the donors and their families feel more "in control" of the destination of their gift, maybe more donations will be offered.
Cross-posted at Galen's Log


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