Theory and practice disparity

Are your kidneys available to me? - Eighth in a series

In theory kidney transplantation, begun in 1954, is being perfected as a medical procedure to save lives and and to improve healthcare; the future looks bright. In practice it is a boondoggle of financial wreckage for taxpayers, questionable truth in advertising to prospective donors, a cauldron brewing up a black market for human organs, a quandary of legal matters, a patchwork of medical and government coordination, and an ethical minefield.

Various approaches have developed to try to resolve these dilemmas.

Public relations efforts are ongoing to recruit living donors. Numerous medical communities hire the best people to achieve results in all program aspects. (example) More living donors will save taxpayers money. (See previous post.)

Changing the law to permit selling ones kidneys is possible, to address the black market mess (previous post). Iran alone among the nations legalized kidney sales, but some countries are very well known for trafficking so much so that selling seems accepted; an internet search will return these perpetrators.

Churches set guidelines to try to enforce an ethic of life that nevertheless upholds transplants, to help clear the ethical minefield (previous posts). Clearing minefields is slow and dangerous work. For example, the Catholic church catechism states:

Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons. (#2296)

The tricky word in this teaching is death. The Catholic hierarchy accepts the neurological definition, or brain death, as true death, but a sizable number of parishioners do not. (example)

They hold to the “the time proven, generally accepted criteria for death — the cessation of circulation, respiration, and reflexes.” This controversy is delineated on the Truth about Organ Donation website.

At a Vatican conference to explore the differing definitions, one doctor provided background information for the controversy:

Dr. Hill recalled that the earliest attempts at transplanting vital organs often failed because the organs, taken from cadavers, did not recover from the period of ischemia following the donor's death. The adoption of brain-death criteria solved that problem, he reported, "by allowing the removal of vital organs before life support was turned off--without the legal consequences that might otherwise have attended the practice.” 
While it is remarkable that the public has accepted these new criteria, Dr. Hill remarked, he attributed that acceptance in large part to the favorable publicity for organ transplants, and in part to public ignorance about the procedures.
“It is not generally realized,” he said, “that life support is not withdrawn before organs are taken; nor that some form of anaesthesia is needed to control the donor whilst the operation is performed. As knowledge of the procedure increases,” he observed, “it is not surprising that — as reported in a 2004 British study – ‘the refusal rate by relatives for organ removal has risen from 30 percent in 1992 to 44 percent.’” Dr. Hill also suggested that when relatives see with their own eyes the evidence that a potential organ donor is still alive, they harbor enough doubts so that they are not ready to consent to the organ removal. (ref)

Dr. Paul A. Byrne may be the best known physician in this camp. His articles have been so helpful to me. He is in agreement with Catholic classical doctrine, but not with the Vatican’s acceptance of the definition of death.

I have gotten off on a rabbit trail exploring the definition of death controversy. We will pause here and take up a few more approaches to resolving dilemmas arising from the practice of transplantation in the next post.

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The payment option

Are your kidneys available to me? - Seventh in a series

Kidtransplant.jpg
By NIH - link, Public Domain, Link
If you read the last post, you may be wondering, “How did taxpayers become liable for Medicare’s renal dialysis payments?” And, “Would we also be liable if a kidney seller becomes incapacitated?”

There are many questions that are circular rabbit trails. We can only shake our heads and try, as Christians, to determine how we ought to think and to act in respect to current and prospective biomedical procedures and practices. Are they OK with God?

 

Currently in America:

Sec. 301. (a) It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation…
(b) Any person who violates subsection (a) shall be fined not more than $50,000 or imprisoned not more than five years, or both. (ref)

This law presumes that organ sharing is right and good, as long as there is no payment involved. Heaven forbid commodifying the human body! Perhaps, though, those who wrote the law overlooked or forgot that there are significant payments made to the doctors and others. (Evidently, in many cases, this law’s word knowingly comes in handy. It’s unlawful to knowingly acquire…)

There will inevitably be a black market for body parts as long as federal law prohibits payment to sellers while there are many times more people needing transplants than there are donors.

Nancy Scheper-Hughes (see previous posts) tracked down “body brokers” and interviewed surgeons and other medical staff in the course of her research-on-a-mission.

An example of a statement from a surgeon paints the picture of how organs slip in under the radar.

