Legal bans on sales could set the odds against patients.

Reuters when reporting on a recent conference on European transplantation policy in Rotterdam, quotes a University of Minnesota transplant surgeon, Dr Arthur Matas, as saying that those who defend legal bans on sales (Europe, North America) "…are sentencing some of our transplantation candidates to death."

The Big Donor Show never touched upon a regulated market in organs but remained within the realm of 'altruistic' donor registration. The stunt aimed to heighten awareness concerning the need for more 'altruistic' donor registrations.

And not without success. After this major publicity stunt took place, fifty thousand donor registration forms were requested. Quite a feat when you compare this number to the entire Dutch donor registration of 2006, a total of 70,000 adults.  Within six weeks from now, the end results of this BNN stunt should be apparent (Volkskrant).

The Dutch government has been spurred to take action as well. Although it is expected that the present Dutch organ registration system (in which the donor is free to register or not) will remain virtually the same, Public Health Minister, Ab Klink (who formerly turned down an invitation to appear on the Big Donor Show and reiterated Education and Culture Minister Ronald Plaskerk's view that the show was "inappropriate and unethical") is seriously exploring other options which are more successful in producing donors (Volkskrant). An example is the Active Donor Registration (ADR), in which if a person fails to respond after having received a number of donor registration notices; this person automatically becomes a donor.

There are twice as many donors in thirteen other European countries, countries in which citizens are automatically registered as donors. In the Netherlands, 1400 people are still waiting for an organ and the waiting time is about four and a half years (BNN Big Donor Show).

Predictions are that the need for kidneys will continue to increase in the future. Certain factors are influential in this development. Kidney transplants have become safer over the years and more kidney failures in the future are expected due to growing levels of diabetes and hypertension (Reuters).

Most of us were taken aback and appalled by the Big Donor Show; relieved to hear at the end of the show that it was just a hoax. But the scary ethical issues on the agenda now are not a hoax. Is a regulated market the answer to the black organ donor market? How much should a kidney cost? Will a regulated market offer 'poor' donors adequate protection?  Or will this market allow the rich (western countries) to exploit the poor (developing countries)?

As Dr Amy Friedman, Associate Professor of Transplant Surgery at Yale Medical School (and author of an article on legalization and the regulation of the sale of human kidneys in Kidney International) said in a radio interview with the American radio station, National Public Radio (NPR), "…this is a very grey area in medicine and it has not yet been fully addressed legally."

14 June 2007

Lesley Thomas, writer and editor, is a regular contributor to Expatica.

[Copyright Expatica 2007]