The Economist has a fascinating essay on whether it makes sense to allow the sale of transplant organs. Would this increase the supply of donated organs? Would it save more lives? Or would it cause the exploitation of the very poor?
“PLEASE don’t take your organs to heaven,” reads the American bumper sticker. “Heaven knows that we need them here on earth.” Last year more than 7,000 Americans died while awaiting an organ transplant—almost double the number of American soldiers killed in Iraq since 2003. In Europe, too, thousands of people whose lives could be extended or transformed (by having sight restored, for example) through transplants forfeit the opportunity for want of available organs.
Research by the World Health Organisation (WHO) has found that only one in ten people in need of a new kidney, the body part most in demand, manages to get one. In the poorest places, of course, a complex transplant—which in the American health system costs $500,000—is unthinkable for most people anyway. But the gap between supply and demand for organs affects the poor too, by creating a market in body parts where abuses are rife.
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The latest of many organ-harvesting scandals is now raging in India, one of several poor countries where the sale of organs used to be legal but has now been banned, with the apparent effect of driving the trade underground. A doctor, Amit Kumar, is awaiting trial after reportedly confessing to having performed hundreds of illegal transplants for rich clients from America, Britain, Canada, Saudi Arabia and Greece. He has been accused of luring labourers into his clinics with job offers; victims were then offered up to $2,000, a princely sum, to part with a kidney. Some who refused are said to have had kidneys removed anyway after being drugged.
Another kidney racket flourished in South Africa between 2001 and 2003. Donors were recruited in Brazil, Israel and Romania with offers of $5,000-20,000 to visit Durban and forfeit a kidney. The 109 recipients, mainly Israelis, each paid up to $120,000 for a “transplant holiday”; they pretended they were relatives of the donors and that no cash changed hands.
At least until very recently, a key destination for such “transplant tourists” was China, where—according to human-rights groups—there used to be a ready supply of organs plucked from the bodies of the thousands of people who are executed every year. China insisted that the prisoners’ organs were only used with their “consent”. But under global pressure, it agreed a year ago to stop the practice; in theory, only blood relatives of the executed can now get their organs. The sale of any human body part was banned in 2006. Before the change, about five Australians a year bought organs from the bodies of Chinese who had been executed, according to Jeremy Chapman, the Australian head of the International Transplantation Society.
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Just why is there such a lack of donors in rich countries, given that, according to opinion polls, most people like the idea of donation and are ready in principle to participate? One big factor has been a stream of media reports that give people the impression of widespread malpractice by the medical profession and the funeral and biomedical industries.
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But it is Iran (with a low deceased-donor rate) that has the highest living-donor rate in the world—23 per 1m. It is also the only country where monetary compensation for organs is officially sanctioned. Iran began paying unrelated living donors for their kidneys in 1988. Just 11 years later it had eliminated its kidney-transplant waiting lists—a feat no other country has achieved. Under the Iranian system, a patient wanting a kidney must first seek a suitable, willing donor in his family. If that fails, he must wait up to six months for a suitable deceased donor.
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In practice, Iran also has a market in kidneys (allowing buyers and sellers to agree a price that tops up the sums officially available). In addition, there are altruistic donors, who offer up kidneys anonymously as an Islamic duty, or in gratitude for a prayer that has been answered. In fact, Iran’s reality runs the gamut of approaches from commerce to state support to kindness. It somehow works; Iranians no longer go abroad for kidneys.
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Gavin Carney, a professor at Australia’s National University Medical Hospital, suggests paying each donor around $47,000. This, he says, would save thousands of Australian lives and billions of dollars in the cost of care for patients, some of whom wait seven years for a kidney. The government “shouldn’t just let people rot on dialysis”, he says. Nadey Hakim, a London transplant surgeon and ex-president of the International College of Surgeons, also favours some form of compensation. “There really is no other option,” he says.
Read it all here. What do you think?