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Wednesday, March 7, 2007

Soliciting organ donations undermines fairness of waiting list, surgeon writes

Soliciting organ donations, whether on billboards or on the Internet, raises ethical questions and threatens the fairness of how organs are allocated, Dr. Douglas W. Hanto writes in tomorrow's New England Journal of Medicine.

Organs from deceased donors go to the people at the top of the waiting list maintained by the United Network for Organ Sharing, which is regulated by the federal government. The only exception is made for family members of deceased donors.

But when it comes to living donors who may come forward to give a kidney or part of a liver, there are no policies regulating directed donations, writes Hanto, chief of transplantation at Beth Israel Deaconess Medical Center and professor of surgery at Harvard Medical School.

"We don't have enough organs for everybody," he said in an interview. "I would like to see the system change so those donations are directed to the top of the waiting lists, after family, friends and pre-existing relationships."

Most organs from living donors go to friends or family members, according to UNOS figures, but there are increasing numbers of prospective donors with no relationship to the potential recipient. Between 1996 and 2006, the percentage of living donors without close ties rose from 6.5 percent to 23 percent.

Websites such as Canton-based matchingdonors.com were created to connect people who need transplants with live organ donors. Phone messages seeking comment today were not returned, but on its website, matchingdonors.com says "there are thousands of wonderful, altruistic and compassionate people willing to help a fellow human being. It is our belief that many of the potential donors would have never considered live organ donation if it wasn’t for the increased awareness due to our site."

Hanto urges development of rules to guard against unfair allocation of organs from living donors that will protect donors and recipients alike. He points to a study in Minnesota of altruistic donors, whose desire to donate was unaffected by knowing who would receive their gift compared with their organ going to the person at the top of a waiting list.

Hanto also cites concerns that organs will go to people with more advantages (as shown by their access to the Internet), that the potential for illegal payment is greater without previous close ties, and that recipients might be vulnerable to later demands from donors.

Dr. Francis L. Delmonico, a transplant surgeon at Massachusetts General Hospital, medical director of the New England Organ Bank and past president of UNOS, agrees that solicitation of living donors raises concerns, but he thinks that there is no legal basis to regulate how people find or identify a donor, through matchingdonors.com or other groups.

"It is not for us to tell people how they can make relationships," he said in an interview. "But it is for UNOS and for the transplant centers to exercise some caution."

Transplant centers perform a psychosocial as well as a medical evaluation of any potential donor.

"I would say this has to be done in a more heightened way," Delmonico said about screening. "The risks that are associated with donors that come along under the circumstances of solicitation are greater in having misunderstanding by the donor and misunderstanding as to what is being derived for the recipient."

Hanto does endorse the New England Kidney Exchange, an effort to pair living donations in cases where one potential donor might not be a match for the loved one they hope to help, but that organ can be exchanged for a match with another pair in the same situation who can provide a compatible organ.

"I think that's a terrific idea," he said. "It's not going to solve the whole problem, but it's a great solution."

Posted by Elizabeth Cooney at 07:29 PM
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