Doctor backs kidney sales

by Mike Enright

Lately, University surgery professor Dr. Arthur Matas has been receiving a few more e-mails in his inbox than usual.

That is because two weeks ago Matas, the University Medical Center Fairview’s chief of renal transplantation, was the subject of an ABC News story.

For the past several years, Matas, a longtime proponent for increased organ donation, has taken a rather controversial stance in the debate over the sale of organs.

“I’ve struggled with it,” Matas said. “There are tons of reasons for why one shouldn’t go forward with it.”

Why, then, does he believe in creating a regulated system of kidney sales?

The reason, Matas said, is simple.

“Every year there are more people added to the (organ) waitlist than we transplant, so every year the waitlist is getting longer,” he said.

In the 1980s, most patients waited about a year to receive a kidney, Matas said, but now, patients spend five or six years waiting, and closer to 10 in some parts of the country.

“The consequence of this long waiting time and the long list is that patients who are acceptable transplant candidates are essentially suffering and dying on dialysis before we can transplant them,” he said. “Nobody would be arguing for a system of sales, if there weren’t this tremendous need.”

But after being involved in the debate for this long, Matas said he has no illusions about the difficulty in convincing others of his point of view.

The sale of organs is still unpopular and illegal – Congress outlawed it in 1984.

The American Society of Transplant Surgeons, which Matas is president of, also doesn’t support the concept.

One critic yet to be convinced is Dr. Steven Miles, University professor of internal medicine.

Miles, a faculty member of the Center for Bioethics, said sales of organs, even regulated, present several dilemmas, namely the potential problem of exploiting people of lower income.

“You still wind up with the problem where the people most susceptible to giving would be people from a lower socio-economic group,” he said.

And in the long run, promoting paid donations from poorer individuals could take a financial toll on the country’s health care system with the public picking up the extra costs, Miles said.

Matas has acknowledged that his idea would only work in more developed countries, such as the United States, where donors can be given the proper long-term care required.

Even so, economically, transplants are extremely cost-effective, he said.

“When we’ve done our modeling, the health-care system saves at least $100,000 for every patient you transplant from dialysis to transplant, and there are models that say it’s multiples of that amount,” Matas said.

People wouldn’t necessarily have to be reimbursed in cash either, he said. Possible compensation could include health insurance, tax breaks, life insurance or college tuition.

The system of sales Matas is proposing would build on the already existing infrastructure that regulates donated organs, he said.

Paid individuals would go through the same screening and approval process that donators already do, Matas said, all of which is coordinated by organ donation organizations that procure the organs and then deliver them to a clinic with a compatible candidate.

Despite her own reservations about organ donors getting paid, physiology and Spanish senior Danielle Alfano said she understands the argument for it.

“Especially today, money is a huge incentive to get people to do things,” she said. “But I don’t know if paying for organs is necessarily the best way to go about it.”

Regardless, Alfano said there is a definite need to increase the number of organ givers.

“I don’t think a lot of people check the box on their IDs,” she said.

But the perception of organ sales is changing, said Dr. John Najarian, University clinical professor of surgery and Regents professor emeritus.

“Initially it was (an idea) that was, as I say, a voice in the wilderness. But now it’s one that most of us in transplantation surgery are taking cognizance of, and I think (Matas has) got something going there,” he said.

With more patients dying after spending years on waiting lists, more and more former critics are at least willing to listen to what people like Matas have to say.

“It makes a lot of sense,” Najarian said. “I must say, I support him in his action.”

Biology sophomore and nursing school hopeful Meredith Lukasek said Matas’ hypothetical system is an interesting concept, but not without its downsides.

“If somebody is donating just for money, that kind of takes away from the good Samaritan aspect of it,” she said.