Alternatively cajoling and asking pointed questions, Scheper-Hughes pressed on. The doctor said that some of the transplants set up by Rosenbaum* seemed ‘fishy.’ “Some of the recipients were from New York, and it did feel a little strange that they found this donor from Israel.” He went on to suggest that it was likely that everyone involved at the hospital had good reason to be suspicious. “There is no question that everyone in the program felt that it would be very possible that there was some kind of incentive there. I didn’t feel that I had to be the police. As long as I don’t know and as long as I don’t have any evidence, I’m not going to deny the transplant just because I have the suspicion,” he said. (ref)

Does it make sense to help one, probably older, person live longer at the expense of another, younger person who is giving up a kidney? In America the recipient will have healthcare options, but perhaps the seller from some other part of the world will have no recourse to compensation for aftercare. How can this inequity and exploitation be avoided?

Would it help if the U. S. began to compensate donors, that is, to pay sellers? The fee of $45,000 for a kidney mentioned in the previous post may initially draw in quite a number of people. But would it prevent exploitation of the poor here or in other countries?

Not likely, says Scott Carney. In his article, “If you’re willing to buy a kidney, you’re willing to exploit the poor” he states:

For argument’s sake, let’s assume that the United States would be able to create its own equitable system. What would happen in the rest of the world? Whether we like it or not, we live in the era of globalization, and if the U.S. legalizes the market for body parts, there is no reason to think that international economies won’t play a role in how a patient decides to procure transplant organs.
According to the National Foundation for Transplants, a kidney transplant costs about $260,000. In the illegal organ markets in India, Egypt and Pakistan, the same procedure rings in at just shy of $20,000 — certified organ included. (ref)

Mr. Carney goes on to point out we can look at what happened in the market for human surrogate babies to determine how the legalization of organ selling would go down.

In the United States, it is legal to pay a woman to carry a child, so long as the money is called “compensation” and not coercion. Even so, an American surrogate might cost as much as $100,000 in such arrangements. Once the market was clearly defined in the United States, other countries, with looser definitions of human rights, fought for their share of the market. In 2002, India became the go-to destination for procuring a budget surrogate womb. To the surprise of no one, the Indian industry soon began to cut corners. Women were housed under lock and key in houses known to the press as “baby factories.” Because U.S. patients demanded to know the condition of their children during the entire course of the pregnancy, surrogates became virtual slaves under the doctor’s perpetual surveillance.
The factories multiplied and soon tens of thousands of international customers reasoned that if it was legal to hire a surrogate at home, why not save money abroad? (ibid)

Is the certainty that some people will be exploited enough reason for Christians to oppose transplantation from live persons, whether donors or sellers? We have seen that

  1. there are not enough live donors to supply the demand
  2. a black market exists to try to fill the gap
  3. even payment will not prevent exploitation; it simply legalizes it

There does not seem a clear way for Christians to assent to organ transplantation, whether they espouse social justice as their highest belief or simply believe the Bible.

In the next post we will play devil's advocate and consider some concepts that may support permission for kidney selling or donation. We will then look at the health risks of donating a kidney and societal implications of selling them.

*Rosenbaum was an organ broker who was convicted and sent to prison. [The article states—]He is the only person so far ever successfully prosecuted for organ trafficking under the 1984 National Organ Transplant Act.

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Angel fish bild.JPG
Public Domain, Link

...and every living creature that moveth, which the waters brought forth abundantly, after their kind, and every winged fowl after his kind ... the living creature after his kind, cattle, and creeping thing, and beast of the earth after his kind ...the beast of the earth after his kind, and cattle after their kind, and every thing that creepeth upon the earth after his kind: and God saw that it was good. -Genesis 1

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A SistersSite eBook

Flesh and Bone and The Protestant Conscience is an e-book on Amazon.com. It is 99¢ and in the Amazon lending library as well. It is also available here in PDF format. The book description follows.

Would you let your conscience be your guide?

Does God care if the skin and bone of the dead are passed along to the living for medical uses? Is organ donation OK with God? Should you sign a Living Will?

Did you know that dead organ donors are often anesthetized before their organs are removed? Do you know the current definition of death? The conscience cannot function without facts.

As we ponder the ethics of in vitro fertilization, stem cell research and man-made chimeras, our thoughts trail off. How then should we live? (Ez 33:10)

How should a Christian think about euthanasia by starvation when doctors and the state attorney general all agree it is time to withhold feeding from a brain injured patient? Some things are family matters, but someday it may be our family.

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