U.S.

Have Organ, Will Donate

By CBSNews.com staff CBSNews.com staff

August 10, 2000 / 3:55 PM EDT / CBS

As many as one in four Americans claim they'd consider donating a healthy organ to a total stranger.

But it's not that easy.

As CBS News Health Correspondent Dr. Emily Senay reports, there are some serious ethical questions involved.

The shortage of organs for transplantation has led to an increase in the number of living donors who volunteer to give up their organs to an unrelated sick person, or in some cases, a total stranger. This is called "nondirected donation" — giving to a person you don't know just out of the goodness of your own heart.

Experts say some people had been asking for decades about giving a kidney to anyone who needed it. But doctors hadn't even considered allowing it until recently, when they discovered that donations from spouses and friends worked better than kidneys from cadavers.

Dr. Senay points out a recent case of nondirected donation: Joyce Rousch, a nurse from Indiana, put her own life on the line for teenager Chris Bienek, a perfect stranger, by donating one of her kidneys. Although the risks to her own life were relatively small, with any operation there is always some risk of complications or even death.

Despite the controversy, it's a practice that is on the increase.

In Thursday's issue of The New England Journal of Medicine, doctors are pointing out some ethical considerations and raising a cautionary flag.

An article written by Dr. Arthur Matas, head of the University of Minnesota program that last year pioneered the use of organs donated by strangers, describes its success. Seven transplants were performed there last year using kidneys from people who did not know the patient.

In addition, doctors at Johns Hopkins University have done at least one nondirected donation transplant and at least 10 other transplant centers have requested information about them, Matas said.

One reason for the increase in nondirected doantions is that it has become safer to donate organs. Doctors can do it with minor surgery and the risk is small.

Nearly 12,500 kidney transplants were performed last year, with 4,153 of the kidneys coming from living donors. More than 3,000 patients died while waiting for a kidney.

Many doctors believe guidelines need to be developed to address concerns that transplant programs have become too aggressive in soliciting living donors. The fear is also that with a shortage of organs from cadavers, competition between hospitals for living donors will be fierce and could lead to a dropping of standards for evaluating donors.

For instance, some medical centers use advertisements to attract transplant business. The University of Maryland recently ran an ad in The New York Times for organ donation. The ad stops short of soliciting a donation, but it's a good example of how hospitals are competing for business.

Another ethical problem asscoiated with nondirected donors is trying to prove that their motivation is purely altruistic, ad that's hard to do.

Many times people are not suitable psychologically to become a donor. In an accompanying editorial in the Journal, Dr. Normal G. Levinsky of Boston University wrote that to prevent hospitals from lowering standards to accept kidney donations from strangers, potential donors should be evaluated at a transplant center other than the one that performs the transplant.

And money should never be involved in the hospital contract, Dr. Senay reports. There may be some reimbursement, but it's against the law to sell organs in the United States.

Although unlikely, donors might demand money or other help from the people who got their kidneys, Matas said. For example, one anonymous donor spent $1,000 on trips to Minneapolis and lodging there, and used 10 days of sick leave. The doctors took out a rib to get the kidney, and left a foot-long scar on that side. It was not clear whether the donor was reimbursed, but this case illustrates the costs involved with being an organ donor.

If more people became organ donors in the event of their death, there would be less of a need for living organ donation, Dr. Senay said.