Organ donation in Germany

Organ donation in Germany is declining, from an already low rate.
 Die WirtschaftsWoche has the story in their February 19 issue:

Die Zahl der Organspenden in Deutschland geht immer stärker zurück. Ökonomen machen dafür auch falsche Anreize verantwortlich. Sie schlagen Modelle vor, um mehr Menschen fürs Spenden zu gewinnen.

Google translate: "This could lead to incentives for organ donation
The number of organ donations in Germany is decreasing more and more. Economists blame it for wrong incentives. They suggest models to get more people to donate."

The article refers in part to this lab experiment investigating giving registered organ donors priority should they need an organ:

Organ donation in the lab: Preferences and votes on the priority rule
by Annika Herr and Hans-Theo Normann
Journal of Economic Behavior & Organization
Volume 131, Part B, November 2016, Pages 139-149

"Abstract: An allocation rule that prioritizes registered donors increases the willingness to register for organ donation, as laboratory experiments show. In public opinion, however, this priority rule faces repugnance. We explore the discrepancy by implementing a vote on the rule in a donation experiment, and we also elicit opinion poll-like views. We find that two-thirds of the participants voted for the priority rule in the experiment. When asked about real-world implementation, participants of the donation experiment were more likely to support the rule than non-participants. We further confirm previous research in that the priority rule increases donation rates. Beyond that, we find medical school students donate more often than participants from other fields."

The newspaper article also quotes German transplant officials as saying that this would be an unethical organ market, and that it would open the door to illegal black markets...

Super bowl thought by Kim Krawiec: football players are paid, why not kidney donors?

While checking up on the super bowl, I'm reminded that Kim Krawiec posted this:
 Super Bowl Week OpEd

"As the Super Bowl approaches, Phil Cook and I have an OpEd running in the Raleigh News & Observer and a few other publications:

Why ban payment to kidney donors but not football players?

BY PHILIP J. COOK AND KIMBERLY D. KRAWIEC 

February 01, 2018 01:06 PM

Super Bowl week rivets national attention on America’s most popular and lucrative sport, professional football. If stories of concussion and permanent injury to players make some fans uneasy, there is always the reassuring fact that the players volunteer for the job and are well compensated – so well compensated that there are untold thousands of young men who would gladly take their place.

Football is so ingrained in our culture that we generally accept this situation without much scrutiny. However, our research got us thinking about the stark contrast with another risky but valuable activity – kidney donation.

About 6,000 people per year donate one of their two kidneys. This selfless act has some risk to the donor, both from the surgery and years later when there is a chance the remaining kidney will fail. In return, kidney donors are rewarded with the knowledge they helped save the life of a loved one. They receive nothing tangible. Indeed, federal law bans compensation for kidney donors, as do the laws of all other countries except Iran (really).

So, why do we pay football players to entertain the public, but are unwilling to pay kidney donors to save lives?

The stakes in both cases are high, but much higher in kidney donation. The total value of NFL teams is about $60 billion. If, in some unlikely future, the risk of serious permanent injury to players led to a ban on professional play, that value would be destroyed.

Meanwhile, the ban on compensation for living kidney donation currently costs thousands of lives and billions of dollars in taxpayer money every year. The waiting list for a kidney now includes 100,000 patients, who for the most part are kept alive by renal dialysis at federal government expense. If they survive long enough, typically more than five years, in this debilitated state, they may hope to rise to the top of the list and receive a kidney from a deceased donor.

Deceased donors are a limited resource: few people die under conditions that permit donation and the United States already procures a large percentage of healthy kidneys from deceased donors. What is needed are many more living donors. Current estimates suggest an offer of $50,000 per living donation would be adequate to recruit sufficient numbers to meet the needs of all transplant-eligible renal patients. This would eliminate the waiting list and prevent thousands of unnecessary deaths and years of unnecessary disability. Given standard value-of-life estimates, the present value of the public benefit of converting to a system of compensated donation would exceed $1 trillion – many times the value of professional football.

