The Insider: Kidneys for sale – Dispatches

With the demand for donor kidneys continuing to outstrip supply, Professor Nadey Hakin proposes a controversial alternative to the current ineffective strategies. In this short documentary Professor Hakin, world president of The International College of Surgeons, advocates forcefully that the UK should adopt a policy of genuine and significant payment to individuals willing to donate a kidney. This is not a new proposal, but is subject to certain taboo with many concerned about the exploitation of the poor. With this in mind, the programme sets out a strong case for donor payment as a route out of the current crisis.

The documentary follows the story of three people, each of whom has been affected by the shortage of available kidneys. The first provides an insight into the life of one of the six thousand people on dialysis in the UK awaiting a suitable transplant. This section (00:01:35 – 00:06:03) describes the trauma of living with dialysis and focuses on one patient who is willing to do anything for a kidney. The second story follows a man who had taken the increasingly common route and travelled abroad to Pakistan, in order to purchase an organ (00:06:05 – 00:10:26). The programme shows how his actions nearly cost him his life and actually led to him spending six months in hospital on his return to the UK (at considerable expense to the NHS).

This next section (00:10:20 – 00:17:12) examines what happens when a suitable donor can be found. The wife of one of Professor Hakin’s patients (with diabetes-induced kidney failure) is able and willing to donate one of her Kidneys to help her husband. Two issues arise in this section. Firstly, we observe that with the aid of immuno-suppressive drugs it is now possible to transplant a kidney between two ‘live, non-genetically related’ individuals, an option which might become more attractive if people were paid for their kidney. Secondly, kidney transplantation is shown to be a simple and low risk procedure, providing that it is done within a clean, safe environment.

Professor Hakin provides a strong case in favour of a paid donor system. In the programme he describes not only the national but also the international organ donation crisis and how this is leading many to take drastic action to ensure they do not suffer a premature death whilst on the waiting list. The final section of the programme (00:17:12 – 00:25:00) delivers some of the main ethical issues that either support or reject Professor Hakin’s arguments. Professor Sir Peter Bell, the former president of The Royal College of Surgeons, admits that despite previously rejecting such an idea he now supports it. He argues that the procedure is now much safer for the donor and the recipient and that it is well proven that individuals have an excellent prognosis and are no worse off with only one kidney.

In contrast, however Dr Tony Calland (Chairman of the Medical Ethics Committee at the British Medical Association) voices his concerns that such a payment system would inevitably exploit the poor, as “the people doing it for the money will be the people who need the money”. This argument is supported by a woman who has been on the transplant list for 5 years. She does not want it on her conscience to have a kidney from someone in a deprived situation. Professor John Harris, Editor of The Journal of Medical Ethics accepts such an argument, but questions whether society is really protecting the poor by denying them the right to sell a resource to help them out of poverty.

As a whole this Dispatches documentary and in particular this section (00:17:12 – 00:25:00) raises the main bioethical issues that surround kidney transplantation and is an excellent resource as either a discussion starter or as a teaching aid. Many believe that the donation of an organ, especially the kidney, should be truly altruistic. Others will argue, why should this often utilitarian act go with out fiscal reward? The doctors, nurses, anaesthetists, the physician who examines the donor’s psychological capacity and even the recipient themselves all receive a financial reward. The fact that such an operation can cure, ultimately means many ex-patients can return to work. So why do those who risk and contribute the most have to settle for nothing?

Against the argument that the poor are being exploited, John Harris and others suggest that it would be impossible to protect all the vulnerable because even within families there is massive emotional pressure for someone to donate on behalf of a relative. Others would add that the current paternalistic approach removes an individual’s right to make the best decision for themselves and is, therefore, ultimately removing their autonomy.  

Despite a paid donor system being implemented in other countries (e.g. Spain and Iran) with some success, the UK’s decision of what to do remains stagnant. The UK’s Chief Medical Officer Sir Liam Donaldson announced in his 2006 annual report that he would strongly support a system of presumed concent for cadavers (please also refer to this article in The Times). There is still scepticism whether this would yield the results necessary to help all six thousand people on the kidney transplant list, since organs donated in these circumstances are often derived from bodies that are old and unhealthy or have been damaged in accidents. The debate will go on, but hopefully it will be resolved sooner rather than later to give all those waiting the best possible chance.   

This 25 minute documentary has been broadcast three times: 16th February 2007 (Channel 4, 19:30pm), 19th February 2007 (S4C, 04:10am) and 20th February 2007 (Channel 4, 01:55am). Copies can be obtained via the BUFVC (TRILT Identifier: 0060F3B3).

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