As a life-prolonging medical procedure, organ transplantation is, in a sense, a victim of its own success. Since the world's first successful kidney transplant in 1954, medical science, bolstered by the development of immuno-suppressant drugs, has created an expectation that cannot always be matched by reality.
The bottom line: There simply aren't enough donated organs available for desperately ill people who need them. Last year, some 23,000 transplants were performed in the United States, but there are about 80,000 people on waiting lists. The coldest statistic of all: 15 people die each day waiting for an organ.
To ease the shortage, new entreaties are being made to relax a 1984 federal law that flatly prohibits the sale or trade of organs. The American Medical Association's committee on ethics and judicial affairs had recommended a study of whether financial incentives such as tax deductions or helping families with funeral expenses might encourage more people to donate. After much debate at the AMA convention in San Francisco last week, the proposal was tabled.
Supporters of the study said physicians have a duty to the living to do everything possible to sustain life. Opponents said ethics shouldn't be determined on the basis of scientific studies.
The federal law banning financial considerations of any kind is based on the premise that organ donations must always be made for altruistic purposes. This is echoed by the Transplantation Society, an international body of physicians and scientists, which states that “organs and tissues should be freely given without commercial consideration or financial profit.”
Injecting money into the life-or-death equation raises valid concerns about exploitation of people who need money and wouldn't otherwise donate; that families of seriously ill patients might be encouraged to withhold medical treatment for financial gain, and the likelihood that the wealthy would always get first crack at available organs.
Jeffrey P. Kahn, director of the Center for Bioethics at the University of Minnesota, argues that allowing any kind of payment for organs “walks a fine line between useful incentive and turning organs and their donors into commodities. We need more organ donors, but incentives ... turn donors into sellers, so that instead of making a gift, they end up making a score - a situation we can't afford.”
Payment for organs, by whatever name, is more than the peak of a slippery ethical slope. It would be a headlong leap into a moral morass that has engulfed so many sectors of society - the idea that money trumps ethical considerations every time. To understand the pitfalls, we need only look to China, where the totalitarian government assures a steady flow of organs from executed prisoners for transplant to wealthy foreigners.
A more intense educational effort is needed to convince Americans of the urgency for stepped up organ donation. This is an area in which religious leaders, especially, can exercise considerable influence by clearing up superstitions and misunderstandings about what most agree is a life-affirming process.
The gift of human organs is truly a gift of life. We would be wrong to place a price tag on that gift.
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