It should be noted that the alternative to the current ban on compensation is not a laissez-faire free market. Rather, the current system for regulating the allocation of available kidneys could be readily expanded. A nonprofit or government organization could offer a fixed payment to living donors who were screened to be physically and mentally sound, and then fully informed of the risks. To avoid “impulse” donations, there could be a mandatory waiting period.

And it should be noted that the medical risks to kidney donors are far less than the risks of a football career; most donors lead normal lives, while most NFL veterans are, to some degree, disabled.

Inevitably the chance to sell a kidney for $50,000 would be most attractive to people who are struggling financially. Some ethicists opine that a compensated system would exploit the poor. Yet, more than a few NFL players also come from poor homes and 70 percent are black, causing many to view the concussion crisis as another example of racial inequality. In our view, the risk of exploitation is not a legitimate reason for forbidding compensation to kidney donors, thus denying the poor full use of one of their potential assets.

Millions of Americans, not just NFL players, work in occupations that have a substantial risk ofserious injury. Loggers, fishermen and others accept these risks in exchange for compensation. Extending that list to include kidney donors is just common sense.

PHILIP COOK IS TERRY SANFORD PROFESSOR EMERITUS OF PUBLIC POLICY AND PROFESSOR OF ECONOMICS AND SOCIOLOGY AT DUKE UNIVERSITY’S SANFORD SCHOOL OF PUBLIC POLICY. KIMBERLY KRAWIEC IS THE KATHRINE ROBINSON EVERETT PROFESSOR OF LAW AT DUKE LAW SCHOOL."

Risks of living kidney donation: a meta-analysis

Better information is accumulating on the risks of living kidney donation. A meta-analysis has just been published January 30 in the Annals of Internal Medicine. It reports what the authors consider to be very moderately increased risk of kidney failure, and of pregnancy complications.

Mid- and Long-Term Health Risks in Living Kidney Donors
A Systematic Review and Meta-analysis
by Linda M. O’Keeffe, PhD*; Anna Ramond, DPharm*; Clare Oliver-Williams, PhD; Peter Willeit, MD; Ellie Paige, PhD;Patrick Trotter, MBChB; Jonathan Evans, MBChB; Jonas Wadstrom, MD; Michael Nicholson, MD; Dave Collett, PhD; and Emanuele Di Angelantonio, MD

From the Abstract:
"Although living kidney donation is associated with higher RRs  [relative risks] for ESRD and preeclampsia, the absolute risk for these outcomes remains low. Compared with nondonor populations, living kidney donors have no increased risk for other major chronic diseases, such as type 2 diabetes, or for adverse psycho-social outcomes."

And from the concluding discussion:
"Findings from this review may have implications for policies and practices related to living kidney donation. For example, donors should be informed that, although nephrectomy is associated with a higher RR for ESRD,the absolute risk is still low for most donors (that is, those not from known high-risk populations [39]). Thus, risk prediction tools for ESRD may better approximate the risks involved for prospective donors (43). Guidelines that do not contain information about pregnancy for living kidney donors should instead include relevant information for women of childbearing age in the informed consent process. Furthermore, this review supports the need for long-term follow-up of donors to monitor their health and mitigate possible increases in disease risks associated with kidney donation (44). In conclusion, compared with nondonor populations, living kidney donors have no increased risk for several major chronic diseases, with the exception of ESRD. However, the absolute risk for this disease remains low. Female donors who become pregnant after nephrectomy also seem to be at increased risk for preeclampsia, but more data are needed to confirm this finding."

The number of organ donors in Germany has fallen to its lowest level in 20 years.

Rosemarie Nagel draws my attention to this article in Der Spiegel on transplantation in Germany:

Transplantation
Wieso werden in Deutschland so wenige Organe gespendet?
Die Zahl der Organspender in Deutschland ist auf den niedrigsten Stand seit 20 Jahren gesunken. Woran liegt das? Und wie kann man einer Spende zustimmen - oder sie ablehnen? Der Überblick.

