An Australian doctor says young, healthy people should be allowed to sell their kidneys for $A50,000 ($NZ60,000) to the Federal Government, which could then give them to sick patients.
Selling or buying organs is illegal in Australia, carrying a penalty of six months' jail and/or a fine of $4400. However, the senior Canberra nephrologist Gavin Carney says changing the law would save thousands of lives and billions of dollars in care for sick patients left languishing on waiting lists for up to 10 years.
More than 1800 people are waiting for a kidney transplant in Australia but only 343 kidneys were donated last year, forcing some to travel to countries such as Pakistan and India to buy organs for up to $30,000 on the blackmarket.
The practice is illegal in every country and considered unethical by transplant experts across the globe.
"Being forced to travel overseas and illegally buy an organ from someone who desperately needs the money, with no medical controls over the process and nobody checking whether the kidney is a good match, is what I call unethical," Dr Carney said.
"But what is the option? Spending eight hours a day on dialysis for up to seven years? Dying on a wait list?"
Australia has one of the lowest organ donor rates in the world - 9.4 donors per million people, and as few as 8 per million in NSW - despite repeated media campaigns and transplant consent now linked to drivers' licences.
"We've tried everything to drum up support for organ donation and the rates have not risen in 10 years," Dr Carney said. "People just don't seem willing to give their organs away for free."
He said the allocation system, which uses cross-matching and tissue typing developed 40 years ago before powerful immunosuppressive drugs were available, disadvantaged the most needy because the longer a person spent on dialysis, the greater their risk of dying before receiving a kidney. "Or, even more cruelly, having their health deteriorate so much from the residual toxins left by dialysis that they will be removed from the list as unsuitable recipients and resign themselves to steady deterioration and premature death," he said.
"Australians should be dissuaded from going to Third World countries to buy kidneys because such countries do not have the ethical, moral or compensatory infrastructure to make such a practice workable and appropriate.
"But we can do the opposite here. Let's pay people some money for a new car or a house deposit and those waiting lists will be halved within about five years."
But the chairman of the Renal Transplant Advisory Committee, Scott Campbell, said trading in organs would exploit the poor and the desperate, and could put donors' and recipients lives at risk.
"There's little doubt that you'll get more kidneys if you offer money but it will only bring out people who are willing to gamble on adverse health outcomes in exchange for $50,000 because they are in desperate need, such as those in mortgage stress or drug addicts," Dr Campbell said.
"If you are donating out of the goodness of your heart, you also tend to be more concerned about any medical history you have which could potentially harm the recipient. Money alters perspectives on honesty and you'll get people who do not tell the truth because they risk losing the cash."
The president-elect of the international Transplantation Society, Jeremy Chapman, agreed, saying a recent national taskforce had made 51 recommendations on increasing donor rates, but paying for organs was not one of them.
"Trading in human organs is wrong and dreadful," Professor Chapman said. "And we would not be entertaining the idea of doing it here."
He said a meeting in Turkey at the weekend found that travel for transplants and organ trafficking was "rampant" worldwide, with about 10 per cent of transplants performed illegally or unethically.
The meeting of 152 doctors from 78 countries agreed on the Istanbul Declaration, an attempt to ban transplant commercialism on the basis that it is "unethical and violates the principles of human dignity, equity and justice".
But for Dr Carney the solution is simple.
"Having someone on dialysis for seven years costs the government about $500,000, and that's conservative," he said. "If it costs about $50,000 to buy a kidney and about $15,000 a year thereafter in health care, the government is miles ahead. And it is a safer outcome for the donor and recipient. If we don't shake the oligarchy, we'll still be in this situation in 10 or 20 years - and people will have died unnecessarily."
- Sydney Morning Herald