Doctors in this week's BMJ debate the issue of selling kidneys.
A regulated system of compensation for living donors may be the solution to the growing shortage of kidneys for transplantation, writes Arthur Matas, Professor of Surgery at the University of Minnesota.
In many areas of the United States the average wait for a transplant from a deceased donor is five years, but in some parts it is as long 10 years. Because of this the annual death rate for suitable transplant candidates has risen from 6.3% in 2001 to 8.1% in 2005.
Current unregulated systems in developing countries only benefit the rich, and provide no long term donor follow-up, or protection for either buyer or seller, he says.
In contrast, Matas argues, a regulated compensation system in the Western world would increase the number of available organs. Such a system would provide strict control and limit harm by allowing every candidate an opportunity for transplant, full donor evaluation, informed consent, long term health follow-up, with payment managed by the government or insurance companies, and the banning of any other commercialisation.
We already compensate people for sperm, ova, surrogate motherhood, and loss of body parts in court cases without any loss of dignity or humanity. Similarly, Matas concludes that we should allow a trial of compensation for living donation to learn if we can increase the number of kidneys while protecting the dignity and humanity of the donors.
But Jeremy Chapman, from the Centre for Transplant and Renal Research in Sydney, argues that this could reduce the supply of all organs.
He believes that the idea of the regulated market is a myth, which could have devastating consequences on the less easily regulated environments of Asia and Africa.
According to Chapman, selling organs does not help lift people out of poverty. In India and Pakistan people sell their kidneys to pay off debts, but they continue to live below the poverty line, and recent data show that 86% report deteriorating health after organ removal.
In addition, he asks, which family member would donate if the government is willing to pay for a kidney? Many would prefer a stranger rather than a family member to take the risk. What's more, if a kidney is worth money before death, then rather than donating, families may demand money for all sorts of organs after death.
The reality of regulated organ purchase will be a reduction in organ donation, and the destruction of kidney, heart, lung, liver, and pancreas transplantation, he concludes.
Professor Jeremy Chapman, Centre for Transplant and Renal Research, University of Sydney, Westmead, Australia.
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