December 17, 2007

Internet Not Just For Venting Spleens

Sally Satel's first online relationship left a permanent scar -- for which she gives profound thanks to God. In yesterday's New York Times, Satel reveals how she found a donor that saved her from end-stage renal disease, and likely a slow death from dialysis while waiting the enormously long time it takes to get a cadaver donor. Satel wonders why we don't have a better system for encouraging live donors (via King at SCSU Scholars):

My story, it turns out, is a triumph of altruism. Looking back, I see that my anxiety over my future donor was a neurotic luxury. I worried about finding the ideal donor, but thousands of people have no donor at all — no relative who will do it out of love or obligation, no friend out of kindness, no stranger out of humane impulse. Alas, I have no kidney to give away. Instead, I am urging wherever I can — in articles, in lectures, from assorted rooftops — that society has a moral imperative to expand the idea of “the gift.”

Altruism is a beautiful virtue, but it has fallen painfully short of its goal. We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind — perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.

In short, we should reward individuals who relinquish an organ to save a life because doing so would encourage others to do the same. Yes, splendid people like Virginia will always be moved to rescue in the face of suffering, and I did get my kidney. But unless we stop thinking of transplantable kidneys solely as gifts, we will never have enough of them.

Anyone who has gone through Satel's process understands the roller coaster ride she describes. We did not have the trouble Satel had with potential donors who backed away without notice or explanation. Both of our donors remained highly committed to the process, as did their families -- a quality that may have been lacking with Satel's. In fact, I cannot imagine our situation without that strength of support from their families, strength that allowed us to accept these gifts with the grace we could muster.

At the time of the First Mate's first transplant, the wait time in California was much shorter, around six months to a year for a cadaver transplant. We expected to start dialysis within days while I continued my tests for being her live donor; in fact, they installed a dialysis shunt in case it would still be necessary at the same time as the transplant. One year on dialysis would have been hard enough on some patients, but five years would be a death sentence for a significant portion of ESRD sufferers. For many, the process has no ill effects, but for some it is nothing more than a slow death.

Should we give material benefits for live-organ donations? It could help boost the market and therefore save lives, but I'm not as sure of that as Satel is. The situations in which donors slipped away do not sound as though a material reward would have salvaged the donation. In one case, the donor got chased away by a transplant surgeon unaffiliated with Satel's case, and the other two gave no reasons for their change of heart.

The suggestion carries some ethical issues of access based on the ability to provide compensation. Satel suggests free Medicare health coverage for a lifetime for those who donate, but that appears to be the direction we all will travel, given the current political environment. Tax breaks for life might also help, but again, if the tax code goes through a major renovation, that will likely disappear. Besides, the demand for free-market compensation delivered by the government sets up a strange dichotomy.

This is no academic matter, however. The need for kidneys is overwhelming, and the pace of donations simply has not met the demand -- and people like Michael Larson will suffer the consequences. Virginia Postrel donated a kidney to Sally Satel, and CapQ reader Paul has begun that process for Michael. In truth, we need many more people to make that decision to give of themselves so that others may live. Would money be the deciding factor in that decision? I suspect not, but I'm open to suggestions that doesn't exploit financial desperation or create a market where the wealthy take precedence over recipients like Michael.

Michael has entered the Fairview University Transplant Program, the same facility that has provided the FM with three life-saving transplants. Anyone wishing to give of themselves to help Michael can call 800-328-5465 to speak to the living donor coordinator. Later, I'll describe that process for readers as well. In the meantime, thank you for reading, and I hope you will offer your prayers and thoughts for Michael and Leah.


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