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Siraj MS. How a compensated kidney donation program facilitates the sale of human organs in a regulated market: the implications of Islam on organ donation and sale. Philos Ethics Humanit Med 2022; 17:10. [PMID: 35897010 PMCID: PMC9331153 DOI: 10.1186/s13010-022-00122-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/05/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Advocates for a regulated system to facilitate kidney donation between unrelated donor-recipient pairs argue that monetary compensation encourages people to donate vital organs that save the lives of patients with end-stage organ failure. Scholars support compensating donors as a form of reciprocity. This study aims to assess the compensation system for the unrelated kidney donation program in the Islamic Republic of Iran, with a particular focus on the implications of Islam on organ donation and organ sales. METHODS This study reviews secondary documents for philosophical argumentation and ethical analysis of human organ donation and sale for transplantation. RESULTS AND DISCUSSION According to Islamic law, organ donation is an act of sadaqatul jariyah, and individuals are permitted to donate organs with the intention of saving lives. The commercialization of humans as organ sellers and buyers is contrary to the Islamic legal maxim eethaar, undermining donors of 'selfless' or 'altruistic' motivations. Such an act should be considered immoral, and the practice should not be introduced into other countries for the sake of protecting human dignity, integrity, solidarity, and respect. I, therefore, argue that Iran's unrelated kidney donation program not only disregards the position of the Islamic religion with respect to the provision or receipt of monetary benefits for human kidneys for transplantation but that it also misinterprets the Islamic legal proscription of the sale of human organs. I also argue that the implementation of Iran's unrelated kidney donor transplantation program is unethical and immoral in that potential donors and recipients engage in a bargaining process akin to that which sellers and buyers regularly face in regulated commodity exchange markets. Conversely, I suggest that a modest fixed monetary remuneration as a gift be provided to a donor as a reward for their altruistic organ donation, which is permissible by Islamic scholars. This may remove the need to bargain for increased or decreased values of payment in exchange for the organ, as well as the transactional nature of 'buyer and seller', ensuring the philosophy of 'donor and recipient' is maintained. CONCLUSIONS Offering a fixed modest monetary incentive to organ donors would serve to increase organ supply while protecting donors' health and reducing human suffering without legalizing the human organ trade.
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Affiliation(s)
- Md Sanwar Siraj
- Department of Government and Politics, Jahangirnagar University, Savar, Dhaka, Bangladesh.
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Fung WWS, Chapman J, Nangaku M, Li PKT. Controversies in Living Kidney Donation. Semin Nephrol 2022; 42:151270. [PMID: 36577646 DOI: 10.1016/j.semnephrol.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The most precious gift that can be given is, arguably, a living organ to a person in need of replacement because of failure of that organ. Kidney transplantation remains the best modality of renal replacement therapy and there is an ever-increasing demand for organ donation. The inability of cadaveric organ donation to meet the needs of the increasing numbers of patients on global waiting lists highlights the important needs for alternate sources for kidneys such as those from living kidney donation. However, living donor kidney transplantation has been a focus of intense debate, with ethical concerns and controversies emanating from operating on an individual who does not need, and is put at a small but quantifiable risk from, the surgical intervention. Furthermore, health care systems across the world also are funded with different levels of national and individual affordability, leading to health inequalities for the sick and risks of exploitation for the poor, especially through commercialization of transplantation. This article highlights some of these contemporary ethical concerns and controversies in living organ donation.
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Affiliation(s)
- Winston Wing-Shing Fung
- Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Jeremy Chapman
- Department of Medicine, Westmead Clinical School, The University of Sydney, Westmead New South Wales, Australia
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
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Organ Trafficking: Why Do Healthcare Workers Engage in It? Camb Q Healthc Ethics 2022; 31:368-378. [PMID: 35899537 DOI: 10.1017/s0963180121000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Organ trafficking in all its various forms is an international crime which could be entirely eliminated if healthcare professionals refused to participate in or be complicit with it. Types of organ trafficking are defined and principal international declarations and resolutions concerning it are discussed. The evidence for the involvement of healthcare professionals is illustrated with examples from South Africa and China. The ways in which healthcare professionals directly or indirectly perpetuate illegal organ transplantation are then considered, including lack of awareness, the paucity of both undergraduate and postgraduate education on organ trafficking, turning a blind eye, advocacy of organ commercialism, and the lure of financial gain.
