Man who got transplant after ads dies

Most marketing executives can only dream of creating an ad campaign as simple and successful as the one a Houston photographer seeking a liver developed last year.

With a couple of billboards and a Web site, cancer patient Todd Krampitz took his quest around the world. A few weeks and several media appearances later, he received a liver.

Krampitz had a liver transplant in August 2004. On April 20, 32-year-old Krampitz died.

His family has not said publicly if liver cancer played a role in his death. Medical ethicists and transplant officials say they will need time to assess what impact his story will have on public solicitations for organs specifically, and on organ donation in general.

"To see a young person die early, it's tragic no matter how you slice it," Mark D. Fox, MD, PhD, chair of the United Network for Organ Sharing's Ethics Committee said. "If it was from liver cancer, that ought to give us pause about how things unfolded."

Grappling with ad campaigns

Krampitz's efforts were an inspiration to others in need of transplants, and public solicitations are increasingly common on the Internet. A site called MatchingDonors.com contains 151 ads for patients seeking a donated kidney, liver, lung or pancreas.

Another site, "Links for Life," is a jumping-off point to Web pages for 24 people seeking organs.

Those in medicine, though, are concerned that solicitation for directed donations to individuals bypasses the UNOS organ allocation system and waiting list. It has led to accusations that Krampitz and his imitators "cut in line."

"MatchingDonors has certainly changed the landscape," said Dr. Fox, a physician ethicist at the University of Oklahoma College of Medicine in Tulsa. "They highlight some ways in which the system doesn't work, and I'm sympathetic, but the system has to work as a whole -- even if it may not work ideally for each patient."

Medical ethicists are concerned that solicitations could give an unfair edge to photogenic patients or those with the resources or marketing savvy to create a successful advertising campaign. They also worry that it could reduce public trust in the fairness of the organ donation system.

Consequently, transplant organizations are trying to discourage the practice. Last November, UNOS board members adopted a position statement opposing efforts to solicit deceased organ donors for transplant candidates where no personal bond exists.

On Jan. 20, the American Society of Transplant Surgeons followed with a statement warning that solicitations for organs will "undermine the trust and fairness on which the system of organ transplantation depends."

While some criticized these statements for not going far enough, Dr. Fox said advertising is protected by the First Amendment and directed donation is still a legal practice, so it would be hard for UNOS or other medical organizations to impose a ban.

"The challenge is to help the donating public to have a better understanding of the impacts of directed donation on the allocation system and, more importantly, to understand the allocation system itself," Dr. Fox said.

The AMA does not have an official position on public solicitation or directed donation of organs, said Robert Sade, MD, a member of the AMA Council on Ethical and Judicial Affairs and a former member of the UNOS ethics committee.

"Before CEJA reaches a definite position on solicited donations, we would like to see some scientific evidence of the effect of solicited donations on the organ pool," Dr. Sade said.

If there were evidence that solicited donations increased the number of available organs, he said, "it would be hard to argue this is a bad thing," but there would be concerns about fairness if the solicitations had a negative or neutral impact.

Some patients, though, say Web site solicitations can have benefits to people other than the one needing a donation. Krampitz inspired New York City truck driver Sonny Velez to develop his own Web site. Velez didn't receive a liver through the Web site, but his wife said the site introduced him to a support group that helped his recovery after he received a liver through traditional channels in November 2004.

"Sometimes, you want to talk to someone who went through the same things you are going through," Caroline Velez said. "A lot of people don't understand how it's an emotional roller coaster ride as you move up and down the list."

Organ donation up in 2004

Despite the negative publicity Krampitz received, 2004 was a record year for organ donation.

Some believe that Krampitz helped contribute to organ donation records in 2004 by stimulating conversation and "putting a face" on the dire need for donated organs.

But many in the transplant community say that the records are a result of the U.S. Dept. of Health and Human Services' Breakthrough Collaborative that seeks to teach more hospitals about techniques that are used by hospitals with high donation rates.

"There were many conditions that may have led to the increase in organ donation, such as the collaborative," said ASTS President Richard Howard, MD, PhD. "But anything that brings attention to the great shortage of organ donors can only help to increase the numbers."

Dallas surgeon and liver-transplant recipient Phil Berry Jr., MD, who recently finished a three-year term on the U.S. Advisory Committee on Organ Transplantation, echoed these sentiments.

"In looking back, there were some good things and some bad things, but it certainly stimulated discussion," Dr. Berry said." Anything that puts it on the table and lets folks understand the bottom line -- there aren't enough organs -- is certainly a good thing." Dr. Berry said Krampitz showed the transplant community how it could do better and how it should do a better job of convincing people to be organ donors.

"That's what I would remember him for," Dr. Berry said.