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“Autonomy” doesn’t mean what you think it does, transplant industry

I stopped reading articles claiming to be about the ‘ethics’ of living organ donation long ago, because they all justify the systemic neglect and harm of living donors by citing “patient autonomy”. They conveniently forget that our greater responsibility is not to hurt someone: not if they put themselves in a position to be hurt, and not even if they “consent” to being hurt. It is simply something that an ethical person does not do if it is avoidable. And if it is unavoidable, the obligation is to keep the harm to a bare minimum.

Today I ran across this study by members of the transplant industry, who would, if asked, state that they care very much about donor safety, that they do not, in any way, prioritize the recipient over the living donor.  Yet, their actions in this study, and its conclusion, advocate sending “educators” to would-be recipients’ HOMES and soliciting – oh, er, I mean educating –  their friends and families about why they should donate a kidney to their sick loved one.

 

In case you didn’t connect the dots yourself, here it is: IT IS IMPOSSIBLE TO CLAIM PATIENT AUTONOMY WHEN MEMBERS OF THE TRANSPLANT INDUSTRY ARE ACTING AS KIDNEY BROKERS. 

 

Yes folks, this is brokerage pure and simple. Transplant surgeons and transplant centers don’t get paid unless there’s an organ to transplant. Since deceased donors don’t appear on-demand, what’s a starving hospital to do?

Find more living donors!

And what better way than by exploiting people’s personal relationship under the guise of “education”, spinning a yarn regarding the horror of kidney disease and dialysis while hyping the miracle of transplant. If necessary, sprinkle in some living donor risk minimization, but only if someone asks. Otherwise, avoid that topic completely. All we need to do right now is to convince – er, persuade – er, no I mean EDUCATE – someone into that first blood draw.

After all, once we tell ’em they’re a match, we’ve got ’em hooked.

 

Worst part is, they don’t even have the decency to be ashamed of themselves. They’ve convinced themselves they’re doing the best thing for their patients. Problem is, living donors are patients too.

 

 
Rodrigue JR, Paek MJ, Egbuna O, Waterman AD, Schold JD, Pavlakis M, & Mandelbrot DA (2014). Making House Calls Increases Living Donor Inquiries and Evaluations for Blacks on the Kidney Transplant Waiting List. Transplantation PMID: 24825528

6 replies on ““Autonomy” doesn’t mean what you think it does, transplant industry”

True, what is meant to be a act of Love/Kindness for another human being; is being changed to a step in the industry . Just by concentrating on Saving a life, does not change the obligation of the surgeon, leaders of hospitals and insurance companies[ As well as our government]. Living Kidney Donors[all living donors] are a after thought, a …; etc.
What is being done , where possible to change the lifestyles that are causing this need. Yes some are natural. the majority are lifestyle pure and simple. where are the schools ; in teaching nutrition, medical society changing more to prevention and education areas; Food industry looking at greed/profit over human lives [sugar it seems is everywhere and in all mass produced foods]; Federal government changing some of it’s assistance programs where now Foodstamps can buy candy, sugary caffinated drinks and all lot of items which may not have a ounce of healthy ingredients in it.
Just is important where is the personal responsibility of each person [including myself], in this equation? Every day we make choices. Every choice has a consequence, this choice has numerous ripples that affect all aspects of our lives and society.
Does not a industry know how to spell and look up Ethics in the dictionary?

“What’s a starving hospital to do?”

I wonder whether the transplant industry is pursuing:
1. public awareness of the benefits of posthumous organ donation
2. a switch to an Opt-Out/ Presumed Consent system.

Couldn’t these efforts increase the availability of transplantable organs? I’ve read that Spain has been able to increase its pool of available organs. by one or both methods.

Last time I looked, Spain does have the highest deceased donor organ rate of any country in the world. Unfortunately US transplant centers abandoned the pursuit of deceased donor organs years ago. Living donor organs are:

A. more lucrative financially (for them)

B. are more convenient (surgeons don’t have to get out of bed in the middle of the night to do surgery, or miss their golf game)

C. give surgeons much more autonomy (there are strict rules to deceased donor allocation, not so with living donors. A patient who is a poor candidate for a deceased donor organ could still have a living donor transplant. And the surgeons aren’t obligated to inform either the would-be recipient or the prospective donor that the odds of transplant success are low)

The transplant industry claims that living donor organs are ‘better’ for recipients than deceased donor organs. However, living donor organ transplants only survive a median of 7 years, and 4000 recipients die every year with a functioning graft. Transplants aren’t cures, and the vast majority of recipients will need multiple transplants to achieve a ‘normal’ life span.

Meanwhile, a living donor is physiologically compromised forever (some are psychologically compromised as well). The longer someone lives with one kidney, the more at-risk they are for cardiovascular disease and death, and kidney disease and death. We have no real data on either of these things, because the transplant industry refuses to collect it.

If living donation is so safe, why aren’t they lining up to donate?

Thanks, LDPeopleToo, for your reply. I’m not sure I understand how living donation is more lucrative. Have you discussed that in a previous post?

This is a long, but fascinating document on presumed consent for deceased donors in Ireland (2013). I think it has a broader scope and is more informative about public attitudes (re: deceased donation) than recent news.
http://www.dohc.ie/press/releases/2013/20131121.html

The evaluation and surgery for a living donor garners the hospital and surgeon a bigger profit then that of a deceased donor.

Most US states rely on next-of-kin to approve deceased organ donation, regardless of what the individual previously declared. In recent years, a few states have switched to what is known as ‘first-person consent’ wherein the potential donor’s wishes are what matters, not the next-of-kin’s.

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