Thursday, June 15, 2017

Legal kidney market seen as way to end shortage

Paying kidney donors: time to follow Iran? - Rupert W.L. Major, McGill Journal of Medicine:

January 2008 - "Since the first kidney transplant was performed over fifty years ago, it has offered the chance of life and the freedom from dialysis for thousands of people. However, demand for organs has always exceeded supply. The gap between the two is widening....

"Renal transplants differ from most other transplants because living people are able to donate without significant adverse effects on their own health. Donated kidneys, therefore, have a potential to become a commercial asset.... Supply, however, is still greatly inferior to demand: the United States Department of Health and Human Services 2006 Annual Report recorded over 82,000 patients on the waiting list for a kidney, up nearly 7% from the previous year.

"In order to resolve the shortage of donors, some have advocated financial payments being made to donors. Despite being illegal in most countries, the trade appears to be booming in nations such as Turkey, Russia, and South Africa.... The dilemma physicians and health officials are faced with is whether to close their eyes to this trade, disregarding ethical implications and the adverse effects of surgeries done on the black market, or to legalize it and try to establish boundaries to protect organ donors that receive compensation....

"One of the few countries that has legalised the sale of organs is Iran.... In 1988, Iran legalized living non-related donation (LNRD) of kidneys and established an associated transplantation system. This government-organized system regulated and funded the transplantation process and compensated the donors for their organ.... Within the first year of the establishment of this system, the number of transplants had almost doubled; nearly four fifths were from living unrelated sources....

"Outside of Iran, the issue continues to be highly contentious. The end-stage renal failure population continues to increase in most countries.... Compensation for living non-related donors, once a taboo subject, has now begun to be discussed openly in transplantation meetings and the medical literature. The advocates for legalization argue that each of us has autonomy over our own body in every aspect of our health and that from this stems the right to donate a kidney to a related or non-related patient. Payment for sperm and eggs is legal in many countries, even though they arguably have greater long-term implications due to the potential to create a whole new individual.

"Whether talk will ever be turned to action in favour of monetary payments to donors remains to be seen. The medical profession may not agree with payments on an ethical level but the increasing problems caused by prohibition of LNRD and the prolific black market of transplants are starting to be considered as good reasons for legalization and tight regulation."

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