Ethical Issues Related to Organ Donations
In 1983 Dr H Barry Jacobs, a physician from Virginia, whose medical license had been revoked after a conviction for Medicare mail-fraud, founded International Kidney Exchange, Ltd. He sent a brochure to 7,500 American hospitals offering to broker contracts between patients with end-stage-renal-disease and persons willing to sell one kidney. His enterprise never got off the ground, but Dr Jacobs did spark an ethical debate that resulted in hearings before a congressional committee headed by Albert Gore, Jr., then a representative from the state of Tennessee. The offensive proposal for kidney sales led to the National Organ Transplant Act to become law in the United States in 1984. An ethical consensus developed around the world that there should be no monetary compensation for transplantable organs, either from living or deceased persons. Unfortunately, the altruistic supply of organs has been much less than adequate, and thousands of patients die each year waiting for organ transplantation.
As the number of patients who die waiting for organ transplants continues to rise, more families are taking the quest for an organ into their own hands, and raising tough ethical questions in the process. In July, 2004 Todd Krampitz, 32, of Houston, Texas received a liver transplant after publicizing his plight through billboards, e-mails, a Web site and an extensive media campaign. He suffered from a liver cancer so extensive that it was unlikely he would ever rise to the top of the waiting list for an organ. Left with no alternative, Krampitz's friends and family publicized his predicament and asked people to donate specifically to him if they or if they had a loved one who died. In August, 2004 a donor family requested that their dying relative's liver go to Krampitz. Nine months after receiving his transplant, Krampitz died. Called a directed donation, these donations are both legal and unusual when they come from cadaveric donors.
The problem with this case is that, from the point of view of the transplant community, he was not a strong enough candidate to get an organ. They didn’t think he would survive a transplant given the nature of his cancer, which was aggressive and very likely to take his life. It is unclear, in fact, that he lived any longer post his transplant than he would have if he had not gotten a directed cadaver donation and a transplant.
A group called LifeSharers asks that people sign up with the Tennessee-based organization and agree both to donate their organs when they die and direct those donations to other LifeSharers members. In exchange for this, the LifeSharers members have first claim on organs donated by other members, according to the group's Web site. By June 2004, the United Network for Organ Sharing (UNOS), the non-profit organization contracted by the US government to monitor the transplant waiting list, had passed a resolution addressing the phenomenon of public solicitation for organs, noting that it poses potential ethical problems.
Another organization called matchingdonors.com gives recipients the opportunity to tell their stories on its website in hopes of attracting the attention of a living donor. Dr. Jay Lowney, medical director and co-founder of matchingdonor.com attributes the current shortage of organs to hospitals' unwillingness to ask grieving family members about the organ-donation option. Lowney believes that all hospitals should be asking, and that if every eligible organ was used, the waiting list would not be so long. His alternative solution includes outreach efforts to potential living donors.
The fairness problem at the heart of almost all transplant discussions, including this one, is the mismatch between the supply of donated organs and the demand from those who need transplants. As of July 30, 2004 more than 86,000 people in the United States were awaiting organ...