Ethics expert advocates payment for organ donorsBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7575.937-a (Published 02 November 2006) Cite this as: BMJ 2006;333:937
Ethical and philosophical arguments against the sale of organs for transplantation are difficult to sustain when scrutinised closely, says a University of Toronto professor of public health and surgery in an article entitled “The case for a regulated system of living kidney sales” (Nature Clinical Practice Nephrology 2006;2:600-1).
Abdallah Daar, director of ethics and policy for the McLaughlin Centre for Molecular Medicine and co-director of the Canadian Program on Genomics and Global Health, says he and colleagues in the International Forum for Transplant Ethics do not argue that organ sales are always acceptable or that the market should be unfettered: “Our claim is that none of the familiar arguments against organ selling work, and this allows for the possibility that better arguments may be found.”
“In the US 90 000 patients are on the waiting list of whom 6000 die every year; in cities, there is a 5-7-year wait for a cadaveric organ, and some patients take matters into their own hands by advertising … on highway billboards, by consulting websites, by making personal pleas in the media, by listing themselves in multiple registries and by relocating. As a result, monetary incentives have been seriously considered. In 2002, the American Medical Association voted to endorse pilot projects to give families financial rewards for donation of deceased relatives' organs and some states do now offer such tax incentives.”
In developing countries where neither donation of cadavers nor dialysis exist, living donations that are often paid for are the only recourse, and the numbers of commercial transplantations and centres are increasing.
Transplant tourism is growing, says Professor Daar. “Overseas Medical Services in Calgary will organize a transplantation from a living donor in Pakistan for $C32 000 [£15 000, $28 500, €22 500]. Paid organ procurement has been documented in the Philippines, Iraq, China, India, South Africa, Turkey, Eastern Europe and elsewhere.
“If misguided policies force this … underground, a black market is created. Middlemen exploit the situation and organised crime moves in. The rich exploit the poor; donors and recipients suffer. Legislation fails to check the problem, or transfers it elsewhere. All this is fact, not speculation, and it will continue to happen if we don't change our approach.”
In Iran, on the other hand, kidney transplantation is sponsored by the state, transparent, non-commercial, and free of intermediaries. Donors are paid by a government sponsored agency, and waiting lists have been eliminated. All patients—rich, poor, educated, or uneducated—receive transplants in well run, scrutinised hospitals. Iranian transplant surgeons, formerly ostracised, are invited to international conferences and their results are published in peer reviewed journals.
“Having studied this issue for nearly two decades, I know that the subject is very complex,” wrote Professor Daar. “I believe, however, that merely expressing revulsion or legislating against the problem does not and will not work.”
See “An ethically defensible market in organs” (BMJ 2002;325:114-5).
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