Log onto an organ donor Web site and you will find desperate people looking for strangers who might give a kidney or piece of liver.
“My friend, Josh, is 26 years old and needs a kidney transplant. He has had cancer since the age of 2,” reads one message.
“Vietnam Veteran with 3 little children desperately needs AB+ liver,” says another.
“I have a cousin ... that is very sick in hospital, he needs a liver transplant very urgently ... my aunty came up with the idea to look in the internet for one,” someone else pleads.
That worries bioethicists, surgeons and federal officials who oversee the transplant system, which is designed to treat all patients fairly.
Most troubling is the possibility that people will buy and sell organs, an illegal practice that is but difficult to uncover if participants are willing to lie about it.
Last year, 86 people donated to people they did not know; in 1997, there were none.
Last week, surgeons in Denver transplanted a kidney into a patient who met his donor through MatchingDonors.com, a commercial site.
Keep playing field level
Denver doctors delayed the surgery for two days amid concerns about the for-profit site and questions about whether the recipient might be paying the donor for his kidney. After the hospital got both men to sign affidavits swearing there was no such payment, the surgery went ahead.
The for-profit nature of MatchingDonors.com, where patients pay $295 per month to post a profile, made officials particularly nervous. But the same sort of matching is rampant on livingdonorsonline.org, a nonprofit site that provides a billboard forum for people looking to find or offer an organ.
“I imagine when people are in need of a lifesaving organ, they’ll do what they can to get one,” said Dr. Andrew Klein, a surgeon who is chairman of the transplant network’s living donor committee.
Some fear that could include paying someone to donate, which could be hard to trace if strangers simply explained that they met on the Internet.
That possibility “is a very real concern,” said James Burdick, who directs Health and Human Services Department’s transplant division.
Gregory Pence, a bioethicist at the University of Alabama, said it “almost seems inevitable that it would happen.”
Dr. Jeremiah Lowney, co-founder of MatchingDonors.com, said organ sales may be possible, but he is not worried. “You have to trust people,” he said.
Experts also are concerned about the open-market nature of the Internet. They say it is unfair to give an edge to people who are simply better at recruiting donors over others who are sicker and ranked higher on the national waiting list.
“We’re trying to keep the playing field as level as possible,” said Dr. Mark Fox, chairman of the ethics committee of the United Network for Organ Sharing, the national transplant network.
“I don’t think the fact that you can write the most appealing ad or got lucky and found someone on the Internet should give you special consideration,” Fox said.
Traditionally, patients who need transplants have waited on the national list for an organ donated by someone who died. Patients are ranked by a complex formula.
Lowney does not agree that giving an organ to one person is unfair just because someone else might be in greater need. The bottom line, he said, is, “You’re giving life to someone.”
The network has approved a resolution suggesting that donations from “altruistic donors” go to the next person on the list. But this is simply a recommendation, with no enforcement envisioned, Klein said.
Living donation has inherent ethical issues as healthy people are having surgeries that will do them no good. There are real medical risks to the donor that are not well documented and not consistently explained.
Still, the number of living donors has climbed steadily over the past few years to 6,811 last year, with living donors now outnumbering dead ones.
The vast majority of living donors give a kidney, which is relatively safe because people typically have two kidneys and only need one.
Also, research has found that kidneys from the living are just as good, if not better, than those from the dead, and that matches do not have to be medically exact to be successful. Laparoscopic surgery, where the kidney is removed through a small incision, has reduced the pain and recovery time for the donor.
About 5 percent of living donors gave a piece of liver. In this operation, each part of the liver grows into a whole organ.
Few people have given a piece of lung, which is combined with another slice of lung from a second donor to transplant into the patient.