- The Washington Times - Wednesday, July 30, 2008

K arl Chapin’s moment of inspiration came when he got a new wallet for Christmas. The 58-year-old, who lost a hand after he was wounded in Vietnam, was cleaning out his old wallet when he came across his organ donor card.

“I thought, ‘I should use this now rather than after I am dead. Let’s see if I can help someone,’” says Mr. Chapin, who lives in Grafton, Mass. “My wife said, ‘Why don’t you help by just doing the laundry?’”

Mr. Chapin made his way to Matchingdonors.com, a Web site where those who need an organ transplant can post profiles about themselves and their failing health in the hope of catching the attention of someone Mr. Chapin found Ricardo Mermet, a 58-year-old Boston-area restaurant owner who, as a result of diabetes and hypertension, needed a kidney. After many rounds of medical testing and psychological counseling for donor and recipient, Mr. Mermet received a kidney from Mr. Chapin in June.

Forty-five percent of the 13,300 kidney transplants in the United States last year were from living donors. An organ from a living donor has a slightly better chance of one-year survival than an organ from a cadaver, according to the nonprofit United Network for Organ Sharing. About 99,000 people are on the national waiting list for various organs. Seventeen people a day die while waiting for an organ transplant, according to the National Kidney Foundation.

Clearly, people are looking for options to shorten the wait times and potentially save their lives.

Matchingdonors.com medical director Dr. Jeremiah Lowney says the nonprofit site has led to more than 80 kidney transplants since it began in early 2004. The site has 348 patient profiles.

Matchingdonors.com is one of a handful of sites that can match potential donors and recipients. However, it is the only one that charges a fee - up to $595 for full membership for potential organ recipients (although Dr. Lowney says no one will be turned away who cannot pay).

Critics, citing the inevitability of abuse, wonder: Are donor matching sites the first step on a slippery slope culminating in a black market in human organs that would exploit financially distressed donors and bypass the most medically needy recipients?

Dr. Timothy Pruett, director of transplantation surgery at the University of Virginia Health System and immediate past president of United Network for Organ Sharing, says his organization is not too concerned with how donors meet.

“We’re not here to intrinsically judge why one person wants to help another,” provided that “they do it within the moral and legal parameters,” he says. “But we want to make sure they are really informed of what risks are involved. It is major surgery to lose a part of yourself.”

Dr. Lowney says Matching donors.com has many procedures in place to follow ethical standards and warn people of the risks. Potential recipients start by writing a profile. Some write just the basics; others write heart-wrenching and attention-getting pieces with tag lines such as “Please help my grandma” or “Pastor’s wife needs a kidney.”

Potential donors can register and, if something interests them, contact the ill person. Several places on the site contain reminders that selling organs is a felony subject to jail time and up to a $50,000 fine.

Patients seeking an organ are registered with an accredited medical transplant center. After initial interest, all testing goes through the hospital transplant team, Dr. Lowney says.

“What we do is get people talking,” he says.

Dr. Lowney says Matching donors.com also removes unethical postings from the site.

“There are always going to be bad people, and they are going to try and infiltrate the system,” he says of those who ask for money in exchange for organs. “But patients have received so much interest from good people.”

Even so, says, Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, donor-matching sites “are a slippery slope toward people selling organs.”

“The problem with this kind of a system is it kind of undercuts the existing system,” he says. “You would like to think the people getting a kidney would be the most in need, but online, you are able to make a personal case, and in a way, you might be taking organs away from someone who is closer to death.”

Complicating matters is that there is no way to determine whether an online profile is true, he argues.

“Some of them are probably about as truthful as an online dating site,” Mr. Caplan says. “There is no way to regulate that because that is a free-speech issue. Transplant centers should reconfirm the facts, but they say ‘It is not our business.’ Kind of no one is taking responsibility.”

Finally, Mr. Caplan doubts that no money is changing hands.

“People want to help people, but almost no one wants to saw out a kidney for strangers for nothing,” he says.

Dr. Pruett, the transplant surgeon, says he would like to believe no money is exchanged.

“We certainly tell people it is against the law,” Dr. Pruett says, “but we are not cops; we’re doctors.”

Dr. Pruett says he has performed a transplant on a patient who met his donor online.

“Other than the fact they were unrelated, there was no difference except for much more in-depth psychosocial counseling,” he says. “We made sure there was no coercion. Our due diligence goes higher the further away [from a relationship] you go.”

Mr. Chapin says he never asked for or received payment. He wouldn’t even accept a free dinner at Mr. Mermet’s restaurant, he says.

Dr. Sally Satel, a Washington psychiatrist and a fellow at the American Enterprise Institute, registered with Matchingdonors.com when she was in unexplained kidney failure four years ago at age 48. She got one unethical response from a prison inmate asking for $900,000 for his kidney but also heard from many other donors who expected nothing. She was on schedule to receive a kidney from a Matchingdonors.com donor, but he eventually backed out. Dr. Satel received a kidney from an acquaintance in 2006.

Dr. Satel says she thinks online matching sites are a great idea and that there are enough checks and balances in place to keep the system ethical.

“The national transplant system has failed people,” she says. “I am appalled at the lack of creativity.

“Remember, you can’t have a back-alley transplant,” Dr. Satel says. “You are not going to coerce a fragile person into doing this. As long as the donor is well-informed, two people will benefit, and a person will have his life saved.”

However, Dr. Satel says she thinks some sort of compensation would not only help thousands of people get the organ they need, but would save the health care system millions of dollars. She makes this argument in her book “When Altruism Isn’t Enough - The Case for Compensating Kidney Donors,” which will be published in the fall.

Dr. Satel says there should be a government-regulated system in which donated kidneys would go to the next person on the transplant list. Donors would then get an in-kind reward, such as health care coverage or a contribution to a retirement account.

“Critics worry about attracting poor people to this,” Dr. Satel says. “What they need to care about is whether they are desperate, not poor.”

In-kind exchanges rather than cash exchanges would guard against people donating for the wrong reasons, she says.

The system even would pay for itself, she contends, with money saved in health care costs offsetting the compensation of donors.

“Medicare pays $22 billion a year for dialysis,” she notes.

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