Kidney sales proposal in 1983, and the origin of the 1984 National Organ Transplant Act (history)

Dr. David Cohen at the NewYork-Presbyterian Hospital/Columbia University Medical Center Renal and Pancreatic Transplant Program recently shared with me the 1983 letter, below, that was received at Presbyterian Hospital from Dr Barry Jacobs, who proposed to purchase kidneys for transplantation, and was looking to enlist partner hospitals.

You should be able to click on the letter to enlarge it. The stamp is a bulk mail stamp (for 10.9 cents), which suggests that this letter was sent to many hospitals.

The letter states that there were 70,000 Americans with end stage renal disease in 1983, and a shortage of organs. Today those numbers are much higher.

I notice that the name of the proposed venture was International Kidney Exchange, Ltd.  The name "kidney exchange" has of course since come to mean something very different--the in kind exchange of kidneys without any money changing hands--although it is also often called "kidney paired donation," perhaps out of a lingering repugnance to the name as well as the idea.

And below is a story that ran in the NY Times at the time. Apparently Dr. Jacobs was not a model citizen: prior to making this proposal his license had been revoked and he had spent time in prison. This may have helped to make his proposal repugnant, and it was outlawed the following year, in the 1984 NOTA, which stated in part:
"TITLE 111-PROHIBITION OF ORGAN PURCHASES
SEC. 301. (a) 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.
(b) Any person who violates subsection (a) shall be fined not more
than $50,000 or imprisoned not more than five years, or both. "

The act has since been amended to read
(a) Prohibition

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. The preceding sentence does not apply with respect to human organ paired donation.

Here's the NY Times story.

BUYING OF KIDNEYS OF POOR ATTACKED

By WALTER SULLIVAN  Published: September 24, 1983

"A plan to purchase kidneys from living donors, primarily the indigent, for sale to people needing transplants and able to afford them drew strong opposition yesterday on ethical and medical grounds from officials of the National Kidney Foundation.

¶A Virginia physician, Dr. H. Barry Jacobs, has formed an organization, International Kidney Exchange, to purchase and market the kidneys. Some of the kidneys would be purchased from people living in underdeveloped countries.

¶''It is immoral and unethical,'' said Dr. David A. Ogden, president of the foundation, ''to place a living person at risk of surgical complication and even death for a cash payment to that person.'' To do so, he said at a news conference in Manhattan, ''would make a travesty of informed consent, by introducing the temptation and bias of a cash award for consent.''

¶Furthermore, he and other specialists in kidney transplantation said the plan could not be justified medically. They asserted that the success rate in transplanting kidneys from cadavers was just as high as from donors with no blood relationship to the recipient. Contrast in Success Rates

¶Where a living donor and the recipient, being closely related, carry a relatively high percentage of similar genes, the rate at which the organ is rejected by the body's immune system is about 10 percent, according to the foundation. Where the kidney came from a cadaver the rate is 40 to 50 percent.

¶Another risk in purchasing kidneys cited by the physicians was uncertainty as to the medical history of the donor. Situations were also forseen in which parents in search of funds would consent to kidney removal from one or more of their children.

¶Dr. Jacobs, in a telephone interview last night at his office in Reston, Va., responded that 70,000 Americans were dependent on dialysis machines, which substitute for kidney function. Yet, he said, there were only enough kidney donors for a little more than 5,000 patients last year.

¶''How are they going to fill the gap?'' he asked. He also said the danger of infection in a cadaver kidney was ''slightly higher'' than that in a kidney from a living donor. He said the risk to the kidney donor was less than that from a hysterectomy, a relatively common operation involving the removal of all or part of the uterus.

¶Asserting that the voluntary approach had not produced the needed kidneys, he asked rhetorically: ''Where is the wind blowing? It is the money wind.'' License Was Revoked

¶In 1977 Dr. Jacobs's license to practice medicine in Virginia was revoked after he was convicted of mail fraud in a case related to Medicare billing, and he spent 10 months in jail.

¶Kidney foundation officials said there appeared to be no legal method to prevent Dr. Jacobs from buying, importing and selling the human organs.

¶They cited several moves to outlaw the sale of human organs and to promote their equitable allocation.

¶Senator Edward M. Kennedy, Democrat of Massachusetts, has introduced a bill that would establish a study group to explore the possibility of establishing a national system for organ procurement. In the House, Albert Gore Jr., Democrat of Tennessee, has introduced a bill that would outlaw the sale of such organs.

¶Foundation officials agreed there was a shortage of kidneys available for transplant. In 1982 more than 10,000 Americans were waiting for kidneys and only 5,358 transplants were performed."