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Organ Donation

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Autor:  anton  29 November 2010
Tags:  Donation
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Ethics: What is a kidney worth?

ѓЮ Every day, 17 Americans die of organ failure.

ѓЮ In Israel, the average wait for a kidney transplant is four years.

ѓЮ In response, a global gray market has bloomed.

Ethical issues

ѓЮ Who owns our bodies?

ѓЮ Should it be illegal to sell an organ if it could save someone's life?

ѓЮ Utilitarian point of view

ѓЮ What is the government's role in protecting two vulnerable groups - the poor, who are willingly exploited, and the sick, who are desperate for healing?

The story of a Brazilian guy

ѓЮ Hernani Gomes da Silva is 32 years old and still lives in his mother's two-room house. Rain comes in through the roof, and cockroaches and rats scuttle across the cement floor. He has three kids, a wife who loathes him, and a mistress 20 years his senior. He is unemployed with no money, no skills, and a criminal record. The future is bleak.

The story of an Israeli man

ѓЮ Arie Pach, a stout Israeli lawyer in failing health, sees his future flash before him.

ѓЮ In February 2002, Arie's doctors told him his kidneys were beginning to falter.

ѓЮ By early 2003, he has had minor surgery to prepare for dialysis


ѓЮ The expense of dialysis to the healthcare system - about $45,000 to $50,000 per year.

ѓЮ Only some 10 percent of dialysis patients live more than 10 years, according to the US National Center for Health Statistics.

ѓЮ Arie has too many things left to do in life. He loves to travel abroad with his wife. One of his two sons will marry this summer. To see any grandchildren, he's got to stick around. But the doctors warn him that his blood could soon start to become toxic. They give him two choices: dialysis or a kidney transplant.


ѓЮ Arie starts surfing the Web, looking at clinics in the United States that do transplant surgery.

ѓЮ A friend suggests a medical-advice hotline run by an aide to an influential rabbi.

ѓЮ Soon, Arie put in touch with a broker who tells him a transplant, done in South Africa, will cost $100,000, with 10 percent paid up front.

ѓЮ Aug./Sept., 2002 - Hernani Gomes da Silva first connects with the kidney-donor syndicate in Recife, Brazil.

ѓЮ October, 2002 - Hernani flies to Durban, South Africa

ѓЮ November 26, 2002 - Hernani's left kidney is removed and implanted in Arie Pach, an Israeli. Hernani is listed as a "live related" donor. He was paid 6000$.

The state of organ trafficking in key countries

South Africa: Human Tissue Act

ѓЮ Sect. 1: "[T]issue means ... any flesh, bone, organ, gland, or body fluid...." Sect. 28: "No person ... may receive any payment in ... the ... acquisition ... of any tissue...." Section 33: Violators "shall be ... liable ... to a fine not exceeding 2,000 Rand or to imprisonment for a period not exceeding one year....Ў§

ѓЮ One year in jail or a fine of about $300.

ѓЮ Under South Africa's 1983 Human Tissue Act, Arie and his donor have broken the law.

ѓЮ But the organ brokers and doctors are the ones making the biggest profits - and are the real targets of the police.

ѓЮ Buying and selling kidneys across three continents is, in some ways, the perfect 21st-century crime.


ѓЮ Donors are getting $6,000 to $18,000 for their kidneys. They're coming from Israel, Brazil, and maybe Russia and Romania, given the Eastern European-sounding names on the hospital records.

ѓЮ Doctors have put in the pocket as much as $450,000 after 2 years doing more than 107 operations in South Africa

General figures

ѓЮ In India, about 2,000 people sell a kidney each year.

ѓЮ One study there in 2002 found 86 percent of organ sellers saying they had significant declines in their health in the three years after surgery.

ѓЮ In the eastern European nation of Moldova, some 300 peasants sold their kidneys between 1999 and 2002.

ѓЮ A study by Organs Watch found 79 percent of Moldovan donors with health problems in the months and years after the procedure.


