Public solicitation of organ donors grabs the spotlight

Recent medical ethics-related news stories have taken on a tone that runs disturbingly close to that of the Jerry Springer show.

A man convicted of selling LSD recently donated a kidney to a stranger who advertised his desperate need for an organ on a commercial Web site. The donor later surrendered to sheriff's deputies and is jailed, while still taking medication, for failing to pay a reported $10,000 in child support.

Another man whose medical tests disqualified his potential kidney donation to a stranger is now suing the man in a Wisconsin small claims court for travel expenses and the wages he lost while taking a day off work to speak to the media about the transplant.

Even as the United Network for Organ Sharing is working on a policy to address public solicitation for organ donations, the situation is threatening to spin out of the organization's control.

And experts are starting to wonder whether the organ allocation system will still be able to steer donated organs to those who most need them in a fair and equitable manner.

An Internet-arranged transplant was performed at Denver's Presbyterian/St. Luke's Medical Center by surgeon Igal Kam, MD, who said his first commercially facilitated transplant will also be his last.

"The concern that I have all the time is that commercially arranged transplants will have people going through the back door and exchanging money for organs in the United States," Dr. Kam said. "I am not going to, at this stage, perform any arranged transplants because of these concerns.

"I'm not sure we can play police and get to the bottom of somebody's motivations," he added. "I personally don't want to be related to any connection like this."

Upon learning how the transplant had been arranged, Dr. Kam initially postponed the operation, which was originally scheduled for Oct. 18. The hospital's clinical ethics committee was convened, and the transplant was performed two days later after both the donor and the recipient signed statements that neither was profiting from the transplant.

The hospital also issued a statement that the operation should not be construed as an endorsement of a "commercial donor organization."

Attracting public attention

Robert Sade, MD, of the AMA Council on Ethical and Judicial Affairs and a former member of the UNOS ethics committee, said public solicitation and directed donation -- where the donor or deceased donor's family directs a donated organ to a specific individual -- are not new issues, but they have never attracted so much public attention.

"It's always been low-profile," said Dr. Sade. "The question is, will these public solicitations increase the organ pool or will they -- because of negative publicity -- decrease it?"

The issue received media attention this summer when a Houston man mounted a successful billboard and Internet advertising campaign for a new liver. Several others in need of organs have followed suit and created their own Web sites.

Ethical concerns were heightened last month when MatchingDonors.com, which charges $295 a month to allow people on the organ waiting list to advertise for the organ they need, announced it had arranged its first transplant between strangers from Colorado and Tennessee.

CEJA will present a report on living organ donors to the AMA House of Delegates when it meets in December, said Dr. Sade, who also noted that, according to CEJA policy, paying for organs is unethical, but it is ethical to reimburse living donors for the expenses they incur in the course of making an organ donation.

UNOS spokeswoman Annie Moore said the organization's board of directors is scheduled to address public solicitation at its Nov. 18-19 meeting in Washington, D.C.

UNOS released a statement in June noting its philosophical opposition to MatchingDonors.com, saying it exploits vulnerable populations and "subverts the equitable allocation of organs for transplantation."

"Our primary concern is maintaining equity and public trust in the national transplant system," Moore said. "Any perceived favoritism or differential treatment could weaken public trust and potentially make people less willing to become donors -- which would hurt all transplant patients."

Handing out flyers

Public solicitations do not always involve spending money on billboards and Internet sites.

Nola Breiling, the significant other of Norbert Sebunia, was passing out flyers advertising Sebunia's need for a kidney at the Lions Day Parade in Sussex, Wis.

When she returned home, she received a call from a man who said he wanted to donate one of his kidneys.

Breiling said she and Sebunia agreed to pay the donor for gasoline to drive to Rochester, Minn., where tests would be performed at the Mayo Clinic, plus four days of lost wages and four nights lodging expenses.

Tests showed that the man was an unsuitable donor.

He is now seeking additional compensation, and a Nov. 15 small claims court date in Waukesha County Circuit Court has been set.

Charlie Fiske, founder of Family Inn in Brookline, Mass., a place family members of patients waiting for an organ transplant can stay, sympathizes with those making public solicitations. He did the same thing on behalf of his 11-month-old daughter 22 years ago. But he said the medical community must resolve the ethical issues.

"[Public solicitation] removes organ transplants further away from the medical community and into the hands of public enterprise," he said. "That in itself is neither bad nor good, but it raises ethical questions. It creates an issue of the haves and the have-nots, and the process needs to be transparent.

"The medical community really needs to step up to the plate and ask: Is the system being responsive?" Fiske added.

"If it isn't, people who are facing a death sentence, they'll step outside the system."