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Beier K, Wöhlke S. An ethical comparison of living kidney donation and surrogacy: understanding the relational dimension. Philos Ethics Humanit Med 2019; 14:13. [PMID: 31533778 PMCID: PMC6749634 DOI: 10.1186/s13010-019-0080-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The bioethical debates concerning living donation and surrogacy revolve around similar ethical questions and moral concepts. Nevertheless, the ethical discourses in both fields grew largely isolated from each other. METHODS Based on a review of ethical, sociological and anthropological research this paper aims to link the ethical discourses on living kidney donation and surrogacy by providing a comparative analysis of the two practices' relational dimension with regard to three aspects, i.e. the normative role of relational dynamics, social norms and gender roles, and reciprocity. Based on this analysis, we derive conclusions for the framing of living organ donation and surrogacy in ethical theory and practice. RESULTS First, our analysis emphasizes the relevance of acknowledging the complex relational implications of living kidney donation and surrogacy. Underestimating this relational dimension may not only lead to individual crises but endanger existing as well as newly emerging familial relationships. Second, we point out differences in the normative assessment of social norms and gender roles in the ethical debates about living kidney donation and surrogacy. In particular, we show how different evaluations of altruism affect the understanding of autonomy in both contexts. In addition, we sensitize for biased perceptions of gender roles. Finally, we argue that challenges resulting from unresolved reciprocity are an issue in living kidney donation and surrogacy independent of whether the exchange of body parts or bodily services is framed as a gift or commercial exchange. By pointing out the limits of financial compensation, we stress the relevance of non-material, relational rewards as potential remedy.
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Affiliation(s)
- Katharina Beier
- Department of Medical Ethics and History of Medicine, University Medical Center, 37073 Göttingen, Germany
| | - Sabine Wöhlke
- Department of Medical Ethics and History of Medicine, University Medical Center, 37073 Göttingen, Germany
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THE RIGHT TO LIFE: MODERN MEDICAL AND LEGAL CONTEXT. WORLD OF MEDICINE AND BIOLOGY 2018. [DOI: 10.26724/2079-8334-2018-1-63-216-223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Semrau L. Reassessing the Likely Harms to Kidney Vendors in Regulated Organ Markets. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2017; 42:634-652. [DOI: 10.1093/jmp/jhx025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Abstract
Proponents of permitting living kidney sales often argue as follows. Many jobs involve significant risks; people are and should be free to take these risks in exchange for money; the risks involved in giving up a kidney are no greater than the risks involved in acceptable hazardous jobs; so people should be free to give up a kidney for money, too. This paper examines this frequently invoked but rarely analysed analogy. Two objections are raised. First, it is far from clear that kidney sales and dangerous jobs involve comparable risks on an appropriately broad comparison. Second, and more importantly, even if they do involve comparable risks it does not follow that kidney sales must be permitted because dangerous jobs are. The analogy assumes that kidney sales are banned for paternalistic reasons. But there may be other, non-paternalistic reasons for the ban. And paternalists, too, can consistently defend the ban even if kidney sales are no riskier than occupations that they find acceptable. Soft paternalists may want to protect would-be vendors from harms that they have not voluntarily chosen. Egalitarian hard paternalists may want to protect already badly off vendors from further worsening their situation. For neither species of paternalist is the size of the risk prevented decisive. I conclude that the analogy with dangerous jobs, while rhetorically powerful, pulls little real argumentative weight. Future debates on living kidney sales should therefore proceed without it.
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Columb S, Ambagtsheer F, Bos M, Ivanovski N, Moorlock G, Weimar W. Re-conceptualizing the organ trade: separating "trafficking" from "trade" and the implications for law and policy. Transpl Int 2016; 30:209-213. [PMID: 27896866 DOI: 10.1111/tri.12899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Seán Columb
- School of Law and Social Justice, The Liverpool Law School, University of Liverpool, Liverpool, UK
| | - Frederike Ambagtsheer
- Section Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Michael Bos
- Ethics Chair, Eurotransplant International Foundation, Leiden, The Netherlands
| | | | - Gregory Moorlock
- Social Studies in Medicine, University of Birmingham, Birmingham, UK
| | - Willem Weimar
- Section Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
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Abstract
In March 1966, the Ciba Foundation sponsored the first international, interdisciplinary symposium focused on ethical and legal issues in transplantation. The attendees included not only physicians and surgeons but also judges and legal scholars, a minister, and a science journalist. In this article, we will consider some of the topics in organ transplantation that were discussed by the attendees, what we have learned in the intervening half century, and the relevance of their discussions today. Specifically, we examine the definition of death and its implications for organ procurement, whether it is ethical and legal to "maim" a living individual for the benefit of another, how to ensure that the consent of the living donor is voluntary and informed, the case of identical twins, the question of whether ethically minors can serve as living donors, the health risks of living donation, the ethics and legality of an organ market, and the economic barriers to living donation. We show that many of the concerns discussed at the Ciba symposium remain highly relevant, and their discussions have helped to shape the ethical boundaries of organ transplantation today.
