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Essentials of Health Care Marketing, Fifth EditionEric N. Berkowitz
The Ethics of Donor TransplantsEach year in the United States, there is a significant wait list for donors for heart, liver, and kidney transplants. Many states have allowed individuals to indicate whether they would be willing donors should it be necessary if they were in a tragic automobile accident, and thus have such an indication for donation identified on their driver’s license. In fact, in some countries, research has indicated whether it is best to ask for individuals for such a donation or indicate the person is a donor unless they want to deny consent as a way to increase the donor pool of available eligible transplants. The table below lists the wait time for some of the major transplant body parts in the U.S.
Body Part Wait time in the U.S. Source
Kidney 5 years https://www.kidneyfund.org/kidney-disease/kidney-failure/treatment-of-kidney-failure /kidney-transplant/transplant-waitlist/
Heart 1.9 to 2.6 months of patients with greatest severity
Goldstein BA, Thomas L, Zaroff JG, Nguyen J, Menza R, Khush KK. Assessment of Heart Transplant Waitlist Time and Pre- and Post-transplant Failure: A Mixed Methods Approach. Epidemiology. 2016;27(4):469–476. doi:10.1097/EDE.0000000000000472
Liver 321 days https://columbiasurgery.org/liver/liver-transplant-waiting-list
This issue is a complex, religious, ethical, and moral question for many people. However, for those in need of a body part, it is a life- saving question. In the United States, the selling of a body part has been illegal for decades. However, body parts are available through rather unsavory sources in many overseas countries. That said, the deceased Pope John II had noted that the selling of any body part was a “vio-lation of the dignity of the human person.” In a 2005 meeting of the American Transplantation Congress, a surgeon noting the rapid rise in wait time had actually proposed to the Congress a regulated system of live kidney donor sales. This system would contain regulatory and insurance incentives to safeguard the potential exploitation and ethical concerns along with careful donor medical and psychosocial evalua-tions, a fixed tax-free payment to the donor, and an option of short- or long-term health and life insurance. The transplant surgeon equated this approach to the same situation that was occurring with the uterine rental by surrogate mothers that was legal within the United States.1
In 2015, more than 123,000 individuals were waiting for a transplant involving some body part. Forbes magazine actually had an article entitled “Let people sell their organs,” which ran in December of that same year. The article noted that on the black market, a kidney can sell for almost $160,000.2 Finally, in a short article that appeared in the Journal of Medical Ethics, two authors observed that there is an actual hypocrisy in the argument against the selling of body parts from live donors as opposed to harvesting organs from cadavers. Everyone involved in the transplant process receives a benefit—the surgeons and assist team are all compensated for being involved in the important process. Most importantly, the recipient of the transplant receives the greatest benefit of all, the organ. However, the donor gets no benefit (although one of course can say there is a psychological benefit of giving someone a valued organ). There are often many fine stories of a person meeting a grateful recipient after the fact. (https://www.youtube.com/watch?v=zpiZHs5ZPWo) These authors called on a strictly regulated market but also highlighted the more positive benefits of live organ donors for outcomes.3
Recently, the head of the transplant team has asked you to develop a proposal to actually present to the health system that will propose a major new initiative to the Transplant Society in Nephrology on again revisiting this issue as the wait time for transplants has increased for pediatric patients as well as for adults. In doing so, he suggests as a first step, you should prepare slides for a full discussion to the annual medical meeting. She has asked that you address the pros and cons of this issue, as you and she are aware the health system’s medical ethicist is a serious and helpful person. In addition to outlining your slides, suggest how you might plan your strategy to present this pro-posal to the health system as well as moving forward to approaching the legislature and publicly, given the emotional nature of this issue.
1 Eli A. Friedman, “Stressful ethical issues in uremia therapy”, Long Island College Hospital Conference, “May 30, 2008), Brooklyn, New York2 Abigail Hall, : Let People Sell Their Organs,” Forbes (December 14, 2015), https://www.forbes.com/sites/realspin/2015/12/14/sell-organs/#3d24
fb4126e43 Charles A. Erin and James Harris, “An ethical market in human organs,” Journal of Medical Ethics (2009), Vol. 29, pp. 139-140
Should There Be the Marketing of Body Parts?CASE STUDY
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