Google translate renders it as: Transplantation
Why are donated so few institutions in Germany?
The number of organ donors in Germany has fallen to its lowest level in 20 years. Why is that? And how can you agree to a donation - or reject it? The overview.

Organ donation in the UK: the particular case of children

Children in need of transplants, particularly very young children, need appropriately sized organs, which can come from deceased donors of similar age. But there are obstacles, including family consent:

Despite removal of many obstacles, UK child organ donation rates remain low

"Despite the removal of many logistical/professional obstacles, and clear guidance from national bodies, UK child organ donation rates remain lower than in other comparable countries, say experts in a leading article published online in the Archives of Disease in Childhood.

"Many families of dying children are simply not even given the chance to consider the option, and potentially save another child's life, they argue.
...
"Family refusal remains a major obstacle to organ donation from children, emphasise the authors, but that is where trained staff are key, as they can ensure that "families are given the chance to consider donation, and that it is broached at the most appropriate time by the most appropriate person, and in the most appropriate way," say the authors.

"Immediate focus should be given to consent rates and supporting family decision-making, they urge."

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:
STATEMENT OF THE DECLARATION OF ISTANBUL CUSTODIAN GROUP CONCERNING ETHICAL OBJECTIONS TO THE PROPOSED GLOBAL KIDNEY EXCHANGE PROGRAM

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."

Loss-of-earnings compensation for live organ donors in New Zealand

The New Zealand law has gone into effect:
Loss of earnings compensation for live organ donors

"The Ministry of Health will be implementing compensation for live organ donors from 5 December. People who donate a live organ will be fully recompensed for lost earnings for up to 12 weeks while they recover. This will be paid weekly following the donation surgery. In the past donors received some assistance in the form of a benefit for this.

‘Loss of income can put people off donating an organ,’ says Clare Perry, Group Manager Integrated Service Design at the Ministry of Health. ‘Removing financial barriers can be a big help in deciding to go-ahead with what is often a life-saving donation.

‘With most live organ donations being made to family members or friends, not having to worry about lost income makes things easier during a time that is already stressful.

‘Most people who donate an organ take between 10 days and six weeks to recover, but if the hospital specialist says you need longer the Ministry of Health will pay your lost earnings for up to 12 weeks so money is less of an issue over this time.

...
‘Travel and accommodation assistance is also available for people who may need to travel to have specialist medical tests associated with their organ donation surgery.’

...

"Additional information
· Between 2012 and 2016 there were 340 live kidney donations. [Source: Organ Donation New Zealand 2016 Annual Report]
· This number has increased each year and was 82 in 2016. [Source: Organ Donation New Zealand 2016 Annual Report]
· Over the same time period (between 2012 and 2016) there were 17 partial live liver donations. [Source: Organ Donation New Zealand 2016 Annual Report]
· 15 of these partial live liver donations were made to children. [Source: Organ Donation New Zealand 2016 Annual Report]
· Between 2011 and 2015, 151 kidney donations were made to blood relatives, with 165 to partners, in-laws, friends and others not directly related to the recipient. [Source: Australia and New Zealand Dialysis and Transplant Registry 39th Annual Report]
· In 2015 there were 2674 New Zealanders on dialysis. [Source: Australia and New Zealand Dialysis and Transplant Registry 39th Annual Report]"

HT: Frank McCormick

Strategies to Increase the Donor Pool

Here's a survey:
Strategies to Increase the Donor Pool, by Michael A. Rees and David E. Fumo

Kidney Transplantation, Bioengineering and Regeneration
Kidney Transplantation in the Regenerative Medicine Era, 2017, Pages 59–83 Chapter 6

Abstract
Kidney transplantation is victim of its own success. Due to its excellent outcome, indications have expanded and more and more patients are registered in the waiting list. However, the number of available organs has not been able to rise at the same pace, and this has led to a dramatic increase of the mortality and dropout rate of patients while on the waiting list. This chapter will illustrate the strategies that are currently being devised and implemented in order to increase the supply of transplantable kidneys.

