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Auditioning for a Kidney

Posted Oct 01 2008 5:07pm
The 7/9/2007 the Chicago Tribune printed an Op-Ed piece by Dr. Timothy Murphy, a professor at a local university where he beat up on Matching Donors. I submitted an Op-Ed piece in response to his article, but I have no idea if it will be published or not.

Here they both are, starting with Dr. Murphy's piece
http://www.chicagotribune.com/news/opinion/chi-oped0709organsjul09,0,2650413.story?coll=chi-newsopinioncommentary-hed

Commentary

Auditioning for a kidney

Transplant policy should be revised so organs go to those most in need, not those with the best appeal for help


By Timothy F. Murphy, professor of philosophy in the biomedical sciences at the University of Illinois College of Medicine at Chicago

July 9, 2007

Dutch television delivered a reality TV show like no other. Producers followed a dying woman as she chose which of three competitors would get one of her kidneys for transplant. The advance details were vague, if only because it was all a hoax: Nobody was dying, and everyone involved was an actor. By way of defense, the producers said they wanted to draw attention to organ shortages.

Finding organs for donation still is an uphill struggle in most countries. In the United States, people do not donate organs and tissues after death in numbers equal to the need. Surprisingly, living organ donors are not always so scarce. For example, since 2000, the number of living people who have given up a kidney for a family member or friend has exceeded the number of people who have been willing to donate kidneys after death.

This inclination to donate to a real, live person--instead of an unknown person on a waiting list somewhere--helps sustain an Internet site that matches living donors with people waiting for organs and tissues. At matchingdonors. com, people waiting for organs and tissues say a bit about themselves and what a transplant would mean to them. In fact, complete strangers do step forward to donate to people whose stories they find compelling. After these donors are screened, surgeons move organs from one body to another, relationships are forged and lives are saved.

Any transplant patient who receives an organ because a living stranger comes forward via the Internet wins the equivalent of a transplantation lottery. But people using the Internet to solicit donors represent only a tiny fraction of the nearly 100,000 people waiting for organs and tissues in this country. This kind of Internet publicity creates an express lane for some patients, to the disadvantage of others. Most people waiting for transplants are invisible to the public as they quietly wait for donations from the dead.

United States transplant policy must move to acknowledge the role the Internet has come to play in direct organ donation. Good-hearted people are using the Internet to search out people who need organs, but this approach does an end run around policies crafted to balance need and availability. To resolve this problem, the government could move to put people in need of a transplant on the Web, at least those willing to go public that way with a picture, a story, and some words of solicitation.

This way, strangers could search the entire catalog of people needing organs, with no one excluded. Yet this approach would ultimately pit transplant patients against one another, with advantages falling to the sympathetic and manipulative. Dubious motives--racism, sexism, ageism--could distort donation decisions as well.

In the name of protecting access for all, another option might be to bar the practice of stranger donation unless the donor surrenders the right to direct where the organs go. Some medical centers already accept stranger donations and treat organs obtained this way as donations from the deceased.

For example, a kidney donated by a stranger goes to the appropriate person at the top of the regional waiting list. This way, nobody jumps the line, and the accidents of fate--one's disease, one's skin color, one's age--don't stand in the way of hope for the organ one needs to stay alive. This option seems reasonable to me, but there may be other options out there that protect access and equity when it comes to sharing all-too-scarce organs. Let's get a discussion under way.

The Dutch public was cool to a television program that treated organ transplantation as reality-show fodder.

In the United States, we should learn from that lesson and reject the idea that one's media appeal ought to decide who gets a lifesaving organ and who does not.

Copyright © 2007, Chicago Tribune
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Here is my response
Internet Kidney Matches: A Donor's Perspective

by Tom Simon

On April 19, I donated a kidney to a woman I met via the website matchingdonors.com. As such, I would like to add my perspective to the thoughts and ideas presented by Dr. Timothy Murphy in his July 9 commentary "Auditioning for a Kidney."

In his piece, Dr. Murphy makes the point that sites such as Matching Donors that allow potential organ recipients to present their cases to the public in hopes of finding a living donor are inherently unfair because they tend to reward the people with the best self-marketing skills rather than with the greatest medical need. He also makes the point that irrational biases such as race, gender, and age may unfairly factor into the donor's decision as to who will be rewarded with the life-saving gift of a vital organ.

When I made the choice to donate a kidney to a stranger, I began the process as a non-directed donor -- meaning I was prepared to let Northwestern Memorial Hospital choose my recipient for me. I immediately began to have misgivings about this approach. What if my kidney wound up inside a registered sex offender or a violent ex-convict? My personal biases were less demographically focused and more lifestyle-based. I was less interested in saving the sickest person I could find, and more interested in saving the life of someone who could make a difference in the world once their health was restored to normal.

I spent some time searching the Matching Donors site until I found the posting of a Chicago woman named Brenda for whom I felt a great deal of empathy. She was young, aspired to have kids, and worked as a domestic violence court victim advocate for the Cook County States Attorneys office. She was also experiencing severe kidney failure combined with complications arising from dialysis. My wife and I discussed the morality of "playing God" and deciding who lives and dies. Finally, I decided to donate my kidney to Brenda for the following reason: if I had let the hospital pick my recipient, I would've hoped that my recipient's personal story be just like Brenda's story. Given that reality, the final decision was easy.

The internet empowers the donor to make his own choice as to whom benefits from the gift of an organ donation. I also feel that as more people take advantage of the internet as a means to match donors and recipients, you will see less donors "chickening out" at the last minute. Being able to put a face and name with your intended recipient creates empathy and accountability – two major deterrents to backing out of this life-saving act moments before surgery.

I see nothing wrong with letting my emotions, preferences, and biases shape my decision regarding who gets my kidney. No one is troubled if I choose to give my other assets (i.e. cash) to people and causes I support. Why do people such as Dr. Murphy short-circuit when I decide to give my kidney to a person I support? Would he police my charitable financial giving with the same zeal that he wishes living organ donations to be regulated?

Dr. Murphy wisely suggested launching a website where all 100,000 needy potential organ recipients in America could put their stories on the web for the public to peruse. I suspect that matchingdonors.com would welcome the opportunity to serve this purpose. The good people at that website (with whom I have no affiliation) recently inked a deal to put 100% of the transplant waiting list of the Commonwealth of the Bahamas on their site. Dr. Murphy lost me, however, when he suggested the alternative of banning the practice of organ donations from strangers that permit the donor to pick a recipient.

The number of individuals currently waiting for a kidney transplant in the United States is nearly 100,000. This year, only about 100 of these individuals will receive kidneys from living strangers -- about half from anonymous living donors and half from people like me who sought out their donors on the internet. The Matching Donors website is responsible for a total of only 47 organ transplants -- hardly a cause for much ethical hand-wringing when lives are being saved by "biased" donors such as me.

I would respectfully recommend that thinkers like Dr. Murphy put some energy into increasing the number of living donors in America rather than scolding and disempowering those of us who stepped up to help.
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