Year: 2012
Type: article
Abstract: To the Editor: The shortage of organs is a critical problem for patients with organ failure, and has led to a polarizing discussion. Some, including us, have suggested that a regulated system of incentives might increase donation and alleviate the crisis (1Radcliffe-Richards J Nefarious goings on: Kidney sales and moral arguments.J Med Philos. 1996; 21: 375-416Crossref PubMed Scopus (102) Google Scholar,2Matas AJ Hippen B Satel S In defense of a regulated system of compensation for living donation.Curr Opin Organ Transplant. 2008; 13: 379-385Crossref PubMed Scopus (50) Google Scholar). Others, championed by Chapman, Danovitch, Padilla and Delmonico, have passionately opposed this option (3Danovitch GM Delmonico FL The prohibition of kidney sales and organ markets should remain.Curr Opin Organ Transplant. 2008; 13: 386-394Crossref PubMed Scopus (28) Google Scholar, 4Delmonico F Danovitch G Capron A Levin A Chapman J “Proposed standards for incentives for organs donation” are neither international nor acceptable.Am J Transplant. 2012; 12: 1954-1955Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 5Chapman J Should we pay donors to increase the supply of organs for transplantation? No.BMJ. 2008; 336Crossref PubMed Google Scholar, 6Padilla B Bayog D Uy NL et al.The Philippines is not the site for incentivized organ donation.Am J Transplant. 2012; 12: 1956Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar). Delmonico et al., representing the Declaration of Istanbul [DoI] Custodial Group (DICG) now write that our proposed guidelines for a regulated system are not acceptable (4Delmonico F Danovitch G Capron A Levin A Chapman J “Proposed standards for incentives for organs donation” are neither international nor acceptable.Am J Transplant. 2012; 12: 1954-1955Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar). Our proposal, as stated in the manuscript, was presented as a basis for discussion (7Matas AJ Satel S et al.Working Group on Incentives for Living DonationIncentives for organ donation: Proposed standards for an internationally acceptable system.Am J Transplant. 2012; 12: 306-312Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar). Rather than suggesting modifications or improvements, the DICG simply condemns it. Their condemnation rests on two arguments. First, that others have suggested that “sales,”“brokering” and “organ markets” are wrong, and that we have “departed from the consensus.” Yet we clearly state our opposition to exploitation and unregulated markets, and instead suggest a government-regulated system with explicit limits to prevent the abuses all parties decry. But even the supposition that we have no right to challenge “the consensus” is suspect. When, in moral debate, is majority opinion the final argument? If it were, homosexuals would still be criminals and women still subordinate to their husbands and excluded from public life–both once widely held majority views enshrined by law. And where does this so-called consensus come from? The DICG refers to the World Health Organization (WHO) and the DoI. Yet, the WHO has updated its Guiding Principles (most recently supporting reimbursement of costs and of emotionally or legally related donors vs. previous stance banning all but genetically related donors and any payment). The draft of the DoI was written by a Steering Committee including Chapman and Delmonico, but no proponent of incentives (8International Summit on Transplant Tourism and Organ TraffickingThe Declaration of Istanbul on organ trafficking and transplant tourism.Kidney Int. 2008; 74: 854-859Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar). The summit was by invitation only, and invitees were invited based on their stance on this issue (Danovitch, personal communication). The few proponents of incentives were vastly, and vociferously, outnumbered. Why are these “consensus” documents immune from challenge? Second, the DICG is incorrect that our proposal is “belied by the reality of markets.” Again, they conflate “unregulated markets” with the government sponsored regulated systems we propose. As we state: (a) each system would be limited (donors and recipients) to citizens of that country, and (b) the organ would be allocated to the #1 person on the list (i.e. not the rich buying from the poor). Each government-regulated system would be based on donor and recipient protection, regulation, transparency and oversight. Finally, we resent the innuendo in the suggestions that our manuscript was prompted and “funded in part by Filipino organizations that have favored organ sales to foreigners” and that the authors would accept “permitting the poor and vulnerable in any community to part with a kidney for the wealthy sick.” These are cheap shots unworthy of a discussion so important to our patients. It may be that there is no place for a regulated system of incentives. But that decision should be made after dispassionate, reasoned discussion and ideally after being informed by hard data. In a second letter, Padilla (another member of DICG) et al., suggest that our proposed system would not work in the Philippines (6Padilla B Bayog D Uy NL et al.The Philippines is not the site for incentivized organ donation.Am J Transplant. 2012; 12: 1956Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar). We recognize that there have been mixed evaluations of the programs implemented in both the Philippines and Iran (9Ghods AJ Savaj S Iranian model of paid and regulated living-unrelated kidney donation.Clin J Am Soc Nephrol. 2006; 1: 1136-1145Crossref PubMed Scopus (193) Google Scholar). However, neither system of incentives meets the guidelines we have proposed. Moreover, the very fact that successes have been reported suggests that the systems could indeed work and should be improved upon rather than abandoned. We did not state that our system would work in every country, but presented guidelines detailing how systems should be designed in order to be acceptable. Each country would need to have appropriate regulation and oversight and to be able to address wrongdoing. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation. ErratumAmerican Journal of TransplantationVol. 12Issue 8PreviewIn the below listed Letter to the Editor, the citation “Danovitch, personal communication” was made in error. There is no source for the comment related to this citation. Full-Text PDF Open Archive
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
OpenAlex ID: W2004790736