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9.19.08 Issue #341 Forward This Newsletter To A Colleague

Risa Pollack-Simon
CMC
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The Organ Shortage Crises: Part III
A Humanitarian Dilemma

In Part I and Part II of this series we discussed the organ shortage, living organ donation and kidney transplantation. To conclude this three-part series, we will explore a unique donor exchange process called paired donation, which offers incompatible donors an alternative way to donate to their loved ones.

Paired Donation

One of the most common challenges for living donors is that they find they are not a compatible match for their intended recipients’ blood type. Incompatibility discoveries can be heartbreaking for a donor who desperately wants to give. It can also be extremely disappointing for the recipient in need, who was deeply moved by the donor’s bequest.

Yet now, through computer-assisted technology, a “search and match” process called paired donationcan provide an incompatible donor the opportunity to give indirectly, through an exchange process. The paired donation database cross-matches incompatible donor/recipients with other incompatible donor/recipients, with the goal of finding more suitable “fits” for all registered participants. 1, 2

This brilliant pay-it-forward process allows a willing but incompatible donor to give a kidney to a stranger, so that another willing but incompatible donor (someone he/she has never met) can offer (in exchange) a more suitably matched kidney for the intended recipient. In the end, each donor has an opportunity to impact the lives of at least two people: the unknown recipient and the intended recipient. Ultimately, a paired exchange can impact several lives, particularly when an altruistic donor (a person who doesn’t require an exchange, but is still willing to give a kidney to anyone in need) is added to a grouping. This creates a Never-Ending Altruistic Donor (NEAD) chain. 3

For some time, though, a good number of hospitals would not perform transplants through paired donation for fear of violating the valuable consideration clause in the National Organ Transplant Act, until dentist-congressman Charlie Norwood said that this fear was “hogwash” and that it made “common sense” to save lives through this opportunity. 4

Norwood stayed the course on this belief even while battling a severe case of lung cancer that subsequently took his life on February 13, 2007 after spreading to his liver. Auspiciously, Norwood wrote his last dying wish in a letter to Congress, asking it to make the paired donation bill he introduced with Congressman Jay Inslee a law. Congressman Inslee was also a strong champion of kidney care issues; his mother Adele, who battled complications from kidney disease, died only two weeks after Norwood. 4

On February 14, 2007 (the day after Norwood died), Congress quickly responded to Norwood’s wish by passing the bill unanimously. This led the U.S. House of Representatives to pass its own paired kidney donation bill, known as HR 710, which also passed unanimously by a vote of 422-0.4 President Bush then signed that bill into law on December 21, 2007.

Can I Be Compensated for My Gift?

The National Organ Transplant Act (NOTA), enacted back in 1984, makes it unlawful to knowingly acquire, receive or otherwise transfer any human organ for valuable consideration. The strongest argument in favor of permitting the sale of human organs is that it would generate an increased supply of a scarce and lifesaving resource.

Some proponents argue that, like bomb disposal experts and fire fighters who are paid for their life-threatening work, people who choose to risk their lives by contributing organs for the well-being of others should also be compensated.6 Furthermore, because hospitals, doctors, laboratories and pharmaceutical companies are charging top dollar for transplantation-related products and services, the person donating the organ that enables the surgery in the first place should theoretically be at the top of the ethical financial consideration chain. As it stands currently, reasonable payments for non-reimbursed expenses (i.e.; travel, housing and lost wages) are the only considerations allowed.

Just Say Yes

Saying yes to donation on your driver’s license is a terrific start. However, discussing your wishes with family members and formally registering your wishes on a donor registry (www.donatelife.net)7 is the best way to secure that your wishes will be carried out when you are deceased.

For people who find the notion of being a “Good Samaritan Donor” more appealing now (while they are still living), paired donation networks eagerly stand by to help potential donors better understand the process before they decide to move forward. 1,2,3 And, although it may be difficult to truly comprehend how someone could willingly donate to a person he/she barely knows (or perhaps has never met), no one argues that this honorable calling is, by far, one of the most selfless acts of human kindness a living legacy has to offer.

References:

1. Alliance for Paired Donation (APD). www.paireddonation.org/donor-info.htm
2. National Kidney Registry. www.nationalkidenyregistry.org
3. www.thenead.com
4. Schall, John A. Congress Passes Legislation on Paired Kidney Donations. American Association of Kidney Patients. www.aakp.org
5. Kidney Exchange: A Life-Saving Application of Matching Theory. National Science Foundation. Discovery. http://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=104404
6. Shapiro, Robyn. S. Legal Issue in Payment of Living Donors for Solid Organs. American Bar Association. Spring 2003.
7. www.donatelife.net
Risa Simon is a certified management consultant, professional speaker and published author who inherited a rare cystic kidney condition that has positioned her among the many in need of a kidney transplant. After observing family members and friends with PKD struggle with dialysis and unrealistic waitlists (and started to experience her own challenges in trying to find a compatible donor), she decided to join a movement to increase awareness in the humanitarian call for “living” and “paired” donation. For more information contact risasimon@cox.net.

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