Dallas, TX –
Have you learned anything from the so-called Presidential debates? I haven't except that Senator Clinton has some excellent writers on staff. Instead of platitudes from both parties, I'd like to know how they think, how they weigh competing interests. Let's start with a life and death issue: organ transplants.
About 95,000 people are on the waiting list for organs, mostly kidneys. About 4,000 die every year while waiting.
The current system of organ allocation is very complicated. It's based on geography and length of time you've been on a waiting list. For some organs like hearts and lung, it also depends on how sick you are. The number of people who need organs has skyrocketed because of an aging population and the epidemic of diabetes, but the number of organs 'harvested' from people who die has stayed about the same.
Organ donations occasionally make front page news as they recently did here in Dallas when a 24 year old mother died of a brain hemorrhage. Her organs went to five different people. But the article didn't even hint at the raging controversies in organ donation.
First, should people be able to sell their organs? You can buy kidneys in countries like Pakistan and the Philippines, and Iran even has a government sanctioned market. China has been a leader, if you can call it that, in medical tourism, with organs of all sorts harvested from condemned prisoners. Because of a human rights outcry, China announced earlier this year it would limit recipients to its own citizens, but their cash strapped hospitals are still doing a booming business with people from other countries.
The sale of organs is illegal here, but again, just this year, a survey of transplant surgeons found that a majority would support a trial project where some people might offer a kidney for compensation of some sort. Opinion is shifting because some leading surgeons and ethicists are questioning the ban. They point out that poor people, the ones who might be exploited, are allowed to make all sorts of decisions for themselves. For example, they can take jobs in dangerous industries. As you can imagine, there is significant opposition to this, but what's interesting is the debate.
There's also a discussion about whether organs, again primarily kidneys, should go to younger people who will have them for many, many years. It's called a "net benefit" analysis. Older people don't like this idea. This is a classic economic debate between "efficiency" which would value younger patients particularly children, and "equity" which says treat everyone the same.
Like immigration, the states are getting into the act and ten states now give tax benefits for organ donation. And there are other issues being debated as well.
So, here are my questions to the Presidential candidates; I just want to hear how they think about them.
First, should younger patients get some preference because they'll have the organs longer?
Should there be a trial project where a limited number of people could offer an organ, like a kidney, receive some sort of compensation so that the value of an organ could be established and the logistics could be evaluated?
Should the government encourage the rapidly growing movement of private donors providing kidneys?
If someone who dies has marked the "organ donor" box on a drivers' license or organ donation cards, should their family be able to overrule that?
Finally, what should be the definition of death? That tells surgeons when organs can be removed?
I'd like to hear each of the candidates discuss these questions, not just provide vague sound bites. After all, as President, he, or she, will have to be able to provide a clear philosophy about the role of government and how to weigh competing priorities. What better place to start than with death - and life?
Merrie Spaeth is a communications consultant based in Dallas.
You can read Merrie's commentary and questions for the candidates at kera.org. Opinions about this commentary can be left there as well or at 214-740-9338.
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