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Perspective: The Ethics of Crowdsourcing for Organs

by Rebekah Apple, MA

A recent news article, linked to AMSA’s Weekly Consult on November 11, told of a Florida college student currently on the kidney transplant waiting list.  As of today, more than 5,800 Floridians are waiting for an organ transplant, and 122,000 nationwide are on the same list.

Living kidney donation offers a method to bypass that list completely, and the luxury of scheduling the transplant at will.  It has provided thousands an opportunity to end grueling dialysis treatments and return to a life void of harsh dietary restrictions and treatment side effects.  Historically, living donors were family members – people intimately aware of their loved one’s suffering, and likely to be a tissue match.  Over time, it became clear to a lot of patients that a large portion of the potential donor pool was being overlooked.  Billboards began appearing on highways, pleading for lifesaving organs, with pictures of patients in need of transplants.  News media outlets included headlines and top stories detailing the difficulties of a life in wait, and an uncertain future.  There is no way to not feel affected upon seeing these struggles.

Organ transplants are wondrous treatment.  Whether a donor made their wishes known and saves lives after death, or if someone undergoes surgery to donate while they’re still alive, the recipient(s) can likely never adequately express their gratitude.

But there are implications to broadcasting medical need, and framing it in such a personal way that outsiders become sympathetically connected to a patient.  For one thing, we can’t diminish the seriousness of the donation surgery.  It makes sense to do this for a sister, but for a stranger in a nearby city, there are different motivations.  Of course altruism is one of them – but what are the others?  Is sympathy enough of a reason to undergo a major procedure, and accept the risks that go along with life with one kidney?  Perhaps it is.

Galvanizing entire communities – and perhaps the country – to care about one patient is an interesting phenomenon.  It demonstrates our society’s charitable nature, while also highlighting one person’s ability to harness advanced marketing – for lack of a better term – techniques.  It calls into question whether or not it creates an unfair advantage for the individual with a lot of friends and expanded resources.  It also results in massive pressure on transplant centers, some of which have occasionally modified their exclusion criteria in order to quell public outcry.  Certainly that’s an institution’s choice, and it can be argued whether or not they made the right one.  But we mustn’t forget the choice evolved from media involvement in what is ultimately a very personal and complex experience.  In other instances – say, a bypass surgery – a news story focusing someone’s need wouldn’t necessarily have same result: press conferences and a hospital altering their policies to approve a procedure with previously established contraindications.  This is not to say transplant centers have moved ahead when they thought the surgery would be harmful, rather, it was when they thought the recipient wasn’t the best candidate for the next organ.  And this compromises the foundation of the transplant list.

Most of us, if found in the traumatic position of needing a life-saving transplant, would want to travel down any available path to get that organ.  We would likely do the same for those we love.  It’s been long established that desperation makes us do desperate things.  We must, however, remain mindful of the integrity of our actions when it comes to medical procedures.  We cannot take lightly the risks we ask others to take, or overlook the reasons for which they may take them.  And we must either honor the systems in place to protect patients or seek ways to alter them for the better, rather than ignoring the systems because they do not suit individual need.

Rebekah Apple is AMSA’s Senior Manager of Programs. Opinions of On Call contributors are their own, and do no necessarily reflect positions of the American Medical Student Association.

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