Alabama adopts a paid leave program for organ donations

Here's the story:
Alabama adopts a paid leave program for organ donations

"Under a new state provision, a permanent employee with at least one year of state service may be granted living donor leave, with pay, for donating an organ or bone marrow.
...
"Based on physician orders, the employer may receive up to 30 days to donate an organ and up to seven days to donate bone marrow. The employee does not have to exhaust his or her leave accruals for the procedures."

Family consent for deceased organ donation in Britain

From the BBC: Hundreds of families block organ donation

"Organs from 505 registered donors could not be made available for transplant in the last five years because of objections from relatives.
...
"The law states that consent lies with the deceased, but in practice, relatives' wishes are always respected.
The NHS wants to reduce the number of "overrides" by encouraging prospective donors to talk to their relatives.
In England, NHS figures showed that 457 people died last year whilst waiting for an organ transplant."

Living kidney donation in Israel: Matnat Chaim in trouble with the law

The Israeli organization Matnat Chaim (gift of life) encourages and facilitates non-directed kidney donation, i.e. living donor kidney donation by donors who don't have a particular recipient in mind. It's generally agreed that they have saved hundreds of lives. In an earlier post I linked to stories reporting that they were under investigation for potential violations of some of Israel's laws involving the financial donations they received. (Israel, like almost everywhere, has laws against paying for a kidney...)

Now the plot has thickened, and some leaders of the organization have been arrested. They have also received strong expressions of support.  Here are two stories in English.

From The Times of Israel:
Head of transplant organization arrested over ‘organs for donations’ scheme
Charity suspected of bumping potential recipients to top of waiting list in exchange for funding, paying illegal compensation to donors 

"The organization is said to have encouraged relatives of those in need of transplants to make donations to the organization in order to shorten the waiting time to receive organs.

"Police noted that they are not treating individual donors or organ recipients as suspects. “If anything, they are victims who themselves have been working to save lives,” the statement said.

"Police said the investigation begun a number of months ago after a complaint was received against the organization from the Health Ministry. Evidence has since been collected from organ recipients, their families and other sources.

"A police spokesperson explained that the investigation was “particularly complex and sensitive” and officers have made an effort not to interrupt the continuing work of the organization “in order to allow its life saving services to continue regardless of the ongoing probe.”
**********

and from Arutz Sheva (channel 7, Israel National News):
Rabbi Kanievsky supports head of NGO investigated by police
Rabbi Chaim Kanievsky publicly visits head of the 'Matanat Chaim' NGO, under investigation for trading organ donations for money.

"Prominent haredi Torah sage and leading halakhic authority Rabbi Chaim Kanievsky visited the house of Rabbi Yeshayahu Haber, who heads the Matnat Chaim NGO, in a public show of support for the embattled organization. Police are currently investigating Matanat Chaim over suspicion that the NGO bumped patients to the top of its recipient list in exchange for donations.

"The visit is seen in the haredi world as signaling Rabbi Kanievsky's support for Haber and Matnat Chaim, which works to assist kidney donations in Israel. Earlier this month, hundreds of people who had received kidney transplants joined in a social media campaign defending Matnat Chaim, which one of them called "a sanctification of Gods name, people who do God's holy work on this earth".

"In early September, police had arrested Haber and other heads of Matnat Chaim over suspicions that members of the association advanced names on the organ transplant wait list in exchange for money that was transferred, in most cases, in the form of donations to the association.

"Police had opened the investigation several months ago following a series of complaints to the Ministry of Health. As part of the probe, police interviewed former donors to the NGO, and their suspicions were strengthened due to the fact that the majority of those donating money were unable to work and their financial situation was poor, leading authorities to conclude that these were not really donations, but in fact payment for being advanced on the waiting list for an organ transplant.

