Viewpoint / Trade in organs? It's inevitable

By Adina Marx

October 7, 2005

The death of a kidney donor two weeks ago reignited the debate about trade in organs, and put the desperate shortage of organs for transplantation back on the agenda.

Organ transplantation, replacing a sick organ with a healthy one, is the last hope for patients for whom no other alternative is available. The science of medicine has found technical ways to transplant organs, but ethical and legal issues remain open. The most burning issues on the public agenda include organ donation, from live or dead donors; transplantation procedures abroad; calls for blood donation in the context of bone marrow donation; and the financial aspect of the process.

About 1,000 people await organs in Israel, but that figure is not representative. There is also traffic of people traveling abroad to buy organs and have them transplanted overseas.

When looking at transplantation, the question of price is subsumed by the patient's desire to live. When "life" confronts "money," the considerations become shrouded in ethical murk.

Donations from live donors, meaning family, have become accepted practice in Israel, but they do not suffice to meet the need. Also, tremendous pressures are sometimes exerted on family members to accede, which is a problem in and of itself.

As for transplantations from the deceased, many good people carry Adi association cards, allowing their organs to be harvested after death. But more people refuse to join the organization than do join, while the list of people waiting for transplants grows longer from year to year. Organ donation in Israel is so sparse that Israeli organizations cannot swap with peer national organizations abroad that might have suitable organs.

Most countries have outlawed the trade in organs. Today's donors for pay hail mostly from the Third World, most notably China and South America. The upshot is a black market in organs: Rich people are buying organs from poor ones, a development that has ethical and diplomatic considerations. One day, a cry will probably arise that the rich of the West have found a new, gross way to exploit the Third World.

The need to increase the scope of organ harvesting by obtaining the consent of the deceased's relatives led to the formulation of the Organ Donations Bill, which has been under debate for the last two years at a designated parliamentary subcommittee. Now, the proposal is being advanced to the Knesset Labor, Social Affairs and Health Committee.

The bill's stated purpose is to "frustrate trade in organs and act to reduce the shortage in organ donation." It also aims to reduce the distress of donor and patient, and outlaws the trade in, or mediation of, organs.

It does not explain where organs for donation will come from, but it does ban the import and export of organs. The proposal is largely devoted to establishing a national organ donation center that may help with distribution, but does nothing whatsoever to address the chronic deficiency.

The death of the kidney donor may deter potential donors. It is important for doctors to explain all the ramifications of organ donation. Learned consent must be preserved: The donor is not a sick person needing medical care; he or she is a healthy one prepared to undergo invasive and not risk-free surgery for the sake of another person. Blithely assuming all will go well at all times is a recipe for eventual disaster.

Various opinions were presented to the committees discussing organ donation. All were formulated delicately, but clarified beyond any doubt that when altruism fails, there is no choice but to grant a reward to donors.

Whether the donor is rewarded with extra medical insurance, or financial compensation for his loss of work time and expenses, it boils down to money.

Therefore, when a person agrees to donate organs posthumously, or while still alive, under these circumstances, one must not pussy-foot about the name of what is really happening - trade in organs.

We must stand tall, and say it straight: Life supersedes other ideals. We have decided to permit a controlled trade in organs.

The author is the chairperson of the Society for Patients' Rights in Israel.

Copyright © 2005 Haaretz.

This article posted October 22, 2005.