Wednesday, October 20, 2004

May I have your liver?

Organ donation has been in the news again. There is a web site that lets people post their stories and requests for organs. Obviously, there is a fee involved($250/month). One person responded to the web site ad and offered to donate his kidney to the rich guy who needed it. The transplant surgeon refused to do it because of ethical issues.

Background info: a nationwide network exists to coordinate transplants. It is a private corporation, with govt. funding. The nation is divided into regions, and each region has its own list of needy patients, listed by who is the sickest on down. Most never get an organ, because the need is greater than the supply. Obviously for heart and lungs(and usually liver) the donor is dead. The family can request that the organs go to a certain person, but not to a certain group(no discrimination). Kidneys can be donated by living people, because we only need one. It is not unusual for a relative to donate a kidney, and in fact is usually preferable(the closer the better) because of rejection issues.

Question: is it ethical(moral, right, pick your word, Halachic) for the rich guy to be able to advertise and get his kidney before the other folks on the list, in other words, get preferential treatment because he can pay for it? or should the person donating the kidney be informed that he should give it to the person(who matches) at the top of the list.

Other facts:In the USA, you cannot be paid to donate an organ, but your expenses are covered. You cannot be paid to donate the organs of your loved one if they are brain dead. Kidney donation at the present is encouraged by most major poskim that I have read(a very interesting study in how the psak, but not the principles involved, changed over time in response to changes in the safety of the procedure).

My approach: The bottom line is whether it is better to have a fair and equitable distribution system, or whether it is better to have more people get organs. As long as it can be shown that the advertising is not taking away from the usual supply(in otherwords, the ads are bringing in new organs, not just redistributing what is already around), I think the ads are ok. Although I always favor the underdog, and oppose letting the rich have additional priveledges, in this case, the greater good of having more people live, out weighs the ideal of equality. In fact, the burden of proof would be to show that the ads are taking organs away from the usual supply. Feel free to vent your spleen

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