Unethical restriction of kidney transplantation

Sixty thousand people in the United States are supposed to die this year because they did not receive a kidney allograft (1). Worldwide, the number could exceed 1 million; In India itself the number of people developing end stage renal disease each year is about 100,000. But with such prohibitive policies, can we prevent the development of a black market worldwide? Numerous reports from all over the world disagree. Laws are violated; some patients, disappointed by the legal routes, take the matter into their own hands by advertising for donors on highway billboards, by consulting websites, by making personal pleas in the media, by listing themselves in multiple registries, and by relocating (2). Paid organ procurement has been documented in the Philippines, Iraq, China, India, South Africa, Turkey, Eastern Europe and elsewhere. You can simply go websites that provide the possibility of finding a living matched donor (such as Matchingdonor.com). Transplant tourism is active, but because of its illegal nature there are numerous problems. An Australian study (3). as well as a Canadian (4) one, surveying a number of patients who had undergone overseas commercial kidney transplantation, found that they had generally poor outcomes compared to a legal procedure. China attracts a lot of people around the world, but reports claimed that up to 90 per cent of these allografts are retrieved from executed prisoners (5).

In a number of countries, health authorities have realised the importance of tackling the increasing gap between supply and demand for organ allograft and have promoted the development of other types of kidney transplantation practices based on their cultural and economic backgrounds. In Korea a programme of paired living donor kidney exchange has been developed, in which living related donors who do not match with their potential recipient exchange their kidneys with another recipient/related donor pair with the same situation. In Iran since 1988 a regulated programme for compensated kidney transplantation from living unrelated donors has been developed, which has eliminated the waiting list in this country. Spain has dramatically increased its donor pool with implementation of “presumed consent” for all deceased potential donors unless the person has expressly refused permission by signing an opting-out register. In China kidneys procured from executed prisoners used for expanding kidney allograft pool.

Lawmakers in some countries still resist developing a way to expand the donor pool. Attempts to pass opt-out (presumed consent) legislation in the UK have failed. The situation is not such better for the USA, Canada and Australia. The waiting list increases each year and people continue to die. Till what time can such a situation be maintained?