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Debate at HMS Frames Ethics of Online Organ Donation
 Photo by Leah Gourley Dan Brock believes that Internet organ solicitations, while problematic, could encourage more people to become organ donors. |
Currently more than 88,000 Americans are waiting to receive a transplanted organ through the United Network for Organ Sharing (UNOS), far more than the number of available cadavers.
UNOS can only take organs from registered organ donors whose families consent. Patients can request organs from healthy relatives and friends, but most cannot find a matching available organ within their immediate community. Because of this shortage, 18 people in the United States die while waiting for an organ every day, an average of one person every 90 minutes.
Jeremiah Lowney, the director of the Board of Health in Milton, Mass., thinks the solution is bringing sympathetic strangers together with needy patients, a process referred to as live directed donation from a stranger. He and a former patient’s son, Paul Dooley, created a website called MatchingDonors.com, on which paying members post profiles requesting an organ from a philanthropic stranger.
So far, seven people have matched with donors through the site. But some doctors don’t feel the site’s service to these seven patients is worth its long-term ethical implications.
On May 12, HMS hosted an ethics forum at which Lowney and three medical ethicists discussed the issues surrounding the site.
Some speakers expressed concerns that allowing donors to decide who could have their organs could keep them from the people who needed them most. “Directed donation ties donation to the emotional appeal and public relations skills, photogenic appeal, and financial resources of the patient, next-of-kin, and others involved in the campaign,” said Douglas Hanto, the Lewis Thomas professor of surgery at HMS and Beth Israel–Deaconess and chair of the ethics committee at the American Society of Transplant Surgeons. Panelist Arthur Caplan concurred, noting, “If you put a series of 60-year-old alcoholics who are homeless on TV and say, ‘These are the people we must help,’ it becomes suspect as to whether people are going to be willing to help these people in need.” Both panelists worried that directed donation could cause patients to “skip ahead in line” and receive organs that should have gone to patients in greater need.
| “If you put a series of 60-year-old alcoholics who are homeless on TV and say, ‘These are the people we must help,’ it becomes suspect as to whether people are going to be willing to help these people in need.” |
It is possible, however, that campaigns such as MatchingDonors.com’s could bring new donors into the system, a scenario that would leave “someone better off and no one worse off,” explained Dan Brock, HMS professor of medical ethics and director of the Division of Medical Ethics. Of greater concern to him was the possibility that the Internet could facilitate organ sales. “What we don’t want is these resources being put on an auction block and sold to the highest bidder,” he said. Similar concerns are being raised globally, as a black market in organs has blossomed in India, and a man attempted to sell his kidney on eBay. Lowney noted that his website specifically says that it is illegal to obtain financial gain from organ donation and that profiles that offer financial remuneration are deleted. While none of the matched donors so far have been paid, one woman who used the site to find a donor remembered that several people had responded to her profile offering to sell her one of their kidneys.
The recipient of such a donation is not the only potential victim in the situation, argued Caplan, the Emanuel and Robert Hart professor of bioethics and director of the Center for Bioethics at the University of Pennsylvania. As long as living donations remain unregulated, he said, anyone considering making a living donation is vulnerable to exploitation and pressure. Caplan described a continuum of living donation, citing at one end the family members unable to emotionally dissociate themselves from the ill sibling, parent, or child. On the other end, he said, were the people who walked into his clinic explaining that Jesus had visited them and commanded them to donate one of their kidneys. When that occurs, he said, “you start to doubt the competency of people who appear out of nowhere and say that they want to help.”