The Organ Business

DANIEL S. GREENBERG

July 02, 1991|By DANIEL S. GREENBERG

WASHINGTON. — Washington -- Organ-transplant techniques are increasingly sophisticated and successful. But kidneys and other transplantable organs are paradoxically scarce and plentiful. Every year, thousands of people die while awaiting transplants. Meanwhile, organs suitable for transplant from victims of fatal accidents and other suitable donors never make it into the medical system. Can the profit motive resolve this dilemma?

Horrors. The profit motive as a factor in organ transplants? There's a federal law against selling organs. But even if it were legal, the sale of body parts is offensive to common values. Nonetheless, people are dying for lack of transplant organs, despite strong efforts to encourage donations. We've got to rethink this problem.

In India, the organ shortage has spawned a new business -- buying, and surgically removing, kidneys from live donors. According to a recent report in the British journal Lancet, the going rate for purchasing a kidney is about $1,400, plus post-operative care. For the recipient, the price can be as high as $10,000. Clearly, it's a very profitable business. But that's nothing new in medicine.

Satisfactory health can be maintained with one kidney. In the United States, it is not unusual for a patient with failing kidneys to receive a replacement from a healthy relative. In India, where the average per-capita income is a few hundred dollars a year, the sum paid for a kidney donation is a fortune that can provide a family with an otherwise unattainable escape from miserable poverty.

In any economic environment, but especially in conditions of Third-World poverty, the organ-selling business is vulnerable to unscrupulous exploitation of both impoverished donors and wealthy, anxiety-ridden patients. Concerns have also been expressed about AIDS patients turning to the kidney market to obtain money. It's therefore doubtful that open organ markets would be tolerated in the U.S.

But what about another scheme of money for organs, proposed by Thomas Peters, a Florida transplant surgeon? He argues that public education programs and anguished pleas have failed to increase the supply of organs for patients who could be saved. The impediment to salvaging organs is often family members who, for one reason or another, do not authorize removal of organs from deceased relatives. To encourage their cooperation, he suggests experimenting with a $1,000 death benefit to the next of kin in return for permission to collect transplantable organs.

Organs thus collected would be distributed on the basis of medical need and matching of tissues, and should not favor rich over poor, he told American Medical News, published by the American Medical Association. Dr. Peters noted that ''Payment would in no way affect the brain-dead donor, as no effort is made to obtain organs prior to brain death.'' Relatives who balk at authorizing organ removal, he said, are not likely to be swayed by the $1,000 benefit. But for many others, he said, the payment would be an inducement.

Organ transplants are a grisly subject that many squeamishly prefer to ignore, and, in fact, do -- which accounts for the shortage of organs and needless deaths of patients awaiting help. The present system isn't working well. If a touch of the profit motive might help, why not?

*Daniel S. Greenberg publishes the newsletter Science & Government Report.

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