The dramatic success of organ replacement over the past three decades has resulted in referral of progressively increasing numbers of patients to compete for the limited number of allografts available for transplantation. The inadequate supply of suitable donors has rapidly become the major obstacle to further extension of this life-saving therapy to patients being maintained on dialysis or dying with end-stage disease of other vital organs. Among the potential solutions that been offered to increase organ donation has been the suggestion that some economic incentive be provided either to the individual, in the case of a living kidney donor, or to the family or estate of a cadaver donor.
Recognizing the potential controversies that could arise from the commercialization or brokerage of transplantable organs, the Ethics Committee and the Council of the Transplantation Society first addressed this matter in the early 1980's. Their clear concern was that if the organ donation process were to be relegated to the laws of the market place, particularly when the less privileged might be exploited to improve the health of the more privileged, the established safeguards surrounding altruistic donation would likely be compromised. After considerable deliberation, specific guidelines for practice were agreed upon 1. The concluding resolution was that: "No transplant surgeon/team shall be involved directly or indirectly in the buying or selling of organs/tissues or in any transplant activity aimed at commercial gain to himself/herself or an associated hospital or institute."
A similar conclusion was reached in the United States Congress where passage of the National Organ Transplantation Act contained a provision which prohibited the purchase of human organs for use in transplantation and provided for a maximum penalty of $50,000.00 or 5 years in prison or both. 2. At approximately the same time, the sale of organs was banned by many other countries and condemned by the World Health Organization.
Nevertheless, as other efforts to increase the donor supply have proved inadequate and with the extension of transplantation to developing countries, the issue of organ commerce has been regularly revisited. For example, an extensive discussion, including viewpoints from many different countries, was included in the deliberations of the First International Congress on Transplantation in Developing Countries 4. Review of this intervening debate by the Transplantation Society's Ethics Committee resulted in the second publication of the Society's position in 1994. 5. This essentially reiterated the contents of the originally published guidelines with very minor revisions.
The Ethics Committee the reconsidered the issue with some additional recommendations which were published in the June 1995 issue of the Society Bulletin. In this latest statement, the Ethics Committee indicated again that "organs and tissues should be freely given without commercial consideration." 6. The Society Council later approved a policy statement by the Ethics Committee, summarizing its conclusions on this and other issues, which all candidates for membership in the Transplantation Society must now sign.
In summary, the Transplantation Society, through its Ethics Committee, has maintained a consistent position regarding paid organ donation over the past two decades. This position is reiterated in the current policy statement provided to member applicants, namely that "...The Transplantation Society states that with respect to more general issues, its position remains unchanged: "organs and tissues should be freely given without commercial consideration or financial profit..."
References
- Council of the Transplantation Society: Commercialization in transplantation: the problems and some guidelines for practice. Lancet, 1985; 2: 715, and, Transplantation, 1986; 41: 1.
- Zaontz, L.: The national organ transplantation act. Bull. Am. Coll. Surg., 1985; 70: 18.
- World Health Organization: Guiding principles on human organ transplantation. Lancet, 1991; 337: 1470.
- First International Congress on Transplantation in Developing Countries. Transplant Proc., 1992; 24: 2087-2126.
- Sheil, R.: The Transplantation Society Bulletin, 1994; 2: 22.
- Sheil, R.: The Transplantation Society Bulletin, 1995; 3: 3.
A. Benedict Cosimi Councilor and Chairman of the Ethics Committee, The Transplantation Society
