Sunday, July 10, 2005

More than the Sum of One's Parts

"I've had doctors tell me they don't even tell their patients that they're about to get an organ that might be infected with hepatitis C because so many of the donated organs may have it."
-- SheldonZink, director of the program for transplant policy and ethics at the University of Pennsylvania, as reported in today's New York Times ("Will Any Organ Do?" by Gretchen Reynolds).

According to Reynolds, more and more people who go in for transplants receive "marginal" or "extended criteria" -- i.e., sick -- organs. Last summer in Dallas, four people died from rabies weeks after receiving transplanted organs from William Beed, Jr.

Initially though to have died from a crack cocaine overdose (marijuana and cocaine were found in his urine at the time of his death), Beed had been living in a bat-infested building when he died. A bite from one had given him rabies, which he then passed on to others in the form of his donated organs.

Beed's drug use would have disqualified him as a blood donor, but drug use does not disqualify people from becoming organ donors. "No government agency sets standards for what makes an organ acceptable," writes Reynolds.

Transplantation is a desperate measure to begin with. Organ recipients are often battling the clock, and comparing the chances of their survival with a healthy versus a compromised organ is dicey. Currently no formal system tracks the short-term fate of individual organs from a particular donor. The United Network for Organ Sharing once applied "marginal" only to kidneys, and only in terms of the donor's age. (Two years ago a Canadian hospital transplanted the liver of a donor who had died at age 93.)

Reynolds asks, "Do kidneys from diabetics, the obese, alcoholics, smokers or drug users generally work over the long term? Surgeons and scientists can't say for sure....There is even less information about imperfect livers, hearts or lungs."

Until the 90s we didn't think in these terms. The waiting lists for transplants were much smaller and donated organs were usually "pristine". Better antirejection drugs and surgical techniques have changed that landscape.

How, then, does one measure the response to desperation? Should we put a system in place that informs potential recipients of what kind of organ they'd be getting, beyond the currently disclosed age and sex of the donor? Biases can create problems; not so long ago some people refused blood transfusions based on race alone. On the other hand, should this be treated in "Right to Know" terms, as is done with consumer products and environmental issues?

Labeling laws keep us informed about what we buy. Disclosure laws require that we be told if a house or an apartment where we plan to live has lead paint or asbestos. But what of body parts? The laws in place for other commodities -- and, let's face it, in this context body parts are commodities -- are based on long-term scientific research. Currently that's what's missing when it comes to organs. Let's start there.

I obtained an organ donor card back in the 70s, long before I got my driver's license. My parents refused to sign as witnesses so instead I used a couple of college classmates. Now my license lists me as an organ donor, should that situation arise. I'd always thought in terms of giving rather than receiving, though blood transfusions saved my life in 1966. I have donated blood as a way of trying to give some of that gift back (I could do more in that department). I view my body as a renewable resource: once I've "left the building" I want it put to good use, however that use is then defined.

But what if I need someone else's recyclables some day? I have no way to tell how I would react (assuming I were able to react) -- there are too many variables to consider. In the face of mortality, how far does caveat emptor apply? And -- were scientific research to yield a grading system for organs -- would body parts become yet another item subject to economic stratification? Who gets the deluxe kidney, who the wrecked but marginally functional heap? Who gets the designer model and who the artfully disguised knockoff?


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