Tuesday, March 4, 2008

why you may not just be able to give your kidney to someone in need

From Laura Meckler in the WSJ...

Each year, hundreds of people decide they want to donate a kidney, not because someone they know needs a transplant, but because they want to help and don't care who benefits. But the desire to give can be hard to fulfill because many hospitals won't accept altruistic donors, and there are few resources to help donors navigate their options.

The hospitals' reluctance grows from concerns that these potential donors may be psychologically unstable, likely to change their minds and, perhaps, secretly paid for their kidneys. Given the risks of the surgery, which are small but real, some argue that it makes little sense for a stranger to donate a kidney.

"If someone really wants to help society, they can go work in a soup kitchen, they can join the Peace Corps, they can do a lot of things that don't put their lives at risk or implicate a [transplant] center," says Timothy Pruett, a kidney-transplant surgeon who is president of the United Network for Organ Sharing, which oversees transplantation under a government contract....

I'm sure Dr. Pruett's sentiment is not much use for someone who needs a kidney-- or someone who wants to help.

Advocates of altruistic donation look at the UNOS transplant list -- where nearly 75,000 people are waiting for a kidney -- and argue that the nation needs every willing kidney it can get. Amid pressure to do more transplants, a few hospitals are starting to loosen their policies. A handful of online and other services have also sprung up that help match would-be donors with strangers in need.

But for the most part, such donors find that few hospitals are willing to take them. Garet Hill, a consultant from West Islip, N.Y., decided to help recruit altruistic donors after his 11-year-old daughter received a kidney from her cousin. He has created a matching service called the National Kidney Registry to help potential donors find a hospital that will take their kidney. Up and running for only about two months, the registry has received about 200 inquiries, most of them from people who said they were interested in donating anonymously to anyone who needs it. Of those, about 10 people have sent back follow-up paperwork so that Mr. Hill's group can make inquiries with hospitals.

The group has found that while some hospitals "welcome us with open arms," many aren't interested....

Over the past decade, more than 450 people have become anonymous donors. (Other altruistic donors have sought a stranger out for purposes of donating a kidney, but those numbers aren't tracked.) Many more have begun the process, but have been ruled out on medical or psychological grounds, or changed their minds. It's a tiny sliver of total live organ donors -- out of 6,400 living kidney donors last year, just 68 were anonymous -- but they raise particularly complex questions for both donors and hospitals alike.

The first question for would-be donors is who should receive the organ. They have two options: approach a hospital and offer their kidney to any needy patient, or hunt a worthy recipient on their own -- typically online. Both make transplant surgeons uncomfortable.

For one, the waiting-list system is set up to allocate organs fairly, basically targeting the neediest and best-matched patient first. But allowing people to find donors online gives an advantage to the savviest recipients -- those best able to craft a heart-stirring online plea, and in some cases, those able to pay a Web site's fee....

One way around the ethical dilemma is to give anonymously to someone on the UNOS waiting list...

At hospitals that are starting to allow altruistic donors, part of the incentive is financial, says Russell Wiesner of the Mayo Clinic Transplant Center in Rochester, Minn., which he says has lowered its standards and now takes a variety of donors who might have been nixed before, including altruistic donors. "The almighty dollar speaks loudly," says Dr. Wiesner, a professor of medicine. "Rewards and salaries are linked to how many [transplants] you do and how much money you make for the clinic."...

One of the funny things in this "market" is that only the organ donor is (forced to be) altruistic. And ironically, if they're "too" altruistic, taht may be out-of-bounds as well!


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