Organ donation is a gift, not a purchase

Published on 18/12/2006 00:13

IN MY last column, I looked at organ harvesting. Away from the alleged situation in China, many people object to the sale of organs, irrespective of their source.

Indeed, the UK legislated in 1989 directly to outlaw the sale of organs from living people. The tradition in the UK has been to value organ donation as a gift: the altruistic act of one person (dead or alive) to offer the chance of life to another. Recent legislation in Scotland, and England and Wales, reinforces the idea that altruism should underpin the provision of organs, placing the authority to decide about donation firmly in the hands of the individuals themselves, or in those closest to them in life where they have not expressed their views.

While altruism drives the UK system, the avoidable loss of life continues to be a matter of concern. While some argue for an opting-out system, others would go further. In some parts of the US, for example, a system of "required request" is in place. This means it is mandatory to ask the relatives of deceased people if they would permit the removal of organs for transplantation where there is a possibility that the organs might be useful, but this strikes many as at best insensitive, and at worst ineffective. Commentators have proposed one way to minimise the difference between supply and demand would be to establish a legal market in human organs.

Earlier this year, for example, two US doctors proposed that the rising demand for human organs, and the apparent failure of existing attempts to increase supply to sufficient levels, coupled with a growing black market in human organs, led to the conclusion that legalisation of organ sales should at least be considered. Their argument was based primarily on the notion that people should be able to control their own bodies, and therefore their own body parts. Many people could benefit from this. For example, the father whose child needs expensive medical treatment, and who is unable to raise the funds otherwise, could sell a kidney: the risks to him are widely regarded as relatively minimal, while the treatment could save his daughter's life.

Equally, selling the organs of a deceased person could help pay for a funeral, and leave a legacy for relatives. Of course, one of the main problems with a market in kidneys is that the rich might benefit at the expense of the poor. Those who cannot afford to purchase an organ are therefore at an unfair disadvantage. For the person providing the organ, the fact that potentially significant sums of money are involved - the US doctors proposed 23,000 for a kidney, and one hospital in China said it could provide a liver for about 50,000 - might be thought to be sufficiently coercive that they would not be making a truly free decision: any control over their body parts would therefore be ephemeral rather than real. Even in a regulated market, the potential for exploitation (of providers and recipients) seems too great for the moment to endorse a market in human organs unreservedly.

Having said this, proposals - from the benign to the troublesome - to modify the system of altruistic donation of organs will continue to surface until sufficient numbers of people register their willingness to become a donor. Although live donation is clinically more successful than cadaveric donation, there are obviously some organs that cannot be taken from a living person but which can be harvested after death. Cadaveric transplantation will still, therefore, be needed. The new legal regimes in the UK give people a real chance to exercise their right to control what happens to their bodies after death, and - if they take advantage of this - they can altruistically save lives.

If all of those who say that they support organ transplantation make their voices heard, at least in the UK, a black market trade in organs would become unnecessary, and organs could be distributed according to need and compatibility, rather than ability to pay or financial need.