June 15, 2001
How much is the gift of life worth?
The black market in human organs is under intense scrutiny
Robin Allen knows precisely how long he was on dialysis: two years, eight months and 26 days. Near the end of that time Allen, who had suffered from polycystic kidney disease, visited the hospital five days each week. Finally, he received a kidney transplant.
Allen is eternally grateful for the organ donor - dialysis, he says, is not a pleasant thing. "I've got the marks on my arms to prove it," he says of the large-gauge needles involved in the procedure. The treatments take over your life, dictating your schedule. And there are side-effects: patients are asked to limit their fluid intake to one litre per day, leaving them parched much of the time. And some patients suffer a condition which causes their skin to itch - scratching only aggravates the problem - and Allen was one of those who suffered such symptoms.
"If you scratch, the itching gets worse, and your skin turns red. I'd jump into a bathtub filled with hot water, then rub myself with ice just to try and get some sleep," said Allen, a radio news broadcaster. "The only good thing I can say about the itch is that it took my mind off how thirsty I was all the time. When your kidneys don't work, you can't get rid of excess fluid at all. And so they gave us fluid restrictions that were just unreal; but I could drive around the planet without making a single bathroom stop."
And yet Allen knows he may well have faced a worse fate. He is one of the lucky few Canadians who have received a donated organ. Traditionally, the odds are against persons waiting for organ donations. Last year, 147 Canadians died while awaiting transplants. Canada, with an organ and tissue donation rate of just 14 per one million persons, has one of the lowest donation rates in the industrialized world.
Knowing that donated organs are in short supply, some Canadians have turned to the international black market. Media reports in recent years have shed light on these shady operations, in which self-styled 'brokers' arrange the sales of organs to patients who can pay. Kidneys are the most commonly traded organs, and in most cases, poor persons in developing nations sell a kidney to wealthy patients. The cost for an organ can run over $100,000 but the person who actually sells an organ often sees very little of what amounts to a tremendous fortune. Recently, Canadians have advertised the sale of their own, healthy kidneys in search of a quick financial windfall.
"What he was doing is wrong because providing a health benefit shouldn't be something that takes away health from somebody else and is compensated by monetary payment, most of which goes to some third party," Solez said. "The donors don't recognize the risk to themselves. The usual way of obtaining the transplant has none of this aspect of purchasing human life."
The trade in human organs is illegal in Canada and the U.S. and considered immoral in many quarters, regardless of its legality. But if so many people are dying because of a lack of human organ donors, why should we prevent such transactions from occurring?
"I just don't know what else it would take to live up to the word 'dehumanizing,'" says Dr. Laura Shanner, a University of Alberta professor of health ethics with the John Dossetor Health Ethics Centre. "My take on it is, without diminishing the needs and interest of people suffering organ failure; as soon as people's body parts have a price tag we have sold ourselves. That is a hard line for me, and I don't have many hard lines."
A healthy kidney may benefit a recipient, and money may benefit someone desperate enough to sell an organ from their own body, Shanner says. "But someone is going to have to convince me that saving our lives from organ failure is worth every imaginable cost."
Despite the hardships he endured while on dialysis, Allen feels the same way. Asked if he would have bought a kidney if the possibility had presented itself, Allen responded with a definite 'no.'
"I have been asking myself that very question as I've been reading these articles over the past couple of weeks," Allen said. "I like to think I'd have the moral fibre to say this is shameful to exploit people who are so poor and desperate they are willing to sell body parts."
Those same media reports have put forward the suggestion that, because the sale of human organs occurs anyway, governments ought to simply regulate the practice.
Allen feels organ donation is above finance. An organ is the gift of life, he says, not a commodity.
"If organ donation becomes a financial transaction, well, maybe I am an old hippie communist guy and think money spoils everything, but when you open up for sale what is a completely unselfish act and a beautiful thing to do, it becomes grotty."
Allen says it's a sad situation to even ask the question, 'why shouldn't people who can pay $150,000 be allowed to buy an organ?' "It seems wrong to me. It seems that if it is going on we should try to do something to solve it, and the solution isn't that they should have the right to sell off body parts; we should be doing something about the conditions that led them to this place."
Solez says something needs to be done, too, about the donor rate in Canada, in order to speed up the transplant process and make the purchase of organs less enticing. To that end, federal health minister Allan Rock announced a $20-million initiative in April aimed at improving Canada's poor donation rates.
Other options include xenotransplantation, the use of animal organs in humans. The problem with xenotransplants is the possibility of animal viruses jumping into human populations. But Allen says that, if the procedure were safe, he'd go for it.
"Apparently there are still some pretty big problems with that, but if it were made safe, hell - It wouldn't bother me in the least," said Allen. "I would take kidneys from a German shepherd, a baboon, a pig. I'd even be willing to take one of the pig's kidney's and promise to take care of that pig for the rest of its natural life."
Ultimately, he adds, organs need to be donated out of pure kindness.
"I don't know how to put this without sounding really corny, but the kidney I got came from a guy killed in a tragic, tragic accident, and in the midst of all this grief his family decided to give this gift to someone they didn't know. If it is a gift, it certainly makes me more aware of everybody's humanity, and I think, 'Geez, it isn't such a bad old world after all.' "