When we hear about harvesting (gathering/collecting) human organs for sale, it suggests the lurid (horrible/savage) world of horror movies and the 19th century graverobbers. Yet now, Singapore pays as much as 50,000 Singapore dollars (almost US$ 36,000) to donors for their organs.
Iran pays itself entirely to the kidney donors and has eliminated the waiting list. Israel implements a “no give, no take” system. This system puts people who opt out (reject) of the donor system at the bottom of the transplant waiting list if they ever need an organ.
Millions of people suffer from kidney disease, but in 2007 there were just 64,606 kidney-transplant operations in the entire world. In the US alone, 83,000 people wait on the official kidney-transplant list. But just 16,500 people received a kidney transplant in 2008, while almost 5000 died waiting for one.
To combat yet another shortfall (deficit/shortage), some American doctors routinely remove pieces of tissues from the deceased patients for transplant without their, or their families’ prior consent.
And the practice is perfectly legal. In many US states, doctors conducting autopsies (postmortems) harvest corneas (eyes) with no family notification. (By the time of autopsy, it is too late to harvest organs such as kidneys.)
There are statutes (laws) that grant routine removal of tissues from deceased patients. These laws have effectively increased cornea transplants. Routine removal is perhaps the main cause of the devastating shortage of organs worldwide.
This shortage is encouraging some countries to try unusual new methods to increase donation. The US has also made some innovation in the field of transplantation but it is both expensive and controversial.
Organs can be taken from deceased donors only after they have been declared dead, but where is the line between life and death? Philosophers have been debating the dividing line between baldness and non baldness for over 2000 years.
So, there is little hope that dividing line between life and death will ever be fixed. In fact, the greatest paradox of deceased donation lies in drawing a line where the donor is dead but the donor’s organs are not.
In 1968, the Journal of the American Medical Association published criteria declaring brain death as the line of death. But today there are fewer potential brain-dead donors because of reduced crimes and better automobile safety.
Now, cardiac death (no heart beat for 2 to 5 minutes) is declared as the deadline. both brain death and cardiac death are controversial – the first human heart transplant was done from a brain-dead donor in 1968.
The surgeon was threatened with prosecution (legal action), like some surgeons using donation after cardiac death. Despite the controversy, donation after cardiac death has tripled between 2002 to 2006.
This accounted for about 8 percent of all deceased donors worldwide. The figure is up to 20 percent in some regions. The shortage of organs has increased the use of so called expanded-criteria organs – or organs that used to be considered unsuitable for transplant.
Kidneys donated from people over 60 or from people who had various medical problems are more likely to fail than organs from younger, healthier donors. But expanded-criteria organs are now being used under the pressure.
The recipients are forced to have even cancerous or other diseased kidneys. High shortage of organs from deceased donors and high risk of waiting recipients’ death prompt surgery. The use of expanded-criteria organs clearly indicates extreme shortage of organs.
As a result, the waiting list keeps growing while the quality of transplant keeps falling. Routine removal has been possible for corneas, but it is unlikely for kidneys, livers, or lungs. However, more countries are moving toward presumed consent.
Under this standard, everyone is considered to be a potential organ donor unless they have clearly opted out (rejected) by signing a non-organ-donor card. Presumed consent is common in Europe with modest (moderate) donation rate.
They also have readily available transplant coordinators, trained organ-procurement specialists, round the clock laboratory facilities, and other required infrastructure.
The British Medical Association has called for (desired/requested for) a presumed consent system in the UK, and Wales also plans to move to this system this year. India is also beginning presumed consent program.
The program will start with corneas, and later expand to other organs. Presumed consent has less support in the US, but experiment at state level can make a useful test.
Today we see Rabbis are selling organs in New Jersey. Organs are sold by poor Indians, Thais, Philippines, and blacks. The transplant black market is surging. If organ sales are voluntary, neither the buyer nor the seller is at fault.
But if the market remains underground, the donors mat not receive adequate post-operative care and financial compensation. Iran alone has eliminated the shortage of transplant of organs.
And it is the only country that has a working and legal payment system for organ donation. In this system, organs are bought and sold at the bazaar.
Person who cannot be given a kidney from a deceased donor and who cannot find a living donor can apply to the nonprofit, volunteer-run Dialysis and Transplant Patients Association (DAPTA).
(DAPTA) identifies potential donors from a pool of applicants. These donors are medically evaluated by transplant physicians and have no connection to Datpa. The government pays donors $1200 and provides one year of limited health insurance coverage.
In addition, working through Datpa, kidney recipients pay donors between $2300 to $4500. If recipients cannot afford to pay, charitable organizations provide remuneration to donors.
This demonstrates Iran has something to teach the world about charity as well as about markets. The Iranian system and the black market demonstrate one important fact: the organ shortage can be solved by paying living donors.
The Iranian system began in 1988 and eliminated the shortage of kidneys by 1999. Some estimated that a payment of $15,000 for living donors would alleviate the shortage of kidneys in the US.
Payment could be made by the federal government to avoid inequality in kidney allocation. Moreover, this system would save the government money because transplant is cheaper than the dialysis.
Singapore also legalized government plan for paying organ donors. Though it isn’t clear when the plan will be implemented, the amount being discussed for payment is around $50,000. This amount suggests possibility of significant donor incentive (motivation/moral force).
So far, the US has lagged other countries in addressing the shortage. However, a draft bill was circulated to US government entities (units) to test compensation programs for organ donation.
These programs would only offer noncash compensation such as funeral expenses for deceased donors and health and life insurance or tax credits (reduction in tax liability) for living donors.
Worldwide we will soon harvest more kidneys from living donors than from deceased donors. In one sense, it is a great success – the body can function perfectly well with one kidney.
So, with care, kidney donation is a low-risk procedure. In another sense, it is an ugly failure. Why must we harvest kidneys from the living? When kidneys that could save lives are routinely being buried and burned?
Just pay the donors funeral expenses and other compensation when they are alive; and harvest their organs when they expire. This could help them alleviate some of their necessities while they are alive.
Two countries, Singapore and Israel have pioneered (innovated/conceived/opened up) nonmonetary incentive systems for potential organ donors. In Singapore, anyone may opt out (reject) of the presumed consent system.
The opted out are given lower priority on the transplant waiting list when they need one. Many people find paying for the organs repugnant (offensive/detestable), but they accept the ethical foundation of no give, no take – those who are willing to give should be the first to receive.
This ethical constraints (restrictions) in turn increases the number of donors thereby reducing the shortage. In the US, a nonprofit network of potential organ donors is Lifesharers org., where the writer is an adviser.
The organization is working to implement a similar system. Israel plans to implement a more flexible version of no give, no take. In the Israeli system, people who sign their organ donor cards are given points pushing them up the transplant list.
For example, if a person’s first-degree relative has signed, he will get one point, and if his first-degree relative has previously donated an organ, he will get 3.5 points.
The worldwide shortage of organs is getting worse, but we do have options. All the above-mentioned programs – presumed consent, financial compensation for living and dead donors, and point systems would increase the supply of transplant organs.
As more people are dying, pressure to find out new ways to save lives is increasing.