Kidney Donations–Some New Ideas

Tom Mayo and I have already posted some thoughts about organ donation in the US and elsewhere on this blog. I’ve just read two interesting recent articles about the problem with regard to kidney transplants in the US. Currently some 80,000 people are on a waiting list for kidneys, and they generally receive dialysis while they wait. About 16,000 people receive transplants each year. Many come from cadavers, although they tend not to be as useful. (My post from November 2, 2008 was concerned with agreements by living people to donate their organs after their death.) About 4000 people on the list die each year for lack of a suitable kidney to transplant. Both articles focus on donations of one kidney by a living donor, which is now much less of a hardship, thanks to new technology.

Virginia Postrel has written an excellent article in The Atlantic about this issue.

She writes with very understandable passion:

With 300 million people in the United States, the numbers shouldn’t be so daunting. Eighty thousand people wouldn’t even fill the Rose Bowl. Surely we could find enough kidney donors to end the list. But solving that problem demands creativity, daring, and, above all, a sense of urgency—a radical break with the fatalism fostered by dialysis culture. Kidney patients ought to command the kind of outrage that demanded a cure for AIDS. The list doesn’t have to exist. It is a result not of medical necessity or economic constraints but of public ignorance, conscious policy, and complacent institutions. Too many people are suffering unnecessarily.

Postrel explains an ingenious new system, the National Kidney Registry, that creates chains of unmatched donors and potential recipients that should be able to increase the number of transplants, given the current supply of willing donors. (She understands the economics behind such a system, having once helped to write the excellent “Economic Scene” column in The New York Times.) This system supplements the main organization overseeing the transplant of kidneys in the US, the United Network for Organ Sharing, which administers the waiting list. But Postrel thinks a system that pays donors is the best way to enlarge the donor pool. She is aware of the ethical objections to this, and gives a very intelligent response to them. I should mention that Postrel herself gave one of her kidneys to an unrelated acquaintance of hers.

There is another interesting article in a recent New Yorker.

(There is unfortunately only an abstract of the article on the site.) The author, Lisa MacFarquhar, focuses on another organization that is trying to increase the number of donors. It operates a website where potential recipients post descriptions and pictures of themselves, and invites people to donate a kidney to one of them. So in this system individuals can pick a particular person to give a kidney to, though they may choose not to have their identity revealed to the recipient. I found this other new system to be strange and unsettling, somewhat like the old TV show, Queen for a Day. On the other hand, MacFarquhar does a nice job of explaining the motivation of people who are prepared to give a kidney to a complete stranger. (Apparently doctors for a long time regarded such radical altruism with great suspicion.)

Both articles describe how certain creative outsiders have tried to supplement the authorized system for matching donors and recipients of kidneys. Of course, the professionals who run that system deserve tremendous praise for saving as many lives as they do, and for fairly carrying out a morally difficult task. But it seems that everyone who understands that system feels that Postrel’s sense of urgency is legitimate, since thousands of Americans a year are needlessly dying.

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