"Matnat Chaim is revered in the haredi world, and many public figures have slammed the investigation, including famed haredi author Chaim Walder, who called it a "witch hunt". Yisrael Hayom's haredi affairs writer Yehuda Shlesinger wrote last week that "the State of Israel should ask forgiveness from Rabbi Yeshayahu Haber, who saved the lives of 466 Israelis and who has been under house arrest for four days in one of the most delusional investigations ever."

The latest Nobel Prize touching on organ donation--Kazuo Ishiguro and Never Let Me Go

The Nobel Prize in Literature was awarded today to Kazuo Ishiguro, whose 2005 novel Never Let Me Go is about a dystopia in which cloned children are raised to be organ donors...

An optimistic view of transplants in China from the Washington Post

I've written a number of posts linking to optimistic stories about China's move away from using executed prisoners as sources of organs for transplants, and others expressing some skepticism. The Washington Post has some elements of reporting that indicates that they explored and discounted some of the reasons for skepticism, so I think this is the most credibly optimistic assessment I've seen to date.

Here's the Washington Post story:
China used to harvest organs from prisoners. Under pressure, that practice is finally ending.

"China had more than 600 organ transplant centers in a sprawling, unregulated system. That number was whittled down to about 160 registered and approved centers in 2007, when legislation was also introduced to outlaw organ trafficking and ban foreigners from coming to the country to receive Chinese organs.
...
"Chinese law does not explicitly rule out using organs of prisoners condemned to death by the criminal courts, and Huang himself was quoted in Chinese media in late 2014 and early 2015 as saying prisoners could “voluntarily” donate organs.

Huang now disavows those comments, insisting there is “zero tolerance” for using any prisoners’ organs in the hospital system. But in a country of 1.3 billion people, he said at a Vatican conference in February, “I am sure, definitely, there is some violation of the law.”

Lawyer Yu Wensheng said that one of his clients had shared a Beijing prison cell with a man facing the death penalty last November and that the condemned man was given a form to sign to “voluntarily” donate his organs.

Death-row prisoners, he said, were “given the choice not to sign the forms, but they would receive much more mistreatment and suffer much more. If they sign, their last days of life would pass more easily.”

Yet the supply of organs from executed prisoners seems to have been drying up because the number of death sentences appears to have fallen dramatically after a 2007 mandate requiring the Supreme Court to review all capital cases."

...

"Transplant patients must take immunosuppressant drugs for life to prevent their bodies from rejecting their transplanted organs. Data compiled by Quintiles IMS, an American health-care-information company, and supplied to The Post, shows China’s share of global demand for immunosuppressants is roughly in line with the proportion of the world’s transplants China says it carries out.

Xu Jiapeng, an account manager at Quintiles IMS in Beijing, said the data included Chinese generic drugs. It was “unthinkable,” he said, that China was operating a clandestine system that the data did not pick up.

Critics counter that China may also be secretly serving large numbers of foreign transplant tourists, whose use of immunosuppressant drugs would not appear in Chinese data. But this assertion does not stand up to scrutiny.

Jose Nuñez, head of the transplantation program at the World Health Organization, which collects information on transplants worldwide, says that in 2015 the number of foreigners going to China for transplants was “really very low,” compared with the traffic to India, Pakistan or the United States, or in comparison with transplant-visitor numbers in China’s past.

Chapman and Millis say it is “not plausible” that China could be doing many times more transplants than, for instance, the United States, where about 24,000 transplants take place every year, without that information leaking out as it did when China used condemned prisoners’ organs.

And lawyers who have defended Falun Gong practitioners also reject allegations that those prisoners’ organs are being harvested.

“I have never heard of organs being taken from live prisoners,” said Liang Xiaojun, who said he had defended 300 to 400 Falun Gong practitioners in civil cases and knew of only three or four deaths in prison.

In China, despite state repression, family members can be determined in speaking out and seeking justice when relatives vanish.

