# Web-arranged transplant



## erickad71 (Oct 21, 2004)

I just saw this, and was wondering what the people here think about transplants and how these should be arranged. What ethical questions does this raise for you? Any opinions? 

I tried to put the link for this in, but it's not working for some reason...so here is the article. Sorry if it's a little long.

*Man Undergoes Web-Arranged Transplant*




_By MELISSA TRUJILLO and LAURA MECKLER, Associated Press Writer_





 DENVER - A Colorado man underwent surgery for a new kidney Wednesday in what was believed to be the first transplant brokered through a commercial Web site _ a transaction that has raised a host of ethical and legal questions.

Presbyterian/St. Luke's Medical Center spokeswoman Stephanie Lewis said the operation on both the donor and recipient was going well.

Bob Hickey, who lives in a mountain town near Vail, had needed a transplant since 1999 because of kidney disease but had grown tired of being on the national waiting list. He met donor Rob Smitty of Chattanooga, Tenn., through MatchingDonors.com, for-profit Web site created in January to match donors and patients for a fee.

"Sitting on a waiting list and hoping for a new kidney for so long, your attention is attracted to anything that might help you," the 58-year-old Hickey said a few hours before the operation.

The transplant had been scheduled for Monday, but doctors called it off at the last moment to look into whether either Hickey or Smitty stood to profit from the arrangement. Both men said no money changed hands for the organ, which would violate federal law.

Ethicists said they still have serious concerns about MatchingDonors.com and the rise in the number of donations from the living.

There are no laws against soliciting an organ donation, but by using the Internet, Hickey bypassed the United Network for Organ Sharing, the nonprofit group that works under government contract to allocate all organs donated from the dead. It doles out organs, in part, according to which patients need them the most.

The network does not oversee the increasing number of live donors, such as Smitty. Last year, there were 6,920 living donors compared with 6,457 dead ones.

University of Pennsylvania bioethicist Arthur Caplan said the first ethical issue raised by Internet donations is financial: Not everyone can afford to pay MatchingDonors.com's fees or donor expenses.

"Those who are better off are going to have access to people as potential donors that the poor or the shy won't have," he said.

Caplan also said the Web site did not highlight potential hazards for donors. "Their job is to make these matches happen," he said. "They're not in the business of trying to discourage anyone or warn them."

MatchingDonors.com, based in Canton, Mass., charges varying fees to post profiles of people looking for live organ donors. The company says all its profits go to maintain the site, and they have no problem waiving their fees.

"If people can't afford it, we get them on it anyway," said Dr. Jeremiah Lowney, the medical director for MatchingDonors.com and a specialist in internal medicine.

Hickey paid the site $295 per month for three months. He is also expected to pick up about $5,000 in transportation costs and other expenses incurred by Smitty. Within three months of posting his profile on the Web site, he received 500 offers for donations.

UNOS came out against MatchingDonors.com in June, saying it "exploits vulnerable populations and subverts the equitable allocation of organs for transplantation." UNOS spokesman Joel Newman said the network is concerned when anyone puts his or her need for an organ above others.

"An organ that becomes available with certain medical characteristics should be offered equally to the people that could benefit from it," he said.

Typically, transplant patients find living donors on their own. Most living donors, though, are family, friends and others who have a personal connection to the patient,

Strangers have occasionally met over the Internet, but the MatchingDonors.com Web site is the first to systematically try to match donors and patients online.

Federal law prohibits the sale of organs, but it does allow payment for living donors' expenses, such as time lost from work or airfare to the hospital.

The Colorado hospital went ahead with the operation after granting what it called a "compassionate exception."

But Mimi Roberson, the hospital's chief executive, insisted that the granting of an exception is not to be construed as an endorsement of MatchingDonors.com and said officials will give greater scrutiny to such arrangements in the future.

"They're allowing me to do something just good for this man," Smitty, a part-time photographer and food distributor, said before the operation. "Maybe they went and found out I don't have a million dollars in the bank somewhere. I feel grateful, privileged to be wearing the shoes I am."

___

Laura Meckler contributed to this story from Washington, D.C.

___

On the Net:

United Network for Organ Sharing: http://www.unos.org 

MatchingDonors: http://www.matchingdonors.com


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## littlemissattitude (Oct 23, 2004)

You know, I'm really not sure what I think about it. If there had been any money, other than expenses, changing hands, such as buying/selling the organ, then I would have a huge problem with it. As it is, I'm of two minds about it. On the one hand, I have a problem with the medical industry's (well, that's what it is) dominance in who they allow on or keep off lists of people waiting for organs. That just smacks of deciding whose lives are more and less valuable, something that really bugs me. On the other hand, opening up the option of people advertising for organs, whether it be on the internet or any other way of advertising, seems to give those with the resources to take out advertisments - the more well-to-do - an advantage over others in obtaining needed organs. The person who can pay for the ads, pay the expenses of the donor, and so forth, gets a better chance of finding a matching donor than someone who has do depend on traditional transplant lists. Which operates as another way of sorting those who need organs by society's criteria of whose lives are more valuable - those with money are, at least in the culture of the United States, seen as intrinsically more valuable than those who are poor.

And that's my very ambivalent two cents' worth.


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## erickad71 (Oct 23, 2004)

Thanks for replying littlemiss. 

I really thought this would get more responses. I'm an organ donor myself...or will be. I'm not sure how they decide who gets to the top of the list, which would be my biggest concern. I'd have to agree with you about money changing hands, I don't think someone should get paid to donate an organ.Although I'm not sure about the person who went this route being able to have a better chance at finding a matching donor. Don't they have a hard time finding donors anyway? It's just when they do, it goes to whoever is at the top of the list? 

Bah, I'm in a hurry this morning and I can't get my thoughts to hold still long enough for me to type them out...  I'll just leave it at that, and hopefully some more people will respond.


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## littlemissattitude (Oct 24, 2004)

From what I've read, there's a certain amount of politics around who gets on or doesn't get on lists for those needing transplants.  "They" (meaning the powers that be in putting the lists together) say that it's the sickest patients who get put on the top of the list.  But then, it isn't necessarily the person at the top of the list who gets the first available organ - it's the person closest to the top that's the closest match to the donor organ.  All that makes sense.

However, then you get the political part.  Some folks try to say that anyone who needs a transplant due to lifestyle choices - alcohol or drug abuse, for example - should not be eligible for transplant.  Some would even say that's true for those who smoke.  They've contributed to their own problems, is the logic, so they shouldn't be given any preference in getting a new organ.  This became a public issue when David Crosby (CSNY) needed a liver transplant due damage done by, I think, hepatitis.  There was a great outcry in the media when he got the transplant that he shouldn't have been eligible due to the fact that he had been a known drug addict.  This, even though he had been clean for a number of years at the time.  And, even though it is his claim that the hepatitis was not caused by drug usage.  There have been other celebrities who have gotten transplants who have been accused of getting first priority because of their fame, or wealthy folks who were said to have gotten an organ because they were able to pay their hospital bills in cash.  And who's to know whether the did get priority because of that?

Personally, I object to the argument that those who have made lifestyle choices in the past should necessarily be excluded from transplant lists.  Certainly, I wouldn't give priority for a liver transplant to an active alcoholic - that would be just silly.  But if someone has overcome their addictive behaviors, who is to say that they should be punished for something they did in the past and are no longer doing?  I'm less tolerant toward the idea of someone getting priority just because they are famous, or just can pay cash for the procedure.  I've never been one who believes that a person is of more intrinsic worth just because they have more money than most people, or more fame.  However, those people shouldn't be given a lower priority because of that, either.

I think that priority should be based strictly on who is in most need of the organ and who is a match to the organ that is available.  It always makes me sad when I see a donation tub in a local business because some family is trying to raise tens or hundreds of thousands of dollars so that a member of the family can be put on a transplant list, as it seems some hospitals will not even consider a person for transplant until they have the money to pay for it, especially when that person is a child.

I think I've probably been rambling here, but I hope I've made at least a bit of sense.  It's an emotional subject, and I tend to get carried away when I start talking, or writing, about it.


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## erickad71 (Oct 24, 2004)

littlemissattitude said:
			
		

> However, then you get the political part. Some folks try to say that anyone who needs a transplant due to lifestyle choices - alcohol or drug abuse, for example - should not be eligible for transplant.


There was a man my husband and I knew who ended up needing a liver transplant. I don't think he was an alcoholic...but he was definitely suffering from a life of steady drinking. He was older, I think he was in his sixties at the time. Needless to say he didn't make it.  



			
				littlemissattitude said:
			
		

> I think I've probably been rambling here, but I hope I've made at least a bit of sense. It's an emotional subject, and I tend to get carried away when I start talking, or writing, about it.


You've not been rambling, at least it made perfect sense to me. I don't think I have anything else to add, you've pretty much summed it up for me too.


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