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Ethical Considerations Living Donor Misinformation Organ Markets

Treating Living Donor like Organ Incubators is Unethical

Once again, the conservative American Enterprise Institute criticizes the U.S. for not allowing legalized organ sales, even though the World Health Organization and every global health initiative has condemned the practice. If this wasn’t such a serious topic, this transparent blog post would be laughable, but seeing as some people will actually think their opinion has validity, it’s my responsibility to offer a counter-perspective.

Read the entire post here.

Each year, this misguided and wrongheaded public policy takes the lives of nearly 5,000 Americans with end-stage renal disease

and

…the backlog of approximately 83,000 people waiting for their turn to receive a donated kidney

I’m tackling both these statements simultaneously because they originate from the same faulty data. According to UNOS/OPTN, there are approximately 83,000 folks in the U.S. waiting for a kidney, and 5000 die each year waiting for one. However, as has been discussed ad nauseum on this blog, 1/3 of those people are ‘inactive’, ie ineligible to receive an organ even if one becomes available. Delmonico and McBride’s recent analysis indicated that 52% of the deaths occuring on the waitlist are inactive too. This alone reduces the yearly ‘death toll’ to 2500. Add in the fact that nearly 20% of those on the waitlist decide for themselves to stop treatment (dialysis), usually due to advancing age, and co-morbid diseases or health problems. After all, the average age of end-stage renal disease onset is 64.5.

Then the question becomes – how many the remaining people have already had one transplant? They’re not cures, remember, but just another form of treatment. The vast majority of recipients will need multiple transplants to achieve a ‘normal’ life span. And, of those approximately 1600 per year who die, how many of them would’ve actually been helped by a transplant? The authors of this blog post certainly don’t know; they’ve found it more effective to use half-truths and scare tactics to encourage a practice which has proven nothing but hazardous to the kidney donor.

Which brings me to:

In the case of kidney transplantation, the donor is subject to relatively little post-surgical risk. Statistically, a kidney donor fares no worse throughout his or her life than a person with both kidneys. Life insurance companies impose no rating on premiums for kidney donors because, actuarially, they represent no greater risk to the insurer.

In a word – bullshit. Approximately 2 living donors die in the U.S. every year as a direct result of the procedure (within 90 days). Many others suffer permanent debilitating physical complications and still more experience depression, anxiety, anger and PTSD symptoms. The only reason the authors use the phrase “little risk” with a straight face is because the transplant industry has failed to track/follow and study living donors in a comprehensive manner. The existing data far under-estimates the short-term risks to living donors, exacerbated by UNOS and ACOT’s acknowledgement that follow-up is spotty at best and non-existent at worst. Long-term data simply doesn’t exist at all.

What is known is that since 1993, nearly 300 living kidney donors have registered on the wait list in need of their own transplant. We also know, from a couple of recent studies that the average time from donation to end-stage renal disease is 13-20 years. We also know, not from studies on living donors, but from research on people who have undergone a nephrectomy for medical reasons, that having a single kidney increases one’s risk for kidney failure (duh) and cardiovasular disease and death.

And btw, some living donors HAVE been unable to get health insurance for having a pre-existing condition. Try a websearch, the articles are plentiful.

Organ transplantation provides a wonderful example of life-saving science…

A kidney is not a life-saver, not in the sense of a heart or lung. People with ESRD have other treatment options. A heart or liver patient does not.

Then, of course, there is the recipient who is, perhaps, compensated best of all. He or she gets his or her life back.

Faulty logic. Not every recipient experiences an increased quality of life. Some die, some actually fare worse with a transplant than on dialysis. Also, anti-rejection medications have their own long-term side effects, including increased risk of malignancy and cancer.

A more serious consequence of this flawed policy is that it costs thousands of lives annually, and consigns thousands of other people to years of expensive dialysis, the bill for which goes to taxpayers.

Not every person with ESRD is on Medicare, which is what the authors are referring to. Some are on private insurance. Also, not every person who undergoes a transplant was on dialysis prior to the transplant, in which case, there is no ‘savings’ to the government or the American taxpayer.

What the authors are also forgetting is that currently, Medicare only pays for 3 years of anti-rejection medications. The recipient is then responsible for the costs of the drugs that will keep the transplanted organ from being rejected. What kind of savings are the American people and the government seeing if a significant percentage of these recipients can’t afford their meds, stop taking them, experience acute rejection and again end up on dialysis? Nothing.

Yes, some might be poor, but what is wrong with a poor person receiving compensation for performing a noble deed?

Every study published on organ sales (legalized or not) has emerged with the same result: kidney vendors (those who sell a kidney) fare worse after the procedure. Their debt is not eliminated, their quality of life suffers and so does their health. To ignore this damning and unequivocal data, as these authors have done, is the most blatant example of their true intentions, which is not repairing a broken system.

AEI, including Sally Satel and Harold Gershowitz are exhibiting the worst trait of recipients, which is a overwhelming sense of entitlement. To some, the fact Gershowitz took a kidney from his own daughter exposes his lack of empathy and parental duty toward her by risking her life and permanently compromising her physiology. If any of these authors were really concerned about alleviating the organ shortage, they’d advocate the improvement of the deceased organ system by mirroring what Spain and other European countries have accomplished and insist on increased quality of matches to incease graft survival rate.

But these authors and their ilk don’t want to wait with the unwashed massed on a national wait list for a deceased organ. Instead, they want the U.S. to emulate Iran and Pakistan and pay to have a living donor kidney at their disposal whenever they want/need one. Their stance is that the living donor is capable of deciding if s/he wishes to sell an organ. Ironically, these same libertarians want the government to foot the bill.

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