A sane policy on transplants

May 18, 1999|By Froma Harrop

IN THE world of organ transplantation, money is a dirty word -- but only if the money is going to the organ donor's family. A liver-transplant operation may cost hundreds of thousands. The megadollars will be divvied among doctors, hospitals and any number of medical administrators.

None of it goes to the family of the guy who was kind enough to offer his liver upon death. Small wonder there is a critical shortage of hearts, lungs and other organs. It takes a certain generosity to sign a donor card indicating willingness to have your organs harvested at death. Most people don't want to think about it.

Pennsylvania, home to the University of Pittsburgh's world-famous organ-transplantation center, has dared to tread where no state has gone before. It is starting a program to compensate the families of organ donors. The hope is that by offering to pay $300 toward the funeral of the deceased, more people will agree to donate organs.

Some leading medical specialists immediately jumped on Pennsylvania's proposal. They condemned the program as the evil selling of body parts. "End-of-life decisions are complex and influenced by many forces," Dr. Jerome Groopman, professor of medicine at Harvard University, wrote in a critique of the Pennsylvania plan. "Money should never be one."

He sees the financial incentive prompting families to remove life support prematurely so as to have usable organs for transplant. He worries that other states might try to outbid Pennsylvania in attracting organs for their transplant programs. "An open market will be created by the plan, a market for death."

Money matters

I hate to break it to you, Doc, but filthy lucre has already sullied our medical system's life-and-death judgments. When an insurance company refuses to pay for a potentially life-saving organ transplant, it is making an end-of-life decision. We don't see many doctors and hospitals donating their time and own resources to transplant organs for free. And besides, money should indeed influence end-of-life decisions. There are just so many health-care dollars to go around. Should our society spend small fortunes on operations offering a tiny chance of survival when uninsured Americans are dying for the lack of rudimentary care?

Now, the outright sale of organs is illegal in this country, and for a good reason. An open market for organs could lead to the murder of innocents, whose bodies would be sent to chop shops and the parts sold. However, Pennsylvania's program has been carefully designed to avoid this. The $300 would go directly to the funeral home and not into the family's pockets.

Unlikely scenario

Despite such safeguards, Dr. Groopman's imagination continues to roam. "Will poor families with sick members move to Pennsylvania to avail themselves of the funeral stipend?" he asks. This is an unlikely scenario. For most families, $300 couldn't even cover Amtrak tickets for the trip across state lines.

And while we are on the subject of poor people, it should be noted that the organ shortage is especially acute in the disproportionately poor black community. To be successful, many transplant procedures must use organs from donors of the same ethnic group. Many poor blacks distrust the medical establishment and see the request for "free" organs as exploitative. Hence, the gap between organ supply and demand is wider among blacks than among whites.

Dr. Groopman believes that Pennsylvania is doing this to help the state's lucrative transplant business. Could we be getting to the crux of the problem? The real objections to the Pennsylvania plan may not be ethical as much as economic -- that it would give Pittsburgh a competitive advantage in the transplant business?

As things now stand, grieving families often stand in the way of allowing the removal of organs, even when the deceased had signed a donor card. The Pennsylvania proposal offers an immediate incentive for familes to give doctors a green light. Would it be preferable for people to donate organs out the goodness of their hearts? Yes, but they don't.

What is the bigger scandal here? Is it the possibility for abuse in a program allowing compensation for organs? Or is it the current setup, where thousands of people die every year because of an unnecessary shortage of transplantable organs? Sick people on the desperate waiting list could easily answer that question.

Froma Harrop is a Providence Journal editorial writer and columnist.

Pub Date: 5/18/99

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