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The Nasty Side of Organ Transplanting.

Chapter 13

Coercion, Live Donation and Slippery Ethics

Transplant agencies relentlessly feed the media stories like that of a tragically killed teenage boy saving the lives of four or maybe five people by donating his organs. The truth is often different.

Transplant coordinators face extreme pressure to obtain consent from relatives. Their careers and a million dollars worth of transplant surgery over the next twenty-four hours depend on the total unquestioning acquiescence from relatives.

The shocked parents are typically in sudden grief, often on sedation and haven’t eaten or slept for the previous 24 hours. They see their terminally injured son or daughter lying apparently sleeping in a hospital bed. Coordinators or intensive care staff face the difficult task of convincing these parents to allow surgeons to cut and saw into this warm body with its beating heart then remove multiple organs thus preventing the natural dying process of their child. They subject the shocked, confused parents to every psychological trick of guilt, hope and intimidation to gain acquiescence to what could easily be seen as a barbarous request. The key propaganda line they hit the parents with is that numerous lives can be saved from this tragic death.

But even this coercion won't address the issue of “brain dead” donor numbers remaining stagnant while demand for kidneys soars. One attempted remedy is by obtaining kidneys from “living donors”.

“Remember that is your decision…It’s OK to say NO!” This is the advice given to prospective kidney donors in “Kidney donation by live donors", a publication from the Australian state government of New South Wales. It raises the question whether live donors offer one of their kidneys or do the patients and transplant coordinators put the hard word on friends and relatives. If donors volunteered then why would a government agency tell them it was okay to say no? I asked this of Marion Downey of the New South Wales Department of Health, but she refused to answer.

This emerging attitude of governments encouraging those on dialysis to pressure relatives to give up a kidney is further exemplified by Sir Peter Bell, Professor of Surgery at the University of Leicester in the United Kingdom.

“I think you could do a lot to encourage live donation from relatives. I think it is wrong to be talking about buying organs from the third world when they have relatives who they could go to, all of whom have not offered a kidney. How can that be right? As long as it is done with proper informed consent, it is a thing to think about.”^[82]

Pressure is also applied to renal failure patients to join the kidney waiting list. Nicholas Tonti-Filippini, a former health care ethicist in Australia, reports:

“…as a hemodialysis patient I have often sat with other patients to whom the alternative of a cadaveric kidney transplant was being put most forcefully, on both economic and personal health grounds, and seen the patients’ disquiet at the prospect, and their unanswered questions about anything to do with the source of the organs.”^[83]

A proclaimed ethical concern of most hospitals, currently, is that before a kidney is removed from the body of a living donor there must not be any suspicion that payment is involved. Some countries disallow transfers of kidneys from low-income donors to wealthy recipients to safeguard against the possibility of payment.

Nick Ross reportedly gave one of his kidneys to his billionaire employer and Australia’s richest man, Kerry Packer, in 2000. They were said to be lifelong friends and Nick received a one-million dollars annual salary for being Packer’s helicopter pilot.

The surgery was approved by the ethics committee of the Royal Prince Alfred Hospital in Sydney and performed there successfully. Packer subsequently donated $10 million to the hospital, part of which was used to refurbish the newly named Nick Ross Clinic. Packer died in 2005, aged 68.

I asked the Royal Prince Alfred Hospital for a copy of their ethics guidelines. These guidelines typically require that living donors are not being coerced or paid, they're informed of the risks to themselves and the fact that the recipient can still survive without a kidney through dialysis.

The hospital failed to provide me with the guidelines and I followed the request up the chain of command to the Health Minister, Morris Iemma, now Premier of New South Wales. His only response was through Marion Downey who posted the above-mentioned donor guide: “Kidney Donation by Live Donors”.^[84] It said that living organ donors must be: psychologically stable, freely willing to donate, free from any coercion, medically and psycho-socially suitable, fully informed of the risks and benefits, fully informed of the effectiveness of current dialysis treatment available to the recipient”

Significantly, it didn't remind prospective donors that it is illegal to sell one’s organs nor did it prohibit inducements either to the donor or to the hospital. These are the issues I wanted to discuss regarding the Packer transplant.

This concept of the rich purchasing body parts from the poor is creeping up on us by stealth and has a logical basis according to Robert Veatch. Feel the ice in your veins as you consider the logic from this leading American intellectual.

“If it is immoral to make an offer to buy organs from someone who is desperate because those making the offer refuse to make available the alternative solutions, [adequate access to food, housing and medicine, etc], it must be even more immoral to continue under these circumstances to withhold the right of the desperate to market the one valuable commodity they possess. If we are a society that deliberately and systematically turns its back on the poor, we must confess our indifference to the poor and lift the prohibition on the one means they have to address their problems themselves.

It is thus with shame and some bitterness that I propose that the time
has come to lift the ban on marketing organs…”^[85]

However, there is a downside to being a living donor. From Israel:

“It must be noted that removing a kidney, even from a healthy person, presents certain dangers. This is an organ that does not restore itself, unlike blood or sperm. The donor, therefore, is left with a defect.”^[86]

And from David Evans in the United Kingdom:

“The short-term risks include life-threatening haemorrhage, pulmonary embolism, pneumothorax, infection, transfusion-transmitted hepatitis and AIDS. In the longer term, there is increased risk of hypertension and renal failure. The long-term psychological effects upon the donor are not known.”^[87]

And from Steve Chadban in Australia:

“At an individual level, the risks associated with donor nephrectomy are borne largely by the donor. These include the risks of complications arising from invasive investigations (particularly angiography), the risks of surgical complications including death, and the long-term impact on risk of end-stage kidney disease and death…”^[88]

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