Ethical Considerations Living Kidney Donor Organ Markets

The Complexities of a Solicited Living Donor

According to various news reports, Dolly Carew posted a profile on a donor-solicitation website. (I’m not naming such website because I think what they do is unethical and I’m not giving them more press. Yes, they charge a fee to the would-be recipients for posting a profile, but that’s not the only reason I find them repulsive). Usually, prospective living kidney donorss scroll through the list of would-be recipients, choosing one to be their beneficiary. Playing God, in other words.

But according to one report, Carew’s sister found Randall on the site’s list of available donors, so he had put himself out there to donate to whoever was willing to have him.

While the details are sketchy (darned privacy and HIPAA laws), a press release from Albert Einstein Medical Center states that Randall was cleared to be a living kidney donor, and offered a chance to donate through a paired donation. Carew and Randall (photo) would be paired with another would-be recipient and prospective donor and the kidneys swapped. Randall’s kidney would be transplanted into the other would-be recipient (a stranger, just as Dolly was a stranger when they hooked up on the website), while the other prospective living donor’s kidney would be transplanted into Dolly. Yes, Carew would still receive a transplant.

While we can’t know exactly why Einstein suggeted this route, kidney swaps and chains in general were created to A. increase the quantity of transplants done and B. improve the quality of transplanted organs. After all, blood type compatibilities prevent transplants from taking place, and HLA matching does affect the longevity of the graft post-transplant. In other words, the better the match, the longer the transplant lasts statistically speaking. Plus, the lower the match, the more anti-rejection meds the recipient must take, which have their own long-term detrimental side effects.

Carew and Randall talked it over and decided not to participate in a paired donation scenario. Randall wanted (and so did Carew), his kidney to be transplanted into her. By now, they had developed a “close relationship” – “bonded”, in their own words, despite his initial willingness to cough up a kidney to just anyone (as evidenced by his registration on the site). Eight days before the scheduled transplant, Einstein Medical Center cancelled the procedure, setting off a firestorm of angry words, speculative news articles and blogs, and really, really uninformed reader comments.

Einstein Medical Center issued the following statement to relevant media outlets:

“Einstein very much wanted to perform a kidney transplant for Dolly Carew and initially offered a paired kidney donation process. In this process, Bob Randall would have been able to donate a kidney through a paired exchange, but Ms. Carew would receive a kidney from a different donor. As he stated, Mr. Randall refused to donate in this way. As we continued the evaluation process, Einstein had reason to believe that Mr. Randall lied during the evaluation process for the donation to Ms. Carew, which precluded him from being her kidney donor. Einstein stands by its decision to postpone Ms. Carew’s transplant surgery. We regret the anguish this situation has caused Ms. Carew and her family, and we are sincere in our desire to help her. It is our hope that she understands we are looking out for her best interests and in no way are discriminating against her, which has been reported.”

Einstein also sent a letter to Bob Randall, which can be read here.

Carew tried another transplant center in the Philly area, but was deniedA previous “Internet connection” transplant in 2007 had resulted in “controversy.”

The public will never know Einstein’s real and detailed reasons for cancelling this surgery. A couple of news articles have hinted (per Carew and Randall) that Randall wasn’t eliminated as a living donor totally, just as Carew’s living donor. I didn’t get that impression at all, but there is always the possibility they are in possession of facts I am not privy to.

That being said, Carew is the single mother of a 9 year old daugther, and multiple articles stated the growing closeness of Randall with that child. An astute commenter revealed that Randall has a history of bad business practices on Ebay, but more importantly is a registered sex offender in Indiana. Could this be the “lie” or “compromising position” Einstein referred to in their missives? If so, the entire drama might’ve been prevented if Randall and Carew had remained strangers, or if Randall had agreed to the Paired Donation in the first place.

PS. The pair has found a hospital in Denver willing to perform the transplant, but Carew doesn’t have the money to make it happen so far from home.

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