Many of those Ling met hadn't realized much lasting financial benefit as a result of their illegal kidney sales, but neither were they distressed at having undergone the potentially dangerous procedure.
Having lost one kidney, donors are more at risk for any problems that could later affect their remaining kidney. Also, the transplant operations themselves can be dangerous or fatalparticularly when carried out in clandestine and illegal facilities.
"We didn't meet anyone who had gotten sick as a result of selling one of their kidneys," Ling said. "The people we met were still living normal lives so they didn't have many regrets, they were surviving OK on one kidney. When you encounter folks who are so poverty-stricken, it's a gruesome option for them but it is an option. It certainly raises a lot of ethical questions."
Such practices in the developing world have led to '"transplant tourism," in which patients travel from wealthier countries without a black market organ trade to parts of the world where both an organ and operation can be hadfor a price.
With demand so high and illicit trade already underway in the developing world, might some form of compensation be tried to ease the organ shortage in industrialized nations?
Experts Urge Compassion, Not Compensation
Anne Paschke explained that UNOS is not opposed to a study of possible incentives that could be provided for postmortem donationsbut even such tentative proposals would fall far short of any "for profit" organ sales.
"It would take action by Congress in order to test financial incentives," Paschke said. "We would support legislation that would allow pilot projects, a very careful testing of some type of financial incentives. We just don't know if it would have a positive or a negative impact."
Some individuals have suggested that more overt compensation could financially benefit donors while physically benefiting thousands in urgent need of transplants. The argument also maintains that a regulated trade would be preferable to existing black market organ dealings, which can be exploitative and unsafe.
Yet such proposals have found little popular acceptance in medical and bioethics circles, where most fear the exploitation of the poor and foresee the first steps on a slippery slope that leads to a dehumanizing trade in bodies and body parts. "I don't think that I've ever seen anyone speak representing an organization that would support such a system," Paschke said.
So how to make more organs available to waiting patients worldwide?
Paschke noted that UNOS is focused on utilizing the organs that are donated as efficiently as possible by streamlining the process that gets them from a deceased donor to a suitable recipient.
Another critical goal is increasing the number of voluntary donorswhich has remained relatively flat even as the waiting list has grown.
The effort relies not on compensation but on compassion.
"What kind of message motivates people to become donors? Most will say, 'Yeah, donation is a good thing,' but that doesn't mean that they've made a decision for themselves or had a conversation with their families," Paschke said. "Our latest research shows that people are inspired when they see a real person, the story of a person who's been helped, so we're trying to focus on individuals, on the real people who are on the list."
Meanwhile, despite such efforts, the real people on the list must deal with the very real fear that they may not get the organ they need in time.
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