BH, a fifty-eight-year-old retired businessman, is a kidney cancer survivor who has been on dialysis for five years while awaiting a transplant. In an effort to find a potential donor, he rents billboards around Texas advertising his condition. He also registers with a for-profit internet service, kidneymatch.com, which allows people to solicit organs from living donors. This listing costs $295 per month.
RS, a thirty-two-year-old photographer, answers BH's internet posting; the two men chat frequently over the telephone during the course of several months, and eventually RS offers to donate a kidney to BH. RS tells the doctors at Texas Hospital that he wishes to donate a kidney to BH because he wants to "do something meaningful with his life." He explains that he has chosen BH because the two men belong to the same political party, share the same religion, and are both "family-oriented men." BH will not compensate RS for his kidney, an arrangement that would be illegal. However, BH does agree to compensate RS for lost wages. BH also pays for first-class, round-trip airline tickets from New York to Texas and for the two weeks that RS stays in a luxury hotel while undergoing preliminary tests as an outpatient. The total cost to BH is $5,000.
BH's surgeons see no problem with conducting the transplant surgery. After all, both parties are willing and no laws have been broken. However, several professional societies and lobbying groups, including the nonprofit organization responsible for running the waiting lists in BH's community, strongly oppose conducting the transplant under these circumstances. These groups claim BH's advertising and web-based solicitation threaten to undermine the existing system for allocating organs and do a disservice to the thousands of other people patiently waiting for kidneys. They urge government action to prevent other patients in need of transplants from following BH's example.
Should patients be able to solicit organs from the general public? Or do the ethical and public policy considerations raised by the outside groups justify restrictions on such solicitation?
The chronic shortage of transplant organs means that many potential recipients will endure lengthy stays on waiting lists. Those in need of kidneys face the lifestyle limitations of long-term dialysis; those needing livers often die before an organ becomes available. Understandably, these patients and their families are willing to take extreme steps to shorten this delay. Mass advertising, particularly via the internet, offers these individuals the promise of finding a donor within days rather than years.
In the United States, the medical community has already embraced directed organ donation from both living and deceased donors to anyone with whom the donor has a pre-existing emotional relationship. (Other nations, notably Mexico and China, restrict directed donations to family members, reflecting a concern that transplants between donors and recipients who are not related may conceal organ sales.) Once we accept directed donation in principle, distinguishing between genuine friendships and "friendships" developed solely for the purpose of organ donation is impractical. Is it enough that both parties hold the same religious or political values? That they hang out in the same internet chat room? Although BH and RS met on an organ-matching website, they now share a real emotional connection.
The danger of public solicitation is that it may lead to organ misallocation. Currently, organs are allocated so as to maximize the overall survival rate of all individuals in need. Scarce organs aren't "wasted" on those patients who are likely to die anyway, for example. This is a valid concern. If BH were at death's door, he might not be the most appropriate recipient for RS's kidney.
On the other hand, it is possible that some organs acquired through private solicitation would not otherwise be available. If RS cannot donate a kidney specifically to BH, he may choose not to donate to anyone. In addition, it seems likely that the publicity paid for by BH will stimulate organ donation more generally. [End Page 14] Rather than merely reallocating organs to...