Kidney transplant turns doctor into activist

Financial incentives would help curb organ shortages, she says. Others fear backlash against altruistic donations.

By Kevin B. O’Reilly — Posted July 17, 2006

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

In 2004, Sally Satel, MD, was diagnosed with end-stage renal disease. She has no siblings, and friends didn't pan out as potential kidney donors. Eager to avoid dialysis, the psychiatrist and conservative author turned to She even considered a black-market kidney before concluding it was too risky.

After a lead from the Web site fell through, an acquaintance -- Atlantic Monthly writer Virginia Postrel -- heard about the physician's predicament and agreed to donate a kidney.

The March 2006 transplant has so far been a success for recipient and donor, but Dr. Satel hasn't left the issue behind. Instead, she has agitated to improve U.S. organ donation rates.

Dr. Satel has criticized what she sees as an overly timid status quo unwilling to test alternatives such as presumed consent, mandated choice or financial incentives to increase donation rates. But bioethicists and most of the transplant community says such alternatives are unproven and could lead to a backlash that harms overall donation rates.

The reality is both sad and well known. There are more than 92,000 people on the United Network for Organ Sharing waiting list. The list is growing by 5% a year, and 17 of those waiting die every day.

As the organizer of a June conference titled "Buy or Die: Market Mechanisms to Reduce the National Organ Shortage," hosted by the American Enterprise Institute in Washington, D.C., Dr. Satel has used her transplant story and media savvy to bring greater attention to the organ shortage.

She said those who oppose radical changes to the U.S. organ procurement system "fail to see the much larger point of what I did by going to This is an act of desperation. ... [Patients in need of organs] wouldn't have to do that if there were more organs, so it's clear that everything tried so far has failed."

Criticism of recent reports, stances

After her experience, Dr. Satel has dubbed the Institute of Medicine's 300-page May report, Organ Donation: Opportunities for Action as a series of "recommendations for inaction" because it didn't recommend pilot-testing presumed consent, mandated choice or financial incentives as means to increase organ donation. The report recommended working to increase the number of transplantable organs from cardiac deaths.

In principle, the IOM's Committee on Increasing Rates of Organ Donation, which authored the report, does not oppose any of the approaches Dr. Satel and others favor, said James F. Childress, PhD, chair of the committee and director of the Institute for Practical Ethics and Public Life at the University of Virginia. But the risk of a backlash against policies viewed by the public as depriving individuals of choice or putting a price tag on body parts is too great to proceed, he said. "Certain underlying social and cultural conditions" would need to change to allow such policies to be widely acceptable to the public.

Dr. Satel said her preference would be for a purely altruistic system but that "it's not working, and it's only going to get worse," referring to the growth of organs needed, which is annually outpacing the number of organs donated.

"Instead of wringing your hands over it," Dr. Satel said, "how about doing something constructive to get more organs? We're reupholstering the deck chairs on the Titanic."

She assailed the IOM committee's conclusion that it was premature to consider more radical alternatives as "a posture of paralysis. We are at a point where something truly creative has to be done."

In June 2004, the UNOS board of directors said " subverts the equitable allocation of organs for transplantation," though it has since softened its stance in public statements, according to UNOS spokesman Joel Newman.

In a January 2005 statement on the public solicitation of donor organs, the American Society of Transplant Surgeons said "the transplant community should continue to discourage such 'directed donation' and educate the public regarding the current allocation policies and their benefits."

But no one is cutting in line, Dr. Satel argued, because in most cases of public solicitation the living donors are people who would not have donated otherwise. According to UNOS, 87 living donors chose to give an organ to an anonymous recipient in 2005.

At its Annual Meeting last month, the AMA's House of Delegates adopted a Council on Ethical and Judicial Affairs opinion stating that public solicitation of organs is ethical so long as no one on the UNOS waiting list is "unreasonably disadvantaged." The newly adopted opinion also says physicians should resist pressure to participate in transplants they feel are ethically improper.

Other AMA policy calls for pilot-testing several methods for increasing organ donation, including presumed consent, mandated choice and financial incentives.

Back to top


Plan proposes fixed payment to donors

Thousands of kidney recipients have paid for organs from live donors on the international black market, according to Amy Friedman, MD, a kidney and pancreas transplant surgeon at the Yale University School of Medicine who argues that the phenomenon should prompt serious consideration of a legal, regulated U.S. market for organs.

In a March Kidney International article, Dr. Friedman called for a fixed payment of $40,000 to organ donors from a federal agency that would cooperate with the United Network for Organs Sharing in organ allocation.

"It's very clearly ethically controversial," Dr. Friedman said, but notes the example of the repeal of alcohol prohibition, which reduced overall harm by legalizing what some consider an unsavory practice.

"Many individuals in a transplant benefit tangibly, excluding the donor," Dr. Friedman said. "The recipient gains years of life and a better quality of life. The hospital, the administrators, the transplant surgeons, the anesthesiologists all benefit in a tangible manner. Even American taxpayers benefit because we foot the majority of the bill for dialysis."

Dr. Friedman argues that the federal agency paying organ donors could be self-funding, thanks to costs saved on dialysis.

The AMA has policy that calls for pilot-testing several methods for increasing organ donation, including presumed consent, mandated choice and financial incentives.

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn