WTC: Let Uncle Sam Be a Kidney Dealer, Proposes Surgeon

BOSTON, July 27 -- A federal agency that compensates fairly for kidney procurement could go a long way toward solving the shortage of donor organs, according to a radical proposal put forth by a Minneapolis transplant surgeon.

Arthur Matas, M.D., of the University of Minnesota in Minneapolis, argued at the World Transplant Congress here that a government-run, tightly regulated organ-procurement system would ensure that live organ donors are fairly compensated for their personal sacrifice, get life insurance policies, and receive life-long medical care.

Such a system would also allow the government to ensure that the distribution of organs is equitable and based on medical need rather than on ability to pay, Dr. Matas added.

The need for such a system, he said, is made evident by the long and growing waiting list for donor organs, an annual mortality rate among patients on dialysis up to 20%, and by the growing practice of transplant tourism, in which patients with renal disease (or other conditions) go overseas to get surgery, with the help of specialty travel agencies and middle men who act as organ brokers.

"In 1980 there was a year's wait for a cadaver kidney," Dr. Matas said in a briefing here.

"Currently in the United States, the average wait time is approaching five years, and there were data presented at this meeting showing that for blood type O the average wait time is more than five years, and for blood type B we can't even tell them the wait time," he said. "Of patients put on the list with blood type B in 2000, 50% of them haven't yet been transplanted."

His solution is to encourage donation through financial incentives, now illegal in the United States and in most nations in the world. Implementing such a system would require both a change in social attitudes to the concept of organ sales and in legislation, he acknowledged.

"I've been interested in looking at a regulated system in this country" Dr. Matas said. "You could build into the system protection of the seller or vendor, long-term followup and long-term care [of donors]."

Under his system, the government would pay for the organs, which would be distributed equitably across income categories. Donors would also get a compensation package that would include a combination of cash for expenses, term life insurance, and health insurance, allowing clinicians to follow donors closely and monitor them for problems.

Hans Sollinger, M.D., Ph.D., a professor of surgery and chairman of the division of transplantation at the University of Wisconsin in Madison said that when he first heard about Dr. Matas' proposal, he was skeptical, but he has since become a convert.

"The opinions I have evolved for myself over the past two years are primarily influenced by the continued severe lack of donor organs," Dr. Sollinger said. "As a transplant surgeon I basically see every day, in my own hospital, patients dying because we cannot get organs."

Dr. Sollinger said that he was initially opposed to the idea because it was a foreign concept, and because the transplantation societies he belonged to had policies opposing the idea of commercialization of organs. He is a past president of the American Society of Transplant Surgeons, one of the sponsor organizations of the World Transplant Congress.

But with the emergence of Internet exchange of organs, medical tourism, and the spontaneous growth of a market in organs, "the concept which Dr. Matas has proposed is becoming increasingly appealing to me," Dr. Sollinger said. "Having a system which is controlled and overseen by the government, which allows the donor of a live donor graft to receive appropriate compensation, registration, control of what's happening as far as the quality of the medical care, is a system I believe that has great merits."

The National Organ Transplant Act states that "it shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce." Violation of the act is punishable by up to five years in a prison and fines of up to ,000.

The Transplantation Society, one of the other sponsor organizations of the meeting, has a policy stating that "no transplant surgeon/team shall be involved directly or indirectly in the buying or selling of organs/tissues or in any transplant activity aimed at commercial gain to himself/herself or an associated hospital or institute."

Similarly, the American Society of Transplantation (AST) has a policy statement that says unequivocally that "payment for living organ donation is contrary to the ethical principles of the AST. Furthermore, any social coercion influencing the decision must be minimized."

But when it comes to the issue of compensating the families of deceased donors, the AST is more open, said AST president Jeffrey S. Crippin, M.D., medical director of liver transplantation at Washington University in St. Louis.

"When it gets to financial incentives, they are not appropriate if there's any evidence of coercion, where someone's going to be taken advantage of," he said in an interview. "For example, where some raised the price so high that some of limited means says 'I can't turn this down because it might help my family in a financial pinch' -- that is not appropriate."

However, the ATS supports pilot studies looking into the idea of a system and a financial amount similar to that used to compensate the families of soldiers who die in combat, Dr. Crippin said.