If tens of thousands of Falun Gong practitioners were being executed every year, that information would emerge, experts say.

A U.S. congressional commission on China, the State Department and the Falun Gong community website have separately tried to estimate the number of political prisoners in China, and the figures range from 1,397 to “tens of thousands” — and even that upper number is significantly lower than the 500,000 to 1 million claimed by Gutmann and others."

A still-skeptical view of transplantation in China

My recent post on transplantation in China reported on optimistic assessments of the move away from using executed prisoners as a source of organs. Not everyone is optimistic: here's a recent editorial from the BMJ:

Engaging with China on organ transplantation
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j665  (Published 07 February 2017)
by Wendy A Rogers, Matthew P Robertson, and Jacob Lavee

It starts with a story from the bad old days, and then turns to the current environment, saying in part:

"Since January 2015, China has vowed to halt the use of organs from executed prisoners. After a pilot in 2010-14, a procurement programme using donated organs from people who meet circulatory death criteria was rolled out nationally. There are now national transplantation registries and organ procurement organisations. Yet there is no new law or regulation in China banning the use of organs from executed prisoners. Nor have existing regulations permitting the use of prisoners’ organs been rescinded. Prisoners remain a legal source of organs if they are deemed to have consented before execution, thus permitting ongoing retrieval of organs from prisoners executed with or without due process.1

"The transplant registries are not open to public scrutiny or independent verification. Inexplicably high volumes of transplantation continue to take place in China,8 and wealthy foreigners can still obtain liver and heart transplants, booked in advance.11 The Transplantation Society’s former president Francis Delmonico acknowledged under oath at a recent US Congressional hearing that he cannot verify claims about reform in China. The main evidence for reform has simply been the public assertions of Huang Jiefu and other government officials."

Organ transplants in China: an optimistic assessment

There are optimistic statements about China's progress on developing a system of voluntary organ donation (to replace the prior system of obtaining organs for transplant from executed prisoners.)   Some of these statements originate with the Chinese press. The Vatican is also optimistic.  The Vatican also has wide ranging diplomacy with China concerning quite different issues.  The stories below collectively reflect each of these things.

Here's a story in the SF Chronicle
China to lead in organ transplants by 2020

"China is on track to lead the world in organ transplant surgeries by 2020 following its abandonment of the much-criticized practice of using organs from executed prisoners, the architect of the country’s transplant program said Wednesday.
Chairman of the China Organ Donation and Transplantation Committee Huang Jiefu said the voluntary civilian organ donations had risen from just 30 in 2010, the first year of a pilot program, to more than 5,500 this year.
That will allow around 15,000 people to receive transplants this year, Huang said. The U.S. currently leads the world in organ transplants, with about 28,000 people receiving them each year.
“We anticipate according to the speed of the development of the organ donation in China, the momentum, in the year 2020, China will become the No. 1 country in the world to perform organ transplantation in an ethical way,” Huang said in an interview at his office in an ancient courtyard house inside Beijing’s old city.
China is seeking to expand the number of willing organ donors, but it has run up against some cultural barriers: Family members are still able to block a donation, even if the giver is willing, and Chinese are averse to registering as donors by ticking a box on their drivers’ licenses, considering it to be tempting fate.
Instead, authorities are partnering with AliBaba, China’s virtually ubiquitous online shopping and payment platform, to allow people to register in just 10 seconds, Huang said. Huang said more than 210,000 Chinese have expressed their willingness to become donors, although that’s a drop in the bucket compared with the country’s population of 1.37 billion.
...
"Huang said China has adhered to a complete ban on the use of organs from executed prisoners that went into effect in 2015, although some in the field outside China have called for the country to allow independent scrutiny to ensure it is keeping to its pledge.
Critics have questioned China’s claims of reform and suggested that the World Health Organization should be allowed to conduct surprise investigations and interview donor relatives. The U.N. health agency has no authority to enter countries without their permission.
Chinese officials say China shouldn’t be singled out for such treatment while other countries are not.
Further moving on from the days when foreigners could fly to China with briefcases of cash to receive often risky, no-questions-asked transplant surgeries, China has also taken measures to stamp out organ trafficking and so-called “transplant tourism,” including by limiting transplants to Chinese citizens."
*********
China’s organ transplantation reform hailed by international community

"By CGTN’s Yang Jinghao

A sensitive issue just a decade ago, organ donation and transplantation in China has seen a remarkable shift during the past few years. A total of 7,000 organs were voluntarily donated between January and July this year, according to a conference on organ transplantation held in China over the weekend.