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Tong A, Ralph AF, Chapman JR, Wong G, Gill JS, Josephson MA, Craig JC. Focus group study of public opinion about paying living kidney donors in Australia. Clin J Am Soc Nephrol 2015; 10:1217-26. [PMID: 25908793 PMCID: PMC4491296 DOI: 10.2215/cjn.10821014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/26/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The unmet demand for kidney transplantation has generated intense controversy about introducing incentives for living kidney donors to increase donation rates. Such debates may affect public perception and acceptance of living kidney donation. This study aims to describe the range and depth of public opinion on financial reimbursement, compensation, and incentives for living kidney donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Twelve focus groups were conducted with 113 participants recruited from the general public in three Australian states in February 2013. Thematic analysis was used to analyze the transcripts. RESULTS Five themes were identified: creating ethical impasses (commodification of the body, quandary of kidney valuation, pushing moral boundaries), corrupting motivations (exposing the vulnerable, inevitable abuse, supplanting altruism), determining justifiable risk (compromising kidney quality, undue harm, accepting a confined risk, trusting protective mechanisms, right to autonomy), driving access (urgency of organ shortage, minimizing disadvantage, guaranteeing cost-efficiency, providing impetus, counteracting black markets), and honoring donor deservingness (fairness and reason, reassurance and rewards, merited recompense). Reimbursement and justifiable recompense are considered by the Australian public as a legitimate way of supporting donors and reducing disadvantage. Financial payment beyond reimbursement is regarded as morally reprehensible, with the potential for exploitative commercialism. Some contend that regulated compensation could be a defensible strategy to increased donation rates provided that mechanisms are in place to protect donors. CONCLUSIONS The perceived threat to community values of human dignity, goodwill, and fairness suggests that there could be strong public resistance to any form of financial inducements for living kidney donors. Policy priorities addressing the removal of disincentives may be more acceptable to the public.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia;
| | - Angelique F Ralph
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jeremy R Chapman
- The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - John S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Quality and Quantity of Health Evaluation and the Follow-up of Iranian Living Donors. Transplant Proc 2015; 47:1092-5. [DOI: 10.1016/j.transproceed.2014.11.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/19/2014] [Indexed: 01/13/2023]
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13
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The Rationale for Incentives for Living Donors: An International Perspective? CURRENT TRANSPLANTATION REPORTS 2015. [DOI: 10.1007/s40472-014-0045-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Shanmugarajah K, Villani V, Madariaga MLL, Shalhoub J, Michel SG. Current progress in public health models addressing the critical organ shortage. Int J Surg 2014; 12:1363-8. [PMID: 25463765 DOI: 10.1016/j.ijsu.2014.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 11/06/2014] [Accepted: 11/11/2014] [Indexed: 11/16/2022]
Abstract
Since its inauguration in 1954, the field of modern transplantation has made great strides in surgical technique, the prevention of acute and chronic rejection, the minimization of immunosuppression-related side-effects and transplant tolerance. As such, organ transplantation is used worldwide as a curative, life-saving treatment for people with end-stage organ failure. However, the successes of organ transplantation have resulted in the number of patients on transplant waiting lists far exceeding the number of organs available, with growing numbers of patients dying while awaiting transplants. In order to address this critical organ shortage, a number of legislative changes have been implemented worldwide to increase the number of individuals registering as organ donors. These have included presumed consent donation, incentivized organ donation, commercial organ transplantation and mandated choice models. This article will address these public health policies in turn. The implementation of these strategies and the evidence for their efficacy will be evaluated. Based on this, we have identified that well-supported transplant coordinators approaching next-of-kin, incentives and public health campaigns are key factors that increase organ donation. Finally we propose a modified mandated choice model that may be an alternative option to maximize the number of available organs for transplantation.
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Affiliation(s)
- Kumaran Shanmugarajah
- Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA; Department of Surgery & Cancer, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom.
| | - Vincenzo Villani
- Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA
| | - Maria Lucia L Madariaga
- Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA; Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02129, USA
| | - Joseph Shalhoub
- Department of Surgery & Cancer, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom
| | - Sebastian G Michel
- Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA; Department of Cardiac Surgery, Ludwig-Maximilians-Universität München, Munich D-81377 Germany
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Tong A, Chapman JR, Wong G, Craig JC. Perspectives of Transplant Physicians and Surgeons on Reimbursement, Compensation, and Incentives for Living Kidney Donors. Am J Kidney Dis 2014; 64:622-32. [DOI: 10.1053/j.ajkd.2014.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/20/2014] [Indexed: 12/19/2022]
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Malmqvist E. Kidney sales and the analogy with dangerous employment. HEALTH CARE ANALYSIS : HCA : JOURNAL OF HEALTH PHILOSOPHY AND POLICY 2013. [PMID: 24370887 DOI: 10.1007/s10728-013-0270-3)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Proponents of permitting living kidney sales often argue as follows. Many jobs involve significant risks; people are and should be free to take these risks in exchange for money; the risks involved in giving up a kidney are no greater than the risks involved in acceptable hazardous jobs; so people should be free to give up a kidney for money, too. This paper examines this frequently invoked but rarely analysed analogy. Two objections are raised. First, it is far from clear that kidney sales and dangerous jobs involve comparable risks on an appropriately broad comparison. Second, and more importantly, even if they do involve comparable risks it does not follow that kidney sales must be permitted because dangerous jobs are. The analogy assumes that kidney sales are banned for paternalistic reasons. But there may be other, non-paternalistic reasons for the ban. And paternalists, too, can consistently defend the ban even if kidney sales are no riskier than occupations that they find acceptable. Soft paternalists may want to protect would-be vendors from harms that they have not voluntarily chosen. Egalitarian hard paternalists may want to protect already badly off vendors from further worsening their situation. For neither species of paternalist is the size of the risk prevented decisive. I conclude that the analogy with dangerous jobs, while rhetorically powerful, pulls little real argumentative weight. Future debates on living kidney sales should therefore proceed without it.
