Politics & Policy

One Harsh Prescription

A doctor vs. cyber humanitarianism.

On February 14, 2006, Paul Wagner gave Gail Tomas, a total stranger, his left kidney. 

Wagner, a 40-year-old Philadelphia purchasing manager, met Tomas, a 65-year-old former opera singer on the Internet — through a site called Matchingdonors.com, which pairs patients needing an organ with humanitarians who are willing to donate.  

Beautiful stories like this will no longer come to be, however, if Dr. Douglas W. Hanto, has his way.

Writing recently in The New England Journal of Medicine Dr. Hanto, a transplant surgeon and head of the transplant division at Beth Israel Deaconess Medical Center, argued that “solicitation” websites such as Matchingdonors.com are unethical and should be banned.

He claims that people like Tomas are violating the “fairness” of the system by jumping their turn on the national organ-waiting list. Dr. Hanto also frets that not all people have access to the Internet and that some will write more compelling ads than others.

These arguments fail.

First, people needing organs do not bypass the list. The national registry operates under government oversight to distribute organs from deceased donors, not living ones.

Today there are over 70,000 people waiting for a cadaver kidney. In cities like Philadelphia the waiting time is at least five years. In the interim, candidates have a 50-50 chance of dying or becoming too sick to get a transplant.

This is why a patient who finds a donor online actually helps others: her name is removed from the list and those behind her move up.

Second, Matchingdonors.com is open to all.  There is no fee to those who can’t afford it. And almost anyone can get Internet access at a public library. Finally, no one is deprived. Solicitors have not snatched a rightful kidney away from someone else — but for the ad, there would be no offer in the first place.

Do would-be donors choose recipients based on their narratives? Of course; it is only natural to give to a person with whom one feels affinity. When Wagner read about Tomas he recalls thinking, “this was a real human being who had a family and whose family wanted to keep their mother. And I just couldn’t turn my back on that.”  

When I wrote my own “ad,” back in the fall of 2005 as I was frantically looking for a kidney donor, I wondered if making it spare, as I preferred to do, would hurt me. I listed only my age, occupation, state of residence, and some medical details. And, still, over 30 people contacted me within six months.

Dr. Hanto’s message to desperate patients is a harsh one: Be passive, wait your turn, and take no initiative to save your own life.

And he means it. Last spring, the plight of a Boston area woman named Lisa Cunningham was the subject of an article in the MetroWest Daily News in Framingham, Mass. Dr. Hanto refused to allow her to undergo transplant surgery at Beth Israel if the only donor she could find was a kind-hearted stranger who responded to the article.

Don’t get me wrong, Dr. Hanto does want to save lives. “We are in favor of donors coming forward and donating to the next person on the waiting list,” he told a reporter last spring. And how many have done that so far over the years, the reporter asked? “Just a couple,” Hanto admitted.

Naturally, Dr. Hanto is free to decline cases and to write articles expressing his views. But I believe he crossed a line a few years ago when he sought to prevent his colleagues from acting on their own consciences. As head of the ethics committee of the American Society of Transplant Surgeons in 2004, he urged its members to boycott solicited transplants. 

Fortunately, they resisted. In fact, Dr. Richard Fine of the American Society of Transplantation, sees Matchingdonors.com as an ally in increasing the supply of organs. In his presidential address Dr. Fine urged his colleagues to “partner with alternative approaches to solicit organ donation” so that more potential recipients can use them and that would-be donors are well-informed.

In the fall of 2005 I wrote about my search for a donor in a major newspaper and mentioned Matchingdonors.com. (I never did get a donor through the website; a friend stepped forward and donated a kidney to me).

In July 2006 I received an e-mail from a man who said he read my article, explored the website, and was inspired. The e-mail was from Paul Wagner. “It was there that I read about a lady in my city, Philadelphia, who was desperate for help….I donated my left kidney to this woman.  It has been one of the best decisions I have ever made.”

A month before he notified me, Mr. Wagner had attended the wedding of Mrs. Tomas’s son. “When Gail did the dance with her son,” he said, “fortunately, no one was looking at me. I was crying. I was moved.”

I am left puzzled — just who was exploited here?

 – Sally Satel is a physician and resident scholar at the American Enterprise Institute.

Sally Satel, M.D., is a resident scholar at the American Enterprise Institute and a visiting professor in the Department of Psychiatry at Columbia University’s Irving Medical Center.

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