Comparatively, the number in 2010 was just 34 for the whole year.

The conference, held in Kunming, southwest China’s Yunnan Province, gathered top organ transplant professionals from major international organizations. They reviewed the achievements China has made and discussed how to strengthen international cooperation."
**********

And here's a story from Crux (whose subhead is "Taking the Catholic Pulse")
Chinese state media highlights Vatican official at organ trafficking conference in Beijing

"In a sign of the slow thawing of relations between China and the Vatican, a Chinese state newspaper reported positively on a Vatican official’s remarks at an organ trafficking conference taking place in Beijing.
Argentine Bishop Marcelo Sánchez Sorondo, the chancellor of the Pontifical Academies of Sciences and Social Sciences, attended the conference on Thursday, part of China’s ongoing efforts to convince the world it has reformed its organ donation procedures.
In 2015, the communist country announced it was stopping the practice of using organs from executed prisoners. In 2016, official statistics stated surgeons in China had harvested organs from 4,080 donors and performed 13,263 transplant surgeries, the second highest in the world. Officials said all donors were through a registered volunteer donor system. By 2020, China is expected to surpass the United States to take the top spot.
Last month the Pontifical Academy of Sciences, the World Health Organization , the Transplantation Society (TTS), and the Declaration of Istanbul Custodian Group (DICG) - four of the most influential societies in promoting global ethical practices in organ transplantation - sent a letter expressing their appreciation for China’s efforts in organ donation and transplantation reform.
Despite the assurances of the government, many human rights activists are skeptical such numbers could be achieved through an exclusively voluntary system, especially after decades of reliance on the organs of prisoners."
*************

Here are comments from Chancellor Marcelo Sanchez Sorondo commending the development of the China Model

*************

And here's a story about another realm in which China and the Vatican are simultaneously engaged.

Vatican official hints at unofficial agreement with China on bishops
"HONG KONG (CNS) -- A senior Vatican official has hinted there is an unofficial agreement between the Holy See and Beijing on the appointment of bishops, even as negotiations to formalize arrangements continue to hit roadblocks, reported ucanews.com.

Argentine Bishop Marcelo Sanchez Sorondo, who attended a conference on the sensitive topic of organ donation and transplants in the southern Chinese city of Kunming, offered the hint during an interview with state-run Global Times Aug. 4.
**************
Here are my earlier posts on the positions taken by the Pontifical Academy regarding transplantation.

Dialysis: Last Week Tonight with John Oliver (HBO)

Laughing through the tears...


The video briefly mentions a new living donor information source and database, Give and Live.

A non-directed kidney donor speaks about his experience (which started with a Freakonomics podcast)

Here's more on Ned Brooks, the non-directed donor who heard about kidney exchange chains on a Freakonomics podcast:

Ned Brooks: Donating His Kidney was Life-Changing. For Him

“The concept of leverage was absolutely the driver for me, “ recalls Ned. “The idea that my one wholly redundant kidney could impact multiple lives, not just the patients themselves but their children, their parents, was huge.”

And the idea of starting a kidney donation chain touched his competitive side: “How many lives could my kidney donation impact?”
***************

See my earlier post

Friday, February 26, 2016

A Freakonomics listener was inspired to become a non-directed kidney donor by the podcast on kidney exchange

Israel transplant investigation

The Israeli organization Matnat Chaim (Gift of Life), founded by Rabbi Yeshayahu Heber, is under investigation about whether it encouraged families to contribute to the organization in order to receive a shorter waiting time for a kidney transplant.

