BehindTheMedspeak: American Society of Transplant Surgeons Blinks

Just in, a statement from the American Society of Transplant Surgeons on donor organs.

It was issued because of certain recent developments threatening to shake the cozy club to its foundations.

Robert Hickey is the man who started the whole thing.

He simply decided that, rather than quietly die while waiting for a kidney to become available for transplant through the usual bureaucratic channels (17 people a day die in the U.S. in just such circumstances), he'd simply advertise for one on the internet.

Matchingdonors.com was where he asked.

And lo and behold, a suitable donor answered.

As our legal brethren like to say: "Asked and answered."

Anyhow, the American Society of Transplant Surgeons is clearly between the proverbial rock and a hard place at the moment.

The rock: UNOS (United Network for Organ Sharing).

The hard place: the thousands of patients waiting years for a suitable organ for transplant.

Between fifty and one hundred Americans weekly die waiting.

Looks like the rock won round 1: below is a statement of policy issued - undoubtedly with the cocked gun of UNOS next to the society's proverbial head - last month by the transplant surgeons.

Memo to UNOS: it's a 15 round fight - and it's still early.

I wonder if there's an aggressive reporter out there interested in a Pulitzer Prize?

If so, all you have to do is follow up this and my previous posts on this subject (there are five, starting this past October) and take it from there.

In the meantime, I guess I'll just keep on posting on the subject out here in virtual nowheresville.

A word to the wise among the ASTS éminence grises: it would appear to this doctor that it is a flagrant transgression of the Hippocratic Oath to refuse to perform a transplant on a patient who would otherwise die without it, if no laws were broken in the method of procuring the organ to be transplanted.

Just an idle thought, before the society ends up as a poster child for "Big Medicine Gone Bad."

Here's the society's statement:

The American Society of Transplant Surgeons (ASTS) Council adopted a statement on the solicitation of deceased and living donors on November 11, 2004. 

The Ethics Committee had been charged by the ASTS Council to examine the solicitation of organ donors because of recent efforts by patients and their families to advertise for deceased and living organ donors for specific patients. 

After careful deliberation the following statement was approved.

AMERICAN SOCIETY OF TRANSPLANT SURGEONS

STATEMENT ON SOLICITATION OF DONOR ORGANS

NOVEMBER 11, 2004

Because of recent events surrounding the solicitation of deceased and living donor organs the American Society of Transplant Surgeons (ASTS) wishes to state our position on these and several related issues.

The ASTS believes that living and deceased organ donation represent altruistic acts. 

The ASTS has consistently been strongly opposed to the buying, selling, or brokering of organs for transplantation in agreement with the National Organ Transplant Act (NOTA) which makes it illegal to exchange organs for "valuable consideration."      

The ASTS supports directed donation (living and deceased donor) only to family members and friends where there has been a pre-existing emotional relationship.  

In the absence of a wait-listed family member or friend, organ donation should proceed according to the standard policies and procedures of the organ procurement organization (OPO) and the allocation policies of the United Network for Organ Sharing (UNOS).   

The ASTS supports "Live Donor Paired Exchange" programs where two donor-recipient pairs exchange donors when the donors are related to or have a pre-existing emotional relationship with the intended, but incompatible recipient.     

The ASTS supports "List Paired Exchange" programs where an ABO-incompatible live donor donates to the waiting list, in accordance with the local OPO and/or institutional guidelines for allocation, and the potential recipient is elevated on the UNOS deceased donor waiting list.   

The ASTS supports altruistic "Good Samaritan" live organ donation when the donation is in accordance with publicly disclosed institutional, regional, and/or OPO standards which preserve equity and justice in allocation to a patient on the waiting list i.e. nondirected donation.   

The ASTS is strongly opposed to the solicitation of organs (deceased) or organ donors (live) by recipients or their agents, whether this is through personal or commercial websites, billboards, media outlets or other forms of advertising when the intent of such solicitation is to redirect the donation to a specific individual rather than according to the fair policies of allocation (UNOS policy on organ allocation) which all members on the waiting list abide by.  

We believe that such solicitation and directed donation will undermine the trust and fairness on which the system of organ transplantation depends.  

Society, in particular potential recipients and their families, must believe that the current organ allocation system is protected from discriminatory practices that will disadvantage certain classes of individuals.

The ASTS recommends that its membership not participate in transplants in which solicitation has occurred.  

Participation in directed donation should only take place when there is a pre-existing relationship between the donor and recipient or the donation is offered to the next person on the appropriate waiting list.  

Furthermore, the ASTS believes that a transplant surgeon should not be compelled to participate in a transplant that he or she believes is ethically improper.