Talking to Nate always stimulated new ideas and new challenges. Last time I met him, we played soccer in the park with the kids (that was also a challenge but fun and easy to win…). We also talked about an interesting hot ethical topic (It was hard and no winners…). Compensation for living organ donors! A taboo no more but nonetheless remains an ethical dilemma that needs public debate, engaging mainly specialists who care for end-stage kidney disease patients. I thought using Nate’s blog for such a debate will please him, so here we are…
My approach will be, what are the facts?
- We have an increasing demand for kidney transplantation that our deceased donor waiting list can’t match. And living donation is not increasing especially when being an organ donor can negatively affect the likelihood of obtaining life, disability and health insurance. This concern is frequently raised by many potential donors.
- Recipients of living donor kidney transplants do better than recipients of deceased donor transplants.
- More people are dying on dialysis waiting for a transplant.
- Kidney donation is safe (Ibrahim et al. NEJM 2009)… Trust me, I finally watched a hockey game last week after I saw a Canadian flag in our Lab.
- And for the government (no offense) and the health insurance payers, Matas et al found that a LURD transplant saved $94,579 (US dollars, 2002), and 3.5 quality-adjusted life years (QALYs) were gained.
What are the ethical hurdles?
If we allow direct compensation between donors and recipients, we are turning the poor of our society into providers of body parts to wealthy people.
But what if the compensation is indirect through government agencies, providing donors, for example, with lifetime health insurance or tax deduction and maybe by treating them as the nation heroes which they deserve by the way.
I’ll be happy to hear your comments.
Hi,
ReplyDeleteWouldn't an obvious question be whether providing universal health insurance coverage, obviating the fear of losing coverage post-donation, provide sufficient incentive for living donors?
As far as indirect compensation is concerned in your scheme, however, there is the view that it is more limiting than direct monetary compensation (i.e. you still turn the poor into organ providers for the rich, but you don't provide them with any choice regarding the compensation of their sacrifice).
In democratic and rich societies like ours in the developped world , coverage and access to health care for eveybody must be undiscussed matter whether or not he or she is a potential organ provider ...
ReplyDeleteIndirect compensation is not a garantee of an ethical or moral treatment of the issue because it still turns the poor into an organ supply system which deprive them of their dignity even if they " choose " to give their organs ... Law must protect people from such" choices " ..
In a country as wealthy as ours there should be a need some poor man to have to sell his organs for money. Shame on us if it happens
ReplyDeleteI should have posted my reply earlier but I was waiting for more comments.
ReplyDeleteI believe that USA is a leader for the world but also for humanity and doctors who graduate from state of the art institution in those democratic and rich societies have the responsibility to improve practice for humans everywhere including the nondemocratic poor societies.
I agree that it will be shame on us if we get involved in organ trafick but I also feel ashamed every time I see a 20 yo kid on dialysis.
The indirect compensation is to alleviate some concerns for people who are willing to donate but anxious about loosing work and insurance but not enough for poor people to go and sell their organs.
If this government centralized. The organs will go to people on the list whether they are rich or poor
can you enlighten on Iranian experience?it might have lessons for us here
ReplyDeleteAs an ED RN, I see depravity and violence on a daily basis. I also see people become more and more critically ill from renal failure and dialysis. The poor a growing class in America thanks to years of government miss-management, and now the financial crisis have the right to extract themselves from poverty by means other than crime, which is often the only means that they can see to get out of a often untenable situation. Is it better to sell drugs or prostitute your self rather than sell a kidney, if that sale will enable you to extract yourself from the grinding poverty your in. Say it will pay for an education that will enable one to get a good job, live in a better neighborhood, give your children a better life, and their is an individual willing and capable of providing that compensation, is it still more wrong than poisoning other peoples kids by illegal drug sales? Think about it. I guess those of you that object to organ sales by the poor don't object to pushers selling drugs or prostitutes with HIV or hepatitis C among our young.
ReplyDeleteThe Renal Association is involved in many joint activities, and liaises with many other relevant groups. Some of the organisations with which we share formal committees are: - renal exam course
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