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July 24, 2008

Technological developments in medicine are making organ transplants fairly routine. When I first entered medical school in the 1970s, a kidney transplant was a major intervention. There were significant side effects to the drugs used to prevent rejection, and the mortality and morbidity rates were high.

Today, however, kidney transplants are routine, as are transplants of other major organs such as the liver and heart. Survival has greatly improved, and the complication rate has dropped dramatically with the advent of powerful new anti-rejection drugs (with few side effects).

The problem? Not enough donor organs. For whatever reason, many members of the public are reluctant to sign up as donors. In Australia, there are only 10 donors per million people – compare that rate to 15/million in Germany, 27/million in the U.S., and 35/million in Spain.

This has led one Australian doctor to suggest a fee for donating. Kidney specialist Kevin Garvey has suggested that $50,000 might provide enough incentive to increase to donation rate. Federal Health Minister Nicola Roxon disagrees, saying:

Putting a price on somebody’s organs, and making it a economic proposition for people that might be financially vulnerable, we don’t think is the right way to go. We don’t want to open up that sort of exploitation.

In a recent post on this subject, I expressed concern over the dangers of commodifying our body organs. Are these concerns justified? After all, since there is such a critical shortage of donors, couldn’t paying for organs help meet our needs?

An amazing news story by BBC reporter Paula MacKinnon shows that concerns about exploitation are quite justified. Ms. MacKinnon is willing to donate one of her kidneys to a stranger in need, and she’ll do this as an act of selfless giving. Her justification is amazingly simple. She states, “I am donating one of my kidneys to a stranger. I don’t need two.”

Here’s where things get bizarre: While researching her story about kidney donation, Ms. MacKinnon secretly filmed people who tried to sell their kidneys. One woman wanted £250,000; another man wanted the price of a Mercedes, about £60,000 (note that at current exchange rates, the equivalent costs in U.S. dollars are $495,000 and $118,800, respectively). As part of her research, the reporter went to India, where she discovered a terrible legacy of butchered paid donors with long-term health problems (see our recent podcast which touches on this issue, as well).

Amazingly, Ms. MacKinnon is undeterred, trusting in the integrity of her own health care system to help her to carry out her altruistic plan safely. I’m impressed.

Financial incentives to make more organs available? It’s still a bad idea, with too many hidden dangers.

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BBC Report

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