Organ donor organization suspected of moving donors to head of line for money
Police currently investigating an organization specializing in organ donor mediation, on suspicion of receiving money to provide donors with organs before others in line for transplants.
Omri Efraim & Rotem Elizera|Published:  31.03.17 , 15:06

"Israel Police is carrying on an investigation into Matnat Chaim, an organization that helps find organ donations for those in need of a transplant. The investigation is centered on claims that the organization charged for a "donation" intended to push forward those who paid it, despite there being other people in front of them in line waiting for the same organ donation.
...
"The police stressed that the investigation is a very delicate one, involving people who are suspected of paying the extra fee out of a wish to facilitate a vital transplant that for a member of their family.

Matnat Chaim stated that "We know nothing about the investigation carried against (the organization—ed), and so we do not find it necessary to respond." The organization has so far aided in some 400 transplants in Israel. It only works with organ donors wishing to donate organs for zero pay."
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Here's another story with a bit more detail:

Police launch inquiry into kidney transplant organizationCops investigating claims that Matnat Chaim bumped patients to top of recipient list in exchange for donations

"The probe follows a complaint from the Health Ministry that recipients were bumped to the top of the list in exchange for donations to the organization.

Police have taken evidence from organ recipients, their families and other sources in the ongoing investigation.

A police spokesperson explained that the investigation was complex and sensitive. The organization is suspected of encouraging relatives of those in need of transplants to make donations to the organization in order to shorten the waiting time to receive a kidney.
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"Over 400 healthy people have donated a kidney through the organization.
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"In the past, the organization has said that it had never agreed to accept donations in exchange for promoting a patient in the waiting list. It said that “it completely rejects any suggestion of any hint of wrong-doing.”

A non-directed kidney donor writes eloquently about his experience

Dylan Matthews is eloquent about his decision to give a kidney to a stranger, and explicit about his experience, including post-surgical pain and his recovery. He's well worth reading.

Vox has the story: Why I gave my kidney to a stranger — and why you should consider doing it too

My colleague, the philosopher Debra Satz, points out to me that one of the altruistic donors whose experience motivated Matthews was her student. Philosophy is powerful.

Kidney donation in Tennessee

Here's a story from the Tennessee Tribune, about Dr. Clarence Foster, an African-American transplant surgeon, who is trying to raise awareness among minority patients.

Minorities Wait for Kidney Transplants

"In 2016, 226 African American Tennesseans received a kidney transplant compared to 222 white and ten Hispanics, according to data from the U.S. Department of Health and Human Services. The numbers are almost identical for 2015.

But, the list for Tennessee residents who need kidney transplant is far longer. Last year, 1, 283 African Americans, 1,166 Whites, 63 Hispanics and 29 Asians, 9 Native American and 29 Multi-Racial people waited for kidney transplants.

Jill Grandas confirmed that the numbers of African Americans waiting for a kidney are almost equal to white patients.

“Among patients in Tennessee waiting for a kidney, about 50 percent are African Americans and they are transplanted at almost the same rate – 48 percent of the patients who received a kidney were African American.”

However, in Tennessee, the number of African American kidney donors is far less than the need. Last year, 211 kidneys were donated by white donors, 43 by black donors, 11 by Hispanic donors and 2 Asian donors and these were from deceased donors.  Among living donors (usually a close family member) there were 55 white donors, 7 black, one Hispanic and one Asian.

“Among, 2,107,231 on the ‘Donate Life Tennessee Organ and Tissue Donor Registry,’ 9.2 percent are African Americans,” said Grandas.

“Our rate of donation from African Americans is much less than from other races. We would assume that if more African Americans would donate, more African American patients would receive an organ from an African American donor.”

“African Americans can safely be a living donor.  We need to overcome the mistrust between the community and the medical profession,” said Dr. Foster."