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Advocacy Ethical Considerations Living Donor Protections

Tissue Ownership Issues Matter to Living Donors

John Moore was diagnosed with hairy-cell luekemia, had his spleen removed and later discovered his doctor had patented his genes and made a cool mint on thier commercialization (This is the very abridged version, clearly). Moore sued and lost in a landmark case in Moore v. The Regents of the University of California wherein it was determined that once tissues (fluids, organs, etc) are detached from a patient, said patient has abdicated ALL rights to those tissues, and like garbage, anyone can pick them up and do with them whatever they choose (again – simplifying, but not so much).

What does this have to do with living organ donation, you may wonder?

Traditionally, the huge majority of living donors have been emotionally, if not biologically, related to their recipients. Their donation has been ‘directed’, meant for a specific recipient and no other. However, with the expansion of paired kidney donation, we’re seeing incompatible pairs (a donor who wants to help a specific recipient but can’t, usually due to blood type and/or HLA mismatch) ‘swapping’ with another pair (if not a chain of pairs) to complete a number of transplants. Because a living donor has no ‘property rights’ over their proffered kidney, they have no authority to determine if A. their organ is being put to good use and/or B. if the kidney their intended recipient is actually receiving is ‘equal’ to theirs.

All of this sounds a bit abstract, so let me put it this way: A brand-new Mercedes and a 20 year old Pinto are both modes of transportation and defined as ‘cars’, yet no one would qualify them as equal.

– A 6/6 HLA match will have a statistically higher success rate than a 3/6 match.
– A 35 year old kidney will, statistically, be of a higher quality than a 60 year old kidney.
– According to SRTR statistics, younger recipients have longer graft survival rates than those 65 and above.

Yet living donors, especially in a ‘paired’ or ‘chain’ situation, have no knowledge of, or control over who will ultimately end up with their kidney, and whose kidney will be transplanted into their original/intended recipient. (Hell, a donor doesn’t even have the right to know if the recipient is on any experimental or otherwise medications that could affect the longevity or success of the transplant)

While the transplant industry has done a superb job of convincing the media and the public that living donors are completely driven by altruism and have no room in their minds or hearts for practical considerations such as this, they’re sorely mistaken. We do, and we should.

An organ is not a ‘gift’, it is a commodity, an object of value to not only the recipient but to the transplant center (surgical fees) and pharmaceutical companies (antirejection meds – $$). Why are the living donors, the originators of this incredible resource, denied any ‘say’ in its use?

There is a flippant perception that if the graft (transplanted organ) fails, it’s no problem to find the would-recipient another one. But where does that leave the living donor? S/he doesn’t get a ‘do over’; they spend the rest of their lives with compromised kidney function and all that it entails, regardless of what befalls the recipient. And despite what the two-kidneyed surgeons want to believe, all living donors have a vested interest in what happens to their kidneys. The courts need to recognize it too.

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