ѓЮ For recipients:

ѓЮ Paying $70,000 for one kidney transplant is far cheaper than $50,000 a year for life in dialysis bills.

ѓЮ The transplant recipient is healthier, and has a better quality of life than a dialysis patient.

ѓЮ For donors:

ѓЮ According to the study in India, organ selling actually increased poverty.

ѓЮ Some 54 percent of sellers were extremely poor before losing a kidney.

ѓЮ A year later, 74 percent were still in debt, and the average family income had declined by about 30 percent.


ѓЮ "If the rich are free to engage in dangerous sports for pleasure ... it is difficult to see why the poor, who take the lesser risk of kidney selling ... should be thought so misguided as to need saving from themselves," says Dr. Friedlaender in Israel.


ѓЮ Creation of regulated market (Michael Friedlaender is one of Arie's doctors):

ѓЮ if something goes wrong during surgery ;

ѓЮ if the financial transaction turns out to be a scam neither the donor nor the recipient has any legal recourse

ѓЮ A regulated system would change that, and allow for things like malpractice suits, which help safeguard the process.

ѓЮ In a free market, Dr. Friedlaender argues, it's unethical not to pay for an organ.

ѓЮ "Someone's saving your life," he says, "and you're not going to reward him? We pay for every other service in the world." Donating an organ is one of the most valuable services, "because it saves a life."

In theory

ѓЮ In Israel, the Ministry of Health propose to target organ brokers - including penalties of up to three years in prison.

ѓЮ Another proposal would allow voluntary organ donors to have all of their related healthcare costs picked up, as well as compensation for lost time at work when recuperating from the surgery.

ѓЮ Others in Israel, such as Friedlaender, argue that the government should set up a fund to give substantial compensation to those who volunteer to be living donors.

In practice

ѓЮ US, Wisconsin recently became the first state to give living donors a tax deduction of up to $10,000, to write off lost salary, and medical and travel costs.

ѓЮ At least 14 other states are considering similar measures.

ѓЮ And in April, President Bush signed the Organ Donation and Recovery Improvement Act, which reimburses living donors for expenses incurred during the process and funds research projects aimed at increasing donations.


ѓЮ But laws may not keep pace with a global market moving at the speed of commerce

ѓЮ The doctors should have ethical principles, and not behave themselves as businessmen






ѓЮ .html

Dr. Frank Riddick chairs the American Medical Association's Council of Ethical and Judicial Affairs. His committee is urging the AMA to endorse a pilot program to study whether modest financial payments would encourage a larger pool of people to donate their organs after death.

More and more transplant surgeries are taking place each year, but it's still not enough to meet the need. Over 80,000 patients are currently awaiting transplants; about 16 people on the waiting list die every day. And that shortage is expected to increase even more dramatically over the next few years.

The medical community is urgently searching for new ways to stimulate more organ and tissue donation. Many are suggesting it may be time to explore something long considered taboo: financial incentives.

In many Third World countries, there is already a flourishing black market for organs. Many believe there is a huge potential market here as well. A Rochester, New York man recently took out a classified ad looking for a living kidney donor. Several respondents offered to do it -- for a price.

AMA officials say their proposal is very narrow. It would only be a study, and it would only apply to donations after death.

One possible test case could be a measure passed in Pennsylvania two years ago. Lawmakers approved a plan to give $300 to organ donor families specifically for the funeral expenses of the donors. That measure was never implemented because it was determined to conflict with the federal law.

LAWTON: For the past 30 years, the organ donation system has depended solely on altruism -- people voluntarily deciding to become donors, often signing up at their local Department of Motor Vehicles.

Transplant advocates have supported public awareness campaigns to encourage more people to make that choice. One popular event is a 5K Race for Life. Race volunteer Georgette Ruth is a vocal advocate of organ donation. Her 21-year-old son Chad was killed in an accident in 1999. Georgette says she has received much comfort in knowing he helped numerous others through donating his organs and tissue. GEORGETTE RUTH: My compensation is knowing that he did that and know that he lives on in other people. For me, I woul

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