At its meeting next month, the American Medical Association will consider recommending a test to see if financial incentives will increase donations of organs after death. But would that become a slippery slope leading to legalizing an organ market? And why would that be a problem? Kim Lawton reports.
KIM LAWTON: Toby Appel and Kate Prager have been good friends for nearly 30 years. They're about to have an even closer bond: Kate is giving Toby one of her kidneys.
At the Washington Hospital Center, they're getting last-minute instructions and doing the final blood tests before surgery. In 1989, Toby was diagnosed with polycystic kidney disease, a hereditary disorder in which cysts progressively impair kidney function. She suffered kidney failure in December of 2000 and was put on dialysis. Her doctor told her she needed a transplant in order to survive.
TOBY APPEL: But the waiting list for my blood type is about five years. I am Type O blood, and that is the most difficult to receive a donation because it matches only with other Type O.
LAWTON: Two of Toby's relatives volunteered to be tested, but neither was a good match. It looked like Toby had a long and frightening wait ahead.
KATE PRAGER: We were talking by phone a year ago and she had told me that some of her relatives had tried to donate, but they were the wrong blood type. And so I said, "What blood type do you need?" She said, "O" and I said, "I'm O," and it just went from there. It's like, "Wow, I could possibly help her."
Ms. APPEL: I was really surprised, and I couldn't believe it at first. I was also very excited about the idea, and I had wanted to make it as easy as possible for her.LAWTON: New drugs and better surgical techniques are indeed making it easier for non-blood relatives such as Kate to donate a kidney or a piece of their liver or lung for transplant. But it is still major surgery, done under general anesthesia. While the majority of kidney transplants are now done from live donors, most other transplants come from donations taken upon death.
More and more transplant surgeries are taking place each year, but it's still not enough to meet the need. Over 80,000 patients are currently awaiting transplants; about 16 people on the waiting list die every day. And that shortage is expected to increase even more dramatically over the next few years.
The medical community is urgently searching for new ways to stimulate more organ and tissue donation. Many are suggesting it may be time to explore something long considered taboo: financial incentives.
Dr. Frank Riddick chairs the American Medical Association's Council of Ethical and Judicial Affairs. His committee is urging the AMA to endorse a pilot program to study whether modest financial payments would encourage a larger pool of people to donate their organs after death.
Dr. FRANK RIDDICK (American Medical Association): These are organs which will be buried or cremated unless they are transplanted, and we would like to increase the percentage of them that actually get to be transplanted. ... There is an ethical obligation to do everything possible to improve the health of the public and to meet the needs of the patient population.LAWTON: Since 1984, federal law has banned the buying and selling of organs for transplants. AMA officials acknowledge a congressional waiver would be required for any pilot incentive program. But many observers say an endorsement from the prestigious AMA could convince Congress to give it a try.
Some ethicists fear any introduction of money will turn the entire organ donation process into a commodity transaction.
Dr. WALTER ROBINSON (Harvard Medical School): I'm concerned by commercializing that exchange you bring that exchange into the kind of usual market exchange that we have in the U.S.LAWTON: Others worry that financial incentives could go higher and higher, with organs eventually being sold to the highest bidder. Some speculate poor people could be exploited or coerced into selling their organs.
Dr. RIDDICK: What we are not doing is advocating any form of an open marketplace for organs. We are not advocating any change in how we allocate the organs.
GEORGETTE RUTH: My compensation is knowing that he did that and know that he lives on in other people. For me, I wouldn't want any compensation. I have my compensation.
TOMMY THOMPSON (U.S. Secretary of Health and Human Services): I think we should look at it. I'm not there yet as a way we should go, but I think it should be studied and reviewed and I'm glad the American medical society is doing it.
