Increasing the supply

One partial remedy considered for the shortage of donor kidneys is a willingness to implant “marginal” kidneys from geriatric, hypertensive, and even proteinuric donors, so-called “expanded criteria donors” (Transpl Int. 2008;21:11-17). A second option is the purchase of kidneys from compensated donors.

Clearly provocative, though broadly practiced, this approach has gradually undergone transformation from an unmentionable despicable practice in developing (poor) countries to a debate topic for national medical organizations (Clin Transplant. 2008;22:378-384), such as the American Society of Nephrology (Kidney Int. 2006; 69:960-962).


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Selling a human organ in the United States has been proscribed for nearly 25 years, as starkly stated in the 1984 National Organ Transplant Act: “It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce.”

Punishment for violation is effected by fines up to $50,000 and/or five years in prison. A year later, the Ethics Committee of the Transplantation Society issued a supporting policy statement: “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 (Transplantation. 1986; 41:1-3).”

Over the ensuing five years, the World Health Organization and multiple nations proscribed organ marketing. Iran is presently the only nation that has established rules governing the marketing of kidneys from living donors (Pediatr Nephrol. 2008; published online ahead of print).

Medical associations around the world decry the sale of human organs as “morally and ethically irresponsible” or “inhumane and unacceptable.” Critics who have evaluated conditions and consequences experienced by paid donors in Brazil, Pakistan, the Philippines, and other countries tacitly permitting solid organ sales denounce the practice as allowing an economically privileged population property rights over the bodies of the disadvantaged.

Pope John Paul II condemned the buying and selling of human organs as violations of “the dignity of the human person.” The American Society of Transplant Surgeons opposed solicitation of organs by intended recipients or their agents, from deceased or living donors, via personal or commercial Web sites, billboards, media outlets, or other forms of advertising intended to direct donation to a specific individual rather than according to the accepted policies of allocation devised by UNOS that apply to all on the waiting list.