Web-based kidney match raises ethics questions

Mass firm's site a link for patient

By Scott Allen, Globe Staff

October 20, 2004

Kidney patient Bob Hickey (left), with Internet donor Rob Smitty. Smitty says he donated a kidney to a total stranger because he wanted to do "something big," and says he did not get paid for it. (AP Photo)

A Colorado man who placed a "transplant wanted" ad on a Massachusetts-based Internet site is expected today to receive a kidney donated by a total stranger who simply wanted to do "something big." The transaction marks the first time an organ transplant has been brokered by a commercial web company.

Officials at Presbyterian/St. Luke's Medical Center in Denver had delayed Bob Hickey's transplant operation on Monday after the lead transplant surgeon raised ethical concerns about the way Hickey met his donor: paying $295 a month to post his story on a website, MatchingDonors.com.

The private agency that manages the nation's organ supply opposes MatchingDonors, charging that the fee-based service undermines the fairness of organ distribution, which is now based on who is sickest and who has waited the longest. Hickey said the surgeon, Dr. Igal Kam, suggested to him that he had paid Rob Smitty to donate his kidney, which would violate federal law against selling human body parts. Smitty denied there was any payment.

Late yesterday afternoon, hospital officials said in a statement that the hospital's ethics committee had decided to make a "compassionate exception" to allow the transplant to go forward, as long as Hickey and Smitty sign a statement attesting that they are not profiting from the donation.

The hospital's CEO, Mimi Roberson, said the hospital acted out of concern for the two men, "but it's also important to note that organ donations continue to be the topic of a broader national debate and more answers are needed."

The decision ends Hickey's five-year wait for a kidney and ushers in a new way to ease an organ shortage so severe that 7,000 people die awaiting transplants each year.

"This could be the start of something very, very big," said Dr. Jeremiah Lowney, a Hyde Park internal medicine specialist who co-founded MatchingDonors.com along with a patient earlier this year. "People who are interested in becoming organ donors can go there and look around, and people who need transplants now have a place to tell their stories."

The website is attempting to fill a gap in the nation's organ distribution system, providing a potential clearinghouse for transplant patients to connect with altruistic strangers who are willing to donate kidneys, livers, and other organs. Although living organ donations are the fastest growing source of transplant organs, most donations come from family members or close friends because there is no system for patients to contact strangers who might agree to donate.

MatchingDonors.com touches on two of the most sensitive issues in the field of organ transplantation: the use of money to encourage organ donations and the wisdom of encouraging healthy people to risk their health to donate organs to people other than immediate family members. Medical ethicists fear that encouraging people to donate organs to strangers increases the risk of payoffs for organs or the exploitation of donors who are not psychologically stable. They note that donors face a small but real risk of death or disability.

Leaders of the United Network for Organ Sharing, which manages the national organ waiting list, passed a resolution in June saying the website's concept "exploits vulnerable populations," including donors and patients alike.

George Annas, a medical ethicist at Boston University, said he understands the nervousness about anything that could commercialize the organ transplant business, giving the wealthy an unfair advantage while tempting others to sell body parts. But he also pointed out that, until now, UNOS has done little to recruit living donors, leaving it to each patient to find a donor.

Annas said MatchingDonors.com is addressing a legitimate issue, but he stressed that the nation's transplant centers and UNOS need to be part of any larger system to bring strangers together for organ donation.

"As a little pilot project, it's hard to argue with this, but it certainly shouldn't be seen as much bigger than this," said Annas.

Lowney said he and website cofounder Paul Dooley simply wanted to help people who now have little hope of getting a transplant before organ failure kills them. He noted that surgical technique is so advanced that the vast majority of living donors recover fully and return to normal lives -- roughly three in 10,000 living kidney donors die as a result of the surgery. However, he said, many people don't know that living donation is even possible, let alone how to find someone who needs their donation.

"The last thing we wanted was to take on some [political fight]. We wanted to do something good," said Lowney.

On the Web page, which went up earlier this year, Lowney said fewer than 20 patients so far have registered to make their case for an organ transplant. Although the fee to post a profile is $295 a month, Lowney said about half of them were allowed to list for free because they couldn't afford the price. Meanwhile, about 170 potential donors have registered at the site and thousands more apparently read the patient profiles.

Hickey, a 58-year-old former chief executive of a health care company, said in an interview that he had nearly given up hope of finding a kidney donor before he found out about MatchingDonors. He paid to register with the site for four months, describing in his posting the way he lost one kidney to cancer six years ago and how he requires constant dialysis because his remaining kidney has failed.

In response to his listing, Hickey said, he received 500 serious responses at his MatchingDonors mailbox, including 50 from people who matched his body and blood type. One of those was Smitty, a 32-year-old meat distributor and sometime photographer from Chattanooga, Tenn.

"I just want to do some good in society, something big that I can look back on and be proud of," Smitty said. Hickey said he paid Smitty only for airfare to Denver for the surgery, as well as hotel accommodations and compensation for the two weeks' pay Smitty will lose while he recovers, payments allowed under federal law. Hickey's health insurance will cover Smitty's medical costs.

Scott Allen can be reached at allen@globe.com.

Copyright © 2004 Globe Newspaper Company.

This article posted November 16, 2004.