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Affiliation(s)
- Erik Malmqvist
- Division of Health and Society, Department of Medical and Health Sciences (IMH), Linköping University, 581 83, Linköping, Sweden,
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Abstract
PURPOSE OF REVIEW The organ shortage is the major problem in kidney transplantation today. Despite aggressive organ procurement efforts, the supply of donated kidneys, living and deceased, has not matched the growing demand; as a consequence, more and more qualified candidates are suffering on dialysis and then dying before being transplanted. Herein, we provide justification for a regulated system of compensation for donation. RECENT FINDINGS The main argument in favor of compensation is simple-financial incentives will increase donation, so fewer transplant candidates will suffer and die while waiting. In addition, development of a regulated system of compensation is the most effective means of crippling the core economic support for transplant tourism. Because dialysis is so much more expensive than a transplant, compensated donation could be cost-neutral to the healthcare system. Importantly, opinion polls suggest that the public would support compensation. As uncompensated kidney donation is widely accepted, persuasive arguments against compensation must explain why such a system would be morally distinguishable from uncompensated donation. SUMMARY We suggest that the potential advantages of a regulated system of compensation for donation far outweigh any potential disadvantages. It is time to advocate for a change in the law so that trials can be done.
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Reidler JS, Berkowitz J. Recent developments in health law. Compensation for organ donation. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2012; 40:409-413. [PMID: 22789057 DOI: 10.1111/j.1748-720x.2012.00675.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Matas AJ, Adair A, Wigmore SJ. Paid organ donation. Ann R Coll Surg Engl 2011; 93:188-92. [PMID: 21477428 DOI: 10.1308/rcsann.2011.93.3.188a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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van Buren MC, Massey EK, Maasdam L, Zuidema WC, Hilhorst MT, Ijzermans JN, Weimar W. For love or money? Attitudes toward financial incentives among actual living kidney donors. Am J Transplant 2010; 10:2488-92. [PMID: 20977640 DOI: 10.1111/j.1600-6143.2010.03278.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Due to lengthening waiting lists for kidney transplantation, a debate has emerged as to whether financial incentives should be used to stimulate living kidney donation. In recent surveys among the general public approximately 25% was in favor of financial incentives while the majority was opposed or undecided. In the present study, we investigated the opinion of living kidney donors regarding financial incentives for living kidney donation. We asked 250 living kidney donors whether they, in retrospect, would have wanted a financial reward for their donation. We also investigated whether they were in favor of using financial incentives in a government-controlled system to stimulate living anonymous donation. Additionally, the type of incentive deemed most appropriate was also investigated. In general almost half (46%) of the study population were positive toward introducing financial incentives for living donors. The majority (78%) was not in favor of any kind of reward for themselves as they had donated out of love for the recipient or out of altruistic principles. Remarkably, 60% of the donors were in favor of a financial incentive for individuals donating anonymously. A reduced premium or free health insurance was the preferred incentive.
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Affiliation(s)
- M C van Buren
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
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Aronsohn A, Thistlethwaite JR, Segev DL, Ross LF. How different conceptions of risk are used in the organ market debate. Am J Transplant 2010; 10:931-937. [PMID: 20199503 DOI: 10.1111/j.1600-6143.2010.03035.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The success of kidney and liver transplantation is hindered by a shortage of organs available for transplantation. Although currently illegal in nearly all parts of the world, a living 'donor' or 'vendor' kidney market has been proposed as a means to reduce or even end this shortage. Physician members of the American Society of Transplantation, the American Society of Transplant Surgeons and the American Association for the Study of Liver Disease were surveyed regarding organ markets for both living kidney and living liver transplantation. The survey queried respondents about their attitudes toward directed living donation, nondirected living donation, the potential legalization of living donor organ markets and the reasons for their support or opposition to organ markets. Partial or completed surveys were returned by 346 of 697 eligible respondents (50%). While virtually all supported or strongly supported directed living donation (98% and 95% for kidney and liver lobes, respectively), the vast majority disagreed or strongly disagreed with the legalization of living donor organ markets (80% for kidneys and 90% for liver lobes). Both those who support and those who oppose a legalized living donor organ market rate risk to the donor among the most important factors to justify their position.
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Affiliation(s)
- A Aronsohn
- MacLean Center for Clinical Medical Ethics.,Section of Gastroenterology, Department of Medicine
| | - J R Thistlethwaite
- Section of Transplant Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - D L Segev
- Department of Surgery and Epidemiology, The Johns Hopkins University, Balitmore, MD
| | - L F Ross
- MacLean Center for Clinical Medical Ethics.,Section of Transplant Surgery, Department of Surgery, University of Chicago, Chicago, IL.,Section of Advanced Pediatrics, Department of Pediatrics, University of Chicago, Chicago, IL
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Halpern SD, Raz A, Kohn R, Rey M, Asch DA, Reese P. Regulated payments for living kidney donation: an empirical assessment of the ethical concerns. Ann Intern Med 2010; 152:358-65. [PMID: 20231566 PMCID: PMC2865248 DOI: 10.7326/0003-4819-152-6-201003160-00005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Although regulated payments to encourage living kidney donation could reduce morbidity and mortality among patients waiting for a kidney transplant, doing so raises several ethical concerns. OBJECTIVE To determine the extent to which the 3 main concerns with paying kidney donors might manifest if a regulated market were created. DESIGN Cross-sectional study of participants' willingness to donate a kidney in 12 scenarios. SETTING Regional rail and urban trolley lines in Philadelphia County, Philadelphia, Pennsylvania. PARTICIPANTS Of 550 potential participants, 409 completed the questionnaire (response rate, 74.4%); 342 of these participants were medically eligible to donate. INTERVENTION Across scenarios, researchers experimentally manipulated the amount of money that participants would receive, the participants' risk for subsequently developing kidney failure themselves, and who would receive the donated kidney. MEASUREMENTS The researchers determined whether payment represents an undue inducement by evaluating participants' sensitivity to risk in relation to the payment offered or an unjust inducement by evaluating participants' sensitivity to payment as a function of their annual income. The researchers also evaluated whether introducing payment would hinder altruistic donations by comparing participants' willingness to donate altruistically before versus after the introduction of payments. RESULTS Generalized estimating equation models revealed that participants' willingness to donate increased significantly as their risk for kidney failure decreased, as the payment offered increased, and when the kidney recipient was a family member rather than a patient on a public waiting list (P < 0.001 for each). No statistical interactions were identified between payment and risk (odds ratio, 1.00 [95% CI, 0.96 to 1.03]) or between payment and income (odds ratio, 1.01 [CI, 0.99 to 1.03]). The proximity of these estimates to 1.0 and narrowness of the CIs suggest that payment is neither an undue nor an unjust inducement, respectively. Alerting participants to the possibility of payment did not alter their willingness to donate for altruistic reasons (P = 0.40). LIMITATION Choices revealed in hypothetical scenarios may not reflect real-world behaviors. CONCLUSION Theoretical concerns about paying persons for living kidney donation are not corroborated by empirical evidence. A real-world test of regulated payments for kidney donation is needed to definitively show whether payment provides a viable and ethical method to increase the supply of kidneys available for transplantation. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Scott D Halpern
- University of Pennsylvania School of Medicine and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania 19104-6021, USA.
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Davis FD, Crowe SJ. Organ Markets and the Ends of Medicine. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2009; 34:586-605. [DOI: 10.1093/jmp/jhp047] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hippen B, Ross LF, Sade RM. Saving lives is more important than abstract moral concerns: financial incentives should be used to increase organ donation. Ann Thorac Surg 2009; 88:1053-61. [PMID: 19766781 PMCID: PMC2766511 DOI: 10.1016/j.athoracsur.2009.06.087] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 06/22/2009] [Accepted: 06/24/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Benjamin Hippen
- Metrolina Nephrology Associates and Carolinas Medical Center, Charlotte, North Carolina, USA
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26
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Testa G, Angelos P, Crowley-Matoka M, Siegler M. Elective surgical patients as living organ donors: a clinical and ethical innovation. Am J Transplant 2009; 9:2400-5. [PMID: 19663888 DOI: 10.1111/j.1600-6143.2009.02773.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We propose a new model for living organ donation that would invite elective laparoscopic cholecystectomy patients to become volunteer, unrelated living kidney donors. Such donors would be surgical patients first and living donors second, in contrast to the current system, which 'creates' a surgical patient by operating on a healthy individual. Elective surgery patients have accepted the risks of anesthesia and surgery for their own surgical needs but would face additional surgical risks when a donor nephrectomy is combined with their cholecystectomy procedure. Because these two procedures have never been performed together, the precise level of additional risk entailed in such a combined approach is unknown and will require further study. However, considering the large number of elective cholecystectomies performed each year in the United States, if as few as 5% of elective cholecystectomy patients agreed to also serve as living kidney donors, the number of living kidney donors would increase substantially. If this proposal is accepted by a minority of patients and surgeons, and proves safe and effective in a protocol study, it could be applied to other elective abdominal surgery procedures and used to obtain other abdominal donor organs (e.g. liver and intestinal segments) for transplantation.
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Affiliation(s)
- G Testa
- Department of Surgery, Director of Liver Transplantation and Hepatobiliary Surgery, The University of Chicago, Chicago, IL, USA.
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27
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Abstract
Over the last 5 years, a number of utility-based allocation systems have been proposed in an effort to increase the life-prolonging potential of deceased donor kidneys in the United States. These have included various adaptations of age-matching and net benefit, including the Eurotransplant Senior Program, Life Years From Transplant, and several systems for avoiding extreme donor/recipient mismatch. However, utility-based allocation is complex and raises issues regarding choice of metric, appropriateness of certain factors for use in allocation, accuracy of prediction models, transparency and perception, and possible effects on donation rates. Changing the role of utility in kidney allocation will likely cause changes to efficiency, equity, predictability, autonomy, controversy, trust and live donation. In this manuscript, various allocation systems are discussed, and a framework is proposed for quantifying the goals of the transplant community and evaluating options for utility-based kidney allocation in this context.
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Affiliation(s)
- D L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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28
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Hippen B. The kidney allocation score: methodological problems, moral concerns and unintended consequences. Am J Transplant 2009; 9:1507-12. [PMID: 19392985 DOI: 10.1111/j.1600-6143.2009.02594.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The growing disparity between the demand for and supply of kidneys for transplantation has generated interest in alternative systems of allocating kidneys from deceased donors. This personal viewpoint focuses attention on the Kidney Allocation Score (KAS) proposal promulgated by the UNOS/OPTN Kidney Committee. I identify several methodological and moral flaws in the proposed system, concluding that any iteration of the KAS proposal should be met with more skepticism than sanguinity.
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Affiliation(s)
- B Hippen
- Metrolina Nephrology Associates, Charlotte, NC, USA.
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29
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Voo TC, Campbell AV, Castro LDD. The Ethics of Organ Transplantation: Shortages and Strategies. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n4p359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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30
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Incentives for organ donation in the United States: feasible alternative or forthcoming apocalypse? Curr Opin Organ Transplant 2009; 14:140-6. [DOI: 10.1097/mot.0b013e3283295e0d] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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31
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Affiliation(s)
- J S Bromberg
- Recanati/MillerTransplantation Institute, Mount Sinai School of Medicine, New York, NY, USA.
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32
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Abstract
Paymentfor livingkidney donation is illegal in most countries. Arthur Matas believes that legalisation is needed to shorten waiting times, but Jeremy Chapman (doi: 10.1136/bmj.a179) argues that it will reduce the supply of all organs
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Affiliation(s)
- Arthur J Matas
- Department of Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, Minnesota 55455, USA
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33
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Pomfret EA, Sung RS, Allan J, Kinkhabwala M, Melancon JK, Roberts JP. Solving the organ shortage crisis: the 7th annual American Society of Transplant Surgeons' State-of-the-Art Winter Symposium. Am J Transplant 2008; 8:745-52. [PMID: 18261169 DOI: 10.1111/j.1600-6143.2007.02146.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The 2007 American Society of Transplant Surgeons' (ASTS) State-of-the-Art Winter Symposium entitled, 'Solving the Organ Shortage Crisis' explored ways to increase the supply of donor organs to meet the challenge of increasing waiting lists and deaths while awaiting transplantation. While the increasing use of organs previously considered marginal, such as those from expanded criteria donors (ECD) or donors after cardiac death (DCD) has increased the number of transplants from deceased donors, these transplants are often associated with inferior outcomes and higher costs. The need remains for innovative ways to increase both deceased and living donor transplants. In addition to increasing ECD and DCD utilization, increasing use of deceased donors with certain types of infections such as Hepatitis B and C, and increasing use of living donor liver, lung and intestinal transplants may also augment the organ supply. The extent by which donors may be offered incentives for donation, and the practical, ethical and legal implications of compensating organ donors were also debated. The expanded use of nonstandard organs raises potential ethical considerations about appropriate recipient selection, informed consent and concerns that the current regulatory environment discourages and penalizes these efforts.
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Affiliation(s)
- E A Pomfret
- Division of Liver Transplantation and Hepatobiliary Surgery, Lahey Clinic Medical Center, Burlington, MA, USA.
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34
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Ethics in Transplantation: Allotransplantation and Xenotransplantation. KIDNEY TRANSPLANTATION 2008. [PMCID: PMC7152151 DOI: 10.1016/b978-1-4160-3343-1.50043-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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36
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Affiliation(s)
- Gabriel M Danovitch
- Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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37
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Westall GP, Snell GI. Lungs don't grow on trees: the ethics of increasing organ donation rates for transplantation and their relevance to the Asia-Pacific region. Respirology 2007; 12:631-3. [PMID: 17875048 DOI: 10.1111/j.1440-1843.2007.01133.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Cantarovich F, Heguilén R, Filho MA, Duro-Garcia V, Fitzgerald R, Mayrhofer-Reinhartshuber D, Lavitrano ML, Esnault VLM. An international opinion poll of well-educated people regarding awareness and feelings about organ donation for transplantation. Transpl Int 2007; 20:512-8. [PMID: 17355245 DOI: 10.1111/j.1432-2277.2007.00473.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite repeated campaigns promoting transplantation, the high donation refusal rate remains unchanged. We targeted a well-educated population to assess the impact of our current transplantation promoting programs and personal feelings toward new approaches to organ donation. A questionnaire was proposed in five universities to students and university staffs that would have been likely to benefit from previous information campaigns in two South American and three European countries. All of the 2321 people interviewed replied to at least one question. Organ shortage was considered as a serious public health issue. However, there was a widespread ignorance of religious precepts concerning transplantation that contributed to the low acceptance rate of organ sharing after death. Financial rewards for donors or their families remain controversial. There was a general agreement for early educational programs in schools. Most people still consider organ donation as a gift, but many would now agree to readily share body parts after death. This biased population of well-educated people has still little knowledge of organ donation. The negative impact of ignorance surrounding religious precepts and the high acceptance rate of educational programs in schools, justify supporting an intensive international effort in education that should also include Church leaders.
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39
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Gaston RS, Danovitch GM, Epstein RA, Kahn JP, Matas AJ, Schnitzler MA. Must All Living Donor Compensation Be Viewed as Valuable Consideration? Am J Transplant 2007. [DOI: 10.1111/j.1600-6143.2007.01739.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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Prasad GVR, Shukla A, Huang M, D'A Honey RJ, Zaltzman JS. Outcomes of commercial renal transplantation: a Canadian experience. Transplantation 2007; 82:1130-5. [PMID: 17102761 DOI: 10.1097/01.tp.0000241072.03400.11] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Financial compensation in exchange for live kidney donation is prohibited in Canada. However, patients in Canada with end-stage renal disease and without a suitable biologically or emotionally related live donor face substantial waiting times on lists for deceased donor kidneys, and so may therefore choose to acquire organs from a live donor in a procedure performed outside Canada as part of a commercial transaction. METHODS We describe the clinical outcomes in such patients transplanted between 1998 and 2005, managed after their surgery at a single Canadian transplant center. RESULTS Patient and graft survival at three years were significantly worse in this group compared to recipients of live biologically related (P<0.0001) and emotionally related transplants (P<0.01) performed in Canada during this period. A number of different surgical and infectious complications were seen, requiring frequent and often lengthy hospitalization. CONCLUSION Patients considering this method of acquiring live-donated kidneys should be counseled of the inherent risks and possible adverse outcomes including diminished dialysis-free survival.
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Affiliation(s)
- G V Ramesh Prasad
- Division of Nephrology, Department of Medicine, University of Toronto, Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada
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41
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Gaston RS, Danovitch GM, Epstein RA, Kahn JP, Matas AJ, Schnitzler MA. Limiting financial disincentives in live organ donation: a rational solution to the kidney shortage. Am J Transplant 2006; 6:2548-55. [PMID: 16889608 DOI: 10.1111/j.1600-6143.2006.01492.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Availability of kidney transplantation is limited by an inadequate supply of organs, with no apparent remedy on the immediate horizon and increasing reliance on living donors (LDs). While some have advocated financial remuneration to stimulate donation, the National Organ Transplant Act (NOTA) of 1984 expressly forbids the offer of 'valuable consideration.' However, recent developments indicate some fluidity in the definition of valuable consideration while evolving international standards highlight deficiencies (particularly regarding long-term care and follow-up) in the current American system. Recognizing that substantial financial and physical disincentives exist for LDs, we propose a policy change that offers the potential to enhance organ availability as well as address concerns regarding long-term care. Donors assume much greater risk than is widely acknowledged, risk that can be approximated for the purpose of determining appropriate compensation. Our proposal offsets donor risk via a package of specific benefits (life insurance, health insurance and a small amount of cash) to minimize hazard and ensure donor interests are protected after as well as before nephrectomy. It will fund medical follow-up and enable data collection so that long-term risk can be accurately assessed. The proposal should be cost effective with only a small increase in the number of LDs, and the net benefit will become greater if removal of disincentives stimulates even further growth. As importantly, by directly linking compensation to risk, we believe it preserves the essence of kidney donation as a gift, consistent with NOTA and implementable in the United States without altering current legal statutes.
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Affiliation(s)
- R S Gaston
- University of Alabama School of Medicine, Birmingham, Alabama, USA.
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42
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Ghods AJ, Savaj S. Iranian model of paid and regulated living-unrelated kidney donation. Clin J Am Soc Nephrol 2006; 1:1136-45. [PMID: 17699338 DOI: 10.2215/cjn.00700206] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Since the 1980s, many countries have passed legislation prohibiting monetary compensation for organ donation. Organ donation for transplantation has become altruistic worldwide. During the past two decades, advances in immunosuppressive therapy has led to greater success in transplantation and to increased numbers of patients on transplant waiting lists. Unfortunately, the altruistic supply of organs has been less than adequate, and severe organ shortage has resulted in many patient deaths. A number of transplant experts have been convinced that providing financial incentives to organ sources as an alternative to altruistic organ donation needs careful reconsideration. In 1988, a compensated and regulated living-unrelated donor renal transplant program was adopted in Iran. As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was completely eliminated. By the end of 2005, a total of 19,609 renal transplants were performed (3421 from living related, 15,356 from living-unrelated and 823 from deceased donors). In this program, many ethical problems that are associated with paid kidney donation also were prevented. Currently, Iran has no renal transplant waiting lists, and >50% of patients with ESRD in the country are living with a functioning graft. In developed countries, the severe shortage of transplantable kidneys has forced the transplant community to adopt new strategies to expand the kidney donor pool. However, compared with the Iranian model, none of these approaches has the potential to eliminate or even alleviate steadily worsening renal transplant waiting lists.
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Affiliation(s)
- Ahad J Ghods
- Transplantation Unit, Hashemi Nejad Kidney Hospital, Iran University of Medical Sciences, Tehran, Iran.
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43
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Matas AJ. Why We Should Develop a Regulated System of Kidney Sales: A Call for Action!: Table 1. Clin J Am Soc Nephrol 2006; 1:1129-32. [PMID: 17699336 DOI: 10.2215/cjn.02940806] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Arthur J Matas
- University of Minnesota-Surgery, Minneapolis, MN 55455, USA.
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44
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Mark PJ, Baker K, Aguayo C, Sorensen JB. Experience with an organ procurement organization-based non-directed living kidney donation programme. Clin Transplant 2006; 20:427-37. [PMID: 16842517 DOI: 10.1111/j.1399-0012.2006.00501.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The organ procurement organization (OPO)-based non-directed living kidney donation programme was developed to decrease wait times for kidney transplants, and to meet the community's desire for altruistic living donation. Community awareness was encouraged through information about non-directed living kidney donation on the state donor registry Web site, and through the media. The OPO received all inquiries and responded with phone calls, e-mails, printed information, medical/social history questionnaires, interviews, and referrals to the transplant centres. Kidneys were allocated according to the United Network for Organ Sharing (UNOS) wait list for the evaluating transplant centre. Between March 2002 and 23 September 2005, there were 608 inquiries to the OPO about non-directed living kidney donation. In 41 months, 20 transplants occurred with kidneys from non-directed donors. The donor registry and OPO-sponsored publicity led to 578 of the 608 inquiries and 15 of the 20 transplants. OPO screening saved transplant centre resources by ruling out 523 inquiries, referring 76 to transplant centres for complete evaluations. Optional donor/recipient meetings appeared to be beneficial to those participating. OPO-based non-directed living donor programmes can be effective and efficient. Standardization of evaluation, allocation, and follow-up will allow for better data collection and more widespread implementation.
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Affiliation(s)
- Paula J Mark
- Intermountain Donor Services, Liver/Kidney/Pancreas Transplant, LDS Hospital, and Kidney Transplant Program, University of Utah Health Sciences Center, Salt Lake City, UT 84102, USA.
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45
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Abstract
The idea of establishing a market for organs is now the subject of unusual controversy. Proponents emphasize the concept of autonomy; opponents invoke fairness and justice. The controversy, however, has given sparse attention to what it would mean to society and medicine to establish a market in organs and to the intended and unintended consequences of such a practice. This article addresses these issues by exploring the tensions between 'extrinsic' and 'intrinsic' incentives, suggesting that donation might well decline were financial incentives introduced. It also contends that social relationship and social welfare policy would be transformed in negative ways and that a regulated market in organs would be extraordinarily difficult to achieve. Finally, it argues that organ sale would have a highly detrimental affect on medicine as a profession.
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Affiliation(s)
- S M Rothman
- Columbia University-Columbia College of Physicians and Surgeons, New York, New York, USA
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46
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Abstract
The growing shortage of deceased-donor kidneys and the rapid growth in the number of patients with end-stage renal failure aged 65 years and older is impacting the current policies for allocation of allografts. The utilitarian and egalitarian philosophies may clash in times of limited resources. Organ transplantation can be viewed as a microcosm concerning healthcare issues facing an aging population and limited resources. The limited resources in organ transplantation are not merely financial. The limits on supply of deceased-donor organs will force the transplant community to deal with allocation issues before the more general population faces other limits in health care. Our discussions may clarify some of the problems.
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Affiliation(s)
- J J Curtis
- University of Alabama, Birmingham-Medicine, Birmingham, Alabama, USA.
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47
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Current World Literature. Curr Opin Organ Transplant 2006. [DOI: 10.1097/01.mot.0000218938.96009.b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Machnicki G, Seriai L, Schnitzler MA. Economics of transplantation: a review of the literature. Transplant Rev (Orlando) 2006. [DOI: 10.1016/j.trre.2006.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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49
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The commercialization of human organs for transplantation: the current status of the ethical debate. Curr Opin Organ Transplant 2006. [DOI: 10.1097/01.mot.0000218924.04526.a4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Spital A. Increasing the pool of transplantable kidneys through unrelated living donors and living donor paired exchanges. Semin Dial 2006; 18:469-73. [PMID: 16398708 DOI: 10.1111/j.1525-139x.2005.00091.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Renal transplantation is the best therapy for eligible patients with end-stage renal disease (ESRD). Unfortunately the ability to perform this procedure is limited by a severe shortage of transplantable kidneys. One of the most successful approaches to this serious problem has been to expand the pool of living donors. This has been accomplished primarily by lifting restrictions on the use of genetically unrelated volunteers. As a result, acceptable living kidney donors now include individuals who are related to their recipients only through emotional bonds (e.g., spouses) and, at some centers, even people who are not related to their recipients at all. Living donor paired kidney exchanges provide a novel means for increasing further the number of kidneys available for transplantation. Each of these approaches will be reviewed.
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Affiliation(s)
- Aaron Spital
- New York Organ Donor Network, New York, New York 10001, USA.
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