In the United States a shortage of organs is leading patients to look for donors among immigrants and foreigners, the Washington Post reported March 3. "As a percentage, every year, U.S. citizens receive more organs than they donate," said Anne Paschke, a spokeswoman for the United Network for Organ Sharing, which links donors with recipients nationwide.
In 2001, U.S. citizens received 96.2% of the transplants in the country, Paschke said. By contrast, 94.8% of the organ donors were citizens. The rest were permanent residents, nonresident foreigners and others, she said. That trend has been constant for more than a decade.
One suggestion, made at a conference of organ-donation experts held in Florida last month, would be to take organs from all those who die and had signed donor cards, even if their families are opposed, the Associated Press reported May 27. Currently, family members have the final say about possible organ donations of dead relatives. And just half of relatives agree to the donations.
"I strongly believe in an individual's right to donate. That right shouldn't be taken away because the family doesn't agree," said Dr. Robert Metzger, the medical director of the organ bank in Orlando, who helped organize the meeting.
In Spain, recent data show an increase in organ donations, the newspaper ABC reported June 5. Last year there were 34 donations per million inhabitants. Yet 856 possible donors were ruled out in 2002 because relatives wouldn't give permission for the organ removal.
The country now has 4,797 people waiting for organ donations of various types; 3,933 of them are waiting for a kidney. The average waiting time to receive a transplant is from one to five months. In the United States, by contrast, 81,100 patients wait for up to three years for an organ, ABC reported.
To remedy the shortage of organ donations some are proposing introducing payments. Nadey Hakim, head of the transplant unit at St. Mary's Hospital, west London, and president of the Royal Society of Medicine's transplant section, said that laws should be changed to make it legal to buy and sell organs, the Telegraph reported May 21. Nearly 5,500 people are waiting for a kidney transplant in Britain, but only about 1,700 operations were carried out last year.
In a BBC radio interview, Hakim explained that as a result of the long waits, people were traveling abroad to buy organs and undergo the surgery. "As this trade is going on anyway, why not have a controlled trade where if someone wants to donate a kidney for a particular price, that would be acceptable?" he asked.
But Dr. Peter Rowe, chairman of the ethics committee of the British Transplantation Society, and Dr. Vivienne Nathanson, head of science and ethics at the British Medical Association, reacted negatively to the suggestion. "We are horrified," said Rowe. "Professor Hakim is out on a limb. The majority of opinion is against payment because it leads to exploitation of the weaker members of society."
In the United States there are also calls for commercial trade in organs. The Associated Press reported on June 1 that a Pittsburgh-based coalition of transplant surgeons, academics and activists sent a letter to 40 U.S. senators and congressmen. They want a 1984 law prohibiting financial incentives for organ donations to be rewritten to allow a project that would award $5,000 to families who authorize a deceased relative's organs to be used for transplantation.
The Virginia-based United Network for Organ Sharing says more than 6,000 people died last year waiting for organs. Both United Network for Organ Sharing -- the nonprofit organization that administers the nation's organ procurement network -- and the American Medical Association have called for studies of financial incentives for organ donations.
The ethical debate
Dr. Leon Kass, who chairs the President's Council on Bioethics, addressed the matter of paying for organs in his recently published collection of essays, "Life, Liberty and the Defense of Dignity." Kass sees a positive side to the idea, since it would alleviate the unmet need for organs.
But there are also problems. Kass asks what type of principles should govern a commercial trade in organs. Should it be the viewpoint of the economist, dominated by rational rules following a utilitarian ethic? Should we adopt the viewpoint of the libertarian, not putting limits on individual autonomy? Should we follow a moralist's position and defend the vulnerable, giving weight to considerations of the exploitation or degradation of people, and the question of ensuring free consent?
Organ donation also runs up against some objections regarding bodily dignity, observes Kass. Regarding living donors, there is a presumption against self-mutilation, even when good can come of it. Donations from cadavers, on the other hand, runs against our respect for the integrity of a corpse, and our desire to honor the dead.
Commercial trade in organs also opens up the question of poorer people selling bodily parts to meet financial needs, to the benefit of the well-off. To a limited extent this already happens, but making payments legal could greatly extend the scope for exploitation.
Catholic moralist Germain Grisez, in the second volume of his treatise on moral theology "The Way of the Lord Jesus Christ," observes that the donation of body parts after our death is permissible. Donations from living people, on the other hand, must not harm the donor or put him at undue risk. Donation can be right "when it only entails a moderate risk of future detriment to function," Grisez writes. For example, donating a kidney can generally be acceptable. Other donations, such as blood, which does no harm to the donor and involves very little risk, is not only licit but even desirable.
Church doctrine leaves the question of organ donation up to the individual. In his encyclical "Evangelium Vitae," John Paul II talks of an authentic culture of life that can be built up by each person. In No. 86 he writes: "A particularly praiseworthy example of such gestures is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope."
Leaving people to die a slow death as they wait in vain for organs is not an attractive prospect. Yet, a commercial trade in organs opens up many unresolved questions. Clearly, further debate on this matter is needed. But a good start would be to encourage more voluntary donations.