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Below is a reply to a student who wrote to Dave with a list of questions for a paper he was preparing on kidney donations. Oddly enough, it includes several arguments from Dave in favour of restrictions on organ donations.

Aha! Robert. Some of your questions are what they call "leading" questions in legal circles, meaning that you appear to have your mind already made up and you are looking for confirmation from me. I may agree with some of your conclusions, but I'll try to make general comments with regard to my position rather than giving straight yes and no type answers to your questions. I hope you will be able to get some benefit from this, and that you do well with your paper.

Obviously, our kidneys do not belong to the government, as you say. They belong to us personally. But the government often has to pass legislation which restricts us with regard to what we can do with our bodies. The reason the government gives for not allowing people to give a kidney to strangers would be the same reasons for why they would at least want to regulate such transactions if they were allowed. I'll try to explain. Remember, this is coming from someone who wants to see the legislation loosened... but it helps to understand how there could be problems if there were no legislation at all.

First, there is the ethical concern that some doctors have, about taking a perfectly healthy person and cutting a major organ out of that person's body. Some doctors feel that it would be on their conscience if that person were to die as a result of such an operation (and it can happen). They make a promise (called the Hippocratic Oath) when they start medicine, that they will not use their skills to do anything that would take away from the health of another person. Even when a kidney donor does not die, there are infections and other complications that come up fairly often with such major surgery. The donor ends up marginally worse off than they were before the operation.

Our position is that the doctors are not looking at the bigger picture. In a skin graft, for example, they take perfectly good skin away from one part of the body, and graft it onto another part that is urgently in need of new skin. The damage to one part of the body is offset by the benefit to another. In fact, with virtually all surgery there is damage to healthy parts of the body to get to the parts that are in need of correction. With a transplant, we just ask that the cost/benefit concerns be expanded to include more than one person, i.e. the damage to the donor's body must be weighed up against the benefit to the recipient. On that basis donations from healthy people start making sense.

However, a better argument for legislation to restricts donations is that the government wants to protect the rights of the donor. In other words, it has nothing to do with saying that the donor does not have a right to do what he/she wants with his/her own kidney, but quite the opposite. It has to do with other people not having the right to coerce someone into parting with a kidney that he/she may not really want to part with.

We have already found that some hospitals make it sound much easier to donate a kidney than what it really is. In other words, they may be trying to hide the risks, because they do not want to frighten people away from donating. (The hospitals make big money through such operations.) I'm not saying that they are lying, but just that they have a tradition of trying to reassure people that "everything is under control", and so they may reassure donors a bit too much as well.

Legislation requires that donors be given a chance to consider all of the worst possible scenarios, including such things as dying on the operating table, or giving a kidney that does not "take" with the recipient. We are dealing with a family in Israel at the moment, where a woman's daughter donated a kidney, but the surgeon cut one artery too short, and they had to throw the kidney out, because it could not be hooked up to the mother's artery when they tried to install it into the mother's body. Imagine how the daughter must have felt! Such things do happen.

Hospitals, too, have regulations, because they do not want to be sued by donors later, if the donors change their minds after making the donation, and if they argue that they were not clearly informed of all the risks. One of our members had had a vasectomy (an operation to stop him and his wife from having babies), but he was never asked whether he had had a vasectomy by the hospital before the operation. It turns out that an artery is cut during a transplant that normally goes on from the kidneys to the testicles. Normally the testicles can manage okay with the blood coming in from a different artery... unless you've had a vasectomy, in which case the other artery has been cut as well. With both arteries cut, the testicle becomes quite sore, and could die. We will not sue the hospital, but this is the kind of thing that legislation can help to prevent, by restricting hospitals from performing such operations until they have gone over all of the issues with the donors.

Then there are people like myself that the legislation is aimed at protecting people from! You must have been able to pick up from the Guardian article that Jon Ronson was trying very hard to depict me as a mind-control manipulator who was secretly coercing the members of our community (Jesus Christians) into donating kidneys so that I could get some kind of publicity for myself out of it. Obviously, I disagree. But I do accept that it is the sort of thing that could happen and the sort of thing that people would suspect. So there need to be things like psychological tests, to determine whether the person is donating because he/she is fully convinced personally about what he/she is doing.

We have lived for some time in India, where poor village people regularly sell their kidneys to hospitals for transplants. On the whole, I think it is a good idea. The village people receive enough money that they can greatly improve their lifestyle. Some have been known to use the money received from donating a kidney to pay for a life-saving operation for themselves or a relative suffering from some other ailment. At the same time, people dying from kidney diseases get the kidneys that they need. If people were allowed to buy and sell kidneys all over the world, there would be no shortage of kidneys for anyone in who needs one (providing they or their insurance companies have the money to pay for the operation plus the cost of the replacement kidney). There are hundreds of thousands of people in the Third World who would love to sell their kidneys for the kind of prices that are presently being offered on the black market (at least $US10,000 plus all expenses). If sales were regulated, the donors could get even better treatment, and probably even higher prices for their kidneys.

BUT... and this is a very big but. When they checked out villages where kidneys were being sold in India, it was learned that almost all of the donors were wives... wives who had been pushed into being the donors, so that the husbands could get the money. It may be that some couples discussed it and felt that the husband, who was involved in heavy physical work, needed two kidneys more than the wives; but my suspicions are that the husbands were just exploiting their wives. That is an example of the sort of thing that governments and hospitals do not want to encourage or to be a part of. Can you see how there must be some kind of legislation to control that sort of thing?

Of course, just outlawing all unrelated kidney donations is not a good solution. Thousands of people are dying needlessly because of that. It is our opinion that the regulatory bodies are often more inclined to stick their heads in the sand and ignore the urgency of the situation... because it is not their life that is in danger.

Although we feel that it is not wrong for people to sell kidneys (After all, everyone else is benefiting from the operations, so why not compensate the person who is losing the most in order for it to take place?) we believe that things may have to be changed one step at a time, and the first step is to allow people like ourselves to donate freely. Investigations could be made to ensure that money is not being paid secretly, but once it is established (at least as far as that is possible) that the donation is made freely, then it is probably unlikely that someone has been coerced into giving. Most corruption comes because someone is trying to make easy money (e.g. the husbands who profit at the expense of their wives in India).

For us as Christians, the motive is extremely important; and that is why we see a significant difference between selling a kidney and giving it away. We do not think that it is wrong to sell a kidney (providing a person is doing it of their own free will, and providing they have a clear understanding of the risks), but when that happens, it clouds the issues over whether love has anything to do with it. We prefer to be clear about the fact that we are giving for love and for God.

As you put it, yes, we are hoping for a reward of some kind from God. Of course, Jesus also said that if we get praise and recognition from others for what we do to help the needy, then that becomes our reward, and there is no need for God to reward us in heaven. Well, we have received a fair bit of praise (and a bit of condemnation as well), so we probably don't have much reward coming from God either. Nevertheless, there is a great deal of personal satisfaction from knowing that we have saved someone's life (or even from knowing that we tried to save someone's life... in the event that it doesn't work.)

One other thing that has not come out so far in the media coverage that we have received. In the U.S., where unrelated live donors are becoming widely accepted, there is an understanding that a donor who should ever need a kidney themselves automatically goes to the top of the priority list. In other words, there is actually a tangible personal benefit to a live kidney donor that helps to offset the argument that you should keep both kidneys "just in case" you should ever need a spare yourself.

And once people get over the initial hesitancy about live donations, one should not have to feel obligated to hang onto an extra kidney in case a relative should ever need one, because there will be so many of us giving that a relative would never need fear being without a donor. It's just that someone has to start the process going, and we are trying to contribute to that movement.

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