Monday, December 25, 2017

Three stories of kidney donations (and one of a grinch that wants to limit them)

I regularly see stories about kidney donation and kidney exchange: they've become so common that they are hardly news. But they are still very moving.  For today, as some of you open your Christmas gifts, here are three recent ones.

The first, from the Toledo (Ohio) Blade features Mike Rees and the Alliance for Paired Donation, and a kidney transplant to a former Blade correspondent, from his daughter:  A daughter’s enduring gift

Here's one from the San Francisco Chronicle, about a police officer who decided to give a kidney to a stranger:
SF police officer’s kidney donation leads to lifesaving chain of events

And here's another story of a kidney exchange chain:
THE ULTIMATE GIFT: Three kidney patients meet their donors at Duke

If those stories make you feel good about donors, they should. And you can feel a little good about economics too, since it is through kidney exchange that many donations happen.

But maybe you should stop here for today, and hold on to that feeling of peace and good will.

Because I also have a less cheerful story, about a vigorous resistance to the idea that donors should be allowed to save the patients they love even if they don't have health insurance, perhaps because they live in a country in which health insurance doesn't cover transplantation.  I'm speaking about efforts to obstruct Global Kidney Exchange , which is a way of inviting such patient-donor pairs to participate in American kidney exchange, free of charge, with their care paid for by the savings to the American health care system that are achieved by transplanting a patient who would otherwise be on dialysis (which is more expensive). At the link above you can see my posts about how GKE works, how it has received support from the American Society of Transplant Surgeons, and how it has attracted statements of opposition, concerned that, because it is free of charge, it resembles organ trafficking.

A new statement of opposition, from the group that calls itself the Declaration of Istanbul Custodian Group, has appeard on their web site:

It's an 8 page document (read it all at the link), but they summarize their position (on p2) this way:
"Although attractive at first glance, the GKEP proposal should be rejected for many reasons. It is deceptive; it creates major ethical problems, such as disproportionately helping the rich over the poor and undermining rather than advancing the welfare of kidney patients in LMICs; it amounts to international organ trafficking; and it will be difficult to administer in a way that actually prevents unethical and even illegal acts.  In the end, “reverse transplant tourism” differs from ordinary transplant tourism only with regards to the people who travel—organ recipients or organ donors—and not in the commercial nature of the organ “donation.”

So...I've written a lot about repugnant transactions (starting with this 2007 article), and repugnance to transactions involving body parts is something that has to be taken with the utmost seriousness.  In the coming year I'll devote some further effort to answering this and other objections with the seriousness that the subject demands.

But, today, in honor of the great Christmas festival of gift exchange, I'll just address this opposition to kidney exchange with these lines from Dr. Seuss's famous book How the Grinch Stole Christmas

"Every Who down in Whoville liked Christmas a lot.
But the Grinch who lived just North of Whoville did not!

The Grinch hated Christmas! The whole Christmas season!
Now, please don't ask why. No one quite knows the reason.

It could be, perhaps, that his shoes were too tight.
It could be his head wasn't screwed on just right.

But I think that the most likely reason of all
May have been that his heart was two sizes too small."

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