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Kidney Protocol

This article challenges the Australian and British medical authorities to reconsider their stance with regard to "non-directed" kidney donations from live donors.  [In fact, there have been changes to the legislation in both countries since the article was written, which reflects policies closer to what we were advocating.]  The article questions the motivation behind the medical ethicists employed by the authorities, and demonstrates how legal non-directed kidney donations assist in minimising concerns regarding donor rights, coercion, and the black market.

Although we Jesus Christians are not experts on the technology related to kidney transplants, we are beginning to think that we may be experts with regard to the ethical issues revolving around such transplants. We are gradually coming to grips with the fact that most of the so-called experts in this field are employed by the institutions that stand to benefit (or lose) most from organ donations. This is hardly a healthy climate for reaching truly ethical conclusions.

The Do-Nothing Mentality

Of all the options available to hospitals and health authorities, the one most certain to encourage black market organ sales is the one so far preferred by Australian and British health authorities, and that is to do nothing. As long as no provisions exist for live willing adults to make donations to strangers who are in need of a kidney, the waiting time for a transplant will remain at four to ten years. As a direct result of this, desperate patients are being, and will continue to be, forced to look overseas to countries where black market transplants are being carried out.

Obviously there are genuine ethical issues to be dealt with, but for the thousands of people on waiting lists, and scores of people who die each year while waiting for a transplant to become available, the issues have obviously been blown far out of proportion. It would appear that the traditional experts have assumed that the safest option is to do nothing. That way they will never have to face legal action for something that they did.

Yet, if one good lawyer were to launch a lawsuit on behalf of the family of a deceased kidney patient against a hospital for refusing to perform a transplant, we could guarantee that protocols would suddenly appear overnight for the hospitals that have been dragging their heels for many years now. It is precisely because they feel no moral obligation for the people who are dying now that they have persevered for so long with such callous indifference on this issue.

Let us be very clear about what the real issue is with people like the Health Minister of Victoria (Brownwyn Pike), who recently issued public statements promising that all Jesus Christians would be barred from donating kidneys in her state. The real concern for such people is to protect their own backsides. Such statements have nothing to do with concern for kidney patients; but they have everything to do with political and financial expediencies. The Jesus Christians have, unthinkingly, been made the scapegoats for moral ineptitude on the part of the Victorian Health Department.

The Black Market

Bronwyn Pike, Health Minister for Victoria, was quoted in the Press on July 7th, 2004, as saying that present guidelines restricting organ donations in her state to relatives and close friends were aimed at stamping out the use of financial incentives to entice people to donate organs.

Quite apart from what may happen if kidney patients go overseas, there is almost nothing that can be done to guarantee that financial incentives are not involved in organ donations as they now exist within Australia. The mere fact that someone is a relative or a close friend does not mean that monetary rewards will not play any part in the transaction. A case in point is that of Kerry Packer's helicopter pilot, who (as a "close friend") donated a kidney to Kerry. Kerry was later reported to have made a "gift" of several hundred thousand dollars to his "close friend". (Note: We do not begrudge the pilot being rewarded for his generosity, but we do object to people like Bronwyn Pike pretending that her Government is doing what is necessary to stop such compensation from taking place.)

There is only one foolproof way to elminate any possibility of financial incentives being used, and that is to let the powers that be supervise donations between donors and recipients without either party having prior personal knowledge of the other. In other words, "non-directed" organ donations... the very thing that the so-called experts in Australia are fighting most strongly against.

Such a protocol has the added advantage that medical authorities can search through extensive lists of potential recipients to find the one most suitable, most worthy, and/or most desperate for the organ being donated.

Mis-matched Friends and Relatives

By letting hospitals direct all of the donations, we avoid the present situation, where so much is left to the chance that a close friend or relative will be a good match. We believe it is good that relatives and friends donate to help someone for whom they have a personal interest; however, far too often, friends and relatives cannot donate, because their blood does not match with the patient whom they wish to help. If the kidney were donated to the overall kidney pool, then the friend or relative on behalf of whom the donation was made could be bumped to the top of the list for the type of kidney that he/she needs. In other words, the donated kidney would go to the person for whom it is most appropriate, whether or not that happens to be the friend for whom the donation is made.

In practical terms, what this means is that a husband whose blood type does not match his wife's, could still donate, with his kidney going to someone of the hospital's choosing, and with his wife being bumped up to the top of the list for the first appropriate kidney to become available in her blood group.

There would be other technical issues to be considered (e.g. finer details with regard to immune factors in the blood) that could be worked out by the authorities, but the overall plan as we have expressed it here should not be a problem for the authorities, and would all but eliminate the present waiting lists without recourse to donations from anonymous members of the public.

Coercion

The other reason given by Bronwyn Pike, Health Minister for Victoria, for regulations banning live non-directed organ donations, is that her Government is concerned about "coercion". This statement from her was specifically given in relation to the fact that a number of Jesus Christians have donated kidneys to kidney patients. The Minister has, unfairly, assumed that anyone who donates a kidney to a stranger must be acting under coercion. And she went further, to actually ban any members of the Jesus Christians from donating to anyone in her state, on the basis of this cruel assumption.

Although there are a number of ways to prove coercion, it is virtually impossible to disprove such an allegation, and that is why Bronwyn's statement is so damaging to ourselves. The general public assumes that she had some reason for implying that we used coercion on members to donate, when, in fact, there is not a single scrap of evidence for this accusation. We would like to publicly challenge the Minister to a face to face and public discussion of her concerns, if she has the courage to do so.

Coercion for profit: With regard to coercion, this is another area where the best possible way to minimise coercion is to keep donations anonymous and non-directed. We have already discussed the matter of compensation for donations. Corruption (or in this case, coercion) is most frequently motivated by greed. If the matter of compensation can be wiped out, then much of the problem of coercion is eliminated at its source.

Coercion for publicity: However, there are two other motives which could result in coercion: publicity and emotional factors. We Jesus Christians have used the media to publicise our campaign for changes to the law, and the hospital authorities have not been able to do much to stop us. Likewise, people like the Health Minister have also used the media to generate their own special flavour of publicity. So either way, publicity is a fact of life. What needs to be considered more seriously is what the publicity is aiming at communicating.

Coercion for emotional reasons: Emotional factors affect almost every person who has ever donated a kidney, including members of the Jesus Christians. We feel empathy with people suffering from kidney disease, and we get this feeling that if we don't help, they will continue to suffer, and may even die. The more aware we become of the need, the more inclined we are to feel an emotional pressure to donate.

But knowing this about kidney patients in general, or even hearing about the suffering of a specific stranger does not impose such great emotional demands on us as it would if the patient were a very close friend or relative. A person making a decision to donate a kidney to whoever happens to be next on a hospital's waiting list is one who makes the decision with the least possible emotional pressure. Close friends and relatives almost certainly would not be free to think as dispassionately as would an anonymous donor.

So here, too, the regulations against non-directed kidney donations are shown to be wholly ineffective against pressures being placed on potential donors. On the other hand, allowing non-directed kidney donations relieves the pressure ("coercion") on friends and relatives.

The Rights of the Donors

Our primary concern has been that of the people dying from kidney disease. However, somewhere down the track, thought needs to be given to the rights of those people who choose to donate kidneys as well. The reason given for concerns about the black market and coercion have often centered around the rights of the donor; but in reality there still seems to be very little interest in real equity.

Some countries (most notably Iran) have tried to legitimise the black market, by legalising paid organ donations and then regulating things so that the donors are adequately compensated, and given the best possible medical treatment. We do not believe that this is a bad thing in itself.

But we also feel that there are plenty of people who would donate freely, in the way that Australian the British citizens now donate blood, if only they were made more aware of the needs, and if only they were given more opportunity to donate organs while still alive.

Expenses: In America, where live non-directed organ donations have been occurring for several years now, there is legislation available to enable hospitals to cover some of the travel and accommodation expenses directly related to the operations. This is on a par with the free orange juice and sandwiches available at most blood banks in Australia.

At the moment, even in America, organ recipients are entitled to mount campaigns to raise funds for operations, while organ donors cannot. We do not have any easy answers to this one, but it does seem fair that funds be made available for genuine out-of-pocket expenses.

Expressions of Appreciation

Although most people who have donated without ever being allowed to meet their recipients have still expressed satisfaction with the procedure afterwards, those of us who have been allowed to meet our recipient and to experience face to face expressions of appreciation after the operation generally feel that such a provision for organ donors is not inconsistent with the goals of combatting payment and/or coercion. After the operation has been completed, it is possible for a donor to do or say things that would embarrass the recipient, or make the recipient feel a moral obligation to return the favour. However, this is true of any number of other things that people do from day to day, and we feel that the possibility of this happening is offset by the emotional satisfaction that comes to both the donor and the recipient in a moment of heartfelt gratitude. Perhaps this could be done without addresses, phone numbers (and possible even names) being revealed. But whether these things are revealed (or whether they are left to the recipients to decide to reveal), the fact is that the operation would have taken place by the time such a face to face encounter took place, thus eliminating any possibility that compensation (or even appreciation) was a determining factor in the original decision.

(Note: Only a few hospitals in America have allowed for meetings between recipients and non-directed donors after the transplants. However, most do make provisions for the recipients and relatives of the recipients, to send anonymous expressions of thanks some time after the operation.)

Future Priority

A practical expression of appreciation offered by some hospitals to donors in America is favoured treatment in the event that the donors themselves should ever need a kidney transplant. This is one way of dealing with the concerns that some people have that they may be giving away a spare kidney that they themselves would need in the future. In reality, most kidney diseases strike both kidneys simultaneously, and so a kidney donor who later gets kidney disease would actually have bought insurance against kidney disease that a person with two healthy kidneys does not have. This seems to be a wonderful way to award donors and solve the need for live donors at the same time.

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