Saturday, February 14, 2004

Doctors broach idea
of selling body organs

Poor people might be the primary
donors, but they would make money
and save lives

Many transplant patients are dying while waiting for organs that could be supplied through organ sales, some doctors suggest.

The two controversial ideas were aired at an International Bioethics Conference attended by more than 250 medical professionals, attorneys and bioethics experts the past two days at St. Francis Medical Center.

Dr. Arthur Matas, University of Minnesota Renal Transplant Service director, said paying unrelated living donors for kidneys, now a federal crime, would be cost-effective compared with extended dialysis.

He advocates a regulated system with specified centers; a fixed, tax-free price for kidneys; and allocation to patients the same as it is done now.

Matas acknowledged ethical concerns about selling body parts and the likelihood that most sales would be by poor people. But they would benefit from the income, and fewer people would die waiting for transplants, he said.

Dr. S.Y. Tan, conference co-chairman and director of the St. Francis International Center for Healthcare Ethics, supported an organ-sales program, saying, "We should save lives."

Another approach is "presumed consent," he said.

Adults who die would be presumed to have agreed to donate their organs for transplantation unless they "opt out" with a registered refusal, he said. This would result in a lot of organs for transplant operations, he said, "but there are critics aplenty."

Critics say mistakes are inevitable, problems would occur in registering and transmitting a person's objection, and the system undermines individual autonomy and the right to delegate decisions to family members, he said.

Tan said Singapore has progressive policies on organ donations, including a presumed-consent law for anyone except Muslims, and donations have increased sevenfold.

Only an average of 12 organs are donated in Hawaii every year, he said, while as of January, 344 patients were waiting for kidneys, 23 for livers, four for hearts and two for a kidney and pancreas.

"Setting Limits to Healthcare: The Time Is Now" was the theme of the conference, with speakers exploring health care reforms and rationing to control skyrocketing costs.

Dr. Lawrence Schneiderman, professor of family and preventive medicine, University of California-San Diego, said managed health care has failed to control costs and put doctors in "a true ethical dilemma."

Their responsibility is to serve the best interests of the patients, but managed care bases their income on giving less care, he said, adding that this has eroded patients' trust in doctors.

Canada, Britain and Singapore also are grappling with health system problems, speakers explained.

For example, Canada gives everyone access to health care, but patients have to wait months to years for consultations and procedures unless it is an emergency, said neurologist Dan Krushelnycky, St. Francis International Center for Healthcare Ethics fellow.

Canadians want the kind of health care Americans have, with speed and access to technology, and Americans want what the Canadians have with basic coverage for all people, he said.

"I think we will